Handy Dandy Note Book Thingy : March 2013

Camps and Social Support
In an article from the Therapeutic Recreation Journal, Vol. XLIV, No.4, 2010, Camp Processes or Mechanisms that Bring about Reports of Social Support, author Samuel G. Roberson shares the details of how a camp designed for the siblings of cancer patients allows those siblings to gain a perspective on how they are supported socially. The following paper will achieve a summary of the article, overview of its strengths and weaknesses, how the material can be applied to therapeutic recreation and my personal reaction to the article.

Summary

Cancer not only affects the patient, but affects the family members who often-times have to cope emotionally in just as much of a manner as those with cancer. Normally, the parents will focus mainly on the child with cancer leaving the sibling feeling alone, jealous, guilty and even delayed in maturity and social skills (256).

Roberson (2010) researches what factors improve campers' feelings of similarity with others. Support received at camp is then focused into four areas that prove to be helpful to campers: emotional, informational, instrumental, and appraisal. This proves that a camp situation is ideal for campers to perform social comparison because the people surrounding them have been through similar circumstances, share opinions and views on life as effects of having a sibling with cancer.

Strengths of the Article

In general, the article was written clearly and the train of thought was fluid. Specifics of how the research was conducted allows readers to visualize and more effectively understand what was being researched. Quotes given by camp participants and examples throughout the article accurately displayed how participants reacted to a camp environment. Not only does the article explain why it works but it displays what the camp was doing for the campers and how it was helping them. Roberson demonstrates this by separating each step of the research process into categories and examining each thoroughly.

Roberson describes how this study can act as a gateway for future studies and the “consideration of alternate methodologies and further examination of how social support can be fostered through camp experiences” (268). The hope of writing this article was to show the effectiveness of camps and that persons like siblings of cancer patients benefit greatly from this experience; both of these goals were successfully and thoroughly addressed in the article.

Weaknesses of the Article

Although the article did well in emulating all aspects of the research process, several concepts were mentioned repeatedly that the reader could infer for themselves at the beginning of the article. The importance and definition of social comparison was mentioned many times, when it was only needed to be clarified once. Roberson mentioned several times that the participants used pseudonyms, whereas it was only necessary to mention the ethics of the research once and then move on with the results of the research.

The concept of using camps to uplift an individual in all aspects of life can be applied to all siblings that have a brother or sister with an illness—whether it's cancer or schizophrenia. If Roberson included other examples of camps that had success, the research would have a more sturdy foundation.

Application of the Article

The idea behind creating camps for siblings to those with cancer is so that these children can receive support. Especially when going through a trial such as witnessing your brother or sister go through treatments and feeling lonely, support is important because it mediates stress and facilitates adjustment to the current situation.The first resource for support is parents and can eventually branch out to relatives, friends, church members, teachers, etc., but a child may not have the resources or consider to reach out to these other groups for support (256).

Camp is also an arena for social comparison, where participants can evaluate themselves and how they are really feelings with people that share similar circumstances and feelings. This often-times increases someones view of themselves in the social sector because they feel belonging and understood. In Roberson's research, campers said they felt support, encouragement and that camp was a safe place to share feelings. They felt that other participants and camp leaders were helpful and thoughtful, which may not be a part of these children's every-day life because parents' attention is focused elsewhere (262).

My Personal Reaction

This article immediately captured my attention because I have been in a similar situation to what these camp participants went through in dealing with a sibling that has an all-consuming illness. When I was in junior high, my younger brother was diagnosed with several mental disabilities. My two older sisters had already moved out of the house so I felt very alone and felt like I had few people that I could truly talk to that could validate my feelings of jealousy, guilt for that jealousy, loneliness, and loss of self because of the seriousness of the situation. Nobody at school could understand what I was going through, plus I was too scared to go out of my way to tell someone about it. I didn't want to be a burden on my parents because they were always gone and busy caring about my brother.

My family sent my brother to residential treatment and every couple months the treatment center organized an event for the families to meet and support each other. Here I was able to interact with siblings of those with mental disabilities and I finally felt validated and accepted for my feelings. I felt that it was a safe place to share, just like the participants in Roberson's research felt.

Camps and small events are essential for groups of people that need support and should become a more wide-spread method to relieving stress and aiding those who are too scared to find help themselves or to inhibited with grief or emotion to find support.

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In an article from the Therapeutic Recreation Journal, Vol. XLIV, No.4, 2010, Camp Processes or Mechanisms that Bring about Reports of Social Support, author Samuel G. Roberson shares the details of how a camp designed for the siblings of cancer patients allows those siblings to gain a perspective on how they are supported socially. The following paper will achieve a summary of the article, overview of its strengths and weaknesses, how the material can be applied to therapeutic recreation and my personal reaction to the article.

Summary

Strengths of the Article

Weaknesses of the Article

Application of the Article

My Personal Reaction

Roberson255

Therapeutic Recreation Journal Vol. XLIV, No. 4 • 255–269 • 2010

Research

Camp Processes or Mechanisms that Bring about Reports of Social Support

Samuel G. Roberson

Abstract

Childhood cancer not only has impacts on the children themselves, but also on their families and siblings. Studies have suggested that siblings of children with cancer are often the most emotionally disregarded and distressed of all family members as a result of their sibling having cancer. Thus, finding mechanisms to ameliorate stress are critical. Early intervention and treatment may serve as protective factors against risky behavior and lead to more normative child development and well-being. One method of improving the psychosocial adjustment of siblings of children with cancer has been through interventions such as camp experiences that include opportunities for campers to experience social support. Thus the purpose of the study was to determine how campers perceived social support and to gain an understanding of what processes occurred at camp that led campers to perceive feelings of social support. Semi-structured interviews were conducted with eight participants in a 3 .-day residential camp for siblings of children with cancer. Qualitative findings provided a narrative description of how campers perceived social support. In addition, social comparison was identified as a critical mechanism. Overarching perceptions of campers were that people at camps were nice and that staff can be instrumental in facilitating universality and a cycle of reciprocity.

KEYWORDS: Camp, cancer, sibling, social support, social comparison, therapeutic recreation, youth development

Biographical sketch of the authors: Sam Roberson is a Ph.D. student in the Department of Recreation, Park and Tourism Sciences at Texas A&M University where his studies focus on Youth Development. Sam is also a recipient of the NRPA Graduate Student of the Year Award 2007.

Correspondence regarding this article can be forwarded to the author at samg@neo.tamu.edu.

Acknowledgments: I thank Any Baby Can staff, Peaceable Kingdom Retreat for Children, and the campers and volunteers at the Camp Grey Dove whose participation made this study possible. Also, special thanks to Seqour Foundation, Peter Witt, Ph.D., Cliff Watts, Ph.D. and Wm. Alex McIntosh, Ph.D. for their support.

256 Camp Processes or Mechanisms

Childhood cancer is among the leading causes of illness-related death of children in the United States (National Cancer Institute, 2008). Childhood cancer has obvious impacts on the children themselves, but also impacts parents and siblings. While studies have been conducted on the impacts of cancer on ill children and their parents, limited consideration has been given to the impacts of cancer on healthy siblings (Murray, 1999). Williams (1997) has suggested that siblings of chronically ill children are at risk for behavior problems, lower social competence and self-esteem, shyness, somatic complaints, poor peer relations, delinquency, loneliness, isolation, anxiety, depression, anger, excessive worry, and poor or failing school grades. Siblings of children with cancer often find their normative development slowed by the priority given by parents to their ill sibling’s treatment and thus siblings may be at risk for delayed maturity and development of socialization skills (Williams). Early intervention and treatment may serve as protective factors against risky behavior and lead to more normative child development and well-being.

A full range of studies have demonstrated that social support has an important causal effect on health and exposure to stress (House, Umberson, & Landis, 1988). Despite existing research, there is still a need to better understand the efficacy of intervention programs designed to reduce stress across a variety of settings. In one study, Murray (2001) suggested that a possible method of improving the psychosocial adjustment of siblings of children with cancer was through interventions such as camp experiences that include opportunities for campers to experience social support. Some research efforts have been undertaken to understand how camp attendance impacts feelings of social support, which is thought to play a role in how children cope with having a sibling diagnosed with cancer (Murray; Roberts, 1988; Williams, 1997). While previous studies have demonstrated that social support occurs at camp, there is a need to understand better how campers perceive social support; and the elements of camp identified as leading to social support.

Meltzer and Rourke (2003) demonstrated that through the mechanism of social comparison, campers reported feeling greater similarity to camp peers than non-camp peers, and improved psychosocial outcomes. However, the study stopped short of identifying what designed or natural factors led campers to their improved perceptions (e.g., social structures and processes naturally occurring within a camp setting). If we can better understand these factors, camps can intentionally plan and design the camp experience for maximum impact. Moreover, if we can better understand the social support perceived by campers, then we can better plan the intentionality of interventions to increase these positive perceptions.

Review of Literature

House (1981) has suggested that we all have an intuitive sense of what constitutes social support: we know people who we regard as “supporters” or “supportive” and that our parents are generally our earliest sources of support. House also points out that support is eventually expanded to include relatives, friends, spouse, children, church members, teachers, physicians and others.

Social support has received substantial consideration as a mediator of the relationship between stress and adjustment in adults (Cobb, 1976; House, 1981) and more recently in children (Murray, 1999). In House’s (1981) seminal work, he identified four broad categories of social support:

Emotional support is associated with sharRoberson257

ing life experiences. It involves the provision of empathy, love, trust and caring.

Informational support involves the provision of advice, suggestions, and information that a person can use to address problems.

Instrumental support involves the provision of tangible aid and services that directly assist a person in need.

Appraisal support involves the provision of information that is useful for self-evaluation purposes: constructive feedback, affirmation and social comparison.

This conception led other scholars (e.g., Barrera, 1986; Vaux et al., 1986) to focus their attention on the elements comprising social support such as the size of network resources and network membership identity, subjective perceptions or appraisals of support provided by network members, and specific behaviors provided by members also referred to as “enacted support” (Dubow & Ullman, 1989). Barrera (1986) also argued that researchers should draw clear distinctions between the different aspects of social support in order to increase understanding of the role of social support in adjustment. A theoretical framework put forth by House, Umberson, and Landis (1988) provided a guide in Roberson’s (2008) efforts to understand the designed and natural factors leading campers to perceive social support and ultimately to improve their well-being. Roberson’s findings suggested that camps may serve as an equalizer of stress and normality for participants during unstable times.

Murray’s (1999) review of the literature concluded that research aimed at identifying what interventions siblings of children with cancer perceive as supportive would be of immense value. House (1981) suggested that the method of using perceived support is the most appropriate procedure in initial efforts to understand the relationship between social support, stress, and health. Martinson et al. (1990) and LaGreca (1992) have suggested that siblings of children with cancer are the most emotionally disregarded and distressed of all family members as a result of their sibling having cancer. This stress can have negative consequences. For example, people under stress are more susceptible to illness; depression, anxiety, low self-confidence, and dissatisfaction with life than are people not experiencing stress (Martiniuk, 2003). Exposure to stress has a negative impact on the immune system and places siblings at risk for health problems. Thus, finding mechanisms to ameliorate stress is critical.

Social Comparison

Feelings of social support may depend on social comparisons that individuals make while they are at camp. Social comparison theory suggests that as humans, we have an innate drive to evaluate our emotions and abilities (Meltzer & Rourke, 2003). One mechanism for achieving comparison is to equate one’s personal circumstances to those of others as a way to understand and cope with difficult life circumstances. “Upward comparisons” occur when comparisons are made to others who are better off, and “downward comparisons” occur when comparisons are made to others that are less-fortunate. Downward comparisons are often helpful to coping as these often present a case where the situation could be worse (Meltzer & Rourke, 2003).

