Abstract
Childhood victimization can negatively affect children’s self-perception, a multifaceted developmental asset that can be delineated into Global Self-Worth, Social Competence, and Behavioral Conduct. Despite the importance of self-perception, few studies have examined how strengths-based interventions impact self-perception among youth experiencing victimization. Using a familial case study design, the current study evaluated how a camp-based intervention, known as Camp HOPE, affected self-perception among siblings who experienced childhood victimization. Participants included three siblings and their mother who all identify as Black/African American and reside in the Midsouth, United States. The siblings participated in a week-long, overnight camp with other children exposed to victimization. The family was evaluated across three timepoints: pre-camp, 1 month post-camp, and 4 months post-camp. Participating in Camp HOPE appeared to have differential effects on the siblings’ self-perception. Specifically, all three children endorsed small to medium improvements in perceived Behavioral Conduct, but the camp differentially impacted their Global Self-Worth and Social Competence. Findings suggest that Camp HOPE may enhance self-perception among Black/African American children who have experienced victimization. This intervention may also be more accessible and acceptable, compared to traditional treatment formats.
1 Theoretical and Research Basis for Treatment
Children’s self-perception is a developmental asset that represents a fruitful target for intervention. This multifaceted construct includes individuals’ sense of Global Self-Worth (overall self-esteem), as well as an evaluation of their skills and abilities in domains such as Social Competence (ability to establish and maintain friendships) and Behavioral Conduct (ability to behave the way they want to behave/are expected to behave in various situations; Harter, 2012). Research shows that self-perception is a mutable factor, and that more victimization (e.g., physical, sexual, and emotional abuse, neglect, peer bullying, and violence exposure in the home or community) is related to lower self-perception (Chan et al., 2011). Given that Black/African American youth experience higher rates of victimization compared to youth of other races (Elsaesser & Voisin, 2015), it is important to examine self-perception among these youth and identify interventions that enhance this construct. Although evidence-based treatments for children exposed to victimization have traditionally focused on reducing psychopathology and behavioral problems, there is increasing acknowledgment that interventions intended to promote strengths are more effective at fostering positive functioning amidst adversity (Howell et al., 2017). Few studies have examined interventions designed to bolster strengths among children affected by victimization, especially among children identifying as Black/African American. Thus, the current study explored how a camp-based intervention, known as Camp HOPE, affects self-perception among three siblings who identify as Black/African American and experienced childhood victimization.
Childhood Victimization and Self-Perception
School-aged youth are exposed to high levels of victimization, which increases their risk for impaired functioning, internalizing and externalizing behavior problems, and adjustment difficulties (Shukla & Wiesner, 2016). Research shows that experiencing one type of victimization is associated with significantly higher risk for experiencing other types (Finkelhor et al., 2005). Due to the systemic barriers of poverty, stress, and violence, Black/African American youth may be at a heightened risk for polyvictimization, or exposure to multiple types of victimization (Elsaesser & Voisin, 2015). Though little research has focused on the link between polyvictimization and self-perception (Turner et al., 2017), existing literature suggests that polyvictimization is related to lower levels of self-perception (Soler et al., 2013).
One guiding framework for understanding the influence of victimization on children’s self-perception is the theory of shattered assumptions. This theory posits that trauma exposure “shatters” individuals’ previously held assumptions about themselves and the world (Janoff-Bulman, 1985). Specifically, exposure to victimization can challenge individuals’ beliefs that they are safe, that they are valuable, and that the world is a safe place (Janoff-Bulman, 1985). Given that polyvictimization involves exposure to multiple traumatic event types, children may be repeatedly taught to view themselves and the world in a more negative light, sometimes resulting in long-lasting alterations in assumptions about their place in the world (Janoff-Bulman, 2010). When children experience polyvictimization in multiple contexts (e.g., school, home, and community), the inability to escape pervasive threats can engender feelings of shame, worthlessness, and helplessness (Irving & Ferraro, 2006). Therefore, children experiencing polyvictimization may be more likely to believe that they are personally responsible for their negative experiences, resulting in reduced feelings of self-competence and self-worth, which are two key components of self-perception (Turner et al., 2017).
Caregiver Victimization and Children’s Self-Perception
However, children’s own victimization experiences can affect their self-perception, caregiver intimate partner violence (IPV)—acts of physical, sexual, and psychological abuse between romantic partners (Black et al., 2010)—has also been linked to children’s self-perception (El-Sheikh et al., 2001). According to the U.S. Bureau of Justice, 73.2% of criminal domestic violence incidents are IPV-related (Truman & Morgan, 2016), with women identifying as Black/African American experiencing higher rates of IPV exposure (43.7%) compared to White/European American women (37.1%; Black et al., 2011). Regardless of whether children witness victimization, caregivers’ exposure to adversity can impact children’s mental health, social interactions, and behavior (Ehrensaft et al., 2017). Although few studies have examined the association between caregiver IPV exposure and children’s self-perception, researchers have found a link between IPV and perceptions of the self, such as lower global self-worth (El-Sheikh et al., 2001).
