Studies have shown that there is an association between exposure to people with intellectual disability who are aggressive and burnout in the staff who support them. Little is known, however, about the experience of summer camp staff who work with this population. This study examined the relationship between aggression and burnout in 169 staff members working at summer camps in Ontario, Canada. The questionnaire used included demographic information, exposure to aggression (frequency and severity), and the Maslach Burnout Inventory—Human Services Survey. Results showed that summer camp staff was exposed to frequent and relatively severe aggression. Severe exposure was associated with higher levels of emotional exhaustion and personal accomplishment. Given that summer camp staff is likely to be exposed to at least some aggression in their summer job, and that this aggression is associated with burnout, greater attention should be paid to training and supporting staff for when aggression occurs.
Burnout among staff who support people with intellectual disability (ID) has been shown to be associated with aggression experienced at work (Chung & Harding, 2009; Hastings & Brown, 2002; Hensel, Lunsky, & Dewa, 2012; Howard, Rose, & Levenson, 2009). Maslach, Jackson, and Leiter (1996) characterized burnout as “a syndrome of emotional exhaustion, depersonalization, and reduced personal accomplishment” (p. 4). This construct is complex, and many factors have been reported to play a part in the development of its dimensions (Maslach, Schaufeli, & Leiter, 2001). Specifically, the demographic variables of age and years of experience (which are often closely associated) are frequently found to predict burnout (Maslach et al., 2001). Gender also has a smaller but replicable impact on burnout, with males scoring higher in depersonalization (Hallberg & Sverke, 2004; Maslach et al., 2001; Mitchell & Hastings, 2001) and females slightly higher in emotional exhaustion (Maslach et al., 2001). Similarly, individual personality characteristics and coping style, as well as organizational support, are important variables (Maslach et al., 2001). The relationship between aggression experienced by ID staff and their level of burnout is also multifactorial and has been found to be mediated to some extent by various individual and organizational factors (see Rose, 2011, for review).
At the service level, burnout has been associated with intention to leave organizations, actual staff turnover, and absenteeism, which can negatively impact the quality of services people with ID receive (Rose, Home, Rose, & Hastings, 2004). Staff stress has been shown to be associated with reduced interaction with clients (Rose, Jones, & Fletcher, 1998), which, in turn, can contribute to the development and maintenance of aggressive behavior (Hastings & Remington, 1994). In addition, high staff turnover can be a significant challenge. One study showed that over a quarter of staff in community settings for people with ID experienced emotional distress, and more than one third reported that they would likely seek new employment in the next year (Robertson et al., 2005). Consequently, this can create an unstable and disruptive environment for service users because it produces a continued loss of people who are familiar with the service users' unique needs and vulnerabilities (U.S. Department of Health and Human Services, 2006).
The presence of and association between aggression exhibited by those with ID and staff burnout in hospitals (Chung & Corbett, 1998), community residential settings (Chung & Harding, 2009; Howard et al., 2009; Mitchell & Hastings, 2001), and schools (Hastings & Brown, 2002) has been previously documented. However, there seems to be a gap in research on the occurrence of aggression and burnout in other, more temporary settings, such as the summer camp environment. Staff in such temporary settings may be at greater risk for burnout because they have less experience handling aggression than permanent staff and may be prone to have more difficulty coping, given the transient nature of their work and limited training. Alternatively, temporary staff may be less likely to experience burnout because burnout, by definition, is a prolonged response to stressors over time. According to one theory discussed in a review by Maslach et al. (2001), the burnout dimensions may develop sequentially over time, with emotional exhaustion occurring first, leading to depersonalization, and eventually to lack of personal accomplishment. It may be, therefore, that temporary staff are at greater risk for emotional exhaustion than the other two burnout dimensions.
No prior research has considered how frequently people who attend camps behave aggressively and the impact of such aggression on staff. However, one study examined staff satisfaction working with people with developmental disabilities as it relates to summer camp job retention (Lawrence, Glidden, & Jobe, 2006). In this study of 48 summer camp counselors, job satisfaction predicted their decision to return to camp, and staff with previous experience tended to have more positive attitudes. The most frequently listed reason counselors did not want to return the next summer was stress/exhaustion, but the cause of this exhaustion was not examined.
The purpose of the present study was to highlight the experience of summer camp staff by reporting on the occurrence of exposure to client aggression in the summer camp setting and examining whether or not it is associated with burnout in staff.
Survey Design and Instruments
This study used a self-report questionnaire adapted from a questionnaire from a parallel study that looked at direct support staff working with adults with ID across Ontario (see Hensel et al., 2012, for details). This original questionnaire was developed by the study authors with input from relevant stakeholders and staff who provide services to adults with ID in Ontario, Canada. Questions in the summer camp version of the questionnaire were adapted to reflect the camp setting and examined the experience of working with adults and children with ID. Data collected included demographics, occupational characteristics, measures of exposure to aggression, and a measure of burnout using validated instruments where available.
Exposure to aggression
Aggression was defined as “any verbal, non-verbal or physical behavior displayed that is threatening or caused harm to self, others or property” (Mitchell & Hastings, 2001). Frequency of aggression was rated on a 5-point scale from never to almost every day. Staff were asked to report the most severe form of aggression they had experienced in each of the four domains of aggression: aggression toward them, aggression toward others, self-injurious behavior, and property aggression. This scale has been used previously and produces a composite severity of aggression score by summing the z-transformations of the four domains (Hastings & Brown, 2002). In addition, staff rated their perceived severity on a numerical scale from 0 (least severe) to 100 (most severe).
Staff burnout was measured using the Maslach Burnout Inventory—Human Services Survey (MBI-HSS; Maslach et al., 1996). The MBI-HSS contains 22 statements that measure three aspects of burnout: emotional exhaustion (feeling that they have little to contribute to the work environment at a psychological level), depersonalization (negative and impersonal attitudes toward clients), and lack of personal accomplishment (tendency to evaluate their competence and job achievements negatively). There are well-established cutoffs for each burnout dimension, and it has been shown to be valid and reliable for use with staff who support people with ID (Hastings, Horne, & Mitchell, 2004). In addition to completing the MBI-HSS, staff was asked if they had taken time off work (yes/no) or had experienced emotional difficulties (yes/no) as a result of exposure to aggression.
A review of the Ontario Camps Association Web site was performed to develop a list of eligible summer camps across the province of Ontario. All camps that specified that they included children or adults with ID in their programs were included in the list. Camp directors were subsequently approached about the study by the first author via e-mail with a standardized information letter explaining the project. A second follow-up email and phone call were made to all camps that did not initially respond. Twenty-eight camps were contacted, and of those, 20 camp directors followed up. When a camp agreed to participate, additional details were provided, and directors were given the option of having their staff complete the survey as an online link or with mailed hardcopies. In total, 16 of the 20 camps who responded to the original request participated in the study. These camps did not differ from the camps that opted not to participate in that all camps described provided services to people with developmental disabilities according to their Web site descriptions. Ten camps mailed back completed surveys; five camps had staff complete them online; and one camp provided staff with the option to complete the paper or online version. Three camps declined participation because of the workload involved and/or they felt their staff would not be able to contribute to the study in a meaningful way. One camp did not end up participating despite initial interest because the agency that ran the camp was unable to provide ethics approval for the study in time. Staff participation in the study was completely voluntary and anonymous. Research ethics approval for this study was granted by the Research Ethics Board at the Centre for Addiction and Mental Health in Toronto, Canada. One of the camps participated in 2009 and again in 2010, but staff members who completed the survey the first summer were asked not to complete it a second time. The remaining camps participated in the summer of 2010 only.
The 16 participating summer camp programs consisted of 10 day camps, 5 residential camps, and 1 camp with both day and residential sites. In total, 191 surveys were returned, however 22 were removed from analyses because more than 90% of items were incomplete. The final sample included 169 staff. The demographic and occupational characteristics of the final sample are summarized in Table 1. There were no demographic differences between staff members who completed the online and paper versions of the questionnaire.
The types of aggression experienced and their frequency rates are presented in Table 2. Sixty-eight (40.2%) staff indicated they had been exposed to aggression almost every day, and only two staff (1.2%) reported no exposure at all. The perceived severity scores ranged from 5 to 90 (M = 58.01, SD = 20.99), with 109 (66.9%) staff members reporting scores above 50. The frequency, perceived severity, and composite severity of aggression were all significantly positively correlated (see Table 3).
Mean burnout scores were 24.46 (SD = 10.94) for emotional exhaustion, 5.77 (SD = 4.98) for depersonalization, and 40.76 (SD = 5.34) for personal accomplishment. Being female was a significant predictor of emotional exhaustion, F(1) = 7.98, p < .01, and age was negatively associated with depersonalization, F(1) = 7.25, p < .01, but no other demographic variables were associated with any of the three burnout dimensions. The percentage of workers who scored in the ranges indicative of burnout were 40.7%, 13.8%, and 5.1% in emotional exhaustion, depersonalization, and personal accomplishment, respectively. Five staff (3.0%) reported a physical injury resulting in time off work as a result of aggression. Eighty-eight individuals (53.7%) said they had struggled with emotional difficulties that they felt were the result of aggression experienced at work.
Partial correlations were performed to examine the relationships between the exposure variables and the dimensions of burnout, controlling for gender and age, as these variables were significantly associated with burnout in this sample. As indicated in Table 3, there was a significant positive partial correlation between the composite aggression severity score and emotional exhaustion, r(138) = .222, p < .01, as well as between composite aggression and personal accomplishment, r(138) = .170, p < .05. Perceived severity was partially correlated with emotional exhaustion, r(138) = .222, p < .01, and personal accomplishment, r(138) = .176, p < .05.
Despite the frequent and severe nature of the aggression they were exposed to, this group of summer camp staff appears to have coped relatively well, with very few staff missing work, low levels of depersonalization, and few problems with personal accomplishment. That being said, over half of staff reported to be struggling with emotional difficulties related to aggression, and 40.7% of staff scored above the high cutoff on the emotional exhaustion dimension of the MBI-HSS, indicating they are possibly burnt out or at a high risk of becoming so. Lower age was associated with more depersonalization that may reflect the lack of experience in terms of both work and life as well as a more detached view of the job. Female gender was associated with more emotional exhaustion, which has been reported in the literature (Maslach et al., 2001). When controlling for age and gender, significant correlations between aggression and both emotional exhaustion and personal accomplishment were found. Thus, aggression is not the only factor contributing to burnout in summer camp staff, but it is an important one worthy of further examination.
Comparison with Other Studies
Because of differences in methodology, definitions, and populations, prevalence rates of aggression among individuals with ID have been found to range anywhere from 2% to 60% (Crocker et al., 2006). Few studies, however, have characterized the frequency of staff exposure, and no such studies have reported on aggression at summer camps. One comparison that can be made is between the present study and a previous study of permanent staff across Ontario, which used the same questionnaire (Hensel et al., 2012). Compared to Hensel and colleagues' study, summer camp staff appear more likely to be exposed to aggression almost every day (40.2% compared to 25%) and less likely to report no exposure at all (1.2% compared to 8%). The mean perceived severity also appeared to be slightly higher for staff in summer camps (M = 58, SD = 21, compared to M = 53, SD = 35). Whether staff in summer camp settings are indeed exposed to more frequent and severe aggression than staff in residential settings and day programs or if this reflects a reporting bias needs further research. It would also be important to learn how prepared staff are for the degree of aggression they encounter, in terms of their orientation and training before camp begins.
In terms of burnout, emotional exhaustion scores from the present sample appeared higher than those obtained in studies of permanent staff (e.g., Chung & Harding, 2009; Howard et al., 2009; Mitchell & Hastings, 2001). Although direct comparisons are difficult, the data suggested that despite higher levels of emotional exhaustion, summer camp staff reported higher rates of personal accomplishment (less supportive of burnout) than staff in other settings. Thus, the burnout “profile” may differ for young seasonal staff than for staff more typically studied with the MBI. This lends support to one possible theory of burnout that suggests that emotional exhaustion emerges at an earlier burnout stage than depersonalization and lack of personal accomplishment (Maslach et al., 2001). It may not make sense to study all three components of burnout in temporary staff, but this study would suggest that emotional exhaustion is still an important construct to measure. Whether emotional exhaustion has the same clinical outcomes as it does in more experienced and permanent staff should be examined. It would also be important to determine the effect of organizational responses in the camp environment on emotional exhaustion in its staff.
