The Summer Camp

Traditionally, camps for children with chronic illness have been seen as a form of recreation for patients and respite for caregivers. There are, of course, health benefits to recreation. Adolescents with low social involvement and activity engagement are thought to be at risk for greater mental health problems. For example, one study investigated the involvement of adolescents in afterschool organized activity and found that those with low involvement also experienced greater depressed mood (19). This was especially true for those with detached relations with parents. Interestingly, for this study, the engagement with the activity leader was a strong determinant for positive outcomes. More involvement in structured outdoor activities is of general benefit and can help overcome barriers to exercise and activity engagement, especially for girls (20). Many children with chronic illness have reduced opportunities for social engagement, leisure, and play. The camp was a simple idea to provide the opportunity for access to leisure with expertise. Often, camps also enabled opportunities for socialization with children experiencing similar problems and opportunities for other family members (e.g., siblings) to be exposed to shared experience. In addition, it is sometimes argued that the camp provides "time-out" from stressful habits and home routines.

There has been a move to view the camp as a potential method for targeting psychosocial and educational interventions aimed specifically at adjustment. Moving beyond shared experience and recreation, some camps have more programmatic and structured content aimed at facilitating or promoting adjustment to chronic illness. There are now camping programs for mixed groups of children with different chronic illnesses and camps that are for specific client groups. The number of specialized camps has increased in the last 20 years, and there are now many camps, particularly in the United States, for children with, for example, asthma, renal disease, burns, cancer, diabetes, obesity, or arthritis.

Plante and colleagues, in a review of group interventions for pediatric chronic conditions, specifically reviewed the literature on summer camps (21). They identified 23 reports of camps that ranged from day or residential camps. In some, the content offered was purely recreational activity; in others, there were clear psychoeducational components. In this overall review, they included all of the studies they could find regardless of quality. Many of the studies were case reports and uncontrolled evaluations, although some investigators had made attempts to control for variables other than the camp-delivered experience. Plante et al.'s overall conclusion was that "pre-post evaluations have indicated that campers gain disease-related knowledge and may have improvements in self-esteem, anxiety, attitudes toward the illness, and management of asthma, diabetes, and obesity" (p. 442), but they cautioned against strong statements regarding the efficacy of these interventions because of the variable and uncontrolled nature of the studies.

In attempting to focus on outcomes, in 2004 Kiernan et al. updated the review of the efficacy of camps, finding much the same result: there may be therapeutic benefits over and above recreation and respite, but they are certainly not global and are inconsistent across camps (22). They therefore undertook an analysis of one large European camp program. The Barretstown Gang camp was founded in Ireland and was based on the Hole in the Wall Gang camps in the United States. This 10-day summer camp was designed for children (or siblings) with life-threatening illness and takes children from all over Europe. They were able to include 240 campers who completed the precamp assessment, and recovered data from 151 immediately postcamp and 119 at 3-month follow-up. The content of the camp was largely recreational and educational. Their findings are worth closer evaluation. They found that younger children gained more benefit from the program in physical symptoms and increases in positive affect. They also found that adolescents reported increases in judgments about quality of life at 3 months postcamp. However, and it is an important qualifier, there were examples of adverse effects immediately postprogram that were thought to be associated with friendship relationships, particularly for some adolescents, an increase in dissatisfaction with physical appearance, and immediate postcamp loss in quality of life, thought to be associated with the sudden drop in social support.

As with any complex intervention that argues for therapeutic status, the responsibility is on the providers to identify and control the therapeutic agent. The question arises regarding whether it is the general landscape of therapy that is crucially important, some aspect of the therapy (e.g., group treatment, the location, the components, the facilitator, etc.), or the content of the treatment specifically. This research has not been undertaken. To date, we do not know if there is anything therapeutic about the specific aspects of being in a camp, such as the country environment, the use of the summer camp model (e.g., in the language), the focus on leisure, recreation, and fun, the focus on friendship and support, the expert facilitation, or any specific combination of these.

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