School-aged youth remain largely dependent on their caregivers, so caregivers’ experiences and functioning can significantly impact their children. The spillover hypothesis suggests that emotions and moods experienced within caregivers’ adult relationships can transfer to the parent–child relationship (Sturge-Apple et al., 2010). As such, it is necessary to consider how caregiver functioning in the context of violent adult relationships might influence their children’s self-perception. Specifically, caregiver victimization exposure may “spillover” to influence child self-perception through parental modeling and negative parent–child interactions. For example, caregivers experiencing IPV may exhibit hostility, disengagement, harsh-intrusive parenting, physical punishment strategies, and impaired responsiveness (i.e., lack of warmth and parent centeredness; Sturge-Apple et al., 2010). To the extent that children internalize feelings of distance and hostility from their caregiver, they may question their own sense of self, ability to meet behavioral expectations, and ability to navigate relationships (Donovan & Brassard, 2011).
Camp Interventions and Self-Perception
Although victimization can have negative effects on children’s self-perception, there are interventions available that effectively enhance self-perception among these youth (Whitson et al., 2012). Traditional evidence-based treatments for this population typically focus on symptom reduction and are often characterized by time and financial constraints (Howell et al., 2017). Camp-based interventions may offer a useful alternative to traditional interventions by reducing stigma often associated with mental health treatment, emphasizing independence and exploration, and providing opportunities to interact with peers (American Camping Association, 2012). Regarding facets of self-perception, studies demonstrate an association between summer camp experiences and improved self-esteem and positive identity among youth (Thurber et al., 2007). One study that evaluated children diagnosed with life-threatening illnesses found that a therapeutic recreational summer camp was associated with positive changes in global self-worth (Kiernan et al., 2004). Additionally, some studies have shown improvements in children’s social skills and prosocial behavior as a result of camp-based intervention (Thurber et al., 2007).
The positive youth development model (PYD) provides a useful framework for understanding why the camp experience may foster self-perception and other positive outcomes among youth (Catalano et al., 2002). Using a strengths-based approach, PYD links positive youth outcomes with environmental conditions, including opportunities for youth to develop skills and a sense of belongingness in the context of safety, support, and structure (Lerner, 2005). These conditions (e.g., safety, support, new experiences, structured opportunities, and sense of belonging) are reflected in the camp experience (Dipeolu et al., 2016). Thus, camp may provide the building blocks for developing life skills that help children perceive themselves in a positive light (Thurber et al., 2007). The present study explored the impact of a camp-based intervention on self-perception among Black/African American siblings who experienced victimization.
2 Case Introduction
Participants in this case study include Ms. Jones and her three children (first and last names changed to protect privacy): Nicole (female; age 10 at camp), Anthony (male; age eight at camp), and Jessica (female; age seven at camp). The Jones siblings attended Camp HOPE (described below) in the summer of 2017. All members of the Jones family self-identified as Black/African American. Ms. Jones was not employed at the time of her pre-camp assessment and reported receiving government assistance (e.g., SNAP, SSI, and WIC). The family was living well below the federal poverty line, with an estimated annual household income of $10,000-$15,000. The Jones family also experienced housing instability, as Ms. Jones reported moving several times and going to a safe house or shelter on six separate occasions. The Jones siblings live with their biological mother, three other siblings who were outside the age range for camp attendance, and intermittently with their mother’s violent partner. The family was assessed at pre-camp, post-camp 1-month follow up, and post-camp 4-month follow up.
The Jones siblings represent three unique personalities. Nicole was noticeably shy and experienced bullying at camp. Anthony was energetic and playful; he displayed externalizing behavior problems during camp and often received negative attention. Jessica was cooperative, engaged, and well-liked, demonstrating behavior that was closest to that of an average camper.
3 Presenting Complaints
The Jones family sought services related to victimization exposure in the home from a family justice center (FJC) in the Midsouth, United States. FJC staff referred the family to Camp HOPE staff, who screened them for eligibility, informed them about the nature and purpose of the camp, and enrolled them in the study. At Ms. Jones’s pre-camp assessment, she endorsed recent IPV victimization and indicated that her children had witnessed violence between her and her partner—the children’s stepfather—in the last 6 months. All three siblings endorsed exposure to direct and indirect victimization, including witnessing violence between their mother and stepfather. Ms. Jones considered herself a single parent to her six children and reported that neither she, nor her children, had received mental health services in the past.
4 History
Ms. Jones reported a history of abuse and neglect during her own childhood. She described being emotionally and physically abused multiple times, as early as age nine. At her pre-camp assessment, Ms. Jones reported having been in upwards of four violent relationships. All three of the Jones siblings appeared to have a close relationship with their mother. However, only Jessica described having a father figure, whereas Anthony and Nicole reported having no father figure and felt that few adults, other than their mother, cared about them and their feelings.
5 Assessment
This study was reviewed and approved by the [masked for review] IRB. Study procedures were developed as part of a collaboration between the research team and the FJC Camp HOPE staff. Before starting the pre-camp assessment, Ms. Jones provided written consent, permission for her children to participate in the project, and consent for future contact. The Jones children provided written assent. Trained study staff then conducted separate one-on-one interviews with the Jones family, at pre-camp (1 month before camp), post-camp 1-month follow up (2 months after pre-camp), and post-camp 4-month follow up (5 months after pre-camp). Interviewers read all items aloud and recorded participants’ responses in an online database. Each interview lasted approximately 45 minutes. The Jones family responded to measures assessing victimization, self-perception, and the children’s strengths and difficulties.
Childhood Polyvictimization
Each child reported on their victimization exposure using the Juvenile Victimization Questionnaire—2nd Revision Reduced Item Version, Youth Past-Year Form (JVQR2-RIV; Hamby et al., 2011). This 12-item measure evaluates multiple forms of victimization: property victimization, physical assault, maltreatment, peer victimization, sexual victimization, and witnessing/indirect victimization (Finkelhor et al., 2005). Youth reported on their own adversity exposure by responding to items (i.e., In the last year, did anyone hit or attack you WITHOUT using an object or weapon?”) on a dichotomous “Yes” or “No” scale. At the pre-camp assessment, victimization exposure was examined in the past year. At subsequent assessments, victimization exposure was assessed since the most recent interview date. Affirmative responses were summed to generate a total polyvictimization score ranging from 0–12. The JVQR2-RIV has demonstrated predictive validity via associations with trauma symptoms (Finkelhor et al., 2005). The measure has also been used with diverse samples, including a racially and socioeconomically diverse sample of urban youth (Holt et al., 2007). The JVQR2-RIV developers were committed to ensuring that the concepts and language of the measure were accessible and understandable for a variety of audiences (Hamby et al., 2005).
Self-Perception
Each child completed the Self-Perception Profile for Children (SPPC; Harter, 2012), which measures a discrete Global Self-Worth scale and five domains of self-perception: Social Competence, Behavioral Conduct, Scholastic Competence, Athletic Competence, and Physical Appearance. The SPPC consists of 36 items using a “structured alternative format” designed to offset social desirability response biases and provide children with a range of response choices (e.g., “Some kids are often unhappy with themselves, BUT other kids are pretty pleased with themselves.”). The child first decides which kind of child they are most like, between the two options, and then decides whether the description chosen is “Really True” or “Sort of True” for them. This procedure results in a four-point scale from 1 to 4, with “1” reflecting the lowest perceived competence/adequacy and “4” reflecting the highest perceived competence/adequacy. Given the association between camp experiences and changes in self-esteem, social skills, and children’s behavior, the current study examined three of the SPPC subscales: Global Self-Worth (GSW), Social Competence (SC), and Behavioral Conduct (BC). Each subscale ranges from 6–24, with higher scores reflecting more positive self-perception. The SPPC has demonstrated adequate internal consistency (α = .78–.91) and convergent validity (Harter, 2012). Some studies have yielded inconsistent findings with content and construct validity of the SPPC for Black/African American youth. However, some factors have been replicated with this population and the subscales comprising the original factor structures have demonstrated good internal consistency (i.e., .77 and above) with this population (Stewart et al., 2010).
Strengths and Difficulties
Ms. Jones rated each of the siblings’ prosocial skills and emotional/behavioral difficulties, as measured by the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997). The SDQ includes 25 items that reflect five domains of functioning. Ms. Jones was asked to rate the accuracy of each statement (e.g., “Your child often fights with other children or bullies them”) on a 3-point scale ranging from 0 (not true) to 2 (certainly true). Four domains (i.e., Emotional Symptoms, Conduct Problems, Hyperactivity/Inattention, and Peer Relationship Problems) are summed to create a Total Difficulties score that ranges from 0–40. The Prosocial Behaviors domain represents its own subscale that ranges from 0–10. The SDQ has demonstrated good internal consistency (α = .73), as well as adequate construct and discriminant validity (Goodman, 2001). The SDQ has been used globally with diverse samples, including a diverse American urban and suburban sample (Ruchkin et al., 2008).
Pre-camp Assessment
At pre-camp, Nicole’s JVQR2-RIV total score was 5. She indicated that she had experienced physical assault, bullying, and had witnessed physical IPV and physical assault with a weapon. Nicole’s self-perception scores were consistent with the sample average for SC (i.e., 17; M = 17.05) and GSW (i.e., 19; M = 19.59), but below the sample average for BC (i.e., 17; M = 18.68). According to Ms. Jones’ report, Nicole’s Total Difficulties score was 17, which was elevated as compared to other female children in her age range. Her Prosocial Behaviors score was notably lower than the sample average (5; M = 7.95). Anthony’s pre-camp JVQR2-RIV score was 2. He endorsed experiencing physical assault and witnessing physical IPV. His SC score of 22 was higher than the sample average (M = 17.05), and his GSW score of 21 was slightly higher than the sample average (M = 19.59). Anthony’s BC score of 16 was lower than the sample average (M = 18.68). Due to time constraints, Ms. Jones did not complete the pre-camp SDQ for Anthony. Attempts to obtain these data before camp began were not successful. Jessica reported that she had experienced emotional abuse, bullying, and multiple forms of physical assault, with a pre-camp JVQR2-RIV score of 5. Jessica’s self-perception scores were lower than the sample average for SC (i.e., 15; M = 17.05). Her BC (i.e., 18; M = 18.68) and GSW (i.e., 19; M = 19.59) scores were less than a point below the sample average. Ms. Jones’s report revealed a Total Difficulties score of seven for Jessica, placing her in the average range compared to her normed peer group. Similar to Nicole, her Prosocial Behaviors score of five was notably lower than the sample average (M = 7.95).
6 Case Conceptualization
The Jones family experienced high rates of victimization exposure within the year prior to seeking services from the FJC. Both childhood victimization and caregiver IPV have been linked to erosion of children’s internal assets, such as self-perception (Graham-Bermann et al., 2009). It is possible that the Jones siblings’ self-perceptions were negatively affected–albeit in different ways–by their recent adverse experiences. Therefore, these siblings may benefit from intervention intended to enhance self-perception. Indeed, when positive self-perception is preserved or restored among children exposed to victimization, this developmental asset can promote well-being (Patterson et al., 1991). Further, research suggests that interventions can effectively enhance self-perception among victimized children (Whitson et al., 2012). Thus, self-perception represents a fruitful candidate for interventions aiming to improve the functioning of children exposed to adversity, and the Jones children may benefit from interventions designed to bolster self-perception. Because the Jones family had not previously sought formal mental health services, the accessibility of a free, camp-based intervention may offer additional benefit.
Camp HOPE is a unique weeklong, overnight camp that is the first camping and mentoring initiative in the United States specifically designed for children exposed to victimization. The program is rooted in trauma-informed care and aims to promote resilience and break cycles of violence. Counselors participate in a customized trauma-informed training (developed by a clinical psychologist) that acknowledges rates and effects of trauma exposure among youth. Several components of Camp HOPE may promote a greater sense of self-perception. For instance, the trauma-informed care practices taught in training include consistent positive reinforcement, effective praise, reflection, and active engagement in youth-led play. The camp is specifically designed to recognize each child’s strengths, via praise and Character Trait Awards, which are provided to each child throughout the week. Additionally, Camp HOPE offers children a variety of trauma-informed activities that create opportunities for demonstration and development of strengths and skills. Thus, Camp HOPE is designed to provide each child with a safe and supportive environment, opportunities to show their novel strengths/skills, and recognition for their unique positive traits throughout the week. Further, the large adult to camper ratio offers more oversight and supervision, more chances for kids to connect with adults they identify as safe and relatable, and more opportunities for each child to receive praise for positive behavior. Finally, camp creates ways to develop new socioemotional skills (e.g., teamwork and emotion regulation) that could foster self-perception. To our knowledge, no studies have examined how camp intervention influences self-perception among children exposed to victimization. Furthermore, an in-depth case examination of children participating in the Camp HOPE program, including an assessment of change in three facets of self-perception over time, has not been conducted. Therefore, the current study added to the existing literature by exploring the potential for a camp-based intervention to promote self-perception among children exposed to victimization, as well as by discussing potential explanations for observed changes in self-perception based on each child’s unique strengths, weaknesses, and experiences.
7 Course of Treatment and Assessment of Progress
One month after the pre-camp assessment, the Jones siblings attended Camp HOPE. Upon arrival, each child was introduced to their cabinmates and counselors. Counselors led icebreaker activities and taught the campers camp songs. Campers were introduced to the Camp HOPE rules, oriented to the campsite, and shown to their cabins. Each subsequent day, campers participated in meals with their cabin, team-building activities, outdoor and creative games, group discussions about the Camp HOPE curriculum, and campfire time.
Camp HOPE offered the Jones siblings a variety of unique daily activities that created opportunities for demonstration and development of strengths. These activities were also designed to promote developmental skills, including teamwork, creativity, problem-solving, self-esteem, agency, self-management, and trust. For example, arts and crafts may have provided Nicole the opportunity to take pride in her achievements and learn new skills, improving her view of self. Field games may have offered Anthony the chance to demonstrate his strengths (e.g., energetic, playful, and spirited) and build self-confidence. Jessica engaged in a variety of activities, which may have given her the opportunity to gain a more formative experience by believing in herself and her abilities.
Using “challenge by choice,” Camp HOPE staff encouraged the campers to push themselves towards daily goals while allowing them to opt out if the challenges became overwhelming. They were also urged to support one another through challenges and to acknowledge effort and steps towards goal attainment, regardless of goal completion. Further, the Camp HOPE curriculum included a theme for each day (e.g., “I am becoming my best self.”; “My future is brighter than my past.”). These positive affirmations aim to promote feelings of future orientation, perseverance, and personal progress. With their cabinmates, the Jones siblings completed themed worksheets and activities that encouraged them to actively integrate the daily theme into their lives. The theme for each day was also woven into nightly campfire discussions, during which the Jones siblings answered questions like, “Where did you see hope today?” Finally, the curriculum taught the Jones siblings about historical figures and role models who have overcome adversity. They were prompted to identify similarities between the stories and their own lives, reflecting on how they might also overcome adversity. These unique aspects of the Camp HOPE curriculum, specifically designed to promote positive perspectives among youth exposed to victimization, encouraged children to set goals and envision steps towards attaining those goals by drawing on their strengths and fostering a sense of self-efficacy.
Although all three children attended the same week of camp, the experience was different for each child. For instance, children spend a large amount of time with their cabins during the week of camp, and each child was in a different cabin with different counselors. All cabin counselors received the same training, but they implemented their knowledge and the curriculum in different ways. Cabinmates also play an important role in the camp experience, and each child was surrounded by a different peer group with different interactions and dynamics. More information about each child’s individual experiences and progress is provided below.
Nicole’s Assessment
At camp, Nicole was initially hesitant to join camp activities, but she participated once she was encouraged by the counselors. Nicole sometimes chose to sit out from activities, particularly those that required energy and movement (e.g., field games), instead appearing more comfortable participating in activities like art. She often conversed with adult staff, as opposed to her peers, during activities. Nicole was kind and patient, but she presented with some internalizing concerns and difficulty interacting with peers. She was teased by other campers about her size and frequently sought adult support in managing these difficult peer interactions. Counselors encouraged her to create positive statements about herself and distance herself from challenging peers. Despite Nicole’s cabin being characterized by cliques and some bullying behavior, as the week progressed, she became friends with one of the girls in her cabin.
