Camp Ramah Darom, in partnership with Nova Southeastern University, provides an overnight camp experience for children with autism and their families. Based upon Ramah Darom's five-day family camp model, adaptations have been made to ensure that the children with autism, their siblings, and parents all enjoy a successful camp experience. Located in rural, north Georgia, this camp draws families from as far away as California and Canada. Having successfully finished its fourth year, other camps around the country have expressed an interest in creating similar programs.

An Idea Is Born

During Ramah Darom's 2004 Family Camp, a single mother and her three children, all on the autism spectrum, participated in the session. At the same time, a member of the camp's Board of Directors brought up the idea of providing some type of camp experience to children with autism. Initial funding was obtained from the Barry and Judy Silverman Foundation, a private foundation, and the Foundation for Jewish Camping. That board member also happened to serve on the board of Nova Southeastern University, an institution well respected for its programs and expertise in the field of autism. A partnership was born.

The Family Camp Model

Ramah Darom has offered a f ive-day family camp session following the camp season for the past ten years. This camp currently enrolls for t y fami l ies in the program. Several components are offered: morning camp activities for the children, morning learning and recreational activities for the adults, afternoon family time, an after-dinner evening family activity, and night-time adult social activities. The camp occurs over the weekend and Shabbat (the Jewish Sabbath) is observed with religious and slower-paced leisure activities.

Adapting the Model for Campers with Autism

It is important to understand the adaptations that need to be made to a family camp model to make it successful for families that have children with autism spectrum disorders. Social-communicative-behavioral symptoms require one set of accommodations, while the diverse range of cognitive functioning found in children with autism requires another set of modifications.

The Staff 
The need for close supervision, prompting to participate in activities, and the need to individualize activities requires a 1:1 staff-to-camp ratio. Each camper with autism is paired with a chaver (pal) who assists him throughout the week. At Camp Yofi, the family camp for families of children with autism provided by Ramah Darom, most of the campers are not previously known to the camp administration and a zero-reject admissions model is in place so it is critical to have enough staff available to handle any children with autism who may present with significant or unexpected behavioral challenges. It is also important to have enough staff on hand who have expertise in autism, including both professionals in the field, as well as individuals having a family member with autism. At Camp Yofi, such an experienced person leads each of the groups of four to five campers with autism. It is also important to have a variety of camp staff to lead the activity groups. The autism professionals are helpful in supporting the specialists in the adaptation of traditional camp activities to meet the learning style and functioning level of children with autism.

The Program
The program consists of parallel schedules for the groups of children with autism, the groups of siblings, and the adult family members. During mealtimes, children eat with their parents. Supervised playrooms are available during the second half of lunch and dinner so that parents have the opportunity to finish their meals in peace and socialize with other family members and camp staff.

The morning sessions consist of a rotation of six activities for the children with autism and their siblings. Activities include: arts and crafts, swimming, climbing the tower, nature, singing, dancing, cooking, story-telling, and yoga. While children are engaged in these activities, parents have the opportunity to participate in recreational activities and learning/support sessions. At Yofi, some of these are of a religious nature, and some are of an autism/ support nature.

After lunch, the chavers have some free time, and families are able to utilize camp facilities as a family, including the pool, boating, and tower climbing. Other activities during this time may include family arts and crafts, scrapbooking, yoga, cooking, and weaving. The chavers rejoin the family in the late afternoon. During that time, the chaver can be responsible for an activity with the child with autism, or the sibling, or join the whole family in an activity like hiking.

After dinner, there is an evening family activity for the whole camp. Examples of successful activities include campfires, camp Olympics, scavenger hunts, and sensory carnivals. The day ends with late-night social activities for the adults, with child care provided by the camp staff who are stationed outside the sleeping facilities. This time allows the parents and grandparents to socialize without worrying about their children. Many of the parents describe this time as the only time they have had with their spouses to go "on a date" since they had a child with autism. During this time, adaptations to popular television shows like Iron Chef, Project Runway, and The Singing Bee take place. Other nighttime social activities include salsa dancing and game playing.

