Risk Management: Baseline for a Healthy Camp Environment

by Linda Ebner Erceg, R.N., M.S., P.H.N.

The American Camp Association's Healthy Camp Study is gearing up for its third summer of data collection. This research is probing the injury-illness experience of our camps, describing those events and exploring how we might intervene to lessen the impact of injuries and illnesses. With three more summers of data collection ahead and the support of a team of people monitoring for meaningful intervention points, the likelihood of this research impacting camps across the U.S. is tremendous.

But will our camps be ready to use this information? Have we positioned our camps so they are, in fact, health-promoting environments? This article explores the markers of a healthy camp environment, markers that evidence the integration of health in the camp structure. When such markers exist, the camp is nimble and responsive to emerging information, and thus more likely to positively impact the experience of its campers and staff.

A healthy camp environment intentionally monitors the injuries and illnesses of its campers and staff.

One distinctive marker of a healthy camp environment is that the camp knows why its campers and staff seek health care. This basic strategy is based on day-to-day surveillance that not only tells camp administration what's going on but also provides clues to improve the health experience. The camp nurse may, for example, summarize the reasons why people are seen in the health center each day. The reasons are listed — headache, sore throat, sprained ankle, burn, etc. — and marked to indicate staff or camper status. This camp's leadership looks at the list almost daily and asks strategic questions, questions designed to tease out information for further examination and/or intervention. For example, is there a difference between camper and staff experiences? Why? Is there a particular activity at which injuries occur? Is there a cabin group with more illness than other cabin groups? What time of day are injuries happening? Is there a difference between male and female experiences? Might a facility area be causing injury? Do things happen during scheduled activities or “free time”? Might weather conditions be impacting injuries or illnesses, or time of day?

Patterns emerge over time, so persistence in this review pays off. This retrospective review means one must still cope with the injury-illness per se, but examining context often provides a clue that makes the incident less likely to occur in the future.

A word of caution: because we're dealing with people, some injury and illness will occur in spite of our best intentions. The puberty plunge, for example, is a given. Campers grow so quickly they may fall over their own two feet, but we can make sure their shoe laces are tied! Rather than focus on things one cannot impact — like puberty — the healthy camp environment focuses on those that are changeable, elements such as a camp's facility, rules, schedule, practices, or policies. When these contribute to an injury-illness event, that's something one can do something about.

A healthy camp environment recognizes the virtue of risk-taking and intentionally frames experiences based on risk-readiness.

Camps with this baseline in place recognize that risk-taking is thrilling; it puts the zest into zip lines, the thrill in sailing alone, and adds a skittish edge to trying that new gymnastics skill. But this camp also recognizes that there's a point when a person is ready to do these things. This camp values healthy risk-taking but predicates that experience by an intentional assessment of risk readiness. Ponton's classic discussion of adolescent risktaking (1997) drew attention to this key life skill, one woefully under-represented in most youth experiences but quite alive in a healthy camp environment.

While camps consistently place challenges in front of campers, the healthy environment intentionally helps the camper determine when s/he is ready for that risk, a critical life skill. This camp places as much value on making that determination as the risk-taking experience itself. In addition, the healthy camp assists campers with strategically moving from skill to skill, often resulting in a capstone experience, and teaches coping strategies when success is temporarily barred by failure.

Interestingly, camps have traditionally employed the older adolescent, eighteento twenty-four-year-olds, to accomplish this. Yet one of the developmental tasks of the older adolescent is risk-taking. They're supposed to “push the edge;” it's hardwired into them. The healthy camp recognizes this, screens prospective employees for indicators of their personal risk-assessment skills, and uses monitoring strategies to keep an eye on things so hubris doesn't carry things too far. This can be dicey!

A healthy camp environment uses its rules, facilities, schedules, and/or practices to improve health outcomes.

This health-promoting strategy means that camp leadership not only knows what is going on but also knows why and how to use elements to intentionally improve health. It's why camp schedules balance active and quiet time, mix group activities with solo work, and distinguish between older and younger campers' need for rest. It's why menus include more fresh fruits and vegetables, lower fat content, and emphasize healthy snack options at the camp canteen. It's a reason for each camp to access its need for adequate supervision with the human need for privacy.

