This article will describe the synergy derived from bringing an evidence-based curriculum into a summer therapeutic day-camp for children diagnosed as severely emotionally disturbed.
What child doesn’t look forward to summer vacation from school? And what child doesn’t anticipate attending a camp or a program where he or she can make friends, play sports, go on trips, learn new hobbies, and just have fun?
Every child yearns for these opportunities. But a segment of our population of children – those who have severe emotional or behavioral challenges and who attend special education programs during the school year – is missing out. Their mental health disorders deny them participation in the kaleidoscope of summer programs open to their typically functioning peers.
Summer Therapeutic Program
The Staten Island Mental Health Society’s (SIMHS) Summer Therapeutic Program (STP) was created to be the answer for many families facing this dilemma; the summer program has been supporting these special-needs children for a quarter-century. Each year, the seven-week long STP enables approximately 100 youngsters, 5 to 12 years old, to enjoy an enriching and playful experience during July and August, and to receive extra therapeutic and educational services. The program operates five days a week from 9 a.m. to 3 p.m., correlating to the full day of supervision and services normally available during the school year, and providing supervised transportation and two nutritious meals a day. This approach also furnishes continuity of care for children who are enrolled in other mental health programs housed within their community-based schools during the rest of the year.
On the heels of Independence Day, the SIMHS’s campus explodes with energy as the STP gets underway, and it doesn’t cool down until the end of August. Launched in 1985, the program is not a school or a camp, but a synergistic mix of therapeutic, educational, social, and recreational activities in the structured and caring environment these children need. The program’s goals are to provide stability, to help the children feel more confident about themselves and their abilities, and to prepare them for the coming school term, with friendship, spontaneity, and fun liberally in the mix.
Integrating an Evidence-Based Curriculum
On the first day of the program, each child is assigned to one of 12 groups, based on his or her age. Each group is led by two counselor-interns who are college or graduate students studying psychology, special education, social work, or a related field. With the interns as their activities counselors, the children participate in a variety of recreational and social activities including sports, art, drama, creative writing, painting, music, trips to local museums, zoos, libraries, and parks, and special projects. The children in each group stay together throughout the day. Each counselor is closely supervised by a member of the SIMHS’s clinical staff.
Using an evidence-based treatment program, our clinical staff provide daily therapeutic counseling, extra support for the children who need it, and crisis services. Medication evaluation and prescriptions are provided by staff physicians as indicated.
The specific evidence-based curriculum that is the basis of the SIMHS STP was developed and refined by Dr. William Pelham and his colleagues at the Center for Children and Families at the State University of New York at Buffalo. The program is based on a social learning model. Throughout each program day’s activities, attention is focused on each child’s needs. Examples include individual and group problem solving and developing appropriate social interactions; improving learning skills and academic achievement; following through on instruction and completing tasks; and developing individual competence and self-esteem.
The SIMHS STP model Point System is based on a systematic reward/response cost program and includes: verbal positive reinforcement, daily report cards taken home, and time-out techniques such as loss of privileges or participation in ongoing activities. Each child’s individually tailored program is based on his or her strengths and treatment goals.
From the child’s perspective, every day is filled with a variety of fun-filled activities including sports, group trips, and arts and crafts, each integrated with academic, remedial, and therapeutic goals. Each individual or group activity, behavior, or interaction – designed to be fun for the child – is the material to be reinforced or discouraged by the SIMHS STP staff, according to social learning principles as delineated in the evidence-based curriculum.
By summer’s end, the children have made good friends and good memories, have a head start on the coming fall school routine, and are meeting their emotional challenges with more confidence.
How We Measure Dysfunction and Improvement
The unique aspect of our work measuring the effectiveness of our services conceptualizes each child’s level of functioning, not as a single condition, to be successfully treated or not. Rather, using the Conners’ Rating Scales (1989), the major types of behavioral problems exhibited by each child are able to be differentiated through factor analyses.
At the Staten Island Mental Health Society, the Conners’ Scales are routinely administered to all children receiving out-patient or day treatment services. The scale scores help us formulate treatment plans and measure improvement for each child, on an ongoing basis.
What We Measured
The seven scores that the child received, as a result of his or her group counselors completing the Conners’ Teacher Questionnaire at the beginning of the summer, were compared with the seven scores similarly obtained at the end of the summer. The same counselor rated each child at the beginning and end of the summer program.
The Conners’ Teacher Rating Scales allow each child’s score to be converted into AT-scores with a mean of 50 and a standard deviation of 10. There were 155 individual children who attended the STP during the summers of 2008 and 2009, when the evidence-based curriculum was utilized. There were 114 children who attend the STP in 2000, several years before the evidence-based curriculum was introduced.
Using the Evidence-Based Curriculum: Pairs of Conners’ Teachers Scales were available for 155 children who attended the SIMHS STP during the summers of 2008 and 2009. For six of the seven factors, there was a significant decrease between the scores obtained at the beginning of the summer as compared to the scores obtained at the end of the 33-day summer program. (See Table One Below)
Non-Evidence-Based Curriculum: The 114 children who attended the SIMHS STP during the summer of 2000 attended a program, which while considered “therapeutic” did not use an evidence-based curriculum. Pairs of Conners’ Teachers Scales derived from scores obtained at the beginning and end of the summer for 114 children who attended the SIMHS STP during the summer of 2000 showed not one significant change in the scores of any of the seven factors. (See Table Two Below)
What Do the Results Mean?
The Staten Island Mental Health Society has been providing a Summer Therapeutic Program for 25 years for children diagnosed as seriously emotionally disturbed. During the summers of 2008 and 2009, an evidence-based curriculum was integrated into the program.
The effectiveness of using the evidence-based program was measured by using the Conners’ Teacher Rating Scales at the beginning and end of the summers. Similar measures were obtained for children attending the Summer Therapeutic Program in a year prior to when the evidence-based program was utilized.
Using the Conners’ Teacher Scale as a measure of the children’s functioning, the evidence-based curriculum was associated with significant improvement in the children’s functioning on six of the seven Conners’ measures. There was no improvement shown on any of the Conners’ measures during the summer prior to when the evidence-based curriculum was used.
Families seeking services for their children with severe behavioral dysfunction rely on community-based providers of children’s mental health services. While from the children’s perspectives, they are attending a fun-filled program with sports and crafts, using an evidence-based curriculum, the program has evolved into a highly effective community resource.
Kenneth Popler, PhD, MBA, ABPP, a clinical psychologist, is the President and Chief Executive Officer of the Staten Island Mental Health Society, an organization that provides mental health and related services to Staten Island children and their families.