Camper Care

MEETING MENTAL, EMOTIONAL AND SOCIAL HEALTH (MESH) NEEDS AT CAMP

24 www.ccca.org June/July 2015®

TREATING WHAT YOU CAN’T

I FEEL LIKE I’M WATCHING A THOUSAND TVS AT ONCE. WHY CAN’T I FEEL

ANYTHING?

I KNOW THEY’RE LAUGHING AT ME.

by Tracey C. Gaslin

June/July 2015 www.ccca.org 25®

On a warm, sunny afternoon at camp, several children show up in the health center.

Sarah has a small cut on her finger from arts and crafts. Her wound is cleaned and

dressed, and she continues with her activities. Sam has a runny nose from his many

allergies and is given an antihistamine. Josh twisted his ankle in a basketball game

and complains of slight pain when he walks. Wrapped in an ace bandage and ice,

he is ready to go. Amy is crying and solemn and is asked to wait for assistance. �

SEE

I HATE MY LIFE.

IT FEELS LIKE FIREWORKS IN MY BRAIN!

DOES ANYBODY LIKE ME?

IT’S ALL MY FAULT.

I WANT TO GO HOME.

iStock

It is easy to treat the known, visibleand obvious. However, when a camperpresents emotional symptoms, our taskin discerning the cause becomes morechallenging. While a physical cut ismanageable, the emotional camperrequires us to use more advanced skills in addressing the concern. Is this camper homesick? Does she havedepression? Did another camper offendor demean her? Is the camper seekingattention? An important part of ourministry is to respond to each situationwith truth and kindness.

Camp professionals are eager tosupport campers with mental,emotional, or social health concerns(MESH). Dealing with MESH can becomplex, but this article will provide an overview to help Christian campleaders and health care providersaddress MESH needs by collectinginformation before camp arrival, recognizing common MESH conditionsand medications and having a plan to respond to MESH emergenciesshould they occur.

Collecting InsightfulInformationCamps might want to consider whatMESH information they are collectingbefore campers arrive. Proactive datacollection helps to establish a plan of

care for campers with MESH chal-lenges. The camper application orhealth assessment might include questions such as:

1. Has the camper experienced anyrecent family alterations (such asdivorce, separation, death)?

2. Has your child spent time away from home for an extended period?

3. Does the camper have a diagnosedmental, emotional or social healthdisorder?

4. Is the camper taking any mood-altering medications?

5. Is the camper currently under thecare of a mental health professional?

6. Are there things we (director orhealth staff) should know to set up your child for success in the camp setting?

Asking a few questions directed atpotential MESH concerns allows thecamp to open conversations withparents regarding how best to care fortheir children in the camp setting. Withparent or guardian assistance, a plancan be established to help children withsensory issues, attention or focus chal-lenges, anxiety or depression. Parentsknow their children best and canprovide insight regarding interventionsthat may work to diffuse or diminishemotional events. It’s also important to

ask parents who to contact, including a doctor or medical provider, and whatsteps should be taken if a potential incident arises.

Common ChallengesAll camps deal with a variety of MESHchallenges. Let’s discuss a few of themore common experiences and oppor-tunities for ministering to individuals in need.

HomesicknessAll camps deal with homesickness. Theexample of Amy in the introduction ofthis article is typical. When asked abouthomesickness, children may not be able to describe their feelings of sadnessor connect them to home. Amy wascrying. Her counselors were unsure howto resolve the issue, so they brought herfor a consultation with health services.Our genuine effort is to help the camperfeel better by taking steps back toward a state of health and happiness. Thereare a couple of helpful steps to do so inaddressing homesickness:

� Be proactive prior to camp arrival.

Gather information from parentsthat helps staff know if the child hasbeen away from home for a period oftime. Understanding nighttime ritu-als at home and allowing campers tobring comfort items, such as astuffed animal or blanket, may also

26 www.ccca.org June/July 2015®

PARTNER WITH THE CAMPER. NEVERPRESUME ANYTHING ABOUT AN INDIVIDUALBASED ON A DIAGNOSIS ALONE.

June/July 2015 www.ccca.org 27 ®

help alleviate some of the emotion.

� Provide time for a child to level the

emotion. When a camper is upset,allow her time to move through the emotion. Constant questioning,even in deciphering the cause, mayonly make the situation more chal-lenging. Lead the child to a safelocation away from the group. Giveher time, and then encourage her tore-engage with peers.

ADD/ADHDJames arrives at camp with medications,and Mom reports that he had somechallenges in school last year. Momhopes camp will be a good experiencefor James and that he will learn to playbetter with others while here. Furtherdiscussion reveals that James takesStrattera and Focalin, ADHD medica-tions, and has challenges staying on taskand following direction. How do wemeet the needs of this young man?Consider the following:

� Understand medication schedule.

Many ADD/ADHD medicationshave unique schedules. Try toadminister the medication on time atcamp to prevent sleep interruptionsor loss of appetite. See “CommonADD/ADHD Medications.”

� Learn what works at home. Talk to Mom about techniques used atschool or home that help James withfocus and taking directions. Keepactivities short in duration. Provideinstructions with no more than threeor four steps, and encourage campersto try new opportunities. Reinforcewith praise.

DepressionAmber is an adolescent who has livedwith depression for a few years. Momtells you that Amber is stable on hermedication and wants her to attend

camp with her friends. You have notspoken with Amber. In an effort tocreate a positive camp experience,consider the following:

� Partner with the camper. Neverpresume anything about an individ-ual based on a diagnosis alone.Arrange an opportunity to talk withAmber and discuss her ideas aboutcamp, her feelings about attending

and her expected outcomes from theexperience.