The Physical Facilities 
The physical facilities at Ramah Darom are exceptionally well-suited to this type of family camp, but many other camps would be able to use their facilities for this type of program. Ramah Darom was designed to operate as a year-round retreat center and has several large buildings featuring motel-like accommodations with private bathrooms and interior corridors. Families are assigned one or two rooms depending upon how many members attend the camp. Families of children with autism are not assigned to rooms with second exits leading to outside patios in order to ensure safety at all times, and especially with consideration to night-time child care. Older, more experienced senior staff are assigned to these rooms while younger staff are assigned to bunk-type buildings.

Activity areas are scheduled for the groups of children with autism and siblings to provide for the most economical and efficient movement around the camp. For the youngest sibling group, activity specialists often go to a location where these campers stay. Campers with autism who are resistant to making the transition to another activity/location are often cajoled through rides on the golf carts or use of behavioral reinforcement strategies.

Care is taken in the scheduling of the pool and lake activities to ensure the safety of the children. The children with autism are not scheduled to use the boats and water trampoline without parental supervision. These activities are available during family time.

As in traditional camping, it is important to have enough indoor spaces to accommodate activities on rainy days. It is critical to have substitute activities planned to take the place of outdoor ones in the event of rain. Children with autism need to have the least amount of commotion possible, so this must be well thought out in advance. It is also important to have alternate plans set up for family time, so that families have other options during inclement weather.

Essential Elements

There are a number of components that make Camp Yofi a success, and camps interested in replicating this model should pay particular attention to these elements.

On-Site Autism Expertise 
Camp Yofi is successful because it has been possible to access strong and plentiful autism expertise through its partnership with Nova Southeastern University. It would be helpful for any camp that is considering replicating a model like this to develop a relationship with either a university, a state or local autism agency, an autism support group, or a school system that may be able to share resources during the summer months. The lead autism person must have extensive experience in adapting programs for children with autism, behavioral techniques effective with children with autism, and the ability to collaborate with the traditional camp administration. This person must be able to make decisions quickly and confidently, as extensive problem solving and program adaptation will enable each participant to be successful in the program. This person should partner with the program director in leading evening problem- solving sessions with the staff.

It is also important to have a number of other people with experience in autism to provide support during the camp program. Placing a lead person with each group of campers with autism provides immediate modeling and coaching for the rest of the 1:1 staff. They can also help the activity leader to adapt the activity if the group, or a member of the group, has difficulty participating.

Staff Training
In most cases, the camp will draw staff from its traditional summer camp. If the traditional camp already serves children with special needs, then it is likely that the staff will have many of the skills necessary to support the children with autism. However, if staff are drawn from a traditional camp without experience in caring for special needs children, it will be necessary to include a training component presented by an autism expert before the families arrive at camp. All of the camp staff need information about the characteristics of children with autism, focusing on the age span that is served by the camp. It is especially important to provide the staff with strategies known to be effective with many children with autism. Training should include the use of visual supports for transition and behavior, including activity schedules, visual first-then boards, and token boards. It should also include how to use positive reinforcement, covering token economies, praise, and tangible reinforcers including preferred activities, objects, and edibles. The emphasis has to be on "making it through the day" successfully, rather than implementing behavior change programs because of the short nature of the program. It is also important that staff be well-trained in the use of universal precautions. While universal precautions are "universal" and not specifically targeted to children with autism, these children are more likely to need assistance toileting, have accidents on uneven terrain, and are less likely to be independent in wiping their nose.

Another area that should be covered is crisis management. Staff should be taught protective procedures such as blocking to prevent being hit, kicked, or bitten. They should be taught how to get a child to release a bite and remove hands from their hair. This training should emphasize that they should not attempt to physically move a child who is lying on the ground having a tantrum or who is resisting moving to the next activity. They should allow the experienced group leader to make a decision regarding the management of that situation. If a child has self-injurious behavior, the staff should be prepared to implement procedures to prevent injury to the child. The camp's autism expert should make decisions, in collaboration with the parent, on how to handle such situations.

High-Interest Activities 
The success of the camp depends upon choosing activities that are motivating and meaningful to children with autism. This entails making adjustments to meet the developmental, as well as chronological, needs of the children. At Yofi, the camp's zero reject model means that there are typically a wide range of cognitive abilities in the group. The activity leader must be able to adapt the activity to meet this need. It is also important to have a choice of activities during each period so that if children have a short attention span, they can move on to something else, or if a camper refuses to participate in a certain activity, there is another that she may choose. