TY - JOUR
AU1 - LCSW, Marion Doctor,
AU2 - PhD, Christopher A. Thurber,
AB - The research in this month's Psychosocial Forum represents an important step in training burn camp staff to manage campers' behavior. There are at least three reasons why such a step, and others like it, is crucial. First, no camp can be its best without a serious investment in staff training. Second, no child can enjoy camp to its fullest without a clear, fair, and consistent set of limits. Third, no researcher can hope to help a camp improve without rigorous process and outcome data. Before you read “Use of a Token Reinforcement System to Promote Appropriate Behavior at a Pediatric Burn Summer Camp,” consider these three factors in more detail. THE IMPORTANCE OF STAFF TRAINING Many people view summer camps as a stereotype of food fights, scatological language, and late-night panty raids. Movies such as the “Meatballs” series, which caricature summer camps, have fueled these stereotypes. Although recent television programs, such as Disney's “Bug Juice,” have provided some realistic views of camp life, stereotypes do persist. And, like it or not, most stereotypes have a basis in reality. There are still some low quality summer camps in the United States where food fights and panty raids are just the tip of the behavior problem iceberg. Fortunately, there are also high quality camps whose directors and staff uphold sterling principles for themselves and their campers. Indeed, of the approximately 6,000 overnight summer camps in the United States, more than a third have voluntarily complied with a rigorous set of health, safety, leadership, and program standards that have earned them accreditation from the American Camping Association. Whatever standards a camp adheres to, the centerpiece of quality is the camp's staff. Fancy equipment, beautiful natural surroundings, and diverse program offerings aside, no camp can do good things for children without a kind-hearted and well-trained staff. Unfortunately, many camps, especially those designed for special populations, have only a kind-hearted staff. Too often, staff training is reduced to a minimal set of orientation exercises, with staff left to lead children and manage their behavior in whatever way they see fit. Sometimes this works; usually it does not. There is no question that many adults who work at burn camps are highly trained. Firefighters, nurses, mental health professionals, and therapists of all kinds bring professionalism and expertise to their work at camp. Many also have their own children or have experience working with children in clinical settings. All of this experience has tremendous merit. Yet little of that professional or clinical training specifically prepares staff for camp challenges, such as organizing a group of 55 screaming 9-year-olds to play Capture The Flag; teaching a table of 12-year-olds good table manners; bringing an ostracized camper out of his shell in an intimidating social context; squashing bullying among a group of rowdy adolescents; reducing distress in a first-year camper whose mother promised to come get him if he felt homesick; or getting a group of needy children to understand the virtue of unselfishness. If we want burn camps—indeed all camps—to be the best that they can be, I believe we must commit to a serious investment in staff training. What to include in this training and how long the training should last depends on the camp and the camp experience of the returning staff. A good length guideline is the standard practice at most high quality camps: A minimum of 5 days for the staff to spiff-up the camp, set goals, bond, and be trained. (Yes, for some burn camps, this represents a training program almost as long as the camp itself.) As for the content of staff training, solid guidelines are provided in the American Camping Association's Accreditation Standards for Camp Programs and Services. Whether or not a camp is seeking accreditation, this book of standards, along with Armand and Beverly Ball's Basic Camp Management are excellent resources. Both are available from the American Camping Association bookstore (www.ACAcamps.org or 800-428-2267). THE IMPORTANCE OF CLEAR, FAIR, CONSISTENT LIMITS Those of you taking the time to read this editorial and the accompanying research need no reminder of the importance of clear, fair, and consistent limits for children. But how to apply these limits to the camp environment is what we need to better understand. Clear, fair, consistent limits help camp leaders provide fun and love to children within a set of boundaries that make them feel safe. As you will see when you read the article by Adams and colleagues, putting limits into practice and reinforcing children for staying within those limits, can be a prodigious task. But it is not an impossible task, and we must remember this. Too often, children with special needs provoke a sort of empathy in adults that leads to permissiveness. The limit-setting mechanism in the parenting section of our brain relaxes or shuts down completely as we attempt to make up for what these children have lost, or at least to soothe their emotional and physical pain. Paradoxically, any significant relaxation of developmentally appropriate limits makes kids feel unsafe and undermines our role as a responsible leader and supervisor. Behavioral frameworks, such as the one suggested by Adams and colleagues, have a two-fold strength. They provide straightforward leadership guidelines for staff and a set of clear, fair, and consistent limits for children. That being said, a behavior management program based on a token economy is neither necessary nor sufficient for running a safe and fun camp. Such behavior management techniques must be used compassionately and in combination with other learning techniques. As the camp counselors who participated in the study by Adams and colleagues suggested, cooperative behavior, activities that promote teamwork, and unselfishness must also be reinforced. In addition, we must look beyond extrinsic reinforcements, such as the rewards that Adams and colleagues used, and explore how intrinsic reinforcements work for children. For example, how could the internal satisfaction of making a new friend substitute for some external reward, such as a candy bar? Clearly, human beings are motivated by both intrinsic and extrinsic rewards. One trick at camp is to teach children the value of intrinsic rewards by not overemphasizing extrinsic rewards. Of course, the other trick is getting those same children to make their beds, clean their cabins, play fairly, and follow the rules. Extrinsic rewards, even in the form of adult praise (a powerful extrinsic social