At her post-camp 1-month follow up evaluation, Nicole’s SC score (i.e., 19) increased by two points, potentially reflecting Nicole’s navigation of difficult social circumstances with the support of trusted adults. This was in line with the average post-camp 1-month follow up score of 18.94 among children who attended camp. Her BC score (i.e., 21) increased by four points and was slightly higher than the sample average of 20.25. It is possible that camp helped improve Nicole’s perception of her behavior by providing structure, praise, and guidance in how to thoughtfully respond to difficult situations. Nicole’s post-camp 1-month follow up GSW score (i.e., 18) decreased by one point, suggesting that although camp provided Nicole with many growth experiences, her overall sense of self-worth may have been negatively impacted by bullying and peer rejection experienced at camp. This score was lower than the sample average of 20.43. Between her pre-camp and post-camp 1-month follow up evaluations, Nicole experienced polyvictimization, with a post-camp 1-month follow up JVQR2-RIV score of 3. Interpretations of how Nicole’s victimization might have influenced her self-perception are complex. However, her self-perception seems to have been resilient to the potentially adverse effects of polyvictimization experienced post-camp, reflecting how camp and other protective factors possibly buffered against effects of victimization. Although this is one of several potential explanations, it is possible that these victimization experiences represent a relatively normative part of Nicole’s life and did not have a significant impact on her self-perception. See Figure 1, Panel A.
Change in the Jones Children’s self-perception from pre-camp to follow-up.
Ms. Jones’s report on the SDQ suggests that Nicole’s overall difficulties declined slightly from pre-camp (i.e., 17) to post-camp 1-month follow up (i.e., 14) but remained elevated, with her score at the 92nd percentile of her normed peer group. Per Ms. Jones’s report, Nicole’s emotional symptoms, conduct problems, and hyperactivity scores declined slightly from pre-camp to post-camp one-month follow up, while her peer problems score increased. Reductions in caregiver-reported hyperactivity and conduct problems are consistent with Nicole’s self-reported increase in BC. However, caregiver-reported elevations in peer problems are not consistent with Nicole’s self-reported increase in SC, and caregiver-reported reductions in emotional symptoms are not consistent with Nicole’s self-reported reduction in GSW. Regarding prosocial behavior, Ms. Jones reported an increase from pre-camp to post-camp one-month follow up, with a score of eight that places Nicole in the 33rd percentile and was consistent with the sample average of 7.63.
Anthony’s Assessment
At camp, Anthony had difficulty engaging in quiet and stationary activities (e.g., mindfulness) and sometimes missed activities due to behavioral concerns (e.g., becoming frustrated and being in timeout). Anthony was most likely to engage in high energy activities, like pool time and field games. His strengths were his energy and fun personality, but he presented with several externalizing concerns (e.g., noncompliant and argumentative), hyperactivity, impulsivity, and difficulty sustaining attention. Anthony’s cabin was characterized by high energy and intermittent arguments between peers that were quickly resolved. Though he made friends easily, he often had conflict with peers, experienced homesickness, and his behavior sometimes warranted utilization of behavior management strategies. Counselors and staff frequently provided Anthony with redirection, encouragement to participate with peers, and time and space for de-escalation and self-reflection.
At his post-camp one-month follow up evaluation, Anthony’s SC score remained unchanged (i.e., 22) and was greater than the sample average of 18.94. It is likely that Anthony’s pattern of peer interactions at camp was similar to his peer interactions in other settings. His post-camp one-month follow up BC score (i.e., 18) increased by two points, which may be due to the structure, clear expectations, individual attention, and behavior management principles implemented in camp. However, his score remained lower than the sample average of 20.25. Anthony’s post-camp one-month follow up GSW score (i.e., 19) decreased by two points and was slightly lower than the sample average of 20.43. Camp offered Anthony the opportunity to develop skills and grow, but he also encountered a significant amount of negative feedback that may have adversely affected his overall sense of self-worth. Between his pre-camp and post-camp one-month follow up evaluations, Anthony reported experiencing direct victimization, with a JVQ-RIV score of 2, but his self-perception scores did not meaningfully decline. Like Nicole, one potential explanation may be that these victimization experiences represent a normative part of Anthony’s life and did not have a significant impact on his self-perception. It is also possible that these victimizations were buffered by his time at camp and other protective factors (e.g., relative stability within the family system during this time). See Figure 1, Panel B.
Anthony’s post-camp one-month follow up total difficulties SDQ score (i.e., 23) placed him in the 98th percentile, and well above the sample average of 10.92. Ms. Jones reported that Anthony showed high levels of emotional symptoms (i.e., 5; 95th percentile), conduct problems (i.e., 7; 99th percentile), hyperactivity (i.e., 7; 90th percentile), and peer problems (i.e., 4; 95th percentile). All of Anthony’s scores on the difficulties subscales were higher than the sample average. Ms. Jones’s report of Anthony’s conduct problems and hyperactivity are consistent with Anthony’s self-reported low BC score. Similarly, Ms. Jones’s endorsement of elevated emotional symptoms for Anthony is consistent with his low self-reported GSW. However, Anthony reported above-average levels of SC, which does not align well with Ms. Jones’s report of his elevated peer problems. Anthony’s prosocial behavior score, per Ms. Jones’s report, was remarkably low, with a score of one placing him well below the sample average of 7.63 and in the zero percentile of his normed peer group. It is possible that witnessing violence perpetration by his stepfather towards his mother could have negatively impacted Anthony’s ability to engage in prosocial behavior (i.e., regular social interactions, concern for other’s well-being, and cooperation). Despite Camp HOPE providing opportunities to foster sociability, Anthony attracted negative attention from his peers and adults at camp, making it difficult to promote the development of prosocial behavior.
