ACA Camp Crisis Hotline Annual Review 2017

November 2017

Since 1985, the American Camp Association® (ACA) has provided crisis support to camps through the confidential ACA Camp Crisis Hotline. This service is available 24-hours-a-day, every day of the year. Camps contact the Hotline to receive support, discuss options, or talk to an objective third party. While Hotline team members do not provide legal or medical advice, we can connect camps with the resources they need and help them think through their options. A review of the summer 2017 calls shows many trends, lessons learned, and case studies that are presented to assist camps in being prepared should a similar crisis occur at their camp.

Call Categories

Health and Medical Issues

For the ninth consecutive year, the top category of calls was related to health and medical issues. This category comprises 33 percent of all the calls received in 2017.

While the ACA Hotline team does not contain medical or legal experts, we do have the experience to direct camps to the best information available. In addition, we collaborate with organizations such as the Centers for Disease Control and Prevention, the American Academy of Pediatrics, and the Association of Camp Nursing to provide education and resources for the camp environment.

The Health and Medical Issues category includes a broad range of topics from the treatment of common childhood illnesses (e.g., chicken pox) and infestations (e.g., bedbugs, lice, etc.), to questions about procedures (e.g., how to perform a lice check). Tragically, it also includes the ACA Hotline being notified of four fatalities this summer.

A common factor we have found in many of these calls is that many camps do not have healthcare staff who are familiar with common issues in a camp setting. Sometimes the questions we receive are regarding the laws related to healthcare at camp (e.g., "Who can distribute medications?", "Is my license accepted in this state?", etc.). In other cases, camps simply want to talk about the steps they have already taken, and want to benefit from talking with a third-party that can help them think about other questions or actions they might not have considered.

Lessons Learned — Health and Medical Issues

  1. Have health and medical support systems in place. Before camp starts, identify the health and medical resources necessary to assist in whatever challenges may occur at camp. This plan includes on-site healthcare staff, as well as a list of contacts (e.g., mental health professionals, dentists, etc.) who can be reached in the event of an unexpected incident.
  2. Prepare for mental health concerns for campers and staff. The number of calls to the Hotline on this topic appears to mirror a societal trend. Camps need to have a mental health support system in place and should add mental health resources and experts to the team and healthcare plan.
  3. Understand your state's laws regarding pregnant campers and staff. There was an increase in Hotline calls regarding this topic. Scenarios ranged from a faith-based camp struggling with the morality of discovering a staff member was pregnant, to a camper disclosing a pregnancy her parents were unaware of, to a camper who was having medical issues that could jeopardize the pregnancy and whose parents would kick her out of the house if/ when they were to find out about the pregnancy.
  4. Distribution of medication laws vary by state. Often a caller will ask, "Can someone other than a registered nurse (RN) distribute medication?" Since these regulations vary, determine the rules that apply to your camp and establish appropriate procedures prior to the start of camp. All staff should understand the issues regarding distribution of medication.
  5. Lice outbreaks happen. One of the most prevalent health and medical issue calls to the Hotline is related to lice outbreaks, specifically whether to treat and keep those infected at camp or send them home. What is important is not that a lice outbreak occurs, but how it is handled. Determine if your camp will be a "nits" or "no-nits" community. Know that new strains of lice evolve that are resistant to over-the-counter remedies, and prescription treatment may be required.
  6. It is critical that your healthcare staff be familiar with the most common childhood illnesses, injuries, and infestations. Many calls in this area came from camps that did not have knowledgeable healthcare staff. Camps had trained RNs on staff, but with specializations not aligned with the camp environment (e.g., operating room nurses, oncology nurses). If your best choice for healthcare staff is lacking in childhood healthcare, it is imperative that they receive training and support prior to camp opening.
  7. Preventing the spread of disease starts before anyone enters your camp. Camps should advise parents not to send sick children to camp. All incoming campers should receive detailed health screenings (taking temperatures, lice head checks, recent exposure to communicable diseases, etc.) prior to arrival at camp, and camps should initiate strict handwashing and camp sanitation procedures.