In his seminal work, Festinger noted that when individuals with unstable self-evaluations are given the opportunity to compare themselves to others, the comparison has considerable impact on future self-evaluations. In experiments examining abilities and opinions, Festinger reported subjects almost always shift their level of aspiration closer to the level of the perfor258 Camp Processes or Mechanisms

mance of others when scores of others are made available for comparison. Festinger further suggested that to the extent an opportunity for self-evaluation does not exist, the drive for self-evaluation becomes a force that motivates persons to belong to groups and associate with others: “People tend to move into groups which, in their judgment, hold opinions which agree with their own and whose abilities are near their own” (p. 136). Meltzer and Rourke (2003) extended studies of social comparison to camp settings and found that:

(a) Participants reported feeling more similar to camp peers that non-camp peers; (b) Adolescent participants reported significantly greater social acceptance when comparing themselves to camp peers versus non-camp peers; and (c) Loneliness was significantly predicted by how different children felt from non-camp peers (those who felt more different reported more loneliness). (p. 7)

Camp Settings

Authors including Freud (1955), Erikson (1963), and Bolig (1980) have suggested that recreation can help children develop adaptive coping skills that contribute to a better sense of well-being (Martiniuk, 2003). In addition, a number of researchers have suggested that recreation has beneficial consequences for psychological well-being and health (Caldwell & Smith, 1988; Chalip, Thomas & Voyle, 1992; Iso-Ahola, 1988; Iso-Ahola & Weissinger, 1984; Tinsley & Tinsley, 1986; Weissinger & Iso-Ahola, 1984). Hvizdala, Miale and Barnard (1978) indicated that the first camp for cancer patients was not established until 1978 and sometime later for siblings of children with cancer. Today, however, psychosocial support programs are more readily available to assist families dealing with the cancer experience. Nevertheless, only a limited number of studies have investigated the efficacy of camps as one method of intervention for children with cancer, and fewer address siblings. In one such study, Martiniuk (2003) suggested that summer camps serving either children with cancer or siblings of children with cancer can produce beneficial outcomes due to their provision of social support.

While previous studies have demonstrated that social support and social comparison occur at camps for siblings of children with cancer (Meltzer & Rourke 2003; Murray, 2001; Roberts, 1988; Williams, 1997), these studies have not fully explored the characteristics of the camp experience that produce these outcomes. Thus, the purpose of this study was to explore how campers experience social support (emotional, informational, instrumental, and appraisal) at a 3 . day residential camp and to gain an understanding of what processes occurred at camp that led campers to perceive feelings of social support.

Methods

Camp Grey Dove is a resident camp program sponsored by Any Baby Can (ABC), an Austin, TX non-profit agency. The camp is held at Peaceable Kingdom (PK) in Killeen, TX. The camp program serves siblings of children with cancer and runs 7 consecutive days with two separate 3 . day sessions. Campers in this study attended one of the two sessions. The camp was staffed by eight social workers, three volunteer counselors, and nine counselors in training. PK staff included a combination of permanent and seasonal camp staff. In addition, specialists were brought in to teach scuba diving and nature education. PK provided basic camp activities and staff to facilitate them, while ABC staff provided facilitation for group sessions, supervised, and worked with campers outside of activities led by PK’s staff. Camp was part of ABC’s overall strategy to provide support services for families of children with special needs.Roberson259

Participants

Campers from two summer camp sessions held at Camp Grey Dove were included in the study, one session serving children ages 7 to 10 and the other children ages 11 to 14. Combined, 31 children arrived at camp. All campers had siblings who were living or had lived with cancer. Over half of the campers (54%) had attended Camp Grey Dove before and 64% attended the previous year. The ethnic makeup of campers was diverse with 50% of the children identified as Hispanic; 20.8% White; 12.5% African-American; and 16.7% other. The camp had approximately the same number of girls and boys.

The study was approved by the University’s Institutional Review Board and written consent was secured from each child’s parent/guardian before camp started. In addition, before participating in planned interviews, assent was secured from the identified campers. Of the original 31 children, one female departed early due to emotional toll created by the recent loss of an ill sibling. In addition, five campers’ parents either failed to sign consent or dropped their child from study upon the conclusion of camp. Thus, there were 25 campers included in the study.

Data Collection/Procedures

Semi-structured interviews were conducted with eight of 25 participants. Each interview was audio-taped and the transcribed. Each interviews lasted approximately 15 minutes. When transcribing the tape, all participants were assigned pseudonyms. The researcher was immersed within the camp with opportunities to observe all aspects of camp. While this study reports on the qualitative interview responses of eight campers, observations of all 25 campers were included in the data analysis.

Participant observations of camp and semi-structured interviews with selected campers were used to help gain insights concerning the impact of the camp experience on siblings of children with cancer. Journaling was used to record structured observations of the researcher during camp (Miles & Huberman, 1994). According to Marshall and Rossman (2006), participant observation requires first hand involvement in the target setting, in this case Camp Grey Dove, as immersion offers the researcher an opportunity to learn from a direct experience of the camp setting. Experiencing camp first hand provided opportunities for personal reflections which were integral to the emerging analysis of this sibling group, and afforded new vantage points and opportunities to make the strange familiar and the familiar strange (Glesne, 1999).

During the study, analytic memos were recorded as a way of noting behaviors and interactions as they occurred at camp. In addition, the researcher kept written notes and created reflective memos describing thoughts and insights gained through observing the camp (Wolcott, 1994). Analytic memos included the noting of observations that appeared to have a literature fit with social support and reflective memos included the researchers periodic summarizing reflection of what had been experienced by the campers and participant researcher.

Interview Guide

Interview questions were used to help gain insights concerning what aspect of the camp experience led campers to feel social support. Questions asked included “I came to camp because?, What did you learn by being at camp?, Tell me about your brother or sister who has cancer., How does their having cancer make you feel?, How did camp help you with your feelings?, Did you make friends at camp?, and If yes, tell me about them?”

Data Analysis

The author conducted a qualitative analysis of the interview and observation 260 Camp Processes or Mechanisms

transcripts through use of a phenomenological approach. The approach allowed for the camper’s collective shared experiences to be narrated (Marshall & Rossman, 2006). The focus of the author’s inquiry was to describe the campers’ essential experience with the phenomenon of social support.

Coding of transcripts was guided by previously indentified components of social support (emotional, informational, instrumental, and appraisal). In addition, open coding was also done to allow other themes to emerge. This process allowed categories to become containers into which segments of text were placed (Marshall & Rossman, 2006). To enhance trustworthiness, it was important to protect against one-sided interpretations; thus, the researcher read and re-read the transcripts to determine appropriate themes (Henderson, 1991). Upon completion of initial categorization into themes, the principal investigator and an academic colleague also read the transcripts and categorized responses. The review of the transcripts demonstrated high level of agreement in terms of themes and the placement of responses within those themes.

As categories of meaning emerged the researcher searched for those that had internal and external convergence (Guba, 1978). Interpretive coding was used to help focus on abstract issues and causal conditions (Patton, 2002). An attempt was made to build a story that identified the connection made in findings with theoretical propositions associated with social support and more recently social comparison as posited in the literature.

The Author’s Frame of Reference

The author’s involvement in understanding childhood cancer and impacts began in 1991 when his own child was diagnosed with leukemia cancer. As a result of experiencing treatment regimes and attending family camp, having two daughters attend sibling camp, and a son attend patient camp, the author developed some understanding of the value of cancer camp interventions. During graduate school studies, an opportunity arose to conduct an evaluation of Camp Grey Dove, a camp for siblings of children with cancer to identify the benefits of the camp experience to help justify requests to foundations for funding. The author conducted an evaluation of Camp Grey Dove for 2 consecutive years. During the first year, the author observed camp and completed an evaluation for Camp Grey Dove. This initial experience was followed by a more intense effort the next summer to provide additional evaluation insights and pursue a thesis study examining the experience of social support (Roberson). The latter findings are presented in this article.

Results

This study was designed to understand better the processes or mechanisms occurring at a camp for siblings of children with cancer that brought about reports of social support. The following themes emerged regarding the types of social support identified by campers and how social comparison helped facilitate these feelings. Pseudonyms for the eight campers interviewed, along with gender, age, prior Camp Grey Dove camp attendance, and status of ill sibling at the time of camp are provided in Table 1.1

Emotional Support

Emerging themes regarding the source of emotional support included: 1) people at camp being encouraging; 2) people being nice; 3) camp providing an empathic support system; and 4) campers being able to express feelings at camp. Campers were

¹All campers were given pseudonyms to protect their identity. Coding at the end of quotes provides information to enabling tracing the quotes back to the original interview transcripts.Roberson261

encouraged to participate by the counselors, supportive peer campers, and Counselors in Training (CITs). Campers described how there was no ridicule associated with not participating. For example, Roderick, during his participation in a rock climbing activity, described how he felt supported at camp. He stated, “Like, ‘you can do it, you can do it, climb!’ but if you don’t climb it and you go back down, they’ll still congratulate you.”

Campers perceived they were able to both express and explain feelings at camp to others who offered empathic support. One camper indicated he was able to “explain how I felt” to a particular counselor and also her friends. Another indicated being “able to talk about feelings” at camp in group sessions and at the lodge cabin. Campers reported that group sessions were a place they felt supported and were able to talk about feelings. Jim attempted to explain the emotional benefits of group sessions when he commented about “just being able to talk about my feelings…having counselors who can relate to us… They’re nice to be around and being allowed to express my feelings in group sessions was like a weight was being lifted off my shoulders.” Empathy was perceived as genuine from similar others who were able to relate to campers’ lived experiences.

Informational Support

Emerging themes regarding the source of informational support were oriented around campers receiving: 1) clarification about the ill sibling’s condition; and 2) information that provided an adaptive skill for the camper. The focus of the camp was not on informing campers about knowledge of cancer, as some sibling camps have done. However, campers shared information amongst themselves, which led to perceptions of informational support. In one instance, a female camper shares how information at camp helped:

Angel … “Because when my sister had just passed, and my grandma and my family wasn’t eating. But when I came to camp, I learned that depression could really hurt a family, and I just talked to my grandma and grandpa how I learned that when you love somebody and they pass, you can move

TABLE 1:

Interviewee Background Information

Pseudonym Name	Gender	Age	Attended Prior CGD Camp	Ill Sibling Status
Jack	M	9	Yes	Off treatment 11 year old brother
Kathy	F	9	Yes	Off treatment 8 year old brother diagnosed at 2 .
Angel	F	10	Yes	Deceased older sister
Roderick	M	10	No	Off treatment older sister
Tabithia	F	12	Yes	Deceased older brother at age 6 when she was age 2
Aaron	M	13	Yes	Off treatment 13 yr old twin brother
Jimmy	M	13	Yes	Deceased older brother at 16
Selena	F	14	No	Deceased recently younger brother age 6

Thoughts About Leisure

Summary

In the article Some Thoughts about Leisure Education, Therapeutic Recreation, and the

Philosophy of Spiderman, John Dattilo and Richard Williams focus on respect, self-determination, and

the need for open-minded research involving therapeutic recreation. Though respect and self-determination don't seem particularly connected with widening research in therapeutic recreation, the authors separate the article by these three principles because understanding them is vital to implementing ever-changing methods regarding recreational therapy.

Dattilo and Williams stress the importance of respecting patients and even other therapists in the field. Respect allows people to feel safe in sharing their perspectives and ideas. This respect is needed in therapy so that patients feel like they are understood and that they can guide their own therapy according to how they feel. Respect is called for in critiquing articles and realizing that there are multiple ways to use recreation as therapy.

The authors demonstrate that there are three aspects that make up self-determination which are: autonomy, competence and relatedness. Self-determination is a key virtue that should be taught (and naturally is taught) through recreation. This virtue should also be used in conducting research and realizing the importance research has on any profession.

The importance of research is clearly established throughout the article. Creating “dialogue” about therapeutic recreation will bring about awareness and inspire new ideas and methods. The authors conclude with their responsibility as recreational therapists and writers of the journal to promote the growth of therapeutic recreation.

Strengths of the Article

Overall, the article was well written and made several valid point as to why and how respect, self-determination, and research are important. The authors included “role models” of respect like Gandhi, Mother Theresa, Dalai Lama, Martin Luther King, Jr., showing how effective respect can be, especially within a monumental cause like civil rights and creating a good life for people with disabilities.

The authors prove that group work and being a part of a cause is actually helping those involved in recreational therapy become more self-determined. Skeptics say that recreational therapy is regressive because of beliefs that something as simple as doing a recreational activity in a group won't promote independence but only furthers dependence. Through research examples, the authors are able to prove that through togetherness, self-determination is attained.

The article is well organized for the most part and is to the point. It allows you to consider all viewpoints and inspires creativity and gaining ideas from others.