Similar to some prior studies of permanent staff (Chung & Harding, 2009; Hastings & Brown, 2002; Howard et al., 2009; Mills & Rose, 2011), our study showed associations between aggression and emotional exhaustion. Other studies have found associations between aggression and depersonalization (Hastings & Brown; Merecz, Rymaszewska, Mościcka, Kiejna, & Jarosz-Nowak, 2006), but our study did not. Differences may be related to the type of work settings studied along with how aggression is measured. Interestingly, when controlling for age and gender, the composite aggression score and the perceived severity of aggression were significant but weakly associated with personal accomplishment, such that those individuals with higher aggression ratings reported higher levels of personal accomplishment. This is the opposite from what might be expected but has also been reported elsewhere (Hastings & Brown; Hensel et al., 2012; Howard et al.). Whether temporary staff have a different sense of well-being or ability than more seasoned employees is worthy of further examination. It may be that, in the short term, staff who are responsible for managing aggression in their job feel a sense of accomplishment but that, in the long term, it could affect them differently. It would be important to include potential mediator variables such as self-efficacy to manage aggression to understand this relationship better.
The present study has several limitations. First, the questionnaire was self-report and therefore subject to recall bias. Furthermore, there was no objective measure of exposure to aggression available for comparison. Indeed, relying on formal records of aggressive incidents is also problematic because of under-reporting by staff (Kiely & Pankhurst, 1998). Second, the questionnaire was voluntary, and the staff who responded only represented a proportion of all summer camp staff. There is no way to know if there are any significant differences between those who chose to respond and those who chose not to respond. Last, the cross-sectional nature of the study can only determine associations and does not infer causality. Further assessment of the summer camp staff experience should consider factors beyond aggression that may influence burnout (e.g., psychological variables such as self-efficacy regarding aggression, personality variables; workplace factors such as camp type, support and resources, scope of staff training). Such variables have been measured in nonsummer-camp settings (see Rose, 2011, for review) and should be explored in camps as well to determine whether similar patterns are found.
Studying the experiences of staff in summer camps advances the literature on burnout among staff in the ID sector. How staff function greatly influences the success of such programs, offering recreational opportunities for people with ID and needed respite for their families. The findings from this study would suggest that summer camp staff need training not only to manage aggression and reduce its likelihood, but also to manage their own emotional responses to the accompanying stress. Investment in training summer camp staff may lead to the greater safety and satisfaction of people who attend camps and their families and potentially increase staff retention. Staff with a good experience are more likely to return the next summer (Lawrence et al., 2006), and they also may be more likely to choose to develop careers working with this population. Conversely, with an unsupported or stressful experience, staff may develop negative attitudes and move away from the field. Schalock (1998) suggested that chance events play prominent roles in people's lives, including getting involved in the ID field; however, it is internal satisfaction, likely influenced by positive experiences, that motivates people to continue working with the ID population. With increased emphasis on targeting the next generation of professionals in the ID field (Havercamp, Tassé, Lunsky, & Garcin, 2003), further research on the experience of young staff is warranted.
The authors would like to acknowledge the camp support staff members from the province of Ontario, Canada, who responded to the survey used in this study. We would also like to extend thanks to the agencies and individuals from the Ministry of Community and Social Services of Ontario who supported us in these research efforts. Dr. Carolyn S. Dewa's Applied CHIR/PHAC Chair supported this work. The research infrastructure at the Centre for Addiction and Mental Health is supported by the Ministry of Health and Long-term Care. The results and opinions expressed in this article do not necessarily reflect those of the supporting organizations.
Editor-in-Charge: Glenn T. Fujiura
Clara Ko, Centre for Addiction and Mental Health Dual Diagnosis Program, Toronto, Ontario Canada; Yona Lunsky (e-mail: firstname.lastname@example.org), University of Toronto, Dual Diagnosis Program, 501 Queen Street West, Toronto, Ontario M5V 2B4, Canada; Jennifer Hensel and Carolyn S. Dewa, Centre for Addiction and Mental Health Work and Well-being Research and Evaluation Program, Toronto, Ontario, Canada.