Staff Training Questions — Health and Medical Issues

  • What would you do if a camper exhibited signs of mental or emotional distress — related to an assault or something else — while in the back country? How would you support that camper and what steps are in place to get that camper to a mental health professional?
  • How would you manage the situation if one of your staff members turned in his pocket knife and told you he has been thinking about hurting himself and hasn't had these thoughts in more than four months?
  • What would you do if a tragedy took place on your site on the same day as a large reunion or alumni event?
  • What would you do with a staff person who is not fully immunized? Allow or not allow the staff member to continue employment? What if you served a medically vulnerable camper population?
  • What if a 16-year-old camper disclosed she was three months pregnant and does not want camp staff to tell her parents?
  • Would you have everything in place if one of your kitchen staff fell down a flight of stairs, was seriously injured, and was airlifted from camp? Would your crisis plan get you through?
  • What would you do if a 19-year-old counselor disclosed she had mild schizophrenia? She also shared she is not on any medication nor under the care of a physician for this condition.
  • What would you do if a 15-year-old camper turned in her birth control pills after her parents left?
  • What would you do if you had to terminate your RN? Can an EMT administer medications?
  • What would you do for a staff member who expresses a desire to commit self-harm?
  • How would you respond to a 15-year-old camper who previously struggled with an eating disorder who has not been eating much?
  • What would you do if you had a lice outbreak? What is your policy on lice? (Nits versus no-nits?)
  • What would you do if one of your counselors committed suicide on their time off from camp?
  • How would you address a medication management mishap? For example, one day a camper receives the wrong medication. The next day a camper receives medication at the wrong time.
  • What would you do if a junior high school-aged camper gave his counselor a note indicating he was depressed and thinking about suicide?

Resources — Health and Medical Issues

Allegations of Abuse

The 21 percent of Hotline calls related to allegations of abuse broke out into four categories.

Allegations of Abuse at Home (48 percent of abuse issue calls)
Children who are the victims of abuse or neglect at home (or some other place outside of camp) will sometimes disclose their abusive situation to a caring adult while at camp. Revelations by campers that they are being abused at home are very difficult to handle for any camp. When this occurs, camp directors have many questions about what to do and who to call.

Allegations of Camper-to-Camper Abuse (38 percent of abuse issue calls)
Hotline calls related to allegations of camper-to-camper abuse have shown a marked increase over the past few years, from 3 percent in 2014, to 11 percent in 2015, to 33 percent in 2016, to the current 38 percent. While many of these calls are to clarify mandated reporter laws and whether or not to call the authorities, often the conversation leads to identifying the need for techniques and tips to manage the way campers treat one another. As with allegations of abuse at home, allegations of camper-tocamper abuse must be reported to the proper authorities, who will then investigate the matter. Sometimes callers to the Hotline want advice on whether a specific situation is abuse or not. The ACA Hotline team cannot make that determination. Making the call to the authorities is the only way to ensure that you are handling any allegation properly.

Allegations of Staff-to-Camper Abuse (7 percent of abuse issue calls)
Seven percent of the abuse-related calls this summer were allegations of abuse of a camper by a staff member, ranging from inappropriate touching to inappropriate comments and verbal abuse of high school-aged campers. While the callers in this category understood and complied with mandated reporting laws, they often wanted to discuss policies, procedures, and staff training ideas to keep their campers safe.

Other Abuse Issues (7 percent of abuse issue calls)
The balance of the abuse calls this summer fall into an "other" category. Camper-to-Staff (camper was older with special needs) and a few general mandated reporter inquiries comprised calls in this category.