Weaknesses of the Article

The article could have been more appealing to the emotions if the authors expanded on what the “role models” did to promote respect and treating others with dignity and how they did it. More could have been done to inspire readers to be more respectful and promote self-determination in their work. The evidence of why these aspects are important was weak. When talking about treating others with respect and dignity and it's application to therapeutic recreation, the topic jumped to including respect when giving feedback to scholarly articles about therapeutic recreation. The connection between respect to patients and respecting researchers was fragmented and confusing to understand. The article expressed multiple topics that were only somewhat related. Even though the authors tried to connect all the ideas, each idea should've had it's own article.

Application of the Article

The article was plentiful in nuggets of wisdom that can be applied to recreational therapy and even every-day life. Word choice and tone can change something you say from being respectful to disrespectful and vice versa. This concept is important to maintaining dignity in therapy and in giving feedback.

When considering self-determination, the article teaches that independence comes from dependence on others—whether this means being part of a group therapy or just any form of socializing. When creating social events, keeping in mind the culture of the people and the context of the event will make the experience more meaningful to that specific person or group.

As far as research goes, accepting others ideas and perspectives is highly important. Nobody ever has the same idea as the person next to them. The article emphasized the fact that “the more we realize how narrow our perspectives are, and subsequently, our need to broaden our perspectives, we feel humility” which will make us willing to learn and broaden our horizons.

My Personal Reaction

I chose to read this article because it would teach me more philosophy behind recreational therapy. This article was pretty broad, so next time I want to choose an article more focused where I can learn to apply concepts based on different populations. Several quotes caught my attention and will be considered when I write my personal mission statement. I loved how it talked about broadening perspective and how that brings humility and thus we will want to gain more knowledge and use others to help us in that.

Therapeutic Recreation Journal Vol. XLVI, No. 1 • pp. 1-8 • 2012

Conceptual paper

Some Thoughts about Leisure Education, Therapeutic Recreation, and the

Philosophy of Spiderman

John Dattilo

Richard Williams

Abstract

In this brief paper, the authors identify a few principles that guide their work as therapeutic recreation practitioners, educators, and researchers that seem appropriate to share here. The authors describe how they believe that respect and self-determination are the foundation of therapeutic recreation practice and leisure education delivery. An overview of these concepts is provided and information is presented about the complexity of the construct of self-determination. In addition, research examining the value of promoting self-determination is highlighted. When providing leisure education and analyzing therapeutic recreation services, professionals are encouraged to access various methods and perspectives to address any issue. Next, the authors draw the reader’s attention to the difference between conducting research and providing comprehensive leisure education services. Further, they suggest that engaging in a dialogue on a topic is helpful and that there is a variety of ways to engage in scholarly discourse. Finally, the authors admit their position of privilege and communicate their dedication to conscientiously pursuing truth in a respectful manner.

Keywords: Leisure education, therapeutic recreation, self-determination, respect, research

John Dattilo, Ph.D., is a professor in the Department of Recreation, Park and Tourism Management at Penn State University.

Richard Williams, Ed.D., LRT/CTRS is an associate professor in the Department of Recreation & Leisure Studies at East Carolina University.

Please send correspondence regarding this article to: jxd8@psu.edu.

2 Thoughts about Leisure Education

Recent critiques of leisure education research (e.g., Dieser, 2011) have created a unique learning opportunity to share some ideas that have helped to guide us as facilitators of therapeutic interventions and leisure services, therapeutic recreation educators, and researchers when we provide services, learn with our students and practitioners, and conduct research. Although some of the concepts addressed in this paper are articulated elsewhere (e.g., Dattilo, in press), this paper addresses ideas that we feel are particularly relevant given the recent critique of leisure education research. We hope other therapeutic recreation specialists who are engaged in research and service delivery might find these issues useful to consider.

The first two ideas addressed in this paper are the importance of respect and the value of self-determination. These two beliefs create the foundation for our work related to therapeutic recreation and leisure education. The third idea we present focuses on the importance of considering multiple perspectives when involved in service delivery as well as any evaluation or research associated with such services. Given some of the confusion about the connection between practice and research we devote the remaining portion of the paper to sharing our thoughts about distinguishing between providing therapeutic recreation services and conducting research, as well as considerations and responsibilities when engaged in scholarly pursuits and dialogue.

We Ought to Treat Everyone We Encounter with Respect

and Dignity

The importance of demonstrating respect for others is a principle that many of our role models such as Mahatma Gandhi, Mother Theresa, the Dalai Lama, and Martin Luther King, Jr. have all expressed and bears repeating here. It is valuable when we present a particular perspective that we remain respectful and treat others with dignity. Sometimes even the choice between words that are otherwise synonymous can change the tone of a sentence from respectful to disrespectful, and it is important for us to consider those choices carefully. Choosing to identify a scholarly body of work as oversimplified may create division between the originator of a message and the person providing feedback. If we are genuinely seeking to offer helpful feedback, it is always worth the time for us to consider how our words may be perceived and work to communicate respectfully, perhaps by suggesting, “The author’s conclusions raise some concerns such as . . .”

Respect for others is a trait essential to the provision of human services. One of the motivations that first drew us to the delivery and research of therapeutic recreation services was a deeply personal concern about the ways in which others are treated. Over the years we have found that an important antidote to oppression of any kind is to consider our common humanness, to be considerate of another’s rights, and to treat each other with dignity. Similar ideas can be presented in very different ways depending on the degree to which the conveyer of ideas maintains respect for others.

Dattilo and Williams 3

Everyone Has the Right to be Self-determined

While not above critique, self-determination is a well-founded principle that is important to our understanding of human behavior. Over decades of research, Edward Deci, Richard Ryan, and colleagues have concluded that three fundamental psychological needs are the basis for motivation and characterize self-determination: autonomy, com-petence, and relatedness. Although these three needs associated with self-determination have been identified, the relevance and importance of each of these varies across individuals and cultures.

Given the interaction of autonomy, competence, and relatedness, many people’s sense of self-determination is affected by a variety of socially influenced factors including gender, race, ethnicity, sexuality, and class. Scully (2008) observed that “what actually makes autonomy possible is not detachments, but the social relationships that provide the conditions for experiencing and maintaining self-determination” (p. 161). Rather than being antithetical to social contexts, self-determination is often intertwined with them. It is worthwhile noting that the social context of leisure experiences is reflected in the leisure education curricula we, and most, if not all others, have developed.

Ryan and Deci (2006) cite several studies that support the conclusion that autonomy functions similarly across cultures, including those where collectivistic thought predominates, such as in Japan (e.g., Yamauchi & Tanaka, 1998) and South Korea (Chirkov, Ryan, Kim, & Kaplan, 2003). Based on extensive research, Ryan and Deci commented on theorists who identify the irrelevance of autonomy in non-Western samples:

These theorists seem to assume that when one fits in with a group, acts in accord with tradition, or follows the guidance of parents, one is necessarily lacking autonomy. Yet the view that assenting to external guides or influences is antithetical to autonomy is inconsistent with current philosophical perspectives on autonomy and is counter to considerable self-determination theory research (Ryan, 1993). Further, we do not dispute that cultures value independence and individualism differently. But the question is, if people truly valued and endorsed collectivism, would they not be autonomous when acting in accord with these values? Conversely, if they felt controlled to act collectively, would this not have psychological costs for them? (pp. 1577-1578)

The principle of self-determination offers both understandable and well-researched explanations for human behavior that are invaluable to research involving humans and with therapeutic recreation services.

Research supports the value of promoting self-determination for people with disabilities. While Deci, Ryan, and others have conducted numerous investigations on self-determination, especially as it influences learning, Wehmeyer and colleagues have extensively researched the implementation of techniques designed to empower people to be self-determined; specifically, people 4 Thoughts about Leisure Education

with disabilities. These researchers have found that instruction that promotes self-determination has a variety of positive effects and has become a best practice in providing services to people with disabilities (e.g., Wehmeyer et al., 2012). For example, after conducting a narrative meta-synthesis on self-determination for youth with disabilities, Cobb, Lehmann, Newman-Gonchar and Alwell (2009) concluded that there has been considerable progress in research and interventions to promote self-determination. Wehmeyer, Palmer, Shogren, Williams-Diehm, and Soukup (2010) reported that such advances are important because research has linked individual self-determination status to the attainment of a variety of positive outcomes for people with disabilities including the ability to transition to adulthood in such areas as recreation (McGuire & McDonnell, 2008), and experiencing a more positive quality of life and life satisfaction (Lachapelle et al., 2005; McDougall, Evans, & Baldwin, 2010).

Over the past decade, Weymeyer and colleagues have tested the self-determination learning model of instruction (Wehmeyer, Palmer Agran, Mithaug, & Martin, 2000) and found considerable evidence supporting the value of such instruction. For example, Shogren, Palmer, Wehmeyer, Williams-Diehm, and Little (2011) examined the impact of education services based on the model and identified significant positive changes in goal attainment and inclusion for youth receiving such treatment.

We Ought to Consider Perspectives that Differ from Our Own

Providing leisure education can be challenging given that people living in diverse situations within our community consider different elements of an experience to be important to a meaningful existence. As a result, developing leisure education services requires careful attention to cultural factors and contexts. It is helpful to develop an understanding that various perspectives exist and are important to consider when attempting to meet the needs of the people we serve. Sackett, Rosenberg, Muir Gray, Haynes and Richardson (1996) identified the importance of considering the values and preferences of clients and that it is a fundamental principle of evidence-based practice. As such, it is helpful for us to learn about these values and preferences. We might discover that some people whom we serve prefer (and respond to) educational interventions that are delivered in settings other than a classroom and that utilize social media rather than paper and pencil worksheets. It also can be useful to remember that it is unlikely that we will ever work with a client who shares the precise set of values and worldview as any other person (including ourselves). These differences provide us with an opportunity to celebrate the uniqueness of each individual and allow us to learn from others and to improve services at the same time.

When we reflect on the many perspectives that are held by individuals across the world, we recognize that our own perspectives on any issue are limited. The more we realize how narrow our perspectives are, and subsequently, our need to broaden our perspectives, we feel humility. As we Dattilo and Williams 5

experience opportunities to become more humble, we believe we grow as individuals.

There is a Difference between Conducting Research and Providing Services

People who conduct research with humans recognize that there are requirements in the design of research studies that differ from those demands associated with typical service delivery. When conducting systematic inquiry about humans, questions are often narrowly-focused so that many variables can be held constant; thereby increasing the validity and reliability of conclusions. Thus, demands of service delivery and research can be quite different.

It is one thing if we limit service delivery to a particular approach; it is a very different thing if we conduct research examining a specific aspect of service delivery to determine effects of the approach on people. When applied researchers work to systematically ask specific and focused research questions, it does not mean they are suggesting that the particular approach being studied is the only idea that practitioners need to consider when addressing the complex challenges that their constituents encounter.

A research study, regardless of how well it is designed, is unable to account for all theoretical perspectives. Accounting for all theoretical perspectives would be intellectually overwhelming, and different theories can contradict one another. Also, when researchers conclude that “X influences Y,” they do not typically mean that “X influences Y, and that there is nothing else to consider” or “Other variables are not important for Y.” Each study adds a piece to a puzzle, moving us closer to evidenced-based practice. Researchers have a relatively narrow scope and are afforded limited space in describing a particular study. We encourage practitioners, researchers, and theorists (e.g., postmodern critics) to realize these limitations and strengths of research and to avoid treating research conclusions as being reflective of comprehensive service delivery.

As discussed, research is often designed to answer relevant and meaningful questions that address socially and personally relevant problems; we are unaware of research associated with therapeutic recreation that is designed to restrict service delivery to only the findings associated with a given study. To this end, we have been taught, and now we teach individuals who plan to conduct research, to be extremely cautious in drawing conclusions that are outside the narrow parameters of the research questions and associated findings of any study.

We suggest that based on available evidence, it may be helpful to evaluate services relative to the impact they have on people’s lives. There is a need for research examining interventions designed to influence service providers, families, individuals with disabilities, and the list goes on. We encourage people conducting research to examine effects of a service such as leisure education that is designed to alleviate barriers. There are advantages in examining issues from a variety of perspectives, and both service providers and researchers can benefit from the influence of such areas of study as psychology, sociology, and anthropology. 6 Thoughts about Leisure Education

Critical and Constructive Thinking Contribute to a More Just Society

We challenge readers of the Therapeutic Recreation Journal to not accept anything presented at face value; rather, we encourage you to think critically about the issues raised in research and other articles and decide for yourself what you believe about these issues. We suggest that you consider clarifying the meaning and significance of what is being presented to you and determine if there is sufficient explanation for you to accept the information as being true. In this way, it is our hope that you analyze others’ behaviors and material closely before accepting the information.

