Summer Camps for Children with Cancer and Their Siblings: Impactof Social Comparisons on Psychosocial Outcomes

Lisa J. Meltzer, Ph.D., (meltzerl@email.chop.edu) and Mary Rourke, Children’s Hospital of Philadelphia

Intuitively, we know that camps are a good thing for children, especially those with chronic illnesses. But there is little research that has been able to demonstrate why these camps are good. For example, self-esteem, which has been most commonly studied, does not change in one week. Many people in both the camp and medical communities argue against disease-specific camps. They state that perhaps children should return to “normalcy” as soon as possible, including attending camp with “regular” kids. This study investigated one possible reason why disease-specific camps are important: social comparisons.

One hundred nine children (sixty-six with cancer and forty-three siblings) who attended the Ronald McDonald Camp (RMC) in the summer of 2002 participated in the study. Participants were 45 percent male and 83 percent Caucasian. Twenty-seven percent of campers were attending for the first time. Ages ranged from eight to eighteen years old. Participants completed questionnaires on the first and last days of camp. Questionnaires were administered in the cabins by volunteer counselors. Time was built into the camp schedule (thirty minutes each day) for the study, thus participants did not miss any camp activity time to participate. On the last day, participants were asked to complete the Harter self-concept measure twice, once comparing themselves to children at home and once comparing themselves to children at camp.

How Are These Findings Helpful to Camp Professionals?

We all know camp is an amazing place. These results suggest that disease-specific camps allow children a membership in a community of similar others, which in the long run will likely enhance self-esteem, self-concept, and social acceptance. The following are suggestions for camp planners, directors, organizers, and fundraisers.

1. Plan disease-specific camp experiences. Disease-specific camps are helpful. This doesn’t mean you have to spend the week focusing on the child’s illness or illness experience. By simply bringing together children who have had similar experiences, you can help decrease social isolation and improve self-concept.
    
2. Include siblings in your camps for populations with special needs. Siblings are often overlooked during a child’s illness, but also face many challenges when a brother or sister is ill. In this study for example, siblings were able to spend time with others who have been through the “cancer experience,” decreasing loneliness. Siblings should be invited to camps with the child who has the illness, or separate sibling camps/weekends should be established (e.g., siblings of children with cancer weekend).
    
3. Don’t exclude adolescents because they are “too old” or they have been to camp too many times. This study demonstrated that adolescents benefit as much, if not more, than younger children from being with other similar campers. Adolescence is a difficult time for any child, with most teens relying on peers for emotional support, including discussing issues of dating, body image, and the future. These topics are complicated if you have or had a serious illness.
    
4. Take these findings to potential donors who say “show me the data.” Money is what it all comes down to in the end. This study and others like it provide solid evidence that camp is a worthwhile investment. With camps competing for limited resources, you need to be armed with facts that demonstrate why your organization is the best.
    
5. Do Research! Although it is difficult to conduct large-scale research with a limited number of trained professionals, with enough preparation time and staff cooperation, it is possible to gather questionnaire data on more than one occasion during a camp session. This study demonstrated the ability of conducting research during camp, without taking away anything from the camp experience. For researchers who are not full-time camp staff members, it is important to partner with camp planners and leaders to create a team approach, resulting in staff buy-in, built in time during the camp schedule, improved data integrity, and increased camper participation.

How Do We Explain Social Comparisonsto Others?

In order to evaluate our emotions and abilities, we need to compare ourselves with other people. There are two types of social comparisons, both of which can be helpful. Upward comparisons occur when we compare ourselves with others who are better off. This gives us information as well as clues about successful coping, providing hope, motivation, and inspiration. Downward comparisons are a cognitive coping mechanism where people compare themselves to less-fortunate others in order to make them feel better about their own situation (“although my situation is/was bad, at least it’s not as bad as some other situations”).

However, if the comparison group is dissimilar, negative emotions can occur. For example, if you are an intermediate level tennis player, and you compare yourself with Andre Agassi, it may frustrate you. But if you compare yourself with another intermediate level tennis player, you may experience the positive benefits described above.

Children with cancer or other chronic illnesses may only be able to compare themselves with their “healthy” peers, which can result in feelings of sadness, frustration, and isolation. Thus, there is a need to provide children with chronic illnesses an environment where they do not feel different from their peers. Camp provides this environment in an intensive and focused way. Camps allow children to make more realistic comparisons, teaching children the coping skills necessary for living with cancer or other illnesses, as well as providing positive role models.

