CAMP HOPE

1. CAMP HOPE Sandra Rangel, MS.,CTRS Recreation Therapy Director Coastal Harbor Health System Savannah, Georgia

2. Objectives • Objective 1: Upon successful completion of this session, each participant will be able to identify three interventions to use within the behavioral health setting • Objective 2: Upon successful completion of this session, each participant will be able to understand the value of a application of a day camp program within the restraints of a lockdown facility by verbalize a potential benefit of participation involved • Objective 3: Upon successful completion of this session, each participant will be able to identify an appropriate behavior management technique to utilize when leading recreation therapy interventions in a behavioral health setting

3. Introductions Who Are You...Who...Who???

4. Format of the Session • Part I- Education on Recreation Therapy in a Behavioral health setting. Understanding the Role of the CTRS and the Client Population. • Part II- Camp Hope-APIE process • Part III-Hands on Interventions-application of behavior management techniques

5. TEST • Identify 3 potential interventions to utilize with youth within the behavioral health setting and a goal for each • Identify 3 potential benefits of applying camp philosophy in a lockdown residential setting • Situational question- If during your session, you identify a patient refusing to participate and bullying peers, identify 2 behavioral interventions to utilize to alter the behavior.

6. Coastal Harbor The mission of Coastal Harbor Treatment Center is to deliver high-quality, affordable education and treatment services to at-risk individuals with special needs.

7. Residential Services • Individualized Programs • Educational Services • Recreational Therapy • Treatment Team Model • Sex Offender Treatment for males and females • Sex Offender Treatment for clients with developmental delays • Treatment for clients with developmental disabilities • We serve youth from ages 4 to 17 • 133 Bed Facility

8. Client Population • Depression • Bipolar Disorder • Conduct Disorder • Anxiety Disorders

9. Major Depression is not a single symptom but a cluster of symptoms. Most likely to present when there has been a change in thought pattern, feelings and/or behavior manifests itself in the following symptoms (Manassis and Levac 2004): Down Mood Increased Anger/hostility Suicidal Isolation/ withdrawing tendencies Lack of motivation to engage in activity Often patients will need assistance in finding outlets to express negative feelings or to develop a positive feeling of self-worth Depression

10. …experience unusual, and sometime drastic, shifts in mood, energy, thoughts, behavior and ability to function that are out of proportion or unrelated to their environment (White, Preston 2009) Often patients will need to develop conflict resolution skills and as they at times will overreact in situations or jump to irrational conclusions Patients benefit from developing positive ways of expressing difficult feelings and emotions Bipolar Disorder

11. “Conduct disorder is a complicated group of behavioral and emotional problems. People with this disorder have difficulty following rules…have repetitive and persistent patterns of violating rights of others….characteristics of this behavior include: (Kaplan, Aguirre, Rater 2007) Aggression towards others or property destruction Difficulties with following rules Conflict with peers Often behavior leads to broken social supports/ family issues Engagement in negative leisure activities Conduct Disorder

12. Children exposed to a traumatic event such as a sexual or physical assault, death, abuse may develop PTSD….common systems are reliving the traumatic event through flashbacks, avoidance behavior or emotional numbing (Newby 2006) Also common anxiety disorders at CHTC Obsessive-compulsive disorder Generalized Anxiety Disorder Often patients will display difficulty in developing and maintaining trust Patients may be observed feeling anxious in attempting new activities Anxiety Disorders-Post Traumatic Stress Disorder

13. Self-Harm Behavior • Patients will at times engage in inflicting harm upon themselves • Two most common reasons children engage in self-harm behavior ( Kaplan, Aguirree, Rater 2007): • (1) To exhibit a sense of control of extremely painful and frightening experiences • (2) Help them escape from the feeling of numbness or emptiness

14. “Most kids truly want to comply with the rules and limits of their family and community. They derive satisfaction through this. When they are unable to meet expectations they begin to de-value themselves. Repeated disappointments can damage an adolescents self-esteem and lead to negative consequences…these failures can often cause a teen to feel a sense of ineffectiveness and hopelessness (Kaplan, Aguirre, Rater (2007)” Social: difficulty to initiate and sustain conversations distorted beliefs regarding friendships and the nature of friends withdrawn from social activities Leisure Deficits: distorted meaning of a “healthy leisure lifestyle” Needs of the residents

15. Role of the CTRS • Therapist and Educator • External Motivation • Enforcing Consequences • Providing acceptable rewards • Enforcing appropriate boundaries • Demonstrating ability to be a positive role model