Indicators for improvement often arise from monitoring reasons why personal injury or illness occurs and then changing an environmental element to minimize, if not eliminate, that reason. For example, a camp professional noted that staff who got the common cold were more likely than campers to end up with exacerbations like sinusitis and bronchitis. Simply asking “Why?” triggered a realization. For a variety of reasons, staff continued working at a normal pace when ill with a cold. Since the common cold is often aggravated by fatigue and dehydration, these staff became more susceptible to complications. Making a basic change in personnel policies – staff, when ill or injured, were expected to recover, not get worse – coupled with supervisors talking with ill staff about job modifications to support recovery was enough to improve health outcomes.

A healthy camp environment complements the developmental needs of participants — both campers and staff — in its routine practices.

This strategy is a wonderful support to growing campers and staff. Developmental needs that have a physical basis, like growth spurts, have direct bearing on health needs such as nutrition and rest. Failure to consider this results in greater injury and illness among participants.

What's more difficult, however, is to remember the psycho-social health needs. A young camper's relative ease with changing clothes in front of others rapidly gives way to desired privacy as puberty is launched. The enjoyment of group participation morphs into a desire for significant one-to-one interactions among older adolescents. And scheduling groups to move from activity to activity may be easier for head counselors but thwart the campers' developmental task associated with self-determination.

Healthy camp environments examine developmental tasks and create camp processes that compliment them. Along with the physical tasks, healthy camps also assess the population's emotional tasks, something first articulated by Maslow:

  • Make sure people feel as though they have a place at camp, that they belong.
  • Address economics from both a camper and staff perspective.
  • Assure that people understand the camp culture and are, in turn, understood as individuals.
  • Minimize, if not eliminate, fears.
  • Institutionalize communication patterns to reflect unconditional positive regard for everyone.
  • Show affection; go beyond merely talking about it.
  • Emphasize responsibility for one's actions, not guilt.
  • Celebrate self-respect rather than self-centeredness.

Only when these basic emotional needs are met does one have energy to focus on growth needs. Consequently, the healthy camp environment is structured to assure that basic needs are, in fact, addressed so campers and staff are free to use their personal energy to become even better individuals. They do not have to squander that energy on the basics. The basics are a given in healthy environments.

A healthy camp environment knows its stressors and allows a repertoire of coping mechanism to be used.

Not everything goes well. There are stressors in every setting and among all populations. The healthy camp certainly knows its stressors but, more importantly, it also expects campers and staff to cope effectively.

However, there's a crucial piece of information to remember here. Campers and young staff are still evolving their coping abilities. They do not, necessarily, have a repertoire of appropriate options from which to select; consequently, the healthy camp environment intentionally coaches these skills, labels them, and helps people evaluate their effectiveness. The ability to cope effectively improves personal resiliency and is a health-maintaining behavior. Given today's intrusion by some parents — like the Helicopter Mom–camp may be one of the few environments where some kids ever get to exercise coping skills.

A healthy camp environment values prevention.

While treatment of health problems is certainly important, preventing them is even better. Given time, the Healthy Camp research will provide indicators of potential risks that camps can use to strategically improve. But a healthy environment doesn't wait for a national study to point things out. Healthy environments are already scanning; they learn to prevent based on their experiences, information they gain from their own scans, and continually asking “Why?” when things happen.

A healthy camp environment benchmarks its progress in health promotion.

The concept of health exists on a continuum. At one extreme is “not healthy.” At the other is “optimum health.” A healthy environment realizes that there's an ebb and flow to progress along the continuum; it's dynamic. Knowing where one's camp sits on the continuum is possible only when indicators of health are articulated and monitored.

Several ideas for benchmarks have been included throughout this column. The injury-illness rate, especially rates that are separate for campers and staff, is an indicator. Artifacts that reflect emotional tasks are another, things like camper return rates, parent calls, and incidents of bullying. Indicators can be as simple as knowing that campers did not gain extra weight or as complex as monitoring how disagreement is handled. A healthy camp environment has an idea of where it stands along the health continuum that is based on benchmarking.

Yes, results from the Healthy Camp Study are beginning to arrive. Many of us look forward to seeing what that data tells us. Now, however, is the time to position our camp cultures so they will be capable of effectively responding to that data. Let's be ready by making sure our baseline is in place to support progress along the health continuum.

Ponton, L.E. (1997). The Romance of Risk. New York: Basic Books.

Linda Ebner Erceg, R.N., M.S., P.H.N., is the health and safety coordinator for Concordia Language Villages and the executive director of the Association of Camp Nurses.

Originally published in the 2008 January/February issue of Camping Magazine.