Lessons Learned — Allegations of Abuse

  1. The law is clear. You MUST contact authorities if there is an allegation of abuse. All camps fall into the category of a mandated reporter. While state laws vary, camp professionals generally serve in loco parentis (in place of the parent) and must call the proper authorities in their state when allegations of abuse are revealed. Camps have a very clear focus and responsibility to protect the children in their care. Camp professionals can be arrested for disregarding these laws. It does not matter whether the allegation is that the abuse occurred at camp by another camper, by a staff member, or at home. Make the call to authorities if you suspect that a child is the victim of abuse. If the child lives in another state, you may be asked by your state to contact authorities in the other state as well.
  2. Because you have created an emotionally safe environment at your camp, children who are in an abusive situation at home may reveal that abuse to you. In these situations, children often say, "Please don't tell anyone." You cannot promise them that. Instead, assure them that you care and that you must tell the people who can help.
  3. Leave the investigating to the authorities. While it is tempting to start your own "investigation" prior to contacting the authorities — especially if you think it is possible that the child is "making it up" — resist this temptation. Let the proper authorities step in and take control of the matter. Documentation is critical. As with any important issue at camp, documentation is key to ensuring that the authorities have what they need to proceed with their investigation.
  4. Vigilant staff supervision is key to keeping campers from harming each other. In most of the situations explained by callers, the allegation of camper-to-camper abuse came in those moments when staff were not directly engaged with campers — shower time, trips to the restroom and changing for the pool. It is imperative that your staff be trained to be even more attentive, active, and involved during these vulnerable times. If your camp does not have staff sleeping in the same room with campers, you must consider what you are doing to ensure no inappropriate behavior occurs during nighttime hours.
  5. See something, say something. Teach your staff to question what they see. It takes just one person to step up and question when they see something is not right about the way an adult is interacting with a child. You may be the one who is able to free a child from serial abuse. Always have the best interest of the child in mind.
  6. Establish and enforce policies regarding staff never being alone with a camper. Your supervision and counseling policies should ensure that one staff person is never alone and out of sight of others with one camper. Is your staff-to-camper ratio high enough to ensure that one staff person cannot be alone with a camper, especially in unique times such as the middle of the night when a camper needs to use the restroom? Develop policies and procedures that support staff in avoiding one-on-one situations, and practice strategies for avoiding these types of situations.
  7. Establish clear policies regarding appropriate physical interaction between staff and campers. Staff members need to understand the camp's policies on physical contact between campers and staff. Do you allow contact such as hugging, lap-sitting, back-patting, high-fiving, tickling? If so, be very clear about what is and is not acceptable. Consider using role-playing during staff training to convey and practice your policies.
  8. Teach and model respectful behavior. To prevent bullying and abuse, and to build respect and inclusiveness, staff must commit to matching actions to words. If your staff are overheard "teasing" or bullying one another, what example does that set? Be clear with your staff that you have a no-tolerance policy on any type of bullying, belittling, or physical abuse. Staff orientation should include training on behavior that addresses the types of bullying counselors might see, what to do when they see it, and how to be vigilant with these issues during the season. Ensure staff behavior matches core camp values.
  9. Keep the phone number of your local child abuse reporting authority readily accessible. Many calls to the ACA Camp Crisis Hotline are simply to ask for help finding the correct phone number. If you don't know who to call (generally, you call the locality where the abuse is alleged to have occurred), don't hesitate to call your own local authority and ask for guidance.

Staff Training Questions — Allegations of Abuse

  • What would you do if, during a reflection activity, two junior high female campers disclosed that they were raped prior to coming to camp?
  • What would you do if a 16-year-old disclosed that he sexually abused another younger child when he was 14 years old? He was convicted as a juvenile and completed courtordered therapy. This was not disclosed on his camp forms.
  • What would you do if a camper discloses to you that another camper has been touching them inappropriately in a tent or in a cabin?
  • A camper from outside the US reports abuse at home by a friend of the family. The parents will be picking up the camper in three days. What do you do?
  • What would you do if you had a 14-year-old male camper who was distraught and reported that he was targeted in a sexual misconduct situation where a 15-year-old male camper hit him with his penis while in the shower house? No staff were present.
  • What would you do if a camper expressed fear in going home due to allegations of abuse?
  • What would you do if a camper discloses that her stepdad beats her brother?
  • What if you just found out that your camp is being investigated for a camper-to-camper incident that occurred previously at camp?
  • What would you do if a parent contacted you after campers went home to report that her son said he didn't want to go back to camp because on the overnight, another male camper pulled down his pants and touched his penis?
  • What would you do if a parent called and accused a current staff member of a sexual encounter with her daughter four years ago while at camp? The daughter was 13 years old and the staff member was over 18 years old at the time.
  • The child of a volunteer has disclosed physical abuse by this individual. The child is currently at camp that is over in four days. You are concerned about the safety of the child and realize it is your duty to report. What else should you consider?
  • What would you do if a 14-yearold female camper shared she was sexually abused at home by her older brother's friend when she was six years old?
  • If your camp uses a buddy system whereby campers have a buddy to go places such as the restroom, what are you doing to make sure that those buddies are not harming each other when they are alone?

