Strategies for a Healthy Camp: Are You Prepared?

Linda Ebner Erceg, RN, MS, PHN

With the summer season looming, camp professionals are focused on hiring staff, recruiting campers, and implementing changes for the 2017 season. But have you also implemented strategies that undergird the health of campers and staff? To provide you with key strategies that support a proactive health stance for your camp program, detailed here is wisdom as well as emerging ideas from ten years of the Healthy Camps Initiative. Have you implemented them?

Informed and Engaged Parents

Informing parents about camp — especially health components — can be tricky. As a result, a growing number of camps are implementing a pre-enrollment agreement that has parents acknowledge aspects of the camp experience and, by (electronically) signing the statement, indicate that they accept the parameters. Such statements may simply entail agreeing to the camp’s parent policies in a written document and/or via an online resource. Other statements get more explicit. For example, stating the things a child must be able to do to participate in the camp experience, acknowledging that withholding requested information means the camp cannot be responsible for that information, and using the acknowledgement to highlight potential problem areas (e.g., “If your child’s allergy is so sensitive that he or she cannot be around others who may be using or eating that item, our program may not be a good fit for your child”).

Camps are also answering a critical parent question: “What should my child be able to do to participate in this camp program?” Linked to a camp’s mission and reflected in its program, these statements include not only physical attributes, but also those associated with mental, emotional, and social health (MESH) skills. Language might include the child is “capable of effective interaction with others in our community living and group-based program.”

Along with informed parents comes engagement. This becomes important as parents ready their child and themselves for the camp experience. The Healthy Camps Toolbox (ACA, 2017) includes a PDF download called “A Healthy Camp Begins and Ends at Home.” Designed for a camp to give to parents, content focuses on what parents can do at home to support their child’s camp experience. It’s recommended that camp professionals adapt the PDF so it accurately addresses their own policies and practices (see “Additional Resources” sidebar on page 10).

Repeated requests for parents to contact the camp when a question arises are showing up on websites, in printed materials, and in electronic messages (including social media). Camps typically initiate this contact when health matters arise. Indeed, camps have an excellent history of parent contact when that parent’s child has a health issue. What has changed is the growing number of camps that preemptively e-mail parents about health concerns, especially outbreaks such as impetigo, head lice, and communicable diseases. This allows camps to shape a message that can minimize concerns, provide information from reputable sources, and reiterate the name/phone number of the camp contact should parents have further questions. Such a proactive strategy also helps manage what might otherwise become a PR issue.

Analysis of Injury-Illness Data

The ACA’s national injury-illness data set is now five years old. Collection and analysis of that data made many attend to their own camp’s injury-illness profile — but has that continued for your camp? Make collection of this information — perhaps using a spreadsheet — a task for health center personnel. Review the data periodically during the camp season (e.g., weekly; after each session) as well as at the end of the season. The data often indicate potential “hot spots” for injury and illness trends that can inform your camp’s communicable disease control practices, opening day screening process, and, perhaps, protocols for your nurse/physician. In addition, determining each year’s injury and illness rates for campers and staff allows you to track the effectiveness of control measures.

MESH-specific Function Statements

Most camp jobs require that an individual has MESH resiliency and skills. A staff member’s ability to maintain his or her own MESH status while caring for campers over time can strain personal MESH reserves. In addition, the ability to collaborate with others to deliver the camp program — a critical skill for camp staff — indicates a need to augment employee essential function statements to include one specific to the MESH profile. Consequently, camps are inserting these into their employee materials with language such as, “capable of effective and sustained mental, emotional, and social interaction with others in the camp’s fast-paced, youth-centered, community living environment.”

Camps adding statements like this often follow up with questions during the interview process that probe applicants’ understanding of that essential function. For example: “Tell me what our camp’s essential function about effective and sustained mental, emotional, and social health interaction and skills means to you.” Responding allows the applicants to demonstrate their level of MESH understanding and the interviewer to ask further questions based on the applicants’ responses. A skilled interviewer might build on that by having applicants discuss distinctions associated with the developmental stages of youth. For example, “How might your response change if you were working with eight-year-olds as opposed to 14-year-olds?”

Communicable Disease Control Strategies

Strategies for communicable disease control were prevalent in 2009 when the threat (or reality) of the H1N1 flu loomed but may have waned over time. However, communicable illnesses will always be a threat whenever a group of people come together. Camp nurses anecdotally report routinely coping with these illnesses; things like the common cold, strep throat, impetigo, Norwalk-like viruses (Norovirus), and chicken pox happen almost every season. So what are some effective control strategies?

  • Hand-washing. Nothing beats soap and water. At minimum, campers and staff should effectively clean their hands before eating and after toileting.
  • Burying coughs/sneezes in one’s shoulder. No more hands covering one’s mouth, please.
  • No sharing of personal items — ever. This includes drink containers, makeup, hair implements, hats/ scarves, and so forth.
  • Maintaining appropriate personal distances from one another. This is why beds and sleeping bags should be at least a yard apart and people should sleep head-to-toe (“Sneeze on the toes, not on the nose”). It’s why people with sore throats and other potentially communicable symptoms should be coached to keep an arm’s length from others.
  • Directing that staff and campers be appropriately immunized. Note the word “appropriately.” This recognizes that some people cannot be immunized for good reason (e.g., immune-compromised; allergic to egg albumin). More camps are determining the percent of their campers and staff who are immunized and reporting that to parents who may ask. Known as “herd immunity,” the percentage of immunized people in a group contributes some protection to those who cannot be fully immunized.

