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Intensive Summer Intervention Found to Increase Prosocial Behaviors in Children with Mild to Moderate Social, Emotional, and/or Behavioral Difficulties

Quest Therapeutic Camps of Southern California offers seven weeks of an intensive, structured outpatient program for children with mild to moderate behavioral, emotional, and/or social difficulties. Quest provides a comprehensive therapeutic system that includes a treatment plan individualized for each child with identified treatment goals, in which each child receives direction throughout the whole day to practice new skill sets and work specifically on their identified goals. In addition, a behavioral milieu is utilized, group therapy is provided five days per week, occupational therapy is provided, and weekly parenting groups are included. The director and counselors create treatment goals based on observations of the child, and reflect feedback from the parent and the child. Children are rated every hour by staff regarding their participation in activities and progress in reaching their goals. Peers and staff also rate the child weekly to give them specific feedback in how the child is progressing in reaching their goals. Parents also create home goals as part of the Quest program.

One common goal among the majority of Quest campers is to improve social skills, and many formal and informal activities and interventions to promote social interactions among all campers occur throughout the day. A probe evaluation was conducted during the 2017 Summer session to explore the impact of the Quest therapeutic program model on increasing campers’ social skills, which examined the frequency of the following behaviors for the duration of the six weeks of day camp: Reciprocal Conversation and Emotion Regulation.
 
The first behavior of engaging in reciprocal conversation with peers was identified as an objective way to evaluate campers’ social participation with peers with a focus on the frequency of campers starting a conversation or responding back when a peer had made a statement. The second behavior of emotion regulation was identified as an objective way to evaluate campers’ ability to appropriately manage their emotions during social situations. Any increase over time in reciprocal conversation or emotion regulation would be interpreted as support that the Quest program model is effective in improving campers’ social skills.
 
Subjects:
Children attending Quest Camp are divided into three smaller camps based on age. Campers age 5- to 7-years-old are in the younger camp, campers 8- to 10-years-old are in the middle camp, and campers 11- to 18-years-old are in the older camp. Children over the age of 11 years are in the older camp. A total of 51 campers (7 from the younger camp, 23 campers from the middle camp, and 21 campers from the older camp) were included in the program evaluation. Campers who were both new and returners to Quest Camp and who attended for at least three consecutive weeks were included. Because the campers started attending at various times during the seven-week summer session, each camper’s first week of attendance was identified as “Week 1” and this result was considered to be each camper’s baseline value. Week 7 was not included in the study since this was a residential week and not all of the individuals who collected data were able to travel. Thus, only the first six weeks of day camp were examined.    
 
Method:
Definition of Behaviors
Reciprocal conversation behavior was defined as any time a camper engaged in two or more exchanges with another child in which the camper effectively began a conversation and/or responded to a statement from a peer. This definition was chosen to include sufficient back-and-forth conversational exchanges to represent aspects of reciprocity with sufficient volume of voice so that the other child was able to hear them, detect a response from the listener, and continue the exchange with another statement. It was also chosen to exclude observational comments that did not identify a specific listener or lead to a reciprocal exchange from the listener. This was measured by observing speech behavior from the subject camper, followed by speech behavior by adjacent camper, and then another incident of speech behavior by the subject camper.
 
Emotion Regulation was defined as any time a camper either engaged in a coping skill or did not show outward signs of distress. This definition was chosen so that information about the type of coping skill that was observed, the amount of coping skills that were observed, topographies observed while having an outburst, the length of time that the outburst occurred could be included. This was measured by observing coping behaviors and outburst behaviors from the camper.
Data Collection
Data for reciprocal conversation was collected during morning game time and lunch periods. Data was collected in 5-minute observation periods using partial interval data in 30-second intervals. Efforts were made to collect data on each camper during both time periods (game time and lunch) each week.
 
During game time, counselors set up a variety of choices that changed daily, and included a variety of board games, Legos, and art stations. Campers were directed to join a game or activity with at least one peer. At lunchtime, all campers ate lunch in the same general area. Sheets and large towels were provided for the campers to sit upon, which encouraged camper groupings of two to four campers for young camp and two to six campers for middle and older camp. All of the campers sat near their group counselors. This facilitated social interaction among the campers while allowing the counselors to observe the campers for supervision and safety.
 
Any incidence of the targeted behavior that occurred during each five-minute interval was documented with a “+” on the data sheet, and any criteria for the targeted behavior that was not met was documented with a “-” or a “0.” The number of successful reciprocal conversation behavior were tallied for each camper per week, and this number was used to calculate the average percentage of occurrence for each group of campers per week.
 
Data for emotion regulation behavior was collected from 9am to 12:30pm. Data was collected for the duration of a campers outburst behavior and/or for the duration a campers coping skill behavior. Data was taken on any camper that had an occurrence of an emotion regulation behavior each week.
 
Any incidence of the observed behavior that occurred during the duration of coping skills or outburst behavior was documented with a “+” on the data sheet, and any criteria that was not observed was documented with a “-” or a “0.” The number of successful coping skills behavior, the number of outburst behavior occurred, and the number of topographies observed during outburst behavior or coping skills behavior was talled for each group per week and this number was used to calculate the average percentage of occurrence for each group per week.
 