Resources — Allegations of Abuse

Camper Issues

Calls related to camper issues rose from 10 to 17 percent of total calls over the last year. This category excludes allegations of camper-tocamper abuse, which was previously addressed in this article. Typically, this category focuses on an individual camper's behavior and concerns with campers who identify as transgender, gender nonconforming, or gender variant. This category also includes acts of bullying among campers.

Lessons Learned — Camper Issues

  1. Attentive and engaged staff supervision is the key to reducing negative camper behavior. Almost all reported incidents of alleged bullying and inappropriate behavior occurred when staff members were not alert or present.
  2. Provide a positive camp environment. Feeling safe is critical to a child's learning and mental health. Promote positive behaviors such as respect, responsibility, and kindness. Provide easily understood rules of conduct and fair discipline practices. Teach campers to work together to stand up to a bully; encourage them to reach out to lonely or excluded peers, celebrate acts of kindness, and reinforce the availability of positive adult support.
  3. Plan for individuals who identify as gender nonconforming. ACA continues to field calls regarding the issues of inclusion and accommodation of people who identify as transgender, gender nonconforming, or gender variant. Formulate a plan. Even if you haven't been approached by a camper family with a transgender or gender variant child, chances are increasing that you will be at some point in the future. Be prepared, as this decision will likely involve many parties, and it will take some time to formulate a plan of action that works for your camp. Educate yourself and your staff. Train yourself and your staff to understand and be aware of gender identity issues. Review your policies once your plan has been developed. Do your policies align with your plan?
  4. Educate staff on the indicators and symptoms of mental health problems. Information breaks down the stigma surrounding mental health issues and enables staff and campers to recognize when to seek help. Your mental health professional network can provide useful information on symptoms of problems such as depression or suicide risk. These symptoms can include acting out, changes in eating or sleeping habits, withdrawal from others, decreased social functioning, erratic or changed behavior, and increased physical complaints.
  5. Take all comments about suicide seriously. ACA received an increase in calls from camps regarding campers making suicidal comments. Often the caller thought the comments were "just to get attention" or "just joking." Unless you are a trained mental health professional, assume the threat is serious. Educate staff on the indicators and symptoms of mental health problems.
  6. Make bullying prevention a priority from the first day of camp, and let all campers and staff know that bullying behavior is unacceptable. All campers need to feel safe both emotionally and physically. One person's description of bullying is another person's description of abuse. Set bunk and group rules with explicit examples of acceptable and unacceptable behaviors regarding bullying. Post these rules and have staff and campers review them together.
  7. Camper (and staff) belongings can be searched if you suspect illegal or unsafe activity. It is a common question to the Hotline: "Can we search a camper's belongings?" Generally, the answer is "yes" with a few exceptions. Prior to the start of camp, determine your policies on when to search.

Staff Training Questions — Camper Issues

  • What would you do if a camper turned in a bag that contained a firearm?
  • What would you do if a camper discusses, looks at, or shares pornography with other campers?
  • What action might you take if a camper continually feigns sick, doesn't want to participate in programs, yet does not have a fever and your health supervisor can find nothing physically wrong with said camper?
  • How would you handle a situation in which two boys used a cell phone to record other campers without their consent and possibly in compromising situations?
  • What would you do about a 14-year-old camper who is biologically female who informed you he identified as male and did not want to sleep in the female cabin? Furthermore, he doesn't want his parents to know, says he'll get in trouble, and has already told campers to call him by a different name.
  • How would you handle a camper expressing hateful and racist remarks to fellow campers?
  • What would you do if had you had a 13-year-old returning camper who was transitioning from female to male who asked if he could take his shirt off while swimming?
  • How would you handle a situation where a camper isolated himself in a cabin after a fight with another camper and is refusing to come out?
  • What would you do if a 9-year-old boy threatened to rape a 9-year-old girl — and meant it?

Resources — Camper Issues

Personnel and Staff Issues

Personnel-related calls accounted for 13 percent of the calls in 2017. In some cases, camps are simply looking for resources to hire an emergency staff replacement due to an unexpected resignation or termination. In other cases, camps are searching for resources to help them make legal decisions regarding the hiring or release of a staff person. However, many calls related to staff behaving inappropriately.

