Training your staff to manage the challenges of adolescence.

Adolescence is a challenging time for everyone. Bodies and minds are in a constant state of flux as young people confront intense emotions and novel experiences. Camp is an ideal environment for older campers and younger staff to get their first real experiences with responsibility and develop new interests--while dealing with the normal challenges of "growing up." Not all challenges are normal, however, and any problems young people have are likely to follow them to camp. We need our staff to be ready for these challenges.

Adolescence

The concept of adolescence--the idea that there is, or should be, a time of transition between childhood and adulthood--is fairly new. Some historians would argue that the idea of adolescence has only existed (in American society, at least) for about a century, and that it started as a privilege of the upper class. Parents with more money could afford to have their older children continue to consume, rather than contribute to, the family's financial resources for a longer period of time. For people in the lower economic strata, there was a smaller margin for error, in that children needed to behave like contributing adults much more quickly. To an extent, this is still true today, though the "option" of adolescence has become the rule instead of the exception. The expansion of the middle class has led to a greater number of young people having "more time" to grow up. In recent years, the duration of adolescence has been extended further and further into what was once considered adulthood. Think about it: How many truly financially and emotionally independent twenty-two-year-olds do you know? The result of this cultural shift is the continued blurring of the line between adult and child. This issue is particularly relevant for staff training, as we have adolescents in charge of other adolescents.

We must also remember that adolescents today--staff and campers--are confronted with a very different world compared to even twenty years ago. From the schizophrenic relationship between society and sex and increased drug use to the perceived pressures "to get into the right school," adolescence is getting increasingly difficult. In a sense, this is okay. Adolescence (and life, in general) is supposed to be challenging, and it is the very act of mastering difficult times that leads to character development. In fact, the majority of teens navigate these choppy waters effectively, and the problems they experience are typically mild and short-lived. It is not, in a statistical sense, "normal" for adolescence to be a time of pathological "storm and stress," as the cliche goes. Still, the subset of young people suffering from the emotional stress that leads to risky behaviors seems to be growing.

We must train our staff members to recognize the presence of risky behaviors in campers and themselves. We also need to train them to know what to do when they are confronted with these behaviors. What follows is a description of some common risky behaviors and other challenges of adolescence in terms of prevalence and warning signs, followed by a series of activities to help staff learn to handle these issues in a way that promotes positive development.

Sexuality

As a society, our attempts to help teens understand their sexuality have been spectacularly hypocritical, ineffective, and flat-out stupid. Hypocritical because parents complain about sex and the media, but research shows most never have a meaningful discussion about anything other than anatomy and menstrual cycles with their children. Ineffective because despite the data supporting the effectiveness of specific approaches to sexual education in reducing teen pregnancy and transmission of sexually transmitted diseases (STDs), science is ignored and politics rules. Flat-out stupid because all of this goes on, and we act surprised when cross-cultural research reveals that American adolescents are among the most sexually illiterate teens (e.g., unable to describe the basic functions of their reproductive systems) of the developed countries, and have some of the highest rates of pregnancy and STD infection. Here are some numbers based on the most up-to-date research about your campers and young staff:

* By age seventeen, over 50 percent of teenagers have engaged in oral sex.

* Between 5 percent and 30 percent (depending on various background factors) of thirteen-year-olds have had sexual intercourse.

* More than nine million new cases of STDs are contracted by Americans between the ages of fifteen and twenty-four every year (Centers for Disease Control, 2004i, 2004j, 2004k; www.cdc.gov).

Campers and staff are coming to camp with more sexual experience--both personally and through exposure to increasingly graphic sexual material on television and the Internet--than ever before. Campers will be curious about sexual issues and will almost certainly discuss these issues amongst themselves at camp (just like they do at home), despite their probable lack of accurate knowledge. Because there is not much of a developmental difference between older campers and younger staff, campers are likely to approach staff with questions involving both physical and emotional intimacy. The perception of blurred boundaries regarding what is appropriate for discussion between campers and staff must be clarified during staff training and monitored throughout the summer.

There are several important points that should be covered during staff training:

* For all camps, but particularly those that are co-ed, set clear limits regarding what constitutes appropriate and inappropriate physical contact between campers, between staff members, and of course, between staff and campers.

* Prepare staff for common questions from campers involving their relationship history ("Do you have a boyfriend/girlfriend?") and personal experiences that could be both innocent ("What does it mean to have sex?") or potentially provocative ("Are you a virgin?" "Do you masturbate?") with the following issues in mind:

** State specifically that staff should never discuss their personal sexual history with campers, no matter what questions are asked. Nor is it appropriate to encourage campers to discuss their experiences with staff. Remember that most staff know this is not acceptable, but may find themselves revealing too much information because they have not been empowered, or given the tools, to set limits. There are other topics through which staff and campers can bond.