The campers who were observed in the program evaluation were not aware that their specific behavior was being monitored. Observations were conducted from a distance and perspective that allowed the observer to know when the camper was speaking and to hear what was actually said by the camper. This was intentional to reduce a possible reactivity effect on the outcome of the study.
Interrater Reliability
To facilitate data collection, a BCBA-D, three individuals who were being supervised for BCBA certification, and one MFTI participated in collection of reciprocal conversation. These individuals were trained regarding the definition of reciprocal conversation behavior and simultaneous data collection occurred until an interrater reliability level of 80% was established. Staff members (camp counselors) participated in collection of reciprocal conversation. These individuals were trained regarding the definition of emotion regulation behavior and in emotion regulation data collection. They were given additional support through camp while taking this data but were not trained or tracked for interrater reliability. Confidentiality of the campers was maintained by using first names on data sheets, and all observers signed confidentiality agreements prior to participation.
Analysis of Data
There was variation among the start date of the campers within the six-week summer program. To calculate the weekly average values, data from each camper’s first week of attendance was grouped, data from each camper’s second week was grouped, and so on, regardless of the camper’s actual start date.
Results:
The average percentage of occurrence of reciprocal conversation behavior was observed and calculated per week for the younger, middle, and older camper groups. The results for reciprocal conversations are presented in Graph 1. The results indicated an upward trend for the younger, middle, and older groups.

The average number of Emotion Regulation behavior across all campers is shown in Graph 2. The results indicated a decrease in average of outbursts over time.

The average number of Emotion Regulation behavior for the younger group, middle group, and older group of campers is shown in Graph 3. The results indicated a decrease in percentage of outbursts over time.

* During weeks one and three, one particular camper had a high number of outbursts from older. During week four, one particular camper had a high number of outbursts from younger camp.
Discussion:
The results presented above indicated that a positive increase in reciprocal conversation was observed among campers in the younger, middle, and older camp groups. These results lend support to the effectiveness of the interventions and programming offered by Quest Therapeutic Camps of Southern California on the improvement of social skills, as represented by the observation of reciprocal conversation behavior with peers. These results are also consistent with two previous studies of the Quest program that found the following: the first study found positive changes in campers’ social responsiveness, based on parents completing measures prior to the intervention and post-intervention. In this study of 47 campers, Quest campers were rated by parents to improve on the Social Responsiveness Scale (SRS-2) in social awareness (ability to observe social cues), social cognition (ability to interpret social cues), and social communication (ability to communicate socially), while also improving in overall social responsiveness. The second study conducted in 2016 indicated a positive increase in reciprocal conversation in younger camp and in middle camp for campers that had no previous involvement with the Quest model. This program evaluation also measured observed reciprocal conversational behaviors with an 80%-90% interrater reliability.
 
Positive improvement among the younger camp members were found for emotion regulation behaviors.   During weeks one and three, one particular camper from older camp had a high number of outbursts and during week four one particular camper from younger camp had a high number of outbursts. It was hypothesized that the methods of data collection for these behaviors was not effective at capturing the true rates of emotion regulation behaviors among the young, middle, and older groups, and more sensitive data collection procedures will be developed for future program evaluations.
 
Efforts were made to minimize confounding variables that might have impacted the results, but, due to the natural setting of Quest Camp and the observational method used, many variables could not be controlled. As a result, there are several limits to the study that must be acknowledged. For example, the results were computed by comparing a baseline value determined at “Week 1” of attendance from each camper regardless of the date on which attendance began. However, there may have been some impact on the results observed due to changes in the cohort of campers present from week to week and other variations that naturally occur at camp (e.g., themes that change each week). In addition, data was collected from campers who were both new and returning to Quest Camp which may have had an impact on results due to returning campers having previous exposure to the Quest Camp program model.
 
Future study on the effectiveness of the Quest Camp model on increasing social skills may include data collectors whose sole job is to take data, in order to obtain a data set that is bias free and complete. Permanent product evaluation can also increase interrater reliability by allowing for data to be reviewed after the fact and by a variety of individuals. Broadening the observation periods of reciprocal conversation to include variety of activities that occur throughout the Quest Camp day (e.g., waiting in line for the restroom, walking from one activity to another) might also provide valuable information about the Quest Therapeutic Camp model. Future studies could also examine what camper characteristics are associated with larger gains as well as the impact of additional weeks of intervention.
 
**This program evaluation was from data collected in 2017 at Quest Therapeutic Camps of Southern California. For more information please contact Dr. Jodie Knott and Brittany McKee at (714) 490-3428 or jknott@questsolutionssocal.com.
Quest Psychological Consulting, Inc., May, 2018

UPCOMING PROGRAMMING

School Year Programming

School year therapy groups are ten-week afternoon therapeutic groups that are designed to provide therapy by specifically targeting individualized goals for our campers.

A minimum of one hour includes therapeutic activities that heavily target the development of social skills, emotion regulation, and positive behaviors, while the next hour focuses on further skill development by providing a variety of experiential activities as part of a group to create opportunities to observe the child in a natural setting and intervene to facilitate change. Some quarters provide a special emphasis to improve skills, while other quarters have a more general offering based on the campers’ interests and often include programming in areas such as video game making, drama, art, movie making, etc.

Spring Group Started March 19th (Fullerton)

Summer Programming

Quest’s intensive summer program offers 7 weeks of programming (6 weeks of day camp and 1 week of residential). The summer program includes individualized behavior plans, group therapy, occupational therapy, a social thinking curriculum, mindfulness activities, yoga, soccer, games in the park, and field trips (beach, Boomers, Rockin’ Jump, Discovery Science Center, bowling, etc.) to create a fun and engaging, therapeutic camp experience for children.

Weekly parent meetings are also included. The summer program has been found across multiple studies to significantly reduce hyperactivity, impulsivity, aggression, and inattention, while improving peer relations, family relations, athletic competency, behavioral control and self-esteem. Quest has also been found to improve social awareness, social cognition, social communication, and social problems.

Summer Camp Dates are:
June 25 through August 9th