A Systematic Review of Therapeutic Recreation Camp Impact on Families of Children With Chronic Health Conditions

Kelly E. Rea, BA; Lauren F. Quast, BS; Mary Gray Stolz, BA; Ronald L. Blount, PHD


J Pediatr Psychol. 2019;44(5):542-556. 

In This Article

Abstract and Introduction


Objective: Parents and siblings of children with chronic illnesses are at increased risk for experiencing psychosocial difficulties. Therapeutic recreation camps have become increasingly popular among these families. The current systematic literature review provides a synthesis of research on how these camps impact the parents and siblings of children facing a variety of chronic health conditions.

Methods: Databases searched: PubMed, PsycInfo, SportDISCUS, and Health Source Nursing/Academic Edition. Inclusion criteria included publication in a peer-reviewed journal between January 2000 and May 2018, written in the English language, and assessment of parent, sibling, or family outcomes.

Results: Twenty-one studies were included. Results indicated that camp attendance relates to positive changes in parent and sibling psychosocial outcomes. Additionally, parents report camp to be a place of social support and respite from daily life, and siblings find camp to be enjoyable and a place of belonging. Given the limited number of methodologically sound studies examining family functioning, it is not yet clear the extent to which camp influences family-level outcomes.

Conclusion: Overall, camp appears to have a positive impact on parents and siblings across chronic illness populations. Future research should specifically assess family outcomes, including communication and family functioning, and the impact of incorporating well-defined interventions and education programming into the traditional therapeutic recreation camp experience.


It is well known that children with chronic illnesses often experience negative effects on their health-related quality of life (QoL), behavior, and psychosocial functioning, however parents and siblings of these children are also impacted. Parents are challenged to balance work, household routines, medical care for their ill child, and ongoing care for their other child, and may experience increased marital strain and greater financial burden. Parents must tend to the needs of the ill child, often leaving siblings to take on adult-like responsibilities (e.g., caretaking roles, greater independence) and cope with their own fears and feelings regarding the illness (Hancock, 2011). Thus, parents and siblings of children with chronic illnesses are at risk for psychosocial difficulties and health-related challenges (Barlow & Ellard, 2006; Cousino & Hazen, 2013; Pinquart & Teubert, 2012).

The long-term nature of a chronic illness or health condition is a source of ongoing stress for the entire family (Wallander & Varni, 1998). Families must cope with an often unexpected diagnosis, long-term repercussions, and the potential for a significantly altered or shortened life. As such, research has sought to understand the impact of a child's chronic illness on siblings and parents. Parents of children with chronic illnesses report significantly greater levels of parenting stress and poorer psychological adjustment as compared to parents of healthy children (Cousino & Hazen, 2013). Across several chronic illness groups, siblings also show psychosocial difficulties, regardless of their ill sibling's disease severity (Sharpe & Rossiter, 2002). However, siblings of children requiring greater day-to-day care are more adversely impacted than those requiring less daily attention (Sharpe & Rossiter, 2002). Additionally, among the negative effects experienced by siblings, internalizing behaviors (i.e., anxiety and depression) have been shown to be more prevalent than externalizing behaviors (Sharpe & Rossiter, 2002). Thus, the adjustment of parents and siblings remains an important focus for intervention.

Therapeutic recreation camps for children with chronic illnesses and their families are an increasingly popular method of psychosocial intervention. Children with chronic medical conditions often report positive psychosocial change after attending camp, including increased hope and positive outlook regarding their future (Woods, Mayes, Bartley, Fedele, & Ryan, 2013), however the impact of therapeutic recreation camps extends beyond the child with the chronic illness. Family members who attend camp report their own benefits, including gaining a social support network of families experiencing a similar situation, greater family bonding, and a new perspective about their ill child or sibling (Barr et al., 2010; Kiernan, Gormley, & MacLachlan, 2004; Williams et al., 2003). A previously published literature review synthesized the research examining the impact of camp programming for families of children with cancer (Martiniuk, Silva, Amylon, & Barr, 2014). Martiniuk and colleagues' (2014) review found that oncology camps for siblings improved emotional skills and self-esteem. Similarly, parents reported camp to be a positive respite that ultimately improved their psychosocial well-being (Martiniuk et al., 2014). However, given the psychosocial and medical differences among pediatric chronic illness populations (Sharpe & Rossiter, 2002), it is important to better understand the ways in which families affected by other chronic illnesses experience therapeutic recreation camps. This literature review sought to provide a synthesis of research on how therapeutic recreation camps impact parents and siblings across a variety of pediatric chronic illness populations.