We think it is important as we learn new information for us to apply critical thinking. The practice of critical thinking can and does challenge unreasoning prejudice and discrimination of all kinds and encourages us to be fair and reasonable. We also believe we then have the responsibility, as we critically examine something, to actively engage in the process of constructive thinking. So, while it is helpful to critique information, it is also important to offer alternatives. It is our hope that professionals choose to use critical and constructive thinking to move beyond the suggestions contained in this article by discovering and creating innovative ways to provide leisure education services. One example of innovative service delivery is titled Get Real and Heel (Groff et al., 2010), an interdisciplinary support program for women recovering from breast cancer. Therapeutic recreation is an integral part of the program that includes using facilitation techniques such as mindfulness training, pain management, and stress management.

There Are a Variety of Ways to Dialogue about a Topic

Dialogue is a valuable way to pursue truth and advance knowledge. One way to dialogue is to conduct research individually and publish findings of the research for public discourse. Although this method can achieve dialogue, there are others. Another way to approach research is to work with colleagues in a collaborative approach, engaging in collegial dialogue during the design, implementation, and dissemination of the research. Working with others during the entire process often helps researchers provide a broader approach to a topic.

With Great Power Comes Great Responsibility

We realize that as writers of any published paper, some readers may immediately place us in the role of expert and, as such, we are privileged individuals who are in a position of power even though we present ideas from a limited perspective. This position of power involves the capacity to influence other people and their actions. We are humbled by being in this position of privilege and feel an important responsibility to be as truthful and respectful as possible. We feel committed to readers of this journal and professionals who consume other scholarly works because we realize that our writings have the capacity to influence therapeutic recreation service delivery. As such, and at the risk of undermining our credibility, we would like to suggest that it is not trivial to remember the advice given to Peter Parker (better known as Spiderman) by Dattilo and Williams7

his Uncle Ben: With great power comes great responsibility. Each time we write something, we find it helpful to reflect on that idea to remind us to be humble and respectful of all people.

References

Chirkov, V., Ryan, R. M., Kim, Y., & Kaplan, U. (2003). Differentiating autonomy from individualism and independence: A self-determination theory perspective on internalization of cultural orientations and well-being. Journal of Personality and Social Psychology, 84, 97-110.

Cobb, B., Lehmann, J., Newman-Gonchar, R., & Alwell, M. (2009). Self-determination for students with disabilities: A narrative metasynthesis. Career Development for Exceptional Individuals, 32, 108-114.

Dattilo, J. (in press). Inclusive leisure services: Respecting the rights of people who experience oppression (3^nded.). State College, PA: Venture.

Dieser, R. (2011). A follow-up investigation of the fundamental attribution error in leisure education research. Therapeutic Recreation Journal, 45, 190-213.

Groff, D., Battaglini, C., Sipe, C., Peppercorn, J., Anderson, M., & Hackney, A. C. (2010). Finding a new normal: Using recreation therapy to improve the well-being of women with breast cancer.Annual in Therapeutic Recreation, 18, 40-52.

Lachapelle, Y., Wehmeyer, M., Halewyck, M., Courbois, Y., Keith, K., Schalock, R., et al. (2005). The relationship between quality of life and self-determination: An international study. Journal of Intellectual Disability Research, 49, 740-744.

McDougall, J., Evans, J., & Baldwin, P. (2010). The importance of self-determination to perceived quality of life for youth and young adults with chronic conditions and disabilities. Remedial and Special Education, 31, 252-260.

McGuire, J., & McDonnell, J. (2008). Relationships between recreation and levels of self-determination for adolescents and young adults with disabilities. Career Development for Exceptional Individuals, 31, 154-163.

Ryan, R. M. (1993). Agency and organization: Intrinsic motivation, autonomy and the self in psychological development. In J. Jacobs (Ed.), Nebraska symposium on motivation: Developmental perspectives on motivation (Vol. 40, pp. 1–56). Lincoln: University of Nebraska Press.

Ryan, R. M., & Deci, E. L. (2006). Self-regulation and the problem of human autonomy: Does psychology need choice, self-determination, and will? Journal of Personality, 74(6), 1557-1585.

Sackett, D. L., Rosenberg, W. M. C., Muir Gray, J. A., Haynes, R. B., & Richardson, W. S. (1996). Evidence-based medicine: What it is and what it isn’t. British Medical Journal, 312(7023), 71-72.

Scully, J. L. (2008). Disability bioethics: Moral bodies, difference. New York: Rowman & Littlefield.

Shogren, K., Palmer, S., Wehmeyer, M.L., Williams-Diehm, K., & Little, T. (2011). Effect of intervention with the Self-Determined Learning Model of Instruction on access and goal attainment. Remedial and Special Education. doi:10.1177/07419325114100728 Thoughts about Leisure Education

Wehmeyer, M. L., Palmer, S. B., Agran, M., Mithaug, D. E., & Martin, J. E. (2000). Promoting causal agency: The self-determined learning model of instruction. Exceptional Children, 66, 439-453.

Wehmeyer, M. L., Palmer, S. B., Shogren, S., Williams-Diehm,K., & Soukup, J. H. (2010). Establishing a causal relationship between intervention to promote self-determination and enhanced student self-determination. Journal of Special Education. doi:10.1177/0022466910392377

Wehmeyer, M. L., Shogren, K., Palmer, S., Williams-Diehm, K., Little, T. D., & Boulton, A. (2012). The impact of the Self-Determination Learning Model of Instruction on student self-determination.Exceptional Children, 78(2), 135-153.

Yamauchi, H., & Tanaka, K. (1998). Relations of autonomy, self-referenced beliefs and self-regulated learning among Japanese children. Psychological Reports, 82, 803-816.

http://js.sagamorepub.com.erl.lib.byu.edu/trj/article/view/2545/2488

Self Esteem and Camp.

In the article, The Effect of a Residential Camp Experience on Self Esteem and Social Acceptance of Youth with Craniofacial Differences, authors Devine and Dawson (2010) describe the effects a week long camp can make on the self esteems of children and adolescents with craniofacial differences. The following paper will achieve a summary of the article, overview of its strengths and weaknesses, how the material can be applied to therapeutic recreation and my personal reaction to the article.

Summary

Research suggests that youth with craniofacial differences, which “include cleft lip or palate, Treacher Collins syndrome, post-trauma facial reconstruction, amniotic band syndrome or Apert Syndrome,” are more prone to “low self-esteem, poor self and body image, feelings of stigma, and lack of social acceptance” (106). The authors explain how previous camps for people with disabilities have been helpful in boosting self-esteem. Thus, the idea came to create a week long camp for youth with CD where self esteem can be cultivated using recreation and leisure.

The staff measured the camp's progress through the Rosenberg Self Esteem Scale. Results showed that the camp was effective in raising self-esteem. Unfortunately, after a phone interview with each participant six weeks after camp, the heightened self-esteem had worn off as participants were back in society experiencing stigmatization. The authors then conclude what would have made the camp more effective in making a longer shelf-life of self-esteem after camp.

Strengths of the Article

The authors presented several strengths in this article, especially in being thorough, clear, and sharing valid information that supports the research. The article was thorough in the fact that it explains why the study was conducted, how previous camps were successful, what the study consisted of and how it could be improved. The build up to support the study took up nearly half of the article because

of it's thoroughness in explaining the cause and effects of different camp experiences on people with

and without disabilities. The syntax used in the article is simple to understand, making it effortless to know what the authors are trying to get across to their readers.

Information from previous camps involving all levels of ability supported the reason for looking further into a camp that would simply raise self-esteem. This showed that the endeavor to create a camp for youth that needed a boost in self-esteem was valid and pertinent to their normalization in society.

Weaknesses of the Article

Very few weaknesses pervaded this article. In fact, the weaknesses I found were just that the strengths of the article were taken too far in some points. At times, the article was too detailed and gave information that wasn't necessary. A grammar error was found as well—though, it is minimal.

The explanation of why the camp was created took eight pages, nearly half of the article, leaving the reader waiting on how the study was carried out and the results. Having so much build up was unnecessary and could have been left out to make the article simpler and shorter. Several definitions were repeated but with different words which was unnecessary—especially when it's a simple definition like “self-esteem.” The authors even went to lengths of sharing the background of the staff members that seemed irrelevant to the reader.

Application of the Article

Building self-esteem for anyone is important, and especially if that person receives outwards disapproval and alienation—often happening to those with craniofacial differences. So much of American society is based on appearance and those who don't have an ideal appearance, as far as American standards go, will suffer from a low self-esteem and feel even less confident to make friends and get the social needs that so many are willing to uphold.

This article shows how a camp can empower those with facial differences to take leadership positions and know they are important. They feel accepted because they are around others who are in a

similar position. This article shows that camps like the one in the study are beneficial, at least during

the time of the camp. Awareness is raised that camps need to be somehow formulated to extend the period that self-esteem lasts after camp—even make those good feelings of self-esteem last throughout the participants' entire lives.

My Personal Reaction

This article caught my attention because I have begun to understand how effective camps can be. For me, I never even considered people with craniofacial differences would be considered having a disability. But how society treats appearances would make it so that these people were made to have handicaps because of how people treated them. After reading this, I would like to create a camp similar to this and find ways to make the effects long lasting.

I don't even have a major craniofacial difference and I even feel the appearance stigma society sends out—I think everyone does. Reading this article made me see how important it is to help others with self-esteem because often-times that's what people need to be able to go outside of themselves and make good change in themselves. Sad thing is, when you doubt your appearances, you will feel the weight of society bring you down.

References

Dawson, S., Devine, M. (2010). The effect of a residential camp experience on self esteem and social acceptance of youth with Craniofacial Differences. Therapeutic Recreation Journal, XLIV,(2), 105-120.

Devine and Dawson 105

Therapeutic Recreation Journal Vol. XLIV, No. 2 • 105–120 • 2010

The Effect of a Residential Camp Experience on Self Esteem and Social Acceptance of Youth with Craniofacial Differences

Mary Ann Devine

Shay Dawson

Abstract

Children and adolescents with significant disabilities have often been at greater risk for lower self-esteem than their peers with mild-moderate disabilities or those without disabilities. This is particularly true for individuals who have disabilities such as craniofacial difference (CD; Tiemens, Beveridge, & Nicholas, 2007). Furthermore, difficulties with social acceptance may be more common among children with craniofacial differences (Pope & Snyder, 2003). This article explores the impact of a week long summer camp specifically for children and adolescents with CD on their self-esteem. The Rosenberg Self Esteem Scale (1965) and a single item indicator of social acceptance were administered to 31 youth prior to, at the conclusion of, and 6-8 weeks after a 5 day residential camping experience. Results indicated that the campers demonstrated significant gains in self-esteem and social acceptance by the end of the week, but the gains for both variables had dissipated 6-8 weeks later. It is recommended that therapeutic recreation specialists use a multi-dimensional approach to address self-esteem and social acceptance among youth with stigmatizing disabilities.

KEYWORDS: Craniofacial differences, residential camp, self-esteem, social acceptance, therapeutic recreation, youth with disabilities

About the Authors: Dr. Mary Ann Devine, CTRS is an associate professor at Kent State University. She is the coordinator of and teaches in the Recreation, Parks, Tourism Management program and the Certificate on Disability Studies and Community Inclusion. Shay Dawson M.A., CTRS is the Director of Therapeutic Recreation at Indiana University’s Outdoor Center, Bradford Woods. He directs the summer camp for disability specific camps through the Riley Hospital for Children, is the lead facilitator for adventure therapy, and an adjunct instructor in therapeutic recreation for the Department of RPTS in the School of HPER at Indiana University.

106 Camp About Face

Childhood is laden with complex and difficult transition periods. For those with craniofacial difference (CD), not only must they negotiate these developmental changes, but also societal responses toward their disability such as stigma and marginalization. A low self-esteem is one of a multitude of consequences experienced by youth with CD both during and after transition periods.

CD can include, but is not limited to, cleft lip or palate, Treacher Collins syndrome, post-trauma facial reconstruction, amniotic band syndrome, or Apert syndrome. Some of these conditions are genetic (e.g., cleft lip or palate), whereas others are acquired (e.g., facial reconstruction due to an accident or burn). Difficulties in verbal communication, facial expression, eating or swallowing, eye blinking, or visual problems may be experienced by individuals with CD (Kapp-Simon, 1998).