** Have each staff member think carefully about what they are comfortable revealing, within the limits mentioned above. If they are comfortable revealing their relationship status, that's probably fine. If not, that's fine, too. Regardless, have them practice in their mind what they would say and how they would set limits. Some people prefer to say things like, "That is my business, not yours," or the less confrontational, "I don't talk about that kind of thing with campers." The key is to make sure that staff are able to answer in a way that is consistent with their own style, within the limits set by the directors.

** When questions are innocent, staff can use the "validate and redirect" strategy to make campers feel heard and unashamed, yet also set boundaries. For example, if a camper asks, "What does it mean to have sex?" the staff member can say, "Lots of kids want to know about that kind of thing, and it's okay to be curious [validate]. But, that's something you should talk about with your parents [redirect]." A good exercise is to have staff break into groups and generate the questions they are most concerned about confronting and then role-playing the responses.

** Prepare staff, especially female staff who work with girls, to deal with necessary aspects of hygiene. It is still, unfortunately, all too common for young girls to be unprepared for menarche (their first menstrual cycle) and not know what is happening to them or what to do about it. They need to know they can ask questions about basic physiology and the proper use of hygiene products.

Finally, it is worth underscoring with your staff one of the reasons of why we need to be so careful about sexual matters. A staggering number of adolescents have been sexually assaulted, abused, or harassed, and the vast majority of cases go unreported (United States Department of Health and Human Services, 2003; United States Department of Justice, 2000a). There is no way to "spot" someone who has had such an experience without careful assessment by a trained professional. Victims of sexual assault are more likely than nonvictims to be easily overwhelmed when confronted with sexual material, reacting in unpredictable, usually negative ways. Camp is a place where everyone, particularly those suffering in silence, should be free of such pressures and stress.

Self-Mutilating Behavior (SMB)

Self-Mutilating Behavior (SMB) refers to the act of deliberately harming oneself without suicidal intent. You may have heard of "cutters," or teens who engage in "cutting," which is a subset of SMB. It is a frightening, dangerous, and unfortunately common problem with many teens. Although carefully controlled research on this topic is scant, some studies have suggested that as many as 14 percent of adolescents have engaged in SMB at some point in their lives. It appears to be far more common in girls (Ross & Heath, 2002). Self-cutting (intentionally lacerating the skin) and self- hitting are probably the most common, followed by actions such as self-burning. This is not considered suicidal behavior, as they are not trying to kill themselves. Instead, adolescents often report that they engage in SMB to relieve intense feelings of stress (like depression or anxiety)--which at first glance seems to make little sense. Unfortunately, however, intentionally self-inflicting harm helps focus attention on external pain, serving to "get them out of their heads" and distract them from their emotional distress. In the absence of other severe problems, it can be thought of as an extremely unhealthy coping skill.

Here is how to prepare your staff to deal with SMB:

* Remind staff that teens who cut usually know they should not be doing it and feel ashamed of themselves for doing so. ** To help them empathize with this problem, have them think of times in their own lives when they "knew in their minds" that they were doing something "wrong," but did not control the impulse to do so anyway.

* State explicitly that SMB is a serious concern that needs to be reported to the director as soon as possible, so that a dialogue with the parents can start right away.

* Teach staff that SMB can be done anywhere on the body, though it is often done on the arms and legs. Particular warning signs include:

** Straight, almost surgical, scratches that appear to have been done by a very sharp object like a razor, tack, or needle

** Small round burns that are the shape and size of a lit cigarette

** Unexplained clusters of small bruises (from pinching or hitting) that do not seem to be the result of daily activities

* Tell staff that if they have any problems with SMB themselves, to feel comfortable approaching the director right away. Directors and other supervisory staff can follow the same guidelines noted below if SMB is disclosed to them.

* Role-play the skills described in the "Guidelines for Training Staff" section.

Eating Disorders 

Eating disorders include anorexia nervosa, bulimia nervosa, and other diagnoses related to body image issues. Both anorexia and bulimia can (and often do) involve binging and purging and are characterized by an intense dislike of one's own body, a fear of becoming fat, and a wide range of intense, distressing emotions. They usually occur in adolescent girls from middle to upper middle class backgrounds (a demographic quite likely to come to camp) and are very difficult to treat. Although eating disorders are thought to be rare by researchers, ask any room full of young women if they know anyone who has some kind of eating issue, and the majority of them will raise their hands. Please see the article, "Children's Mental Health and Camp," in the September/October 2005 issue of Camping Magazine for a more complete discussion of this critical issue.

Suicide

While it is not uncommon to have passing thoughts of death or to say things like, "I wish I was never born" when agitated, actively considering suicide is not a "normal" part of adolescence. Girls attempt suicide more often than boys, though boys complete suicide more often because they tend to use more lethal means. About 30 percent of depressed teens will make a serious suicide attempt (Goldston, Daniel, & Arnold, 2004; Ryan et al. 1987). Expressing a place, time, or method of suicide are particular warning signs that must be dealt with immediately (meaning right that second, not in a "little while"), involving both the director and the parents. Campers and staff who express these problems should be sent home for immediate treatment.

