Camp Health Services: Updating the Paradigm

Risk Management

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

Editor's Note: Beginning with this first issue of 2005, Linda Ebner Erceg and Ed Schirick will be alternating as authors of the Risk Management column. Each brings an extraordinary level of knowledge to the topic with different perspectives and different areas of expertise. We welcome Linda and thank Ed for his continuing commitment to Camping Magazine and the camp profession.

A quiet evolution has occurred within camps during the past few years. Quite simply, the camp infirmary has become the health center; prevention of illness and injury has become as important as appropriate treatment; and care of campers and staff is no longer bound by the four walls of a building. Triggered by the risk-reduction initiative of the 1990s, camps are reshaping their health service paradigm and, as a result, embracing a more holistic approach to wellness. The purpose of this article is to briefly discuss how this happened and suggest a common ground foundation upon which camp professionals can shape their camps' health services future.

Valuing Camp Traditions

Most readers are well aware of the benefits of a camp experience. Improved self-confidence, increased self-esteem, and an expanded repertoire of social skills have long been the anecdotal outcomes of many camper experiences. Given any camp activity, staff magically use that activity to make a difference in these attributes.

Except in the camp infirmary — here campers were placed in an environment in which they were not partners in their health care but rather objects to which things were done. Someone washed their wound and put on the bandage. Someone took their medication and chased after them if they forgot to get it. Someone told them when it was time to "go see the nurse."

Couched within the laudable desire to take care of campers, we at camp neglected to realize that practices of the infirmary were the very antithesis of what camp was all about. Instead of learning how capable they were, campers and staff experienced a setting where they were not capable. Someone else had to do for them. Even the name of the place, "infirmary," was a throw-back to where one went to be taken care of because one was not able to do that for one's self. Campers were sent to the infirmary when there was a problem, and the infirmary was merely a support service of the camp program.

Yet today's camps, like those since the days of the Gunnery, are vibrant community experiences that use the natural environment to celebrate the capabilities of youth. Examine any individual camp's philosophy and one sees words that speak to those capabilities. In looking at camp programs, one notes options for engagement based on appropriate risk taking under the guidance of caring, life coaches known as camp staff.

There should not be a disconnect between this and the camp's place for seeking care. If anything, that care center should be setting the pace for affirming capability while preserving the feeling of individual care. Given this perspective, the camp health center has emerged and camp health-care staff have emerged with it. Be it reminding staff about the developmental tasks of incoming campers, consulting with food service about special diets, working with maintenance to increase shade places, or talking to a parent about an incoming camper's needs, the proactive style of today's camp health program has moved from a support service to an integral part of the program itself.

Describing the Concept: Building on Tradition

The concept of camp health services was coined to describe the expanded role of health within the camp community. The health center still provides a place in which one component of health services — care of acute and chronic health needs — is met but two other components have also been articulated. One is a management function, and the other is an emergency services function.
An overview of each functional area of camp health services follows:

The Functional Role
The first component, the provider of health care, is a familiar functional role. Often known as the camp nurse, this person — or team of people — is the designated health-care provider(s). Traditionally housed in the camp's health center, these folks are charged with the primary responsibility of caring for and managing acute and chronic health needs of campers and staff during the camp session. Sometimes this role is temporarily delegated to people such as tripping staff or partially delegated to staff such as lifeguards. However, in addition to addressing individual health needs, health center staff also champion health needs of the camp as a whole. These are the folks who know about developmental needs of clients, who understand the dynamic interface between program and health, and who facilitate psychosocial adjustment to the camp environment. The provider function has a place with both individual and community health aspects of a camp.

The Management Function
The second functional role is a management function. Often vested with the camp director or a year-round nurse, this function of health services includes tasks such as determining the scope of health care provided by the camp; determining the mix of health providers needed and personnel management of that team; interfacing with insurance companies; overseeing budget decisions specific to the camp's health services; writing policy that impacts the health of both campers and staff; arranging services from out-of-camp providers (e.g., pharmacies, hospitals, mental health professionals dentists); and monitoring the impact of regulatory bodies such as the Occupational Safety and Health Administration (OSHA) upon the camp. In today's world, the management function is not bound by the dates of a camp session; it functions year-round and includes an interface with clients, especially parents, when questions about health arise prior to and/or after a camp session.