Most individuals who have CD have lived through multiple surgeries and medical treatments to rectify their conditions, often resulting in extended time away from typically developing peers and experiencing difficulty adjusting to typical life transitions (Pruzinsky, 2005). These occurrences often force children into dependent roles in which they must relinquish control and subsequently question their sense of self-worth. As Strax (1991) has noted, disability increases the risk of changing a child’s developmental trajectory. Children progress through complex developmental changes and a disability or medical condition can slow, if not halt, further advances toward adulthood. While having a CD is not always causally associated with difficult adjustment and transition periods, children and adolescents with these conditions appear to be at a higher risk for psychosocial concerns such as low self-esteem, poor self and body image, feelings of stigma, and lack of social acceptance (Pope & Snyder, 2003). Central to the current study was the concept of self esteem; however, secondary consideration was given to social acceptance as it was a primary goal of the camp program.

Self-esteem is the degree to which one feels a sense of self worth (Rosenberg, 1965). Some have identified self-esteem as the most fundamental manifestation of core self-evaluations, as it represents the overall value that one places on his or her self as a person (Judge & Bono, 2001; Judge, Locke, & Durham, 1997). According to Sherrill (1998), self-esteem represents the core sense of self and the degree to which individuals value themselves. Self-esteem can also refer to feelings of satisfaction a person has about his or her self, which reflects the relationship between one’s actual self-image and one’s ideal self-image (Silber & Tippett, 1965).

On a daily basis people experience instances that diminish and build their self-esteem. Encounters that have been found to build self-esteem are positive parent-child relationships, job satisfaction (Judge & Bono, 2001), satisfying social relationships, self-efficacy, and positive social and personal identity (Sherrill). Instances that have shown to decrease self-esteem include, but are not limited to, physical, cognitive, or mental health conditions such as obesity or disabilities (Crocker & Major, 1989), job dissatisfaction (Locke, McClear, & Knight, 1996), academic failure, or negative parent-child relationships. According to Stein and Jessop (1984), the fewer opportunities children have to perform age-appropriate roles and tasks, the more self-esteem deteriorates. When faced with unfavorable circumstances, individuals with a positive, optimistic explanatory style will be less likely to display motivational deficits (Seligman, Steen, Park, & Peterson, 2005). Additionally, according to Dodgson and Wood (1998), individuals Devine and Dawson 107

with high self-esteem maintain optimism in the face of failure, which makes life satisfaction more likely. Understanding how to respond to instances that impact self-esteem is important for personal growth throughout one’s lifespan (Rosenberg).

Various psycho-social constructs play a part in healthy development, but self-esteem is the foundation of many (e.g., self-identity, self-determination, and self-efficacy). Individuals with disabilities have historically reported low self-esteem compared to their peers without disabilities and may be more vulnerable to negative or stifling experiences throughout their lifespan (Strax, 1991).

In general, recreation engagement can improve one’s self-esteem, given certain conditions (Mannell & Kleiber, 1997). While several leisure contexts have been found to be effective in addressing the self-esteem of individuals with disabilities, camp contexts have an established record for documenting the benefits of engagement, including the promotion of positive self-esteem (ACA, 2005). Camps can also provide an opportunity for children with disabilities such as CD to be free from stigmatizing encounters and allow them to experience the essence of play and leisure. In other words, camps can be used to foster the social acceptance that is necessary for genuine and successful social leisure experiences, thereby bolstering self-esteem. This benefit may be especially present in camps designed specifically for persons who share a common disability. The purpose of this study was to examine the impact of a 1-week residential camp experience on the self-esteem and social acceptance of youth with CD.

Literature Review

The American Camp Association (ACA) reports that 11 million children and adults engage in camping using the more than 12,000 available camps across the United States (ACA, 2008). The ACA has an established accreditation of more than 2400 camps annually and report that 14% of these camps serve individuals with disability in some capacity. Establishing empirical evidence supporting the benefits of camp has been a focus of the ACA in recent years including two landmark studies investigating the benefits of camp for children. Although not focused on youth with disabilities, these two studies help to frame the experience of camp as a modality for developmental gains for youth and provide a roadmap for future investigation into these findings for youth that do have disabilities.

A 3-year study conducted by the ACA (2005) examined over 5000 parents/guardians and campers, 80 different camps including their staff revealed a multitude of benefits from the camp experience. The research team surveyed parents and campers at the various camps across the nation prior to and after attending camp, as well as 6 months post camp. In addition, camp staff completed an “observational check list” at the beginning and end of camp that provided initial impressions of the campers strengths related to positive identity, physical and thinking skills, positive values and spirituality, and social skills. Finally, camp directors provided detailed descriptions of each specific camp and its programs. Findings indicated that participation in camp for these youth promoted positive development in: a) self-confidence and self-esteem, b) social skills and friendship development skills, c) independence and leadership skills, d) a willingness to try new things and take calculated risks, and e) spiritual growth at camps for which this was a key outcome. Six month follow-up demonstrated that positive growth was maintained post camp. In particular, 92% of the campers reported the positive effects of the camp experience on their self-108 Camp About Face

esteem and self-confidence. Results from this study provide support that camp experiences can promote healthy psycho-social skills that can be generalized to daily life. The question raised by these findings pertains to whether the same results would be found with campers who had a disability, particularly when there is a higher risk of psycho-social concerns.

The American Camp Association (2006) later explored the camp experiences that fostered healthy development associated with the measured benefits found in their 2005 study. The subjects were youth (N = 7,654) between the ages of 10-18 years of age from 80 camps across the United States participating in day and residential summer camp programs. Campers were surveyed at the end of their camp session to explore the areas in which camp promoted healthy development. Findings indicated that four areas were found to be common sources of positive development: a) overall supportive relationships (emotional support and guidance, adults knowing who they are), b) safety (campers feeling emotionally and physically secure), c) development (campers being involved in a meaningful way by having input and opportunities to lead while having a sense of belonging), and d) skill building (campers having a challenging and interesting learning experience and a sense of growth and progress). The most statistically significant and impactful camp experience that lead to healthy development was in the area of supportive relationships. Specifically, campers showed positive development as a result of the emotional support and guidance received by an adult staff member who has a high sense of personal identity. Moreover, campers attending camp for multiple years were more inclined to have higher scores in the supportive relationship and safety domain categories. Again, this study population did not specifically consider campers with disabilities.

Benefits of Camp for Children with Disabilities

A limited number of studies have reported the benefits of camp for children with disabilities and can be used to develop a rationale for engagement in such camps as a developmentally and therapeutically valuable modality. These articles also point to the need for further investigation into questions yet to be fully answered. For example, the National Camp Evaluation Project (Brannan, 1997) provided data on a 3 year national study of 15 camps specializing in serving children, youth, and young adults. This study evaluated camp programs that specifically serve individuals with disabilities through a 1-week camp experience. Male and female participants were between the ages of 7-21 years old with the population size of 2,184 participants. Diagnosis included, mental retardation (50%), physical disability (25%), and the remaining campers (25%) diagnosis were classified as “other disabilities”. Mixed methodology was used to elicit findings. Quantitative instrumentation consisted of a pre and post test using the Effective Behavior Skills Disabled (ABSD) and Outdoor Skills Inventory (OSI). Qualitative measures consisted of interviews using the Outdoor Case Study Method (OCSM). Major findings of the study indicated that campers experienced positive changes in development that transferred to home life in the areas consisting of independence, self esteem, communication, and self reliance. Campers also showed improvement in recreational skills. The conclusion drawn from the results indicated that a 1-week residential camp experience can be an effective tool for the growth and development of individuals with disabilities.

Briery and Rabian (1999) used a pre-test post-test design to determine the attitudinal changes associated with participation in three separate week long medDevine and Dawson 109

ically specific summer camp experiences for campers between 6-16 years of age with spina bifida (n = 21), asthma (n = 37), and diabetes (n = 32). The Child Attitude Towards Illness Scale (CATIS) and the A-Trait Form from the State-Trait Anxiety Inventory for Children (STAIC) were used to collect data. Their findings suggest that participating in a camp that is specific to the children’s disease or condition helps campers improve their attitudes towards their medical condition or disability. They concluded that continued examination on the benefits of summer camp experiences for children with specific medical needs would provide data useful for designing services in traditional therapeutic settings.

Cushner-Weinstein and colleagues (2006) examined the benefits of a summer camp for children youth with Epilepsy over a 3-year span. The Camp Vineland Adaptive Behavioral Scale (C-VABS) was used to assess social interaction, responsibility of initiating daily living tasks, cooperation and active participation, and communication. Pre and post data were collected over the 3 years to determine the benefits given longevity. Although there were variations on the impact of the camp experience from year to year in relation to the domains, results indicate that participation in the camp positively impacted all four domains after 3 years of participation in the camp program.

Other research has examined the impact of a 3-week residential summer camp on the social competence, self-esteem, self-confidence, and social connectedness (i.e., social acceptance) of 92 children and adolescents with learning disabilities (Michalski, Mishna,Worthington, & Cummings, 2003). Using a pre-post design with a 6-8 month follow-up, Michalski and colleagues collected data using the Self Esteem Index, Children’s Loneliness Questionnaire, and the Social Skills Rating System. Instruments were administered to campers within 48 hours of arrival, the day prior to departure from camp, and 6-8 months after camp ended. Parents also completed the Social Skills Rating System at all three data collection points.

Although results were mixed, the findings indicated that campers and parents indicated benefits from attending the camp, including a gain in pre-post test self esteem scores for the children when compared to the general population. These gains were sustained as they remained several points higher than the general population according to follow-up data. Campers also demonstrated a moderate degree of social bonding and reported feeling less socially isolated. Parents reported higher social skills among campers following camp and at follow-up compared to pre-camp scores, as well as positive changes in camper behaviors related to self-responsibility, self-control, and cooperation.

The authors concluded that disability specific summer camps can be an effective intervention to increase self-esteem for kids who have specific needs that preclude them from attending inclusive camps. According to Michalski et al. (2003), “There appears to be precious few ‘sanctuaries’ to which children and parents alike can turn for the type of supports, learning, and growth opportunities provided by a therapeutic summer camp” (p. 75).

Goodwin and Staples (2005) used a qualitative design to elicit the meaning of camp for nine campers that had various disabilities such as sensory impairments, cerebral palsy, and autism spectrum disorder attending a camp specifically designed for individuals with disabilities to share in an experience with others that have a disability. Male and female participants were from urban and rural regions of Canada and ranged in aged from 14-19 years of age. Phone interviews lasting 45-60 min110 Camp About Face

utes were conducted with participants and their mothers. In addition, participants provided pictures of their camp experience with written explanations of why they chose these pictures to describe there experience. Findings revealed three major themes related to camp benefits, including 1) the opportunity to not be alone, 2) the opportunity for independence, and 3) a chance to discover.

Finally, a review of camp research was conducted by Henderson, Bialeski, and James (2007) in which they recommended directions for future camp research with campers with and without disabilities. In particular, the authors recommended researchers conduct outcome studies regarding camps for children with disabilities. They also propose that researchers study the benefits of both inclusive and disability specific camps. The authors also urge future empirical studies to address why campers are experiencing these benefits specifically. Regardless of the specific groups attending camps, Henderson and colleagues state that research on the short term and long term impact of the camp experience should be studied to determine the generalizability of skills beyond the camp. To that end, the authors suggest future research include data on the transference of skills learned at camp to everyday life. Furthermore, results from this study point to the need to conduct follow-up analyses to determine the long-term impact of benefits gained at camp.

In conclusion, research on disability specific camps continues to grow yet many aspects still need to be addressed (Briery & Rabian, 1999; Cushner-Weinstein et al., 2006; Goodwin & Staples, 2005; Henderson et al., 2007; Michalski et al., 2003). In an attempt to answer the call of these authors, the current study begins to address the continued need to document the benefits of disability specific camp opportunities, as well as the transference of these therapeutic benefits post camp. The current study examines the impact of a condition specific residential camp for youth and adolescents with cranial facial differences on self esteem. As noted, this study population may be especially susceptible to threats to self esteem. To date, no research has been conducted to determine if this population receives the same benefits from summer camp experiences that have been observed in other studies. The research questions examined were: Does self-esteem increase after participation in a disability specific, week-long residential camp for youth and adolescents with cranial facial differences? Does self-esteem change 6 weeks following the conclusion of the camp? Does social acceptance increase after participation in a disability specific, week-long residential camp for youth and adolescents with cranial facial differences? Does social acceptance change 6 weeks following the conclusion of the camp?