The Voice of the Campers — Research FindingsThrough Qualitative Data Collection

M. Deborah Bialeschki, Ph.D., (moon@email.unc.edu); Amy Krehbiel, M.S.R.A.;Karla Henderson, Ph.D., The University of North Carolina-Chapel Hill; and Dawn Ewing, Morry’s Camp

Camp professionals and researchers inherently believe that “Camp Gives Kids a World of Good®,” yet the general public, foundations, board members, and parents want to see proof that camp is positively influencing campers’ lives. Staff at Morry’s Camp were interested in the outcome process and partnered with the University of North Carolina at Chapel Hill (UNC-CH) to conduct a four-year longitudinal study of one group of campers.

Morry’s Camp is a year-round youth development organization that provides each child with a multiyear commitment anchored in a residential summer camp experience. The children, for whom these experiences would not otherwise be available, benefit from a network of support that is focused on social skills, enhanced self-esteem, positive core values, and a greater sense of personal responsibility. The research team used a mixed-methods approach to gather data from the campers and parents to examine the camp mission and outcomes. The purpose of this study was to investigate what campers were gaining from the camp experience — from the camper’s perspective.

Description of the Research Process

The longitudinal study began during the 2002 summer season and followed thirty “frosh,” fifth grade campers throughout the school year. The qualitative data were gathered through summer journals, year-round journal entries, and camper focus groups. During the summer, the campers answered questions in their journals, such as: “How has camp made you a better person?” “What are your future goals?” “What at camp has helped you with the way you think of yourself?” The campers continued to answer monthly journal questions throughout the school year. Examples of the type of questions asked were: “How has Morry’s Camp made you different from other kids at school?” “What did you learn at Morry’s Camp about how to treat others?” “Describe a time when you were angry and what you did because you were angry.”

The UNC-CH and Morry’s Camp research team conducted three focus groups in January 2002. Two of the groups consisted of sixteen fifth-grade campers. The third group consisted of eight “post-grad” campers (campers who had graduated from the four-year program). The focus group questions addressed the camp’s outcomes specific to responsibility, self-esteem, and respect for other people.

Initial Results

Several themes emerged from the data — intrapersonal growth, interpersonal growth, and uniqueness of the camp experience/environment.

Intrapersonal Growth — Progression and GrowthWithin the Individual Camper.

• sense of security
• independence
• sense of personal achievement

“(At Camp) I learned how to swim and when I came back home, we went to New Jersey and my uncle has a pool, so me, my sister, and brother went swimming. My sister and brother did not know how to swim so I taught them.” (Example of personal achievement)

Interpersonal Growth — Progression and GrowthWithin the Camper Group, Peer Relations.

• networks of support
• social skills

“You meet a lot of different people that’s so fun and you wanna be around all these different people and different kinds of personalities and that’s what I like about Morry’s Camp.”

Camp Experience/Environment — The Components that Led to the Campers’ Interpersonal and Intrapersonal Growth.

• staff as facilitators and role models
• camper freedom to choose within the program
• camper freedom from city life
• boundaries and clear expectations set at camp
• peer camper groups and communal living
• new, safe, and natural environment

“I like camp because you can see animals that you’ve never seen up close before. And you learn how to swim and learn about the bugs.”

What Can Camp Directors Learn from This Study?

Directors can use journal entries to gain insights from their campers. A simple journal entry about campers’ experiences and perceptions at camp may help directors address issues relevant to campers’ positive growth and development.

Directors’ can also use focus groups or personal interviews during the summer program, or throughout the year, to understand the campers’ perspectives on the camp program and the benefits.

It appeared that the campers’ positive outcomes resulted from the camp experience/environment (camp culture). Attention to the camp culture created at camps seems to be an important context for meeting desired outcomes.

Directors should consider staff training as an opportunity to focus on facilitation techniques, role modeling, and setting boundaries.

In this study, the conclusions based on the qualitative data suggested that camp administrators may want to emphasize the mission and goals of camp to staff members, set specific boundaries and expectations for campers, create intentional, outcome-based activities and special events, and provide some sort of natural or unique environment for the campers. The camp experience coupled with opportunities for camper intrapersonal and interpersonal growth lends support to the fact that camp can build an empowered camper and can truly do “a world of good.”