Jessica’s Assessment
At camp, Jessica was the most likely child of this sibling set to participate in a wide variety of camp activities. She sometimes needed encouragement from counselors to engage, but she appeared to enjoy all types of camp activities. Jessica had many strengths, including kindness, curiosity, and attentiveness. She got along well with her peers, which contrasted with her siblings’ experiences. Jessica’s cabin was characterized by generally compliant children with varying levels of energy and requiring varying levels of redirection. Cabinmates appeared to enjoy being with one another. Despite being somewhat shy, Jessica easily made friends with her cabinmates and was cooperative with staff, counselors, and peers. She also seemed to enjoy the positive attention from adults at camp. Among this sibling set, Jessica likely benefited the most from the structure of Camp HOPE, where counselors and adult staff naturally provided this type of support and encouragement.
At her post-camp one-month follow up, Jessica’s SC score (i.e., 19) increased by four points, possibly reflecting camp opportunities for engagement with peers and social skill development. Jessica’s post-camp one-month follow up SC score was close to the sample average (M = 18.94). Her post-camp one-month follow up BC score (i.e., 19) increased by one point, possibly due to the positive attention she received at camp. Notably, her post-camp one-month follow up BC score remained below the sample average of 20.25. At post-camp one-month follow up, Jessica’s GSW score (i.e., 24) increased by five points, possibly highlighting how camp provided a safe place to learn and grow, consistently receive praise, and an opportunity to recognize one’s own strengths and self-worth. This was more than three points higher than the sample average of 20.43. Jessica indicated that she had experienced both direct and indirect violence exposure between the pre-camp and post-camp one-month follow up assessments, with a JVQ-RIV score of 3. It is somewhat difficult to understand why Jessica’s self-perception scores increased amid victimization. Similar to Nicole and Anthony, it is possible that Jessica’s self-perception is not heavily influenced by victimization because these experiences represent a somewhat normative part of her life. See Figure 1, Panel C.
Ms. Jones’s report on the SDQ revealed a slight increase in Jessica’s total difficulties score from pre-camp (i.e., 7) to post-camp one-month follow up (i.e., 8). This score places Jessica in the average range (68th percentile) and slightly below the sample average of 10.92. Ms. Jones’s report of Jessica’s emotional symptoms, hyperactivity, and peer problems scores remained the same from pre-camp to post-camp one-month follow up, while her conduct problems score increased. Of note, Ms. Jones’s rating of Jessica’s peer problems was the most elevated subscale for Jessica, with a score of three that places her in the 93rd percentile and slightly above the sample average of 2.51. Ms. Jones’s report is somewhat inconsistent with Jessica’s self-report, which revealed improvements across domains of self-perception. Finally, per Ms. Jones’s report, Jessica’s prosocial behavior score increased substantially from pre-camp (i.e., 5) to post-camp one-month follow up (i.e., 9). This score places her in the 56th percentile and slightly above the sample average of 7.63
Qualitative Caregiver Feedback
In a brief interview with Ms. Jones after her children participated in Camp HOPE, she reflected on how the camp impacted her children. Ms. Jones stated that her children were “more outgoing” and talkative after attending camp, which is consistent with improvements in SC. She also noted that her children “want[ed] to explore more” and seemed “more excited.” Similarly, she described her children as “hav[ing] a little more confidence,” potentially reflecting increased GSW. Ms. Jones noted “a little bit of improvement” in behavior across all three of her children.
When Ms. Jones was asked why camp might have impacted her children, she discussed her children’s connection with camp staff and counselors. She explained that “[The children] are always connected when they come back [from camp]. They’re like, ‘Mom oh I love my staff and they’re so great!’” In addition to the strong connection Ms. Jones noted between her children and the camp counselors/staff, she also indicated that the camp experience, particularly the new and different activities, provide excitement. She stated, “The camp experience is just great. It has a great impact on them.” Ms. Jones shared that her children returned from camp eager to share stories about their experiences. It is possible that this opportunity for novel activities expands the children’s view of themselves and the world.
8 Complicating Factors
Each child’s age, developmental stage, and gender likely affected their response to Camp HOPE. Nicole’s time at camp epitomizes many elements of the pre-adolescent female experience, including escalating relational aggression (Neal, 2007) and defiance (Van Petegem et al., 2015). Anthony’s experience is consistent with many typical childhood experiences of boys, including high energy, being playful, and peer conflict that dissipates quickly (Noakes & Rinaldi, 2006). Jessica’s experience is best understood in the context of her age, as children in the early elementary school years tend to be more curious, agreeable, and less cliquey (Noakes & Rinaldi, 2006).
In addition to demographic and developmental effects, each child was exposed to different cabins, counselors, cabinmates, and adult support staff during the week of camp. These differences all resulted in novel interactions and experiences for each child. Each child’s experience was also different because of their choices to participate or not participate in certain camp activities. The children also presented to camp with unique strengths, weaknesses, resources, and needs. These factors interact with the different elements of camp to affect the intervention’s impact on each child.
9 Access and Barriers to Care
The Jones family faced several barriers to care, including intermittent difficulty with transportation, housing instability and few financial resources. Additionally, Ms. Jones had limited time and resources, as she was the primary caregiver for six children, working, and navigating divorce proceedings. One of the primary advantages of Camp HOPE is that it directly addresses and reduces barriers to care that families often face when accessing traditional interventions. More specifically, the camp is free, offers transportation assistance, and provides basic necessities for camp (e.g., blankets and towels). Further, because this intervention is camp-based, it reduces some of the stigma around mental health care. Thus, Camp HOPE may have been a more comfortable option than typical interventions.