16. Camp Hope • First Camp: Summer 2011 • Purpose: to bring a normalizing “Summer Day Camp” experience to residents in a lockdown facility • Goal: To provide interventions which are inspiring and motivational to the participants engaging in them

17. CTRS Focus and Goals-Camp Hope • Development of positive coping outlets • Decrease aggressive tendencies through physically engaging activities • Development of positive conflict resolution skills through problem solving activities • Develop healthy relationships through trust building activities • Increase positive feelings of self-worth • Engage in creative expression activities to aide in the expression of difficult emotions through a positive outlet

18. Determine the needs of the residents Know the diagnosis and characteristics of each of the participants Determine a goal for your program and measurable objectives Understand the constraints of your facility and safety considerations Understand your staffing situation within the department as well as in the facility in terms of ensuring safe monitoring of the patients Step One- Assess

19. Program Locations • Art Room

20. Program Locations • Gym • Pool • Court • Zone (Open green space) • Garden

21. Identify the categories of interventions which will meet pre-determined goals Assign your staff to each category and develop protocols for each area Develop a schedule within the limitations of your programming areas Nature Crafts Music and Movement Sports and Games Aquatic Games Teambuilding Cooking Special Events Creative Expression Step Two – Planning-Identify Interventions

22. Daily Schedule • Camp Hope- Tuesday July 5th • Quote: What oxygen is to the lungs, such is hope to the meaning of life.” Emil Brunner • TODAY: Dress like your favorite super hero! • Special Event: Camp Light, Songs and Unit HOPE Skits • On-Unit MHA lead activity: Unit Posters (Please bring to special event @3:15) • 9:30-10:15 • 2E- Music and Movement-Gym(Kaitlin) • 3N- Nature Crafts- Zone A (Sandra) • 1E- Pool Activities-Pool (Hayley) • 1W- Cooking-Art Room (Lauren) • 10:30-11:15 • Acute- Sports and Initiatives-Gym (John) • 3E- Music and Movement-Court(Kaitlin) • 1N- Nature Crafts- Café (Sandra) • 1S- Pool Activities-Pool (Hayley) • 2N- Cooking-Art Room (Lauren) • 11:30-12:15 • 1W- Music and Movement-Gym(Kaitlin) • 3W- Nature Crafts- Zone A (Sandra) • 1N- Pool Activities-Pool (Hayley) • 1E- Cooking-Art Room (Lauren) • 1:15-2:00 • 2N- Sports and Initiatives-Gym (John) • 1S- Nature Crafts- Cafe (Sandra) • 3W- Pool Activities-Pool (Hayley) • 2E- Cooking-Art Room (Lauren) • 2:15-3:00 • 3N- Music and Movement-Court (Kaitlin) • 3E- Sports and Initiatives-Gym (John) • Acute- On-Unit-Hayley • 3:15-4:15 • Special Event: Camp Light, Songs and Unit HOPE Skits • (All Resident’s welcome to attend the special event which are not on EP and have not had an incident in 72 hours. There must me 4+ residents in the unit skit. LF can perform in skit. Winning unit receives a pizza party!)

23. Daily format 2 location based activities 1 on-unit activity 1 special event activity Keep a copy of all protocols in a “camp notebook” for the CTRS staff to reference on a daily basis to on a daily basis Keep the theme of “hope” alive during activity and process It helps to have a theme each day for participation as it encourages “camp spirit” (example dress as your favorite hip hop artist) Start each day with a quote and have residents develop personal goals to work on through the day. Encourage healthy competition by motivating patients with “camp contests” Step Three- Implementation (Pointers for Success)

24. Purpose: Develop an “identity” for their unit in the context how the members of the unit as a whole goes through ups and downs. This will encourage participants to cooperate as they help relate their ideas of personal identity to a group identity Domain: Emotional, Social, Physical Safety- All equipment use monitored carefully by staff Overview-Patients will come together to “re-name” themselves as a positive attribute and display this through a group mural Goals: Self-Expression, Relaxation, Self-awareness, group cooperation HOPE PROCESS POINT? Creative Expression-Group Mural

25. Interventions Continued • Aquatics- Inner Tube Water Polo • Cooking- Ice Cream in a Bag • Nature- Sun Catcher Craft • Special Event- Obstacle Course

26. Safety Considerations • Co-ed activities • Self harm issues • Elopement Precautions • Modifications • Resident’s behavior: misbehavior creating an unsafe environment for self and peers

27. Reaction to Intervention Reaction to Staff Improvements for next year Surveys may be completed by the participants to evaluate the camp program An evaluative report summarizing the feedback can be written and information may be applied for the upcoming camp year Evaluation

28. BEHAVIOR MANAGEMENT

29. What is “Behavior?” attempt to meet a need or get a need met Residents must get their needs meet by staff when in a lockdown facility and freedom is taken away Behavior comes across as unmanageable because they can not meet their own needs (Irwin, Robinson and Pascoe 2006) Several of our residents are here for “bad choices” made in the past Utilize “management techniques” to help patient make more positive choices Understand that frustration arises in us as staff when a resident is not meeting a set expectation Behavior Management

30. 5 Step Method- Increase Compliance • Identify the problem- identify problematic behavior (resident begins swearing when asked to participate in group) • Tell the expectation- focus on a “do” behavior- (I expect that you will participate in this session without becoming aggressive towards your peers) • Have the expectation repeated back to make sure it is understood • Tell the consequence for compliance and non-compliance • FOLLOW THROUGH- Be consistent! (Windell 1994)

31. Setting Limits • Setting limits can reduce client’s anxiety by providing external control when client can no longer use coping skills (Irwin, Robinson, Pascoe 2006) • Increase structure by decreasing stimulation • Offer Choices by setting parameters with 2-3 choices • Give patient time to make a decision

32. Active Listening • “…used appropriately, active listening will usually lead to a reduction in the client’s level of tension…because they have been helped to verbally express their concerns, and felt heard and acknowledged in the process, clients will have no need to escalate their behavior in order to be understood ( Irwin, Robinson and Pascoe 2006)” • Reflect compassion, residents need to know you can be trusted before they open up to you

33. Positive Reinforcement • Children and teenagers learn to do things that lead to positive payoffs or positive consequences • There are three ways to reinforce compliant behavior (Windell 1994) : • Praise and Attention • Rewards and Privileges • Reminder Praise CHTC- Utilizes these techniques: • RT points incentive • Level system and acquisition of points • Point Store • Verbal Praise

34. TIME FOR THE FUN STUFF!!

35. Camp Hope Protocols • There will be 3 different protocols lead by a “CTRS” • In each there will be roles identified as “upset patient”, “staff” and “participants” • Please be mindful of “behaviors,” “behavior management techniques” and “goal of activity.” • ANY VOLUNTEERS????

36. Music and Movement- Hungry, Hungry Hippos • Purpose: • Domain: • Safety- • Overview- • Goals • Behaviors • Behavior Management Techniques • Hope Process Point

37. Sports and Games: Sticker Tag • Purpose: • Domain: • Safety- • Overview- • Goals • Behaviors • Behavior Management Techniques • Hope Process Point

38. Teambuilding: Disc Lacrosse • Purpose: • Domain: • Safety- • Overview- • Goals • Behaviors • Behavior Management Techniques • Hope Process Point

39. Is this practical for…. use with the patients at your facility?

40. Post-Test • Identify three interventions to use within the behavioral health setting • Identify 2 important reasons value of implementing a day camp program within the restraints of a lockdown facility for a behavioral health setting: • Identify an appropriate behavior management technique to utilize when leading a recreation therapy intervention in a behavioral health setting :

41. Questions

42. Resources • Irwin, Diane, Robinson, Bill and Jim Pascoe (2006),Verbal de-escalation training, A training program developed for the staff of Universal Health Services. • Kaplan, C. S., Aguirre, B. A., & Rater, M. (2007). Helping your troubled teen. Learn to recognize, understand and address the destructive behavior of today's teens. :Beverly, MA: Fair Winds Press • Manassis, Katrina and Levac, Anne M. (2004). Helping your teenager beat depression, A problem-solving approach for families. Bethesda, MD: Woodbine House • Newby, Robert F. (2006). Your struggling child, A guide to diagnosing, understanding, and advocating for your child with learning, behavior, or emotional problems. New York, NY: Harper Collins Publishers • Windell, James (1994). 8 Weeks to a Well-Behaved Child A Failsafe program for Toddlers through Teens. New York, New York :Macmillan. • White, R.C.,& Preston, J.D., (2009).Bipolar 101 A Practical Guide to Identifying Triggers, Managing Medication, Coping with Symptoms, and More. Oakland, CA. : New Harbinger Publications, Inc