Expand your MESH Capacity Before Summer Begins

Linda Ebner Erceg, RN, MS, PHN
March 2016

Consider these scenarios:

  • A parent calls: “My child has ADD and takes medication for depression. Can she come to camp?”
  • A counselor dashes into your office: “We need you at Cabin 5. A camper is freaking out; what’ll we do?”
  • A board member asks: “Who do we call if a camper or staff member has a mental health problem?”

These situations were drawn from camp experience. Indeed, some camp professionals have already noted an increase in the mental, emotional, and social health (MESH) concerns with which they must cope. That isn’t surprising because, according to recent information from the Centers for Disease Control (CDC, 2015), “it is estimated that 13–20 percent of children living in the United States (up to one out of five children) experience a mental disorder in a given year . . .”

MESH concerns are as common as physical health concerns. Indeed, today’s camp professional can assume that at least 15 percent of his or her camper and staff population will arrive with a MESH concern. Some of these are minor and have minimal impact on the camp experience. But others can be very impactful, especially if no one has assessed the situation and planned accordingly.

Short of becoming a clinical psychologist or social worker, how might one build personal skills and resources to be more adept with MESH concerns? That’s the focus of the Healthy Camps committee, a group of camp professionals who now bring two powerful resources to your attention: a course called “Mental Health First Aid” and a tool called “Assessment of a Camper’s Behavior of Concern.”

Mental Health First Aid

Many readers have spent time developing first-aid skills that address physical injuries and illnesses. But given the number of youth who present with MESH needs, how many of us have developed skills to address mental health needs? That’s the focus of the Mental Health First Aid program (MentalHealthFirstAid.org). Supported by the National Council for Behavioral Health and already taught to over 500,000 people, the eight-hour Mental Health First Aid course targets four objectives:

  • How to recognize the signs of addictions and mental illness
  • Using a five-step action plan when responding to a MESH incident
  • Understanding the impact of MESH concerns
  • Where to go for immediate help as well as how to access local MESH resources

The course recognizes that the Mental Health First Aid (MHFA) response is based on the same principles that guide our familiar first-aid practices; our response is an immediate and temporary support given to people experiencing a MESH crisis. The course also recognizes that MESH incidents typically don’t occur in professional settings; rather, they happen wherever the person happens to be — that includes camp. So the course prepares participants (regular people) to appropriately respond without overstepping boundaries.

Alli Faricy, director of Camp Foley (Pine River, Minnesota) and a Healthy Camps committee member, took an MHFA course in the spring of 2015 and then implemented the program at her camp. According to Faricy:

“The MHFA course created awareness among our supervisory staff that trickled down to our college-aged counselors, especially the information about tipping points, what signs of distress to note, and the appropriate responses to MESH-related concerns. We were better able to identify behaviors that could become problematic and create proactive plans to eliminate many stressors for both our campers and staff. The course provided a natural conversation platform that allowed us to practice our terminology, which, in turn, improved our ability to talk with parents about the MESH concerns of their kids. When you stop to think about it, more staff deal with mental health first-aid issues among their campers than they do physical first aid. Why not give them a tool they can use every day?

Last summer, we used the course content at camp in a few ways:

  1. Although we only had our supervisory staff go through the official MHFA training, we reframed our staff training about many of the MESH issues (including homesickness and kids not making friends, as well as more serious topics) to include the terminology of Mental Health First Aid. Our staff seemed to grasp that idea and could really understand what it meant to do first aid with kids. That allowed us to open up conversations with the staff about supporting campers who needed that extra help.
  2. The textbook that was given to us is a great resource to have on hand at camp. It can be easily grabbed when on the phone with a parent and you want to understand and communicate in lay person terms a particular diagnosis or set of behaviors.
  3. Our class also included a handout of local mental health resources, specifically phone numbers, contacts, and websites that could be used in crisis. Luckily, we never had to use it, but it was nice to have an updated list at our fingertips in case of an emergency.” (2016)

The Healthy Camps committee strongly recommends that camp professionals take a Mental Health First Aid course. To support that effort, Faricy and the Healthy Camps committee have posted a one-page PDF document in ACA’s Healthy Camps Toolbox, specifically the MESH area (see sidebar). The flier provides information needed to set up a course for your camp staff or training for your ACA section. Those who plan ACA section or regional events might also offer this as a pre-conference training.

Why scramble wondering what to do when MESH situations arise? Get trained — now.

Assessing a Camper’s Behavior of Concern

This tool (including a direction sheet) helps camp professionals talk with parents who are asking about a camp experience for their child who also has a MESH concern. Assessing a Camper’s Behavior of Concern recognizes that a child must be ready for a camp experience, not all camps are a good fit for kids with MESH challenges, and some camp professionals want a tool to guide their conversation with parents of MESH-challenged youth. It also recognizes that having a diagnosis — say AD/HD — doesn’t tell us much. More questions need to be asked, questions that end up focusing on the child’s behavior(s) of concern. Consequently, the tool focuses on behavior(s) rather than a diagnostic label per se.