Method

The purpose of this study was to determine the effects of participation in a residential camp experience on the self-esteem of youth and adolescents with cranial facial differences. A pre/post with 6-week follow-up design was used to detect any changes in self-esteem.

Participants

The research participants for this study were campers who attend the week-long camp for youth and adolescents with CD. Of the 35 possible campers, 31 agreed to participate in the study.

The subjects ranged in age from 9-18, were male (n = 12) and female (n = 19), and had a range of CD including bilateral cleft pallet (n = 21), Goldenharr syndrome (n = 3), amniotic band Syndrome (n = 2), Apert syndrome (n = 2), 18Q syndrome (n = 1), Treacher Collins syndrome (n = 1), Devine and Dawson 111

Pierre-Robin sequence angolosis of TMJ (n = 1). Only one camper had a developmental disability, secondary to the CD. For some campers, this was their first year at camp and for others it was their 10th. Most campers live within a 100 mile radius of the camp location (see Table 1).

Instrumentation

The Rosenberg Self Esteem Scale (1965) was used to collect all data. This instrument was selected to conduct pre, post and follow-up on self-esteem as it addressed constructs of personal qualities, positive attitudes, self-efficacy, pride, self-worth, and self-respect, which were constructs addressed during the camp. This scale is a 10 question Likert style self-report questionnaire. This instrument was developed to measure the general level of self-esteem of youth, adolescents, and adults. It has high test-retest reliability (.92) and validity (.72) measures as well as face/content validity (Rosenberg, 1988). Responses to the questions are on a 4-point scale of agreement and are coded from 0 = strongly disagree to 3 = strongly agree. Scores are summed with a maximum self esteem score of 30. In addition to the self-esteem scale, one additional question was added for participants to respond to, “Others like being around me” to examine a social acceptance variable.

Setting

The setting is a residential summer camp for youth with cranial facial differences located at a university-based outdoor center in the Midwest. It was established in 1941 with the purpose of providing camping programs for children with medical conditions and disabilities. In 1955,

the camp established a partnership with a comprehensive children’s hospital to provide camping programs for youth with a variety of medical conditions. This facility highlights best practice using the principles of universal design and the therapeutic recreation process in all camping programs for children with disabilities and chronic illness. The 2,500 acre site includes cabins, an equine therapy facility, lake, pool, and adventure challenge low and high elements. Programming consists of fishing, swimming, climbing, teambuilding, cabin camp outs to promote outdoor living skills, recreational games, archery, arts, music, and nature activities.

Each summer, nine 1-week camping programs are available for children, youth, and adolescents with disabilities or chronic illnesses as well as one 2-week session. The current study examined the effect of participation in the 1-week session specifically designed for children with CD. The camp experience is designed to meet the specific recreation and medical needs of those registered including children with a variety of physical disabilities, cancer, sickle cell anemia, burns requiring hospitalization, Down syndrome, hearing impairments, and CD. The camp staff include a full time director who is a certified therapeutic recreation specialist as well as a full time program specialist. During each summer, an additional 90 seasonal staff are employed along with various medically based volunteers and students. The summer staff is predominantly students from domestic and international universities who are studying therapeutic recreation, special educational, rehabilitation counseling, or a component of the medical or human service fields. Additionally, a full time medical staff is present during each summer camp, which consists of four to five registered nurses and a pediatric resident from the partnering children’s hospital. The staff is specifically trained to work with youth that have disabilities or chronic illness. This includes using person first language, empowering campers to be independent, using empathy rather than sympathy in viewing camper’s life situation, and engaging campers socially at all times. The staff is also trained to prevent bullying at camp and to handle behavior management in a proactive manner while putting the camper’s first before their own needs. A strong sense of community is promoted within the staff as well as within each specific camp that focuses on establishing a feeling of safety and an ability to truly be yourself.

Craniofacial Differences Week

The camp context for this study is specifically for children who have craniofacial differences. The camp partners with medical and rehabilitation staff from the comprehensive children’s hospital (cranial facial anomalies clinic) to provide the camp. Since its inception 22 years ago, the rationale for this camp was and continues to be to provide a traditional camp experience for children and adolescents with cranial facial differences that promoted positive psycho-social principles. Specifically, the camp focuses on promoting increased self esteem, self confidence, and an acceptance of congenital anomalies that would help the young campers mature into productive adults. As previously mentioned, each week of camp is designed to meet the specific needs of that group.

The needs of the campers who attend the camp include opportunities to bolster their self-esteem and self-image. Thus, a supportive environment and atmosphere was designed by the camp director, staff from the children’s hospital, camp staff, former campers, and peer mentors. These mentors, current campers who have also attended camp in previous years, play a large role in supporting and nurturing the younger campers in the development and Devine and Dawson 113

acceptance of their condition. As part of their preparation, mentors take part in a 3-day Leadership Academy offered prior to the start of the week long summer camp. During the leadership academy, there is a focus on mentoring these campers by adults with CD who have been personally and professionally successful. Approximately 10% of those who attended the camp participated in this 3-day day leadership and mentoring program.

To promote a positive self-esteem and a non-stigmatizing, accepting atmosphere, a strong sense of community was developed and nurtured during the camp week. Team building exercises were an integral part of the camp to promote a sense of community, creativity, and a sense of pride including high and low ropes, non-competitive team-oriented activities, and a group challenge day. Specific and concerted effort was made for the campers to get to know each other personally. Campers who have aged-out of camp as participants, return to spend time with the current campers for sponsor/mentor day. Former campers that took an active leadership role at camp in the past are provided an opportunity to become staff members the following year through a cabin counselor assistant program. Another way self-esteem was facilitated was through service projects in which campers were able to give back by working with children that have disabilities in a local community program.

Positive leadership and promotion of a positive self esteem were emphasized throughout the week. For instance campers were encouraged to lead activities and returning campers were paired with less experienced campers for mentoring. Staff and peer leaders were also encouraged to praise campers regularly rather than critique or criticize. At the end of each day, camp staff conducted a debriefing session with the campers on their perceptions of howparticipation in the day’s activities had made them feel about themselves. Campers had the opportunity to engage in typical camp activities such as horseback riding, archery, camp outs, creative arts, nature activities, canoeing, and boating. During these activities care was given to promote a positive self-image and self-esteem through peer mentoring, creating an environment that promoted self-determination and empowerment and adhering to the person-centered camp philosophy. Until this point, the camp evaluated the participant’s satisfaction with their camp experiences, but only anecdotal evidence was collected to support the efficacy of the camp on their self esteem and the transference of this apparent gain to life post camp.

Research Design

A single group repeated measures design was implemented in this study (pre, post, post). Data were collected on the first and last days of camp, as well as 6 weeks following the conclusion of the camp. The independent variable in the study was the camp experience. The dependent variables were self esteem and social acceptance.

Procedures

Pre-test data were collected on the first day of camp, shortly after the campers’ arrival. Campers arrived on Sunday for the check-in process. At this time, parents and campers were reminded of the study and given an additional opportunity to participate. After a signed assent/consent was granted, campers wishing to participate completed the Rosenberg Self-Esteem Scale. Scales were completed at a table in a private location or in their cabin. Assistance with reading questions and basic instruction on how to select a response was available upon request. Approximately five campers asked for assistance with reading the instrument and those campers were 114 Camp bout Face

on the younger age spectrum. The camp Director read the instructions and each statement to the camper without deviating from the scale (i.e., paraphrasing, rewording).

On the last day of camp, post-test data were collected using the same method and instrument as collection of pre-test data. Specifically, prior to breakfast and check out, the campers were in their cabins and verbally given the opportunity to participate in answering the same questions given to them on the first day. Again, they were able to receive assistance upon request with reading the questions and instructions on how to select a response. During data collection three of the five campers who requested assistance during pre-test data collection again asked for assistance in completing the instrument. The camp Director, again, read the instructions and each statement to the camper without deviating from the scale. Once completed, the scales were collected for analysis.

Six weeks post-camp, the campers who participated in the on-site study were called on the telephone by the camp Director. The purpose was to analyze carry-over effect from the camp experience on self-esteem. Using a simple script (see figure 1), the former campers who completed the

pre-post camp instrument were presented with the opportunity to answer the questions on the Rosenberg Self-Esteem scale and the additional question on social acceptance. When the campers agreed, they were read the questions and the responses, then provided opportunity to respond. Responses were then manually recorded.

Data Analysis

Data were analyzed using repeated measures multivariate analysis of variance (MANOVA) with SPSS 15.0 for Windows. Dependent variables included the Rosenberg Self-Esteem Scale and the single item social acceptance measure. The per comparison Alpha rate was set at .10 for all comparisons, which is supported by Stevens (1996) in cases where power is restricted and the consequences of a type 1 error presents limited risk.

Results

Prior to interpretation of results, a Mauchley’s test of Sphericity was conducted and found to be met. Primary analysis was found to partly support the hypotheses that self esteem would increases from pretest to post-test and that this increase would be maintained 6 weeks post-camp. The mean self-esteem scores for each trial (pre-camp, post camp, and 6-week follow-up) are displayed in Table 2. The participants reported a higher self-esteem post camp (M = 24.32; SD= 4.28) than at the pre-test (M = 21.20; SD = 5.18) and these means were statistically significant at the .10 level (F [2, 29] = 2.76, p = .086). The 6-week follow up mean was also higher than the pretest (M = 23.00; SD = 2.94), but was not statistically different compared to posttest.

A similar outcome occurred in regard to the hypothesis that social acceptance would increase from precamp to postcamp, and be maintained 6 weeks post-camp (see Table 2). The results of the repeated measures analysis of the social acceptance measure indicated that campers perceived greater social acceptance at a significantly higher level immediately following camp, F(2,29) = .67, p = .015, M = 2.23; SD = .58, as compared to pre camp (M = 1.27; SD = .72). The 6 weeks post camp follow-up was also greater than the pretest (M = 2.19; SD = .55), but dropped slightly to a level that was no longer significantly greater than the pretest).

It should also be noted that the small sample size prevented additional factors, including gender and years attending.

TABLE 1:

Mean and SD for Self-Esteem and Social Acceptance Over Time

Self Esteem	Social Acceptance
Trial	Mean	SD	Mean	SD
Pre Camp	21.20	5.18	1.27	.72
Post Camp	24.32*	4.28	2.23**	.58
6-week Follow Up	23.00	2.94	2.19	.55

TABLE 1:

Camper Demographics for Sex, Age, and Race

Sex

Age

Race

Female

19–12

Caucasian

13–18

Caucasian

African American

Male

19–12

Caucasian

13–18

Caucasian

African American

Asian

TherapeuTic recreaTion Journal Vol. Xliii, No. 3, 2009 • 41–48

A Miracle in the outfield: The Benefits of Participation in organized Baseball leagues for children with Mental and Physical disabilities
Stacy Lyons, BS; Danielle Corneille, BS; Patricia Coker, MHS; and Charles Ellis, Ph.D.
Abstract
Few studies have examined the perceived benefit of recreational activities for children with disabilities from the parent’s perspective. The purpose of this pilot study was to measure the per- ceptions of parents whose children with disabilities participated in an organized community base- ball league. data were collected using a survey instrument that was administered to 42 parents of children with disabilities participating in a community baseball league. An analysis of the quanti- tative and qualitative data suggests that parents of children with disabilities believe participation in sport activities enhances motor and psychosocial skills and that participation has a positive im- pact on the entire family unit. The observed positive results indicate a need for future systematic studies designed to examine the positive effects of community baseball leagues on children with disabilities and their families.
Keywords: recreation, Disability, children, community sports, Benefits
Stacy Lyons is a recent graduate from the occupational Therapy Program at the Medical University of South carolina and is pediatric occupational Therapist at kiddos clubhouse in Alpharetta, GA.
Danielle Cornielle is a recent graduate from the communication Sciences and disorders Program at the Medical University of South carolina and is completing her clinical fellowship in Speech language Pathology at the children’s Healthcare of Atlanta center for craniofacial disorders.
Patty Coker is an Assistant Professor in the division of occupational Therapy in the department of Health Profes- sions at the Medical University of South carolina
Charles Ellis is an Assistant Professor in the communication Sciences and disorders Program and the department of Health Science and Research at the Medical University of South carolina
correspondence regarding this article should be directed toward Patty coker at cokerpc@musc.edu
Acknowledgements: We would like to thank channing Proctor, the founder of the charleston Miracle league, and the charleston Miracle league families, players, coaches and volunteers.
lyonS, corneille, coker, adn elliS 41