10 Follow-Up
The Jones family completed a third evaluation four months after camp to assess the long-term impact of participating in Camp HOPE. Information about each child is provided below.
Nicole’s Assessment
At the post-camp four-month follow-up, Nicole’s SC score (i.e., 23) increased by four points compared to her 1-month follow-up. Her follow-up SC score was six points higher than her pre-camp score and over four points higher than the sample average of 18.85. This ongoing improvement may reflect her continued practice of social skills learned at camp, incorporation of these skills into her daily life, and opportunities to develop new social skills at school, home, or extracurricular settings. Nicole’s BC score declined by five points between the 1-month and 4-month follow-up evaluations. Nicole’s score of 16 was one point lower than her pre-camp BC score and lower than the sample average of 19.70. It is possible that Nicole’s reluctance to participate and engage in activities is considered more problematic in a school setting (compared to camp), which could result in negative feedback or punishment from adults and contribute to Nicole’s perception that her behavior is not acceptable. Nicole’s four-month follow-up GSW score increased by five points, to 23. This score was four points higher than her pre-camp score and nearly two points higher than the sample average of 21.10. To the extent that the camp experience offered opportunities for Nicole to enhance her sense of self (e.g., through new activities, reinforcement of positive character traits), this improved sense of self may have manifested in her life and interactions in a self-sustaining manner. Additional life factors (e.g., experiences at school and home) likely contributed to this score as well. See Figure 1, Panel A.
According to Ms. Jones’s report on the SDQ, Nicole’s emotional and behavioral difficulties increased by four points between post-camp one-month follow up and post-camp four-month follow up (i.e., from 14 to 18). Her total difficulties score of 18 was one point higher than her pre-camp score and falls in the 97th percentile. From Ms. Jones’s perspective, Nicole experienced more difficulties compared to the sample average (M = 12.32). Nicole’s emotional symptoms, conduct problems, and hyperactivity scores all increased from post-camp one-month follow up to post-camp four-month follow up. Her prosocial behavior score decreased from post-camp one-month follow up (i.e., 8) to post-camp four-month follow up (i.e., 5), which is identical to her pre-camp score. Nicole’s prosocial behavior score places her in the sixth percentile compared to her normed peer group and notably lower than the sample average of 7.41. Given Nicole’s self-reported improvements in social, behavioral, and global self-perception, her mother’s report of emotional and behavioral difficulties is unexpected. It may be that these discrepancies between Nicole’s report and her mother’s represent Nicole’s transition to adolescence, when developmentally appropriate changes can make it difficult for caregivers to accurately attune to their children’s experiences.
Anthony’s Assessment
At post-camp four-month follow-up, Anthony’s SC score (i.e., 22) was identical to his post-camp one-month follow up and pre-camp scores, with a final score above the sample average of 18.85. Anthony’s BC score decreased from post-camp one-month follow up (i.e., 18) to post-camp four-month follow up (i.e., 14) and was lower than his pre-camp score (i.e., 16) and the sample average of 19.70. This finding may reflect that Anthony’s hyperactivity and disruptive behavior attract more negative attention in a school setting than in the camp setting, given that school provides fewer outlets for Anthony’s energy. His GSW increased from post-camp one-month follow up (i.e., 19) to post-camp four-month follow up (i.e., 22) was higher than his pre-camp score. This growth may have started with Camp HOPE, where Anthony’s mentors recognized his positive traits and encouraged him to apply those traits to his daily life. It is possible that these interactions increased Anthony’s awareness of his own strengths and ability to use those strengths. This personal growth, in conjunction with other life factors (e.g., praise from other adults; new peers at school), may have helped Anthony sustain a more positive self-perception. Anthony’s final score of 22 was slightly above the sample average follow-up score of 21.10. See Figure 1, Panel B.
Ms. Jones’s report of Anthony’s emotions and behaviors at post-camp four-month follow up revealed a total difficulties score (i.e., 24) that was one point higher than his post-camp one-month follow up score. This placed Anthony in the 98th percentile compared to his normed peer group and considerably higher than the sample average (M = 12.32). Anthony’s emotional symptoms score decreased by two points and his peer problems score decreased by one point, which are consistent with improvements in self-reported GSW and sustained SC. Ms. Jones reported that Anthony’s conduct problem score increased by one point, and his hyperactivity score increased by three points—changes that are consistent with Anthony’s self-reported decrease in BC. Anthony’s prosocial behavior score remained the same from post-camp one-month follow up to post-camp four-month follow up, with a final score of one that places him in the zero-percentile compared to his normed peer group and significantly below the sample average of 7.41.
Jessica’s Assessment
Four months after camp, Jessica’s SC score continued to increase by two points, to 21. This score was six points higher than her pre-camp score and above the sample average of 18.85. Jessica’s BC score increased between post-camp one-month follow up (i.e., 19) and post-camp four-month follow up (i.e., 24). Her final score was six points higher than her pre-camp score and notably higher than the sample average of 19.70. Though Jessica’s follow-up GSW score (i.e., 23) decreased by one point from her post-camp one-month follow up score, it was four points higher than her pre-camp score. This final score was higher than the sample average of 21.10. All three of Jessica’s follow-up self-perception scores were higher than the average scores across campers, which may indicate that she was particularly receptive to the experiences camp offered and that this growth was sustained over time. At camp, Jessica engaged in more activities, established peer relationships more easily, and generally had more positive experiences than her siblings. Thus, Jessica may have emerged from camp with more skill growth, reflected in more social skills, increased ability to behave and cooperate in a range of situations, and enhanced sense of self-worth. This growth may have been sustained over time with the addition of other life factors (e.g., experiences at school and at home). See Figure 1, Panel C.