The Emergency Response Function
The third functional role is the camp's emergency response system. Typically headed by the camp director, this is a team of people who plan and initiate the camp's response to both external threats like forest fires and electrical black-outs, and internal threats such as a lost camper or severe weather plan. Emergency medical services (EMS) are only a part of this third functional role. Indeed, the most critical part of this functional role pertains to that which we've learned as a result of 9/11: camp resources and needs must be melded with the surrounding community's resources and needs.

The Scope of Camp Health Services

Someone once said, "Camp health services are no longer confined to the camp session." How right that is! Gone are the days when camp health starts with the arrival of campers and staff. Given the three functional roles, even health-care providers need lead time to meet the needs of an increasingly medically complex group of campers and staff. As a result, it makes sense to include health services in all phases of a camp program. Some aspects happen prior to arrival or start up, some things occur during the program, and other elements take place once a program is completed and/or a participant leaves camp. This holds true whether the camp operates seasonally or year-round.

Camp health services have a cyclic nature; each aspect of the cycle has an evaluative element that, if intentionally monitored, contributes to further development of the service. Take, for example, the health history form. Prior to a program's start, a form appropriate to the planned program and expected clientele is developed, sent to participants for completion, and returned to the camp office for pre-arrival review. This review elicits information pertinent to the session such as dietary needs for food service, special training needed by staff, adaptive responses for client housing and activities, and medication and treatment demands from health-care providers. All three functional areas of camp health services — management, care provider, and the emergency response system — glean information germane to their ability to function appropriately. Indeed, having health histories in hand before participants arrive places camp management, providers, and the emergency response functions in a position of preparedness and reduces the impact of "surprise" information on Opening Day or the entire session. Once a program is in operation, the health history form continues its cyclic influence and becomes a reference tool used as information about an individual is needed. Post-session, that same form as well as the information it contains can be evaluated to identify strategies for improvement.

Expanding the Clients of Camp Health Services

Up to this time, camp health services have classically been described with reference to campers, their parents, and staff. With expansion of the concept comes inclusion of additional people — clients — impacted by camp health services.

A camp's internal clients remain about the same: campers, their parents, and staff. However, a camp's insurance company should probably be added to this group. Given the increasing need of camps to interact more effectively and consistently with insurance companies — especially if one is interested in impacting the camp's loss ratio — this makes good sense. A camp has a vested interest in how satisfied internal clients are with the camp's health service. Things such as camper return rate, employee job satisfaction, public relations, and the financial bottom line are impacted by a camp's attention to — or disregard for — the health needs of internal clients.

But a camp's external clients also need attention. These are often vendors, businesses that support camp health services, often with essential services. In turn, these vendors (e.g., local clinics and hospitals, pharmacies, dentists, mental health providers, medical supply houses, the ambulance service, police, and so forth) benefit from their relationship with camp. As constituents of the camp's health services, aggravating one of these can result in withdrawal of services. Given that camps may have very few options in their surrounding community, this can place the camp in a situation that is difficult to resolve.

There's another group of external clients that often go unrecognized with regard to camp health services. This group is comprised of agencies that regulate aspects of camp health-care delivery. It includes entities such as OSHA, state boards of nursing, the state's licensing agent for camps and the state pharmacy board. Our camp history includes occasions when agencies of this ilk have created regulations that impact the business of running camp. In the past, we've taken a reactive stance when we perceive a threat from them. However, with the repositioning of camp health comes an opportunity to be more proactive, a position that is increasingly apparent within American Camp Association local offices that monitor legislative actions.

Recognizing a Window of Opportunity

The youth and staff that come to our camps now come with a much broader health profile than what existed a mere fifteen years ago. The parents that enroll these kids have an expectation that camp leaders, professionals in the business of youth development, are capable of meeting those health needs within the mission of the camp program. Camp staff are asking for an employee health program, one designed to meet their needs and not merely an extension of what is provided for campers.

Yes, camp health has changed. Effective response to the opportunities this provides is critical to our continued effectiveness in today's world.

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 2005 January/February issue of Camping Magazine.

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