Reports from the World Health organiza- tion (WHo) estimate that approximately 200 million children worldwide experience some form of disability (World Health organization, 2008). According to the American communi- ty Survey (AcS) conducted by the U.S. cen- sus Bureau, the prevalence of disability among children in the U.S. ages 5-15 is 6.3% (U.S. census Bureau, 2006). Unfortunately in the U.S., the lives of children with disabilities are oftentimes made more difficult by societal bar- riers and the way society responds to disability (Sloper & Turner, 1992). While there are a number of available services designed to meet the needs of families of children with disabili- ties, many families continue to have a number of unmet needs.
opportunities for recreation participation
Participation in typical age-appropriate activities is among the most difficult challenges facing children with disabilities. children with disabilities are limited in their participation in recreational and social activities relative to their peers without disabilities (Antle, Mills, Steel, kalnins, & Rossen, 2008; Murphy & carbone, 2008). As a result, many feel socially isolated, thus compounding the magnitude of the disability (laGreca, 1990; law & dunn, 1993; Zabriskie, lundberg, & Groff, 2005). This perceived isolation can lead to poor health, limited community participation, and poor quality of life (Zabriskie et al.).
it is well documented that participation in age-appropriate activities is important for developing friendships and achieving mental and physical health (edouards, Gautherona, d’Anjoub, Pupiera, & devillarda, 2007; Wil- son, 2002). Regular participation in physical activity is one of the most effective ways chil- dren, including those with disabilities, prevent chronic disease, promote independence, and increase quality of life as they grow older (cress et al., 2004). despite the increased number of community-based programs for children with disabilities, there has been limited research designed to examine the specific benefits of baseball as a primary form of recreational ac- tivity for children with mental and physical disabilities and their families. Additionally, little is known about the satisfaction of parents of children with disabilities who currently are involved in structured community based recre-

ational programs, particularly organized base- ball leagues specifically designed for children with special needs. Therefore, the specific aim of this pilot project was to examine the per- ceived needs, benefits, and satisfaction among parents of children with mental and physical disabilities who participated in a community baseball league.
Method
sample
The targeted population for this study was parents of children participating in a “Miracle league”. The “Miracle leagues” are a network of community baseball organizations designed to increase recreational activity in children with physical and mental disabilities. chil- dren with disabilities are assigned to organized baseball teams with peers. Miracle leagues are organized with community volunteers or “bud- dies” who assist the players with batting and reaching the bases. Miracle league games op- erate using the following basic rules: (1) all players have a turn to bat each inning, (2) all base runners are safe, (3) every player scores a run before the inning is over, and (4) each team and each player wins. There are over 200 Miracle leagues in the United States and Puerto Rico consisting of approximately 80,000 children and young adult players.
The study sample was made up of parents whose children participated in the charles- ton Miracle league (cMl) in charleston, Sc. Participants in the charleston Miracle league youth league range in ages of 4 to 17 years. All parents of children participating in the charleston Miracle league in 2008 were emailed an invitation to participate in a survey. The survey was conducted by the charleston Miracle league organization to collect data on the impact of the league on the families and players. The information was used to help guide future growth and development of the league and provide valuable information to sponsors and donors. of the 130 children participating in the league, approximately 98 parents were contacted using this process. Additionally, all parents were also personally invited by the executive director of the charleston Miracle league to complete the survey during sched- uled Miracle league games. Parents were al- lowed to either return the survey via email or submit directly to the league director during

a Miracle in The ouTfield

scheduled games. of the 98 parents contacted, 42 returned the survey resulting in a 43% re- sponse rate.
Instrumentation
A 10-question likert-type scale survey was designed by the staff of the charleston Miracle league to measure: (1) the perceived need for recreational activities of children with disabilities residing in charleston, Sc, (2) the perceived benefits of participating in the charleston Miracle league including improve- ments in motor function, self confidence, so- cial skills, and beliefs of being able to succeed, and (3) the overall effect the Miracle league has on the families of children participating in the league (See Figure 1). Survey responses consisted of: strongly agree, agree, neutral, disagree, or strongly disagree. The survey also included a section for parents to provide writ- ten responses to open-ended questions related to their favorite part of league, effects on the child, and suggestions for league improve- ments. The primary aim of the survey was to examine the parent’s global perception of the benefits of their child participating in a struc-

tured baseball league. The information from this survey was collected anonymously from families; therefore, responses cannot be linked to specific families and their children. Reliabil- ity and validity of the survey instrument were not established.
Analysis
Results of the data collected from this survey were analyzed by the authors of this pa- per to explore the parents’ perceptions of the impact of their child’s participation in an or- ganized baseball league. All responses to ques- tions 1-10 were analyzed using in Statistical Package for the Social Sciences (SPSS 14.0). For ease of analysis, responses were collapsed into three categories: strongly agree/agree, neutral, or disagree/strongly disagree. data were then analyzed to determine the percent- age of parents who responded to the questions in each of the three revised categories (agree, neutral, disagree). The responses to the three open-ended questions were reviewed using a general thematic analysis. Responses were grouped into five thematic categories: (1) health/motor skills, (2) motivation, (3) self-

FiGURe 1.
QueSTion STeMS FroM The Miracle leaGue parenT SurVeY

Items rated on a 5-point Likert scale ranging from strongly agree to strongly disagree
1.	There is a need for recreational activities for children with disabilities in Charleston County.
2.	My child has enjoyed participating in the Charleston County Miracle League.
3.	I have noticed an increase in my child’s motor skills since playing in the Miracle League.
4.	I have noticed an increase in my child’s baseball skills since playing in the Miracle League.
5.	I have noticed an increase in my child’s self confidence since playing in the Miracle League.
6.	My child has a stronger belief that he/she can succeed at something since playing in the Miracle League.
7.	I have noticed an improvement in my child’s social skills since playing in the Miracle League.
8.	My child has made new friends by playing in the Miracle League.
9.	My child’s participation in the Miracle League has had a positive impact on our family.
10.	Playing in the Miracle League on Saturday is one of my child’s favorite activities.

Open ended questions posed after the Likert Scale
1.	What do you like most about the Charleston Miracle League?
2.	What would you like to see us do better?
3.	Tell us your story? How participation in the Miracle League affected your child? Family?
4.	Please provide any additional comments about how we can improve the league in the future.

lyonS, corneille, coker, adn elliS 43

esteem/confidence, (4) friends/social relation- ships, and (5) family. This information provid- ed greater insight and supported the responses given in the 10 likert scale questions
Results
sample
in 2008, approximately 130 children par- ticipated in the charleston Miracle league and almost one-third or 42 parents completed the survey (n = 42). The survey did not re- quest parents to identify their child’s medical diagnosis, therefore specific disabilities repre- sented by the parents responding to the survey (n = 42) are unknown. The authors were able to collect general data on 2008 cMl league participants and types of disabilities through player registration forms. Among children participating in the 2008 season, 29% had a diagnosis of autism; 15% cerebral palsy; 10% down Syndrome, 10% an unspecified devel- opmental disorder; 5% attention deficit hy- peractivity disorder, 5% intellectual disability, 5% a seizure disorder, 5% a genetic syndrome and the remaining children (16%) had some type of speech/language disorder, neuromuscu- lar disorder, endocrine disorder, or orthopedic condition. Many of the children had multiple medical diagnoses from several of the afore- mentioned categories.

Quantitative survey results
in regard to perceived needs, 100% of the 42 parents who completed the survey agreed that a need existed for recreational activities for children with disabilities in charleston county, Sc. likewise, 100% agreed their child’s partici- pation in the league had an impact on the entire family, 100% agreed that their children enjoyed participating in the charleston Miracle league. Finally, 97.6% agreed that participation in the charleston Miracle league was one of their child’s favorite activities.
The specific benefits reported by parents as a result of their children participating in the charleston Miracle league were as fol- lows: 97.6% increased self-confidence, 92.8% increased motor skills, 92.9% improved social skills, 92.9% made new friends, 85.7% improved baseball skills, and 83.3% improved belief in their ability to succeed (see Table 1). Although no items received ‘disagree’ responses, improved baseball skills (14%) and improved belief in ability to succeed (17%) received the greatest number of neutral responses. The surveys did not require parents to identify their child’s spe- cific diagnosis, thus no analysis can be made be- tween the specific disabilities of the participat- ing children and development of specific skills resulting from participation in the program.

TABle 1.
perceiVeD BeneFiTS oF parTicipaTion in The charleSTon Miracle leaGue

Perceived Benefits	Agree	Neutral	Disagree
Positive impact on the family	100%	0	0
Need for recreational activity in Charleston County	100%	0	0
Enjoyed participation in baseball league	100%	0	0
Favorite Saturday activity	97.6%	2.4%	0
Increased self-confidence	97.6%	2.4%	0
Improved social skills	92.9%	7.1%	0
Made new friends	92.9%	7.1%	0
Increased motor skills	92.8%	7.1%	0
Improved baseball skills	85.7%	14.3%	0
Improved belief in ability to succeed	83.3%	16.7%	0

* Note. There were no results in negative ranges (disagree or strongly disagree) for any of the survey questions. Values reported in table are percentages of overall parent responses given.

44 a Miracle in The ouTfield

open-ended responses
The open-ended questions were answered by 33 of the 42 parents who completed the survey. Responses to the open-ended questions regarding observed benefits indicated that the parents surveyed valued their child’s par- ticipation in the charleston Miracle league. comments reported included: (1) improved motor coordination, (2) greater motivation to participate in recreational activity, and (3) improved self esteem. eighty-two percent of the parents responding to these questions reported that their child experienced an in- crease in social relationships by gaining new friendships with same aged peers both with and without disabilities. Seventy-eight percent of these parents expressed that participation of their disabled child in an organized recre- ational activity like the cMl had a significant positive impact on the entire family unit. They noted that participation in the cMl offered a weekly community based recreational activity

for their child and family unit to share and build relationships with other children with disabilities and their families. Additionally, parental responses indicated that the relation- ships between children with disabilities and their siblings were enhanced by the athlete’s participation in the league. Specific examples of parents’ comments are provided in Table 2. An additional question on the survey asked parents their opinion of what could be done to improve the recreational experience for play- ers. only 21% of the parents who answered the open-ended questions provided responses which ranged from requests to add more sports, such as swimming or soccer, to making the league more competitive for players.
Discussion
The principal findings of this pilot study were that parents of children with dis- abilities who participated in the cMl highly value their child’s involvement in the baseball league. The majority of the parents respond-

TABle 2.
SaMpleS oF reporTeD BeneFiTS oF parTicipaTion in The charleSTon Miracle leaGue

Theme	Parent Responses
Health/Motor Skills	“Physically, he has better motor coordination and has even started running independently. He interacts with others much better now. He loved watching the Braves on TV and now he gets to play baseball.”
Motivation	“The ML has given our daughter a chance of doing something that is ‘hers’ and she enjoys every minute of it. Usually her little sister gets to do everything while she looks like she is left on her own.” “My child wakes up everyday asking if it is Saturday. He sits on the sidelines watching his brother most of the time. Now he is the star.”
Self-Esteem/ Confidence	“The opportunity that ML gives to each child with a disability to feel like a regular non-disabled child, if only for an hour. The joy that you see in these children’s faces warms your heart and it is very priceless. " “The way it makes the children feel, especially not allowing them to focus on their disabilities. It allows them to just have fun.”
Friends/Social Relationships	“My child has little fun time that she can do and has no friends so this makes her week. I wish there were other sports that she could do after this.” “My child never really had an interest in sports until Miracle League. He now understands the concept of baseball and thoroughly enjoys the game and socializing with his teammates and coach.”
Family	“It’s a wonderful experience for the entire family! We all feel welcomed and supported. Special needs families don’t get that very often.” “It has brought our family together. All the cousins, on both sides, attend the games. His teachers are even out there. It’s been great!”

