Keeping them at camp: how to work with youth at risk to prevent expulsions from recreation services.

The 8-year-old boy stood in the gym stunned with disbelief. It took him a few seconds to realize that, indeed, it was his name that was just called. He slowly began to walk toward the front of the room for the coveted "Camper of the Week" award. Through his sobbing, the counselors could hear a muffled "thank you" being uttered.

The boy was soon surrounded by all of his fellow campers--many of whom have a history of expressing their mixed feelings by swinging a closed fist-but today, they were cheering and hugging this child who had just "beaten them" in a competition. As the child wiped his face on his sleeve and carefully worked the plastic medal over his head, the counselors couldn't help but watch through teary eyes and recall that the week before, this very same child had a severe breakdown that resulted in a violent 35-minute tantrum.

Many summer camps and recreation programs have at least one participant who continually disrupts activities with hyperactive, aggressive or oppositional behavior. It is easy to label these children "bad kids." The response to this label is behavior that takes a toll on camp staff. These children may have an emotional or behavioral disorder such as Oppositional Defiant Disorder, anxiety or Attention Deficit Hyperactivity Disorder. However, if the disorder is dealt with appropriately, the entire program will benefit.

Children with emotional and behavioral disorders have difficulty processing social information, which frequently results in peer rejection. Their inadequacy with making and keeping friends puts them at risk for later antisocial behaviors. Studies have found that programs like summer camps provide an opportunity to practice social skills, and can have positive, long-lasting effects for these children.

However, when these children express their frustrations through aggressive and disruptive behaviors, it becomes challenging to safely mainstream them into a group. Expulsions can be common and will likely further a child's belief that they are "bad" or "uncontrollable."

For seven years now, Children's Memorial Hospital in Chicago has been filling a void for these children with an out-patient program called Children's Therapeutic Summer Camp (CTSC). The experiences and techniques of CTSC can prove to be a valuable resource for creating an inclusive summer camp or recreation program that will allow participants to have fun and learn valuable life skills.

Created in 1998, under the leadership of Colleen Cicchetti, Ph.D, CTSC provides a structured therapeutic environment, which includes recreational therapy, social skills group, horticultural therapy, education, field trips and parent training. The staff includes psychologists, social workers, a certified therapeutic recreation specialist, recreation therapy interns and Milieu therapists, who treat patients by manipulating their environment.

The camp was an answer to a post-hospitalization survey that discovered only two percent of parents utilized community recreation referrals which identify appropriate leisure resources for patients after discharge. On those surveys, parents and guardians reported that it was difficult to find programs that would "put up with [their child's] behavior" or were "trained appropriately in dealing with situations." Parents continually reported difficulties within the camp setting.

One parent of a 2004 CTSC camper states, "I was constantly getting phone calls to pick up my child early." Another parent admitted that she was afraid of what the camp staff would do when her child demonstrated his anxious behaviors. She was concerned that he would repeatedly be told that he was "bad" and it would hurt the progress he had made with his self-esteem. Other respondents reported that experiences were limited because their child was not allowed to attend field trips without a parent or guardian.

CTSC provided a therapeutic environment for these children where they could safely work on social interactions and learn positive coping skills to help them succeed in the community setting. The evaluations from parents, children, clinicians and community agency partners have been overwhelmingly positive. However, CTSC is costly and limited in the number of children it can serve. For many parents of children with behavioral disabilities, community-based summer camps are the only option they can afford.

Structure

Uncertainty is cause for concern for most people, but for a child with an anxiety disorder, this concern can be overwhelming. One parent explains how this affects her child.

"One day I forgot to remind my son that he was going to the firehouse for a field trip. It was not a big deal because they only had to walk two blocks and they even ate lunch at school like every other day. However, he was not able to stop focusing on how I did not remind him. His entire day was ruined. He wasn't prepared for the change and could not complete his tasks."

A number of methods can help reduce a child's anxiety at camps or recreation programs so they can relax and focus on the important aspects of learning new skills and making friends. These include the following:

* Have a weekly calendar sent home to parents with similar schedules each week. Encourage parents to review the schedule with the child the night before.

* Start each camp day with a community meeting that includes a brief overview of the schedule, emphasizing any changes.

* Allow parents to show the child the facility a few days before camp starts. If possible, have an open house for all campers with staff present to meet the parents and children.

Interaction with Parents and Staff

Parents want to know what is happening with their children, especially a parent of a child who frequently has difficulty in social settings. "I wasn't there at camp, but I knew what was going on and it gave me peace of mind," one parent said, referring to the few minutes each day that the CTSC staff would spend discussing the child at check-in and check-out.

Another parent says that she has noticed "some parents want to bury their head in the sand and hope the problems will go away. I, on the other hand, want the staff to know the issues with my child and what they should and shouldn't do about them. The staff needs to know things like my son's ways of dealing with stress. It can be very confusing and possibly scary to the staff otherwise."

There are a number of ways to enhance communication with parents:

* Ask on the registration form if participants have a behavioral disorder, such as ADHD, Oppositional Defiant Disorder or anxiety. This will allow parents an opportunity, if they choose, to provide you with a better understanding of the types of behaviors their child may exhibit. "Many camps avoid asking questions about problem behaviors and end up being unprepared and over-reactive with the consequences, including expulsion," says Cicchetti.

* Teach staff how to talk with the parents. Parents do not want to hear simply that their child is "bad." They want to hear about the "things that still need to be worked on," intermixed with the positives of the day.