Lessons Learned — Personnel and Staff Issues

  1. Enlist the services of an employment attorney. Identify this person before you begin the hiring cycle. An attorney with experience in labor laws, contracts, and employment issues who can be contacted for help at any time is an invaluable resource.
  2. Set and enforce clear policies regarding acceptable relationships between staff while at camp. Callers frequently wanted to discuss sexual relationships between staff that include both consensual acts and allegations of forced relationships. Understand that if an allegation of force is made by adults, that situation is a police matter, and the alleged victim decides if they want to contact the authorities. If they do, the authorities will help navigate what happens next with the alleged victim and the alleged perpetrator.
  3. Take any threat of suicide very seriously. As previously discussed in the health and medical section, suicide threats are a serious mental health issue. It is imperative to seek the help of mental health professionals and get the necessary help for the staff member.
  4. Understand the employment protection afforded in the Americans with Disabilities Act (ADA). ADA laws provide protection from discrimination in hiring people with a broad spectrum of physical challenges. Craft your job descriptions with the assistance of your attorney and get legal advice before beginning your hiring process.
  5. If an employee or potential employee shares with you that they are transgender, gender variant, gender nonconforming, or in the process of reassigning their gender, understand all the issues related to employment and privacy. Camps want to know everything from how to accommodate transgender individuals to whether they are protected by law and if camps are required to accommodate them. There are no definitive answers and laws vary by state, so be sure to consult with your legal counsel.
  6. Have a back-up plan for staff coverage in an emergency or unexpected loss of staff. Supervision ratios are critical to ensuring the safety of your campers. In the event of a necessary staff termination, camps do not want to be stuck between considering not firing someone due to an inability to cover supervision ratios for campers or firing and risking the safety of campers. Consider what your camp would do if it suddenly lost one or more key staff members — especially those in critical roles such as your nurse or cook. Before the season begins, identify short-term options you can turn to for coverage in an emergency. Consider how properly trained volunteers might help you if you suddenly find yourself short-staffed.
  7. Set thresholds for acceptable criminal records before you conduct your criminal background checks. Protecting the safety of those in your care must be a top priority. Serving in loco parentis, camps and other youth-serving organizations need to use all the information at their disposal to screen applicants who will have access to children, youth, or vulnerable adults. Developing a threshold policy will allow camps to comply with the law and protect the safety of everyone participating in their programs. Although some organizations have set policies not to hire anyone with a criminal record of any kind, ACA's guidance is to establish a criminal background threshold for each position within your organization. Some states have already enacted laws regarding thresholds for individuals who work with children and vulnerable adults. A threshold policy should always be developed working in conjunction with your legal counsel.
  8. Enforce your personnel policies. It's not enough simply to have personnel policies — they must also be enforced. Establish a clear understanding of what the consequences are (e.g., reprimand, suspension, dismissal) for violation of the policies. If camps do not enforce their own policies, they are left open to a variety of risks, including lawsuits, especially if policies are not consistently enforced (e.g., treating one staff member differently than another when they have both ignored one of your policies).
  9. Establish clear policies for employees who are minors. In addition to paying close attention to the laws governing minimum wage, overtime, nondiscrimination, and child labor, minors on staff require additional considerations on how you will handle the employment relationship. It's important to have a well-defined policy on communication with parents, exceptions or modifications to your regular personnel policies, and a comprehensive training plan for this group that is new to the workforce.

Staff Training Questions — Personnel and Staff Issues

  • Would you recognize the signs of depression or other mental health challenges in your staff? If so, how would you support these staff members?
  • What would you do if campers found a stash of marijuana belonging to a staff person?
  • A group of staff are on their time off and in a personal vehicle. They are involved in an auto accident resulting in serious injuries to individuals in the other vehicle. Alcohol/drugs were not an issue, yet it was late at night so fatigue might have been an issue. The driver was issued a citation. What, if any, actions should you take?
  • You operate a day camp where both campers and staff bring their own lunch. Due to the potential of peanut allergies, it is the policy of the camp to not allow anyone to have any peanut butter-based items in any lunch — sandwiches, cookies, crackers, etc. You have a staff member continually bring a PB sandwich for lunch. What do you do?
  • What are your staff sexual harassment policies? What are your policies regarding relationships between staff? Does your staff know what to do if another staff member harasses them?
  • What would you do if a staff member threatened suicide?
  • If a minor is an employee, and they violate a personnel policy or break a law, who would you contact? Would you call the parent(s)?