lyonS, corneille, coker, adn elliS 45

ing to this survey reported that participation in this weekly sports activity resulted in increased self-esteem, motor functions, and social skills for their child with physical and/or mental dis- abilities. Additionally, most parents reported that their children made new friends, and their participation had a positive impact on their entire family.
These preliminary findings are supported by literature related to the positive effects of participation in recreational sports among children with disabilities. Studies of partici- pation in organized recreational activities by children with disabilities report improvements in self-esteem, motivation, physical well-being, and overall quality of life (Hanson, Nabavi, & Yuen, 2001; Murphy & carbone, 2008; Patel & Greydanus, 2002; Zabriskie et al., 2005). Yet, despite these benefits, children with dis- abilities are more restricted in their partici- pation, have lower levels of fitness, and have higher levels of obesity than their peers with- out disabilities (Murphy & carbone, 2008). in fact, Mharada and Siperstien (2009) recently found that over one-third of Special olympic athletes leave organized sports due to changes in interest and limited program availability.
Implications
Parents are responsible for enrolling and sustaining their children into community based recreational programs; therefore, their attitudes and perceptions are essential for planning suc- cessful community based sports programs. Un- fortunately, there are limited studies regarding the perception of parents whose children par- ticipate in local community sports programs or the impact of the athlete’s participation on the entire family unit. despite the limited scope of this project, the results provide important in- sight into parental perceptions of the benefits of participation in organized sports activity. Since the data are mostly descriptive, it is not feasible to further analysis is not feasible be- yond the evidence provided. The survey used in this study had been previously developed and administered by league officials to provide feedback on the benefits of the sports program and the responses were anonymous. Thus, the findings from this pilot study are limited by the descriptive nature of the information col- lected and an inability to solicit follow up data. in spite of these limitations, the results offer

occupational therapists, recreational thera- pists, physical therapists, speech-language pa- thologists, community recreation providers, and special educators a unique insight into the perception of parents who have children with special needs and their perceived value of community-based sport activities for their children. Further, the findings of this study provide several meaningful directions for fu- ture research to examine the benefit of sports activities among children with disabilities and their families. These include:

outcomes research related to physical, cogni- tive, social, and emotional benefits of partici- pation in the Miracle league programs. This could be completed with a validated survey of quality of life involving health indicators (fitness level, pain, or disability), self esteem (respect for oneself, ability to handle prob- lems), emotional functioning, and goals and values (Young et al., 2009). Such an approach would for a more scientific verification of the findings from the current pilot study.
An examination of how community bases sports programs for children with disabilities impact children with specific medical diag- noses (mental disability/impairment versus social or physical disability/impairment) and if correlations can be made between type of disability and specific benefits gained from various types of programs.
Further examination of the impact of such programs on siblings of children with dis- abilities, as well as sibling relationships. Vari- ous factors such as level of inclusion and the extent of sibling involvement in the program should also be considered.
Finally, the impact of such programs on par- ents and the family unit as a whole should be considered. Furthermore, both inter-family and intra-family relationships could be ex- plored.
As we seek to gain knowledge across

these areas, it is critical that rigor be main- tained within the research process. Both quali- tative and quantitative methods are valuable within this area of study, and should be well conceptualized prior to initiating any research initiative. one of the significant limitations of this pilot study was the use of a data collec- tion mechanism that was put into place as an

a Miracle in The ouTfield

evaluative mechanism, without the intent of answering research questions. Future research must involve collaboration of program provid- ers and experts in research design so that efforts produce information that is valuable in both realms. creative partnerships and methodolo- gies will allow for evaluative and informative conclusions to be drawn about the usefulness and successfulness of the Miracle league pro- gram and other similar recreation opportuni- ties for children with disabilities.
Conclusion
The findings offer important information regarding the benefits of participation in a Mir- acle league baseball program. Furthermore, qualitative responses from parents support the occurrence of benefits related to health and motor skills, motivation, self esteem, friends and social relationships, and child-family rela- tionships. disability can have a significant im- pact on the internal dynamics of a family unit, potentially causing increased family stress, strained sibling relationships, marital tension, and economic hardship (Havens, 2005). For example, Havens (2005) suggests that through recreational activity, families can help build the self-esteem of children and of the entire family, as well as build upon intra-family and inter-family social relationships. Although Havens (2005) was referring to families in general, this study also asserts that recreational activity is likely to be beneficial to families of children with disabilities as well. The qualita- tive and quantitative results of the survey sup- port these assertions and reveal that participa- tion in a weekly sports activity has a markedly positive impact on the participants and family. This information provides new insight into the importance of community based sports for children with disabilities as few studies have reported the potential impact of community recreation on the the entire family unit. More importantly, the findings highlight the need for local communities to develop and sustain recreational opportunities for children with disabilities and their families. To validate these assertions, it is critical that a comprehensive research effort be put in place, with the par- ticular research objectives spelled out in this paper being at the forefront. With extensive programming throughout the Nation, there is little justification for the absence of such an

effort. Findings would not only shed further light on the findings of this study, but would provide a more comprehensive understanding for how to best provide therapeutic recreation opportunities for children with disabilities and their families.
References
Antle, B. J., Mills, W., Steel, c., kalnins, i., & Rossen, B. (2008). An exploratory study of parents’ approaches to health promotion in families of adolescents with physical disabilities. child: care, health and Devel- opment, 34(2), 185-193.
cress, M., Buchner, d., Prhaska, T., Rimmer, J., Brown, M., Macera, c., depietro, l., & chodzko-Zajko, W., (2004). Physical activity programs and behavior counseling in older adult populations. Medicine & Science in Sports & exercise, 36(11), 1997-2003.
edouards, P., Gautherona, V., d’Anjoub, M.c., Pupiera, l., & devillarda, X. (2007). Training programs for children: literature review. annales de réadaptation et de Médecine physique, 50, 510-519.
Hanson, c. S., Nabavi, d. & Yuen, H. k. (2001). The ef- fect of sports on level of community integration as reported by persons with spinal cord injury. ameri- can Journal of occupational Therapy, 55(3), 332-8.
Havens, A. (2005). Becoming a resilient family: child disability and the family system. access Today, Special issue 17. Retrieved fromhttp://www.indiana. edu/~nca/monographs/17family.shtml on dec. 17, 2008.
laGreca, A. M. (1990). Social consequences of pediatric conditions: fertile area for future investigation and intervention? Journal of pediatric psychology, 15, 285-307.
law, M., & dunn, W. (1993). Perspectives on understand- ing and changing the environments of children with disabilities. physical and occupational Thearpy in pe- diatrics, 13(3),1-17.
Mharada, c, & Siperstein, G. (2009). The sport experi- ence of athletes with intellectual
disabilities: a national survey of Special olympics athletes and their families. adapted physical activity Quarterly, 26(1), 68-85.
Murphy, N. A., & carbone, P. S. (2008). Promoting the participation of children with disabilities in sports, recreation, and physical activities. pediatrics, 121(5), 1057-61.
Patel, d. R., & Greydanus,d. e. (2002). The pediatric athlete with disabilities. pediatric clinics of north america, 49(4), 803-827.
Sloper, P., & Turner, S. (1992). Service needs of families of children with severe physical disability. child: care, health, and Development, 18(5), 259-282.

lyonS, corneille, coker, adn elliS

U.S. census Bureau. (2006). Disability status and the char- acteristics of people in group quarters: a brief analysis of disability prevalence among the civilian noninstitution- alized and total populations in the american commu- nity Survey. Washington, dc: U.S. census Bureau, Housing and Household economic Statistics divi- sion.
Wilson, P. e. (2002). exercise and sports for children who have disabilities. physical Medicine and rehabilitation clinics of north america, 13, 907-923.
World Health organization. (2008). World Health Sta- tistics. Retrieved from http://www.who.int/whosis/ whostat/eN_WHS09_ on dec. 17, 2008.
Young, N., Varni, J., Snider, l., Mccormick, A., Sawatzky, B., Scott, M., king, G., Hetherington, R., Sears, e., & Nicholas, d. (2009). The internet is valid and re- liable for child-report: an example using the Activi- ties Scale for kids (ASk) and the Pediatric Qual- ity of life inventory (PedsQl). Journal of clinical epidemiology,
62(3), 314-20.
Zabriskie, R. B., lundberg, N. R., & Groff, d. G. (2005). Quality of life and identity: the benefits of com- munity-based therapeutic recreation and adap- tive sports program. Therapeutic recreation Journal, 39(3), 176-191.

a Miracle in The ouTfield

Article Critique #1: A Miracle in the Outfield: The Benefits of

Participation in Organized Baseball Leagues

for Children with Mental and Physical Disabilities

Kari Durrant

Brigham Young University

Article Critique #1: A Miracle in the Outfield: The Benefits of Participation in Organized Baseball Leagues for Children with Mental and Physical Disabilities

Summary

A Miracle in the Outfield, a pilot study done by Lyons, Corneille, Coker, and Ellis (2009), had the purpose to determine the impact of organized baseball leagues for children with disabilities on the child and family from the parents’ perspective. Lyons et al. gathered qualitative and quantitative data from 42 parents of children participating in Charleston, South Carolina’s “Miracle League Baseball”, one of 200 Miracle Leagues in the United States. The participating parents were surveyed, given the options of strongly agree to strongly disagree, on points having to do with the need for recreational activities for children with disabilities, the child’s benefits of participating in the league, and the influence on the family unit (Lyons et al., 2009).

The overall conclusion of the study was that parents of children with disabilities see a lot of worth in the baseball league for their child. Of the parents surveyed, 100% believed that there is a need for recreational activities for their children, their children’s participation in the league has a positive impact on the family, and their children enjoy the league (Lyons et al., 2009). There was not a single “disagree” response on any of the items surveyed, some of these include “Miracle League is my child’s favorite Saturday activity”, and “My child made new friends in Miracle League”, and items involving the improvement of child’s social skills, motor skills, self-confidence, and belief in ability to succeed. The results of the above items ranges from 83% to 97% agree, the rest being neutral (Lyons et al., 2009). The sport is obviously highly valued to the parents of these children.

Strengths of Article

The strengths I found in this article are the focus group of the study, and the implication it will bring to many people. Because the study examines the benefit of Miracle League from the perspective of the parents, it is unique. It gives the opportunity to other parents to see the benefits from a perspective similar to theirs. This leads to the next strength, which is the implication this has on those who read it, especially those with children with disabilities, which will be discussed in greater detail later.

Weaknesses of Article

The weaknesses I found in this study are typical to the fact that this is a simple pilot study, not meant to have concrete scientific data. Because of this, a relatively small sample is used, and data gathered is mostly descriptive. Overall, the study is quite limited. The group that was surveyed was only the CML, or Charleston Miracle League. There could most definitely be a difference in responses depending on location. Also, since only the one group was surveyed, a very small number of surveys were completed, only 43.

How the Article can be Applied

A Miracle in the Outfield, as previously stated, has strong implications on parents with children with disabilities to enroll their children in recreational programs such as a Miracle League to receive the great benefits for their children that many other have had. It also applies to recreational, occupational and physical therapists, community recreation providers, and special educators to see the perception of the parents of children with disabilities participating in activities. There is a great section of the article that explains many directions for more research regarding children with disabilities and sports (Lyons et al., 2009). The first suggestion is to conduct a study on physical, cognitive, social, and emotional benefits of participation in such a league, since this was only a pilot study, a more validated and scientific study would verify the results of this simple study. The next suggestion given in the article is to examine the effects of such community based sports programs on children with specific disabilities rather than generally (Lyons et al., 2009). The article also suggests research on the effects of participation in these sports programs on the family unit and its’ various parts, such as the impact on siblings (Lyons et al., 2009).

My Interests and Reactions

This article interests me for many reasons. I have a strong admiration for many aspects of the study; children, recreation as therapy, and baseball. I have also participated as a “buddy”, as the article mentions, in the Miracle League run through Salt Lake Adaptive Recreation. I have seen the confidence and happiness in the children as they finally get to be involved and have fun. Many of these children live most of their time involving recreation in the stands watching their siblings. Miracle League gives these children the chance to know they have abilities and can participate.

My reaction to this article and its’ result is simple; happiness. I’m glad someone did this study, even a pilot study, to show parents and professionals the importance of recreation in their children’s lives, and in their family’s lives. Now so much more can be done when it comes to research and this general topic to show the world even more of the importance of recreation in all lives.

References

Lyons, S., Corneille, D., Coker, P., Ellis, C. (2009) A Miracle in the Outfield: The Benefits of Participation in Organized Baseball Leagues for Children with Mental and Physical Disabilities. Therapeutic Recreation Journal, (43)3, 41-48.

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Friday, March 29, 2013

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