reinforcement) are quite effective for that. Ultimately, one begins to appreciate the nuances of behavioral management. The question is not, “Can we get these kids to do what we want?” The proper set of environmental reinforcements can guarantee that. Rather, the question is, “Can we get these kids to internalize what we are teaching them, so they become more skilled at the self-regulation of their behavior?” THE IMPORTANCE OF PROCESS AND OUTCOME DATA The critic has an easy job: To describe strengths and weaknesses; maybe even to suggest improvements. The researcher has a more difficult job: To describe reality, provoke and measure change, and then come up with an explanation. In this context, one appreciates Adams and colleagues' two-year research effort. Moreover, those of us who have conducted—or have tried to conduct—research at a burn camp are especially appreciative of this study. Directors of camps for children with special needs feel understandably protective of their campers. These are children who have been poked and prodded enough; whose willingness to participate in research has been tempered by the physical and psychological demands that have already been placed on them; whose parents want them simply to have a good time at camp. These are all legitimate concerns. Yet without data to help guide improvements to our camps, we are left with biased impressions and unrepresentative anecdotes that sometimes steer us in the wrong direction. Case in point: Camp lore since the turn of the last century was that homesickness faded after the first few days at camp. Camp directors' impressions became the gospel truth that was preached in thousands of camps across the country. Millions of camp counselors were taught, throughout the twentieth century, to “get kids through” the first three or four days of camp, and then to back off, expecting no further problems with homesickness.1 Then, in 1995, my colleagues and I published the first in a series of empirical studies on homesickness.2 Contrary to the conventional wisdom, our data showed that, for the most homesick campers, the intensity of their homesickness increased through the first 12 days of a 14-day stay. Having replicated this finding several times with different samples,3,4 we now feel confident recommending that staff remain vigilant for signs of homesickness well beyond the first few days of camp. Understanding the chronology of homesickness has also informed our interventions. There is no substitute for data when it comes to the accurate evaluation of camps and kids. One of the strengths of the Adams and colleagues study is its empirical—not anecdotal—design. I found their polling of staff for feedback on changes to the token economy system especially wise. CRITICISM Like any piece of research, the Adams and colleagues study has limitations. I offer these criticisms not only to guide readers' interpretations of the findings, but to stimulate us all to design future research that builds on this study's strengths. The primary dependent variable in this study was counselors' ratings of how much they thought “that a point-reward system would help/helped reduce problem behavior” and “increase appropriate behavior.” Results suggested that in both years of the study, counselors' opinions became more positive from precamp to postcamp. However, this is quite different from what the authors claim. Adams and colleagues state, “Ratings indicated that the Token System successfully increased appropriate behavior and decreased inappropriate behavior exhibited by campers.” Of course, that would be the ultimate goal of such a program, but to conclude that camper behavior actually changed (and not that counselors' opinions about the effectiveness of the program changed), future researchers will need to measure camper behavior. This study did not directly measure camper behavior. Reliable and valid instruments, such as the Child Behavior Checklist, the Behavior Assessment Scale for Children, or the Dimensional Behavior Scale,2 could be used to measure actual changes in children's behavior before, during, and after camp. Although it is good to know that counselors viewed the token system in a mostly positive light, Adams and colleagues provide no data to support their claim that actual behavior change occurred. Finally, in any therapeutic program, counselors' adherence to the protocol in which they were trained is important. It is difficult to know, without objective observational data, whether counselors in this study were manipulated by some children, or whether consistency existed among counselors. The fact that so many of the full-time staff did not stay the full five days of camp adds an additional threat to the fidelity and reliability of the Adams and colleagues protocol. (It also weakens the unity and spirit that is central to a meaningful camp experience.) However, adding a visual component to the token system and standardizing the reporting periods was probably helpful. The protocol was also flexible enough to be customized for individual children, which is an asset to any behavioral program. CONCLUSION Camps can be powerfully positive forces in children's lives. Burn camps are especially important because they give young burn survivors an opportunity to live and learn with other burn survivors, to become more comfortable with their bodies, and to push their own mental, physical, and spiritual limits. By advocating specialized training for the adults who run burn camps, Adams and colleagues have made this growth more attainable for young burn survivors. REFERENCES 1. Thurber CA Children's coping with homesickness: phenomenology and intervention. In: van Tilburg M A, Vingerhoets AJJM, editors Psychological aspects of geographical moves: homesickness and acculturation stress.  Tilburg, the Netherlands: Tilburg University Press; 1997. p. 143– 63. 2. Thurber CA The experience expression of homesickness in preadolescent adolescent boys. Child Dev.  1995; 66: 1162– 78. Google Scholar CrossRef Search ADS PubMed  3. Thurber CA The phenomenology of homesickness in boys. J Abnorm Child Psychol.  1999; 27: 125– 39. Google Scholar CrossRef Search ADS PubMed  4. Thurber CA, Sigman MD, Weisz JR, Schmidt CK Homesickness in preadolescent adolescent girls: risk factors, behavioral correlates, sequelae. J Child Clin Psychol.  1999; 28: 185– 96. Google Scholar CrossRef Search ADS   Copyright © 2002 by the American Burn Association
TI - PSYCHOSOCIAL FORUM
JF - Journal of Burn Care & Research
DO - 10.1097/00004630-200207000-00014
DA - 2002-07-01
UR - https://www.deepdyve.com/lp/oxford-university-press/psychosocial-forum-QO0y0qF9HE
SP - 294
EP - 296
VL - 23
IS - 4
DP - DeepDyve
ER -