(See “Additional Resources” sidebar for locations to learn about other strategies.)

Building Staff Expertise in MESH Areas

More camp staff need information about MESH topics, how these areas are supported and/or challenged by the camp experience, and how to respond when an affected individual needs help. Typically taught during orientation, these conversations are supported by content from both Christopher Thurber, PhD, and Bob Ditter, familiar authors to ACA members. Their articles are searchable on ACA’s website and cover topics such as disordered eating, AD/HD, and emotional readiness for camp.

Those who want to know how to respond when someone is experiencing a MESH crisis benefit from taking a Mental Health First Aid Course (see “Additional Resources” sidebar). Some local ACA offices are setting up these trainings for camp professionals, but one can also bring a trainer to camp. The course’s text, Youth Mental Health First Aid USA (Mental Health Association of Maryland, 2012), is available from suppliers such as Amazon and makes an excellent addition to one’s resource shelf.

Camp directors who talk with parents of a child with a MESH concern are using the form, “Assessment of a Camper’s Behavior of Concern,” to guide that discussion (see “Additional Resources” sidebar). Focusing on behavior rather than diagnosis, this tool guides camp professionals as they explore the child’s readiness for camp and management strategies to support the child and the campers and/or staff who may also be impacted. This tool is part of the Healthy Camps Toolbox, a searchable topic on ACA’s website (ACAcamps.org).

Another web support is the Mental Health content within ACA’s “core competencies” area (ACAcamps.org/ staff-professionals/core-competencies/ health-wellness/mental-health). Articles, resources, blogs, and more are just a mouse click away on this page, one that is growing as information is added. Consider bookmarking it.

Technologies for the Health Center

Health center staff access online resources to help identify camper/staff health problems, plan interventions, and obtain staff/camper education tools. Does your health center have a computer with adequate bandwidth? In addition, does that computer have back-up power supported by a plan that directs action when power fails? Sometimes provided by a laptop’s battery, back-up becomes critical when storms crash that power.

A growing number of software developers are marketing packages designed to support the needs of camp nurses and physicians while also allowing parents to submit health information about their camper. Does that software meet critical criteria? See the PDF in ACA’s Healthy Camps Toolbox, “Selecting Camp Healthcare Technologies,” to make that determination.

Technology is a moving target. Apps, connecting tablets to the health center’s computer, and using personal cell phones to capture information when outside the health center all demonstrate the need for camp administrators to monitor these advances and develop policies about their use to complement camp needs. Camps are becoming more aware of this as time unfolds; indeed, some leadership teams routinely discuss technology to both stay abreast of emerging ideas and stay timely with policy development. Doing so should be helpful to camps’ risk management.

Updated Emergency Plans

Emergency plans may well reflect a camp’s most vulnerable area. Camp leaders typically develop emergency plans and brief staff about them during orientation. Some, such as the fire and/or “lost camper” drills, may even be practiced. Indeed, camps have a history of astute planning for camp-centric emergencies. But what about those arising from other sources, such as regional power grids going down for an extended time, events that shut down national or regional transportation, and/or threats from the external community? These illustrate vulnerabilities for many camps — and lend themselves to discussion with key personnel prior to the next camp season.

Getting ready for your camp’s next season must include auditing and updating your health practices. Some directly impact people; others impact activities and policies. At minimum, a robust plan helps everyone have a more enjoyable camp experience. Make “Healthier Camping for All” a part of your goals.

References

ACA. (2017). A healthy camp begins and ends at home. Healthy Camp Toolbox. Retrieved from ACAcamps.org/sites/default/files/resource_library/ research/Healthy-Camp-Update-2014-ParentsCaregivers.pdf

Mental Health Association of Maryland. (2012). Youth mental health first aid USA. Retrieved from amazon.com/Youth-Mental-Health-First-Aid/ dp/0988517604/ref=sr_1_1?ie=UTF8&qid=14841 74125&sr=8-1&keywords=Youth+Mental+Health+ First+Aid+USA

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.

Additional Resources

Injury-Illness Oversight:

An Ounce of Prevention: Collecting and Using Injury-Illness Data for Program Improvement (online course)

• Spreadsheet to capture information about your camp’s illness and injury trends: send an e-mail request to Linda Erceg at erceg@campnurse.org

In ACA’s Healthy Camps Toolbox:

A Healthy Camp Begins and Ends at Home (PDF): a handout to give parents and/ or modify to more effectively reflect your own program

Mental Health First Aid Course (PDF): explains how to get this training for your staff

Assessment of a Camper’s Behavior of Concern (PDF): a tool designed for use by a camp professional when talking with parents of a child with MESH concerns

Staff Training Activities to Promote Camp Health and Safety (webinar)

Selecting Camp Healthcare Technologies (article): guides camp professionals through decision-making about software for the health center

Resources from the Association of Camp Nurses (ACN):

Communicable Disease Control in the Camp Setting: a practice guideline for nurses

Further Safety Resources:

Why Don’t We Do It in Our Sleeves? — YouTube video that demonstrates the virtue of burying coughs/sneezes in our sleeve instead of using our hands

Herd Immunity: explains this concept and provides the percent of campers and staff who should be immunized to create herd immunity for selected diseases