� Manage medication. Discuss withparents the medications she currentlytakes for depression. The mostcommon class of antidepressantmedications are Selective SeratoninReuptake Inhibitors (SSRIs, see“Anxiety and Depression Medica-tions,” page 28). Psychologist �

Class

AmphetamineStimulants

MethylphenidateStimulants

Focalin 4–6 hours

Include some lossof appetite,weight loss,

sleep problems,irritability, tics

Ritalin 3–4 hours

Metadate 6–10 hours

Concerta 10–12 hours

Nonstimulants Strattera 24 hoursInclude sleepproblems,

anxiety, fatigue,upset stomach,dizziness, dry

mouth

Intuniv 24 hoursInclude

sleepiness,headache,

abdominal pain,fatigue

Medication

Adderall

Dexadrine

Vyvanse

Dosing

4–6 hours

4–6 hours

10–12 hours

Side Effects

Include someloss of

appetite,weight loss,

sleepproblems,

irritability, tics

EXTRA INFO

COMMON ADD/ADHD MEDICATIONS

For more information: www.webmd.com/add-adhd/guide/adhd-medication-chart

Chris Thurber suggests that changesin climate, schedule, diet and activitycould impact the effectiveness ofnormal doses of these medications.

� Develop healthy social connections.

Social connections can help anchora camper’s mental health. Thurber

recommends developing oppor-tunities for campers to make meaningful independent choices,partnering with staff in creativeactivities or enhancing theirpersonal experience by sharingaccomplishments with others.

Preventing and Preparing for CrisesAs we work with children through thecamp experience, we hope to proactivelyprevent negative issues from occurring.However, even in the best of circum-stances, situations can arise, and we needto be prepared to respond to MESHemergencies in the event they occur.When planning, it’s also important toconsider the possibility of and protocolsfor a staff member’s MESH crisis.

Most crises occur when an individ-ual expresses a desire to hurt himself oranother person. This intent may beexpressed verbally, by physical assault,through medication overdose or manyother venues. It is important that werecognize these emergencies and takethe necessary steps to prevent harm oreven death. There are situations whereit is imperative that we seek assistancefor campers. Consider including theseelements in a MESH rescue plan:

� Prepare a consultation list. Have alist of support services readily avail-able for access. The list may includemedical health professionals,psychologists, psychiatrists, mentalhealth services, a crisis hotline, thelocal hospital and other availableresources. Connect with the individ-uals on your resource list prior toneeding their service, and establish a

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MOST CRISES OCCUR WHEN ANINDIVIDUAL EXPRESSES A DESIRE TOHURT HIMSELF OR ANOTHER PERSON.

Fluoxetine(Prozac)

Fluvoxamine(Luvox)

Sertraline (Zoloft,Lustral)

Class

SelectiveSeratoninReuptakeInhibitors(SSRIs)

Medication(Brand Names)

Citalopram(Celexa)

Escitalopram(Lexapro, Cipralex)

Paroxetine (Paxil, Seroxat)

Side Effects

Include nausea, agitation,dizziness, drowsiness,

insomnia, weight gain/loss,headache, dry mouth,

vomiting, diarrhea, suicidalthoughts or behavior

EXTRA INFO

ANXIETY AND DEPRESSIONMEDICATIONS

For more information: www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

rapport that will promote engage-ment and help in time of need.

� Connect with the camper in need.

Listen and respond in a nonjudgmen-tal way. Know the camper’s story asyou seek help from a pre-establishedlist of resources and medical provid-ers. Providing empathy and supportcan help soften the camper’s feelings.

� Consult with appropriate camp staff.

Meet with leadership, health carestaff, and others who play an integralrole in addressing the MESH crisis.Contact parents. Share information.Develop a plan of action, andconsider strong vigilance in protect-ing the privacy of the camper’s healthinformation. Remind everyone thatmaintaining protected health infor-mation (PHI) is a critical role foreveryone involved in caring forcampers. For more on PHI, seewww.hipaa.com/hipaa-protected-

health-information-what-does-phi-include.

Mental, emotional and social healthissues will be ever-present as we minister to individuals in our care.Addressing these needs helps to fosteran environment of safety, love andrespect—and contributes to the spiritualhealth, growth and ongoing life-changethat campers can experience even afterthey leave camp property. l

June/July 2015 www.ccca.org 29 ®

Tracey C. Gaslin, Ph.D., CRNI, CPNP,

FNP-BC, is executive director of

the Association of Camp Nurses.

A professor and dual-certified nurse

practitioner in pediatrics and adults, she specializes in

camp nursing, pediatrics and children with bleeding

disorders. Dr. Gaslin previously served as medical director

at The Center for Courageous Kids, where she worked

with children with chronic disease, disability and life-

threatening illness. Email her at gaslin@campnurse.org.

EXTRA INFO

GO DEEPER“Addressing MESH Needs of Children Through Camp,” by JeanaWilcox, CompassPoint, June 2014, www.acn.org/store/acn.php

“Medication Management for Day and Resident Camps,”www.acn.org/edcenter/acn_practice_guidelines_for_camp_nurses_in_the_us.php

“Mental Health Problem Flowchart” and “Camper Mental Health” byDr. Christopher Thurber, www.campspirit.com/purchase-handouts