Guidelines for Training Staff to Manage Challenging Situations with Adolescents

Campers and staff form close emotional bonds over the course of the summer. Indeed, this is one of the special benefits of going to camp. Sometimes, bonds can get too intense and boundaries need to be reestablished. Other times, campers will feel comfortable enough to tell staff distressing things they have never told anyone else. Staff need the tools to feel prepared for these situations and to handle them in a manner that promotes growth. The following guidelines can be used to plan your staff training program:

* A child who discloses concerns about sexuality, SMB, or any other intense emotional issue obviously trusts the staff person, indicating that a strong emotional bond has developed. Remind staff that they are to be commended for creating such a relationship.

* Practice basic listening skills.

** The idea is to listen without judgment, problem-solving, or agreeing or disagreeing. It is also important to fight the urge to share a personal experience, related to it or not, while a camper is disclosing. Remember that the last thing any of us want to hear when we are talking about a problem is someone else telling us what to do (that's for later), how to feel, or how someone else went through the same thing.

** Help the camper clarify his or her feelings with brief, reflective statements that echo the camper's own words and emotional state, like "It sounds like it's been a very hard time for you. You look really sad/scared/worried."

** Role-play listening skills by breaking staff into pairs. Have one staff member start talking about a recent challenging experience, while the other simply tries to understand the partner's experience through reflective listening. Then, have them give each other feedback. Developing good listening skills is much harder than you might think and requires practice.

* Whenever a camper discloses something that triggers further conversation with the director, his or her parents, or mandatory reporting laws, it is important that staff make the immediate future seem as structured and predictable as possible.

** First, tell them that they have done the right thing by talking, that they have done nothing wrong, and that they are not in trouble. Try to "normalize" their issue by reminding them that lots of kids go through the problems they have talked about. Reassure them that things will get better soon. It is astonishing how helpful it is to put a hand on the shoulder and tell someone, "I know this is hard, but it's going to be okay."

** Second, tell them exactly who they will talk to and why in the next few hours.

** Third, ask them what questions they have, if any.

** Finally, give them an idea of what they will be doing over the next day or two. Will they be getting ready to go home? Will they be participating in the normal camp program? Be ready to answer these questions.

* Confrontation with concern.

** Sometimes, adolescents will not acknowledge what appear to be fairly obvious problems. For example, campers can often ask or say things that violate the boundaries regarding sexuality noted above. Confront this behavior the first time with a brief reminder of the rules and what you expect of them. If it persists, add concern to the confrontation. For example, "It sounds like you really have something you want to talk about, and I'm concerned about doing this the right way. Maybe we need to involve your parents/the director?"

Adolescence will always be a time of unique challenges, some of which we recall with nostalgia for lost naivete, others which we look back on and think, "How in the world did I get through THAT?" The opportunities and challenges inherent in the camp experience are especially powerful for adolescent campers and staff, who are experiencing so many feelings for the first time. Clear boundaries, expectations, and practical staff training will help adolescent staff and campers make the most of their summer.

References

Centers for Disease Control. (2004i). National Youth Risk Behavior Survey: Trends in the prevalence of sexual behaviors. Located at www.cdc.gov/HealthyYouth/yrbs/pdfs/trends-sex.pdf.

Centers for Disease Control. (2004j). STD surveillance 2003. Located at www.cdc.gov/std/stats/toc2003.htm.

Centers for Disease Control. (2004k). Youth risk behavior surveillance: United States, 2003. Located at www.cdc.gov/mmwr/PDF/SS/SS5302.pdf.

Goldston, D., Daniel, S., & Arnold, E. (2004). Suicidal and non-suicidal self-harm behaviors. In D.A. Wolfe & E.J. Mash (Eds.), Behavioral and Emotional Disorders in Adolescents: Nature, Assessment, and Treatment. New York: Guilford Press.

Ross, S. & Heath, N. (2002). A study of the frequency of self-mutilation in a community sample of adolescents. Journal of Youth and Adolescence, 31(1), p. 67-77.

Ryan, N. et al. (1987). The clinical picture of major depression in children and adolescents. Archives of General Psychiatry, 44, 854 - 861.

United States Department of Health and Human Services (2003). Child Maltreatment, 2001. Administration on Children, Youth, and Families, Washington, DC: U.S. Government Printing Press.

United States Department of Justice (2000a). Full report of the prevalence, incidence, consequences of violence against women. Located at www.ncjrs.org/pdffiles1/nij/183781.pdf.

Ethan D. Schafer, Ph.D., is a licensed child psychologist and a partner with Spectrum Psychological Associates, a private practice in the Cleveland area. He is on the faculty of the psychology department at Case Western Reserve University, where he teaches classes in abnormal child development, human sexual behavior, and psychological assessment. He has over fifteen years of camp experience and consults with summer camps across the country, helping staff work more effectively with campers. He can be reached at [e-mail] or 440-666-3053.

Originally published in the 2006 May/June issue of Camping Magazine.