Like information about Mental Health First Aid, the assessment tool is in ACA’s Healthy Camp Toolbox as a PFD download. “Assessing a Camper’s Behavior of Concern” is designed for use by a camp professional, specifically someone who knows the camp and its program, to guide his or her conversation with the parent/guardian. The goal is to exchange information about the child, camp life, and the behaviors associated with the MESH concern (behaviors of concern) in order to:

  1. Determine if the child is ready for a camp experience and if the camp has the capacity to support the child.
  2. Develop a plan, with input from the child’s parent/guardian, for use during the child’s camp stay.

Use of the tool may indicate that the child is not a good candidate for camp. In that case, the conversation is ended by identifying what change the child might make to be considered in the future. It also recommends giving the parent information about a camp that might be a better match for what the child needs.

If readiness is apparent, the tool leads the conversation to explore the context within which the behavior of concern is likely to occur, and then to developing a plan — with parental input — for use during the child’s camp session. The planning process includes examining the behavior’s impact upon others, in various activities, and within cabin/group experiences. It also guides a conversation about what will happen if breakthrough behaviors occur and helps define a response if the prospective camper’s behavior impacts the camp experience of others. The tool additionally provides a place to record information about breakthrough behaviors that occur during the child’s camp session.

This tool has the potential to be help families select the right camp for their child while also helping camp professionals engage in more meaningful conversations with those families. The tool has been piloted in ACA camps with good results. Interestingly, the assessment reinforces the need for camps to tell prospective families what a child should be able to do in order to participate in the camp program (aka: the essential functions of a camper; see sidebar). The answer to that question may be straightforward for some programs (e.g., “Your child should simply want to be at our camp.”) while other camps may have a more nuanced response.
As summer’s camp season looms, seriously consider utilizing one, if not both, of these resources as well as others in the Healthy Camp Toolbox. All of us respond to the mental, emotional, and social health needs of campers and staff. And more of us are handling MESH concerns that stretch our ability to be supportive. Use the Mental Health First Aid course to build your skills and the assessment tool to guide your conversation with parents.

Healthy Camp MESH Toolbox

Find the Healthy Camp MESH Toolbox at: ACAcamps.org/resource-library/research/healthy-camp-toolbox

Bookmark this page. More information is in development. And look for these additional resources within the toolbox:

  • Download the MESH icon. Use it to highlight MESH information in your parent and/or staff materials.
  • Find the PDF that tells you how to access a Mental Health First Aid course for staff training or an ACA section event.
  • Download the Assessing a Camper’s Behavior of Concern tool along with its instruction sheet.
  • Got a question or have a comment about camp MESH? E-mail Linda Erceg at erceg@campnurse.org.

What Is an Essential Function of a Camper and Why Is It Important?

An “essential function of a camper” answers the question: “What should a child be able to do in order to participate in this camp’s program?” It’s provided to parents so they can determine if their child’s abilities are a good fit for your camp program.

Determine your camp’s essential functions by considering what every camper experiences and, with that in mind, what abilities a child needs to do that. For example, if your camp program sends every camper on an extended wilderness back-packing trip, then carrying a loaded backpack over uneven terrain in a variety of weather conditions may be an essential function. If your camp doesn’t send every camper on such trips, then that function isn’t necessary for participation; it isn’t an essential function.

Some camp professionals may discover that their essential functions are straightforward and simple. For example, “Your child must simply want to be in our camp program.” But other camp programs are predicated on the camper coming with some skills.
Here are examples of essential functions of campers. Some camp programs may need only one statement; others may need three, four, or five. The key is to answer the question previously posed. Examples include:

  • Your child should be able to meet his/her personal needs (dresses self, showers independently, eats without assistance, can maintain personal hygiene independently).
  • Your child should be able to move independently from place to place at camp.
  • Your child should be capable of effective interaction in our group-based and community-living environment.
  • Your child should be able to carry 40 pounds over uneven terrain in all weather conditions.
  • Your child should be able to talk with a camp counselor when assistance is needed.

Questions about essential functions of campers? E-mail Linda Erceg at erceg@campnurse.org.

References
Centers for Disease Control. (2015). Children’s mental health: New report. Retrieved from cdc.gov/features/childrensmentalhealth
Faricy, A. (2016). Personal communication.
National Council for Behavioral Health. (2015). Mental health first aid. Retrieved from mentalhealthfirstaid.org/cs

Linda Ebner Erceg, RN, MS, PHN, is the program coordinator for Bemidji State University’s Certificate in Camp Nursing (MN). Her experience includes over 30 years as a year-round camp nurse for Concordia Language Villages and deep experience in working with camp professionals to address camp health needs. She currently chairs ACA’s Healthy Camps committee where her time at camp as well as her former role as executive director for the Association of Camp Nurses now contributes to her educational and research activities.