* Remind staff to separate the child from the behaviors. There is no such thing as a "bad child," only a child who demonstrated a "bad behavior." This mindset will help staff reframe their words so they can have productive conversations with parents.

Positive Reinforcement 

When counselors want to increase a behavior, they should provide consequences that give rewards. This process of promoting positive pro-social behavior has been shown to be more effective than punishment procedures. When you praise one child, and identify clearly the behavior you are praising, other children will notice and realize what they can do in order to receive the praise as well.

Instead of saying "Susie, you are the only one not sitting down," say "I like how Johnny is sitting down, and Jane is doing a great job as well." It is easy to catch someone being bad, but encourage your staff to "catch them being good." Ask them to consciously attempt to provide verbal praise to each child at least once a day. The praise can be for behaviors as simple as waiting patiently, raising hand, sharing, or apologizing.

Instruct the staff to give praise immediately following the positive behavior. Children who are having difficulty may benefit from an individualized reinforcement program. Allow the child to receive points for positive interactions. Specific goals should be determined with the participant, parents and staff.

Do not allow points to be taken away once given--the motivation inherent in the points is decreased if the child feels that they will lose them. Instead, have separate penalty procedures for negative behaviors. A back-up reward such as basketball time with staff may be necessary to ensure success.

Place Children with the Right Group

Know your campers and place them in a group that will help them succeed; if something is not working, do not be afraid to change it. One parent described a typical personality clash that may affect her child. "Placing an active, impulsive child with someone like my son, who has anxiety issues, can cause problems. It seems to me children with anxiety work much better with a mellow, calm and dependable person. My son is naturally drawn to this type of person at school."

When a possible poor fit is noticed, staff should discuss the problem and, if feasible, adjust the groups. If that cannot be done, lead a calm discussion between the two participants away from the others so they can work on an agreement that will make their camp experience better. Any agreement made should be written on paper and include consequences if broken. It is best if the children choose appropriate mutual consequences themselves instead of the staff imposing them.

Time-Outs

If used properly, time-outs can help a child calm him or herself and adjust their behavior before it becomes too difficult for the child to control. For time-outs to be effective, explain the proper time-out techniques with staff (see sidebar on page 56).

Have a role-playing session during staff training. While your staff may snicker at first, it will be a perfect opportunity to provide feedback and problem solve so they can learn to effectively initiate and end a time-out. In addition, make sure rules are clear to participants. Be consistent with timeouts every time a rule is broken and make sure penalties are always given in a non-punitive manner, maintain a teaching and protecting tone rather than sounding as if you are out for retribution.

When administering a time-out, allow the child an opportunity to make decisions whenever possible (i.e. "you can either put down the ball or you will have to take a time-out"). Have back-up plans if a child refuses to take a timeout and staff does not immediately have time to deal with the child (i.e. "You can either take your time-out now for three minutes or sit out of free time for five minutes"). Always follow through with proposed consequences.

Inclusion

David Kersner, director of the Looking-glass summer camp that helped to mainstream the CTSC disciplinary process, says, "Children have amazing power to be both inclusive with their friends as well as exclusive, even more so than adults. What we need to do is push them in the direction of inclusion and it will take off."

A father of a CTSC camper worried that his child would not make friends at Lookingglass because she would "appear to be special and different" if she was with the CTSC camp two of the five camp days. However, in the end, David's philosophy held true. The daughter made many close friends at both camps and the father became one the biggest advocates for CTSC. Follow these tips for inclusion success:

* Make your entire staff set inclusion as a goal.

* Award staff members for making outstanding efforts with inclusion.

* Be creative in your approach. Motivate your staff and you will be amazed at the success you will see.

"To think these kids had no place to go before this, and now ... it is like a world of opportunities are opened to them," says Jim Harisades, the director of Child Advocacy at Children's Memorial Hospital. It was his forward-thinking that helped CTSC acquire the money to start the program.

The world truly is opening up but the need is still very great. The 2000 U.S. Census indicated two million children in the United States have a mental disability, which does not take into account a 1995 study finding that an estimated 80 percent of all children with mental health problems are not diagnosed and remain untreated. No matter how much CTSC expands, there will be children in need of a program for structure, guidance, social skills education and all of the other many benefits recreation provides.

Steps to an Effective Time-Out

Time-out for non-compliance: Three minutes

1. Observe the direct behavior you want to decrease.

2. Give the command in a clear, specific and positive manner.

3. Wait quietly for five to 10 seconds for an appropriate response from the child.

4. If the child responds appropriately, praise him or her verbally.

5. If the child does not do as told give him or her a warning with a choice: "You can either stop yelling or you will have to take a time-out."

6. Wait quietly for five to 10 seconds.

7. If the child responds appropriately, praise him or her verbally.

8. If the child does not do as told, give the time out. Say, "You have to take a time out." The child should be siring in order to start the 3 minutes. Do not engage in conversation with the child during time-out.

9. At the end of the time-out, talk to the child about why they received it.

10. Discuss possible coping tools they could use next time, (i.e. deep breathing, take space, count to 10, ask for help, ask permission to do push-ups).

Aggressive time-out for more serious infractions: 10 minutes

If the action is aggressive in nature (i.e. hitting, spitting, threatening etc.), do not give a warning. Try to remain calm and separate the child from the staff or peer who is upsetting him or her. When the child is sitting, start the 10-minute timeout. Continue with steps 8 through 10.