Resources — Personnel and Staff Issues

Business Operations

Seven percent of the calls this summer were about issues regarding the business of running camp. One camp was being investigated for a camperto- camper issue that had previously occurred at camp. Other callers had questions about taxes, wages, insurance, and workers' compensation. These calls typically concern questions about applicable laws, closing a camp, handling negative social media, international insurance considerations, legal counsel, liability questions, and risk and release waivers.

Lessons Learned — Business Operations

  1. Operating a business is complex — seek and retain expert counsel. While ACA cannot provide legal advice, we do help callers understand the questions to discuss with legal counsel.
  2. Understand the laws applicable to your camp — state, federal, and local. Know when the law requires you to call the authorities.
  3. Understand the programs and services offered by your insurance company. Your insurance company may have additional resources to support and guide you through a crisis or help with risk management.

Staff Training Questions — Business Operations

  • Who is ensuring that your camp is compliant with all relevant local, state, and federal laws and regulations?
  • What are the state challenge course and zip line laws and regulations applicable to your camp?
  • If a child tells their counselor that her parents are alcoholics and "always drunk" are you required to report that to the authorities?
  • If an international camper has an "international insurance card," what does that mean for your camp should the child need outside medical care?
  • How would you handle a rather large unpaid camp tuition, where the parents are dodging your calls and child is still at camp?
  • Do you fully understand the coverages afforded your camp by your various insurance policies?

Resources — Business Operations

Miscellaneous Issues

Miscellaneous questions comprised the remaining 5 percent of calls. These issues included handling a persistent intruder in the evenings on a camp's site, possible bedbugs coming to camp with campers that have them in their home, evacuating for a wildfire, answering questions about ACA's Standards, and discussing "hypothetical" questions. The most frequently referenced resources used by the Hotline team to answer these and other questions can be found online.

Parent Behavior

While only 4 percent of calls to the Hotline were regarding parent behavior, they continue to be some of the most difficult issues for camps. As camp professionals, we know we partner with parents, but sometimes it appears that parents are not agreeable to the partnership. In one example, divorced parents with shared custody of their child vehemently disagreed on the name and gender of the child who was attending camp. The child identified as transgender, and one parent supported the identity, while the other did not.

Lessons Learned – Parent Behavior

  1. Require at least one emergency contact who is not the parent of the camper. Some of our calls are from camps regarding parents who are refusing to pick up their child early from camp when the camp has determined that they must expel the child. The reasons for expulsion range from threatening behavior to serious medical conditions. As shocking as it seems to the camp, there are parents who simply want the camp to handle everything until the scheduled end of camp. If the camp is unable to get a parent or other emergency contact to take custody of the child in cases of threatening behavior, sometimes the camp's only recourse is to call the authorities to take custody. These extreme situations are rare, but real. Be sure that your camp families understand your expectations and the parameters that might force you to determine that a child must be sent home — including any medical situations (e.g., if you have a "no nits" policy about lice that deems that if a child has lice, they will be sent home — be sure your families are aware of your policy).
  2. Not every camp is right for every child — but there is a camp for every child. Be clear with families prior to registration about the culture and practices of your camp. Allow parents to make informed choices about whether their child is suited to your camp or a different camp. Consider ACA's Find a Camp (find.ACAcamps.org) as a tool for directing parents to a camp that might be better suited to their child's needs.
  3. Communication is the key to success. An informed parent is a partner. An uninformed parent can become an adversary — with their children caught in the middle.

Staff Training Questions — Parent Behavior

  • How would you handle a furious parent who calls and emails saying she doesn't care if she is "politically correct" and wants to know why the camp did not pre-notify her that "pansexual or transgender" campers were in the same cabin as her child?
  • What would you do if the parent of a first-year counselor has called to dispute the fact that their 20-yearold daughter has not had a day off in three weeks (according to the daughter) — which is the reason the daughter has not been home?
  • If a parent refuses to pick up their child when you have expelled her from camp because she harmed other campers, what would you do?

Resources — Parent Behavior

Crisis Hotline Case Studies

Contributed by the ACA Hotline Team: Tori Barnes, Kim Brosnan, Laurie Browne, Abby Burbank, and Rhonda Mickelson.