According to Ms. Jones’s report, Jessica’s total difficulties score decreased by five points between post-camp one-month follow up and post-camp four-month follow up, with a final score of three that is lower than her normed peer group average (i.e., 28th percentile) and the current sample average (M = 12.32). Ms. Jones noted reductions in emotional symptoms, hyperactivity, and peer problems. In general, Ms. Jones’s report of improvements in emotional and behavioral difficulties for Jessica is consistent with Jessica’s self-perception scores. Jessica’s prosocial behavior score decreased by one point, to a score of 8, which places her in the 37th percentile of her peers, but slightly above the current sample average (M = 7.41).
11 Treatment Implications of the Case
All three of the Jones siblings endorsed small to medium improvements in behavioral competence, which provides preliminary support for the notion that camp creates opportunities for children to learn how to manage their behavior in various situations. Research suggests that clear, consistent behavioral expectations and behavior management strategies, like those implemented at Camp HOPE, support children’s behavioral competence (Cartledge & Lo, 2006). Thus, it is possible that Camp HOPE could increase its long-term impact by offering parent training in some of the core principles of the camp curriculum. Additionally, Camp HOPE may enhance its effects by placing more emphasis on teaching children emotion regulation strategies and establishing a plan for maintaining emotion regulation skills post-camp. A focus on providing youth with transferable skills that can be used in multiple settings may lead to ongoing long-term camp benefits. Regarding children’s social competence, findings imply that camp offers opportunities for social skill development. It is theorized that social skills are developed through participating in activities designed to promote cooperation and team-building, as well as through real-time support from adults when navigating potentially challenging peer interactions. If gains in social competence are attributable to camp, it is important that children learn to translate these skills to other settings. Camp HOPE could support this goal by providing ways to cultivate skills that apply to children’s real-life experiences and helping children master these skills through repeated practice, identification of how skills apply to life outside of camp, and discussion of how children’s strengths can support their social skills.
Camp differentially affected global self-worth, such that the two Jones children with internalizing and externalizing difficulties at pre-camp reported reduced GSW, whereas the Jones child with no notable internalizing or externalizing challenges (Jessica) reported increased GSW after participating in camp. Camp HOPE offered opportunities for personal growth and expansion of self-concept, but it also presented potential challenges, including separation from home/primary caregiver(s), some negative peer interactions, high expectations for cooperative behavior, and activities that move children out of their comfort zone. Children with emotional and behavioral difficulties may lack the foundational skills to navigate these challenges, which may increase their likelihood of experiencing camp-related difficulties or internalizing negative experiences. Of note, follow-up scores suggest that the potentially negative impact of Camp HOPE on GSW dissipated, while the positive effects of camp were sustained over time.
Camp HOPE appears to foster some forms of positive growth, but it may have a different impact on children depending on their unique characteristics, personality traits, and experiences. For example, it is possible that Anthony would have benefited from a more rigid behavioral management system and individualized support to build regulation and attention skills. Nicole, on the other hand, may have benefited most from a kind and supportive peer environment and opportunities for positive affirmation, as well as personalized support for engaging in activities and practice in having a more positive attitude. Jessica may have benefited most from the existing structure of Camp HOPE, in which counselors and adult staff provided substantial support and encouragement. Thus, it is important to consider how different children might benefit from distinct components of the camp.
12 Recommendations to Clinicians and Students
This case study illustrates that Camp HOPE may foster improved self-perception among Black/African American children who have experienced victimization. Although formal mental health services are often stigmatized or present practical barriers to care, Camp HOPE offers an intervention format that may be more accessible and acceptable. Thus, it is recommended that interventions aiming to support families who are not engaged in formal mental health services continue to explore alternative formats that enhance engagement, such as camp-based care.
At Camp HOPE, staff and counselors represented the communities that campers were from, which likely made them more relatable to campers and allowed them to serve as role models of local individuals. Thus, it is recommended that future camps recruit locally representative staff and counselors. It is also recommended that staff be well-versed in trauma-informed care to offer the most appropriate support to campers. Although the current study did not examine mechanisms of change, trauma-informed care is a well-established approach to supporting youth who have experienced victimization. Finally, given that some of the campers have experienced loss and abandonment, camp staff must strategize how to manage the end of camp and associated separation of campers from their counselors and peers.
Future research should supplement existing survey data with more in-depth qualitative interviews in which both children and caregivers can provide insight into how children see themselves and how camp impacts their self-perception. Dismantling studies may be valuable to understand which components of camp are most effective at promoting self-perception. Such evaluations should include measures of behavioral targets reported by campers and counselors, which would help link specific intervention practices to observable outcomes and clarify mechanisms of change that the current study cannot definitively identify. Finally, future research should examine how camp impacts other indicators of psychological functioning.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the University of Memphis Research Fund (principal investigator: Kathryn H. Howell) and the Memphis Research Consortium (principal investigator: Kathryn H. Howell). This support does not imply endorsement by the funding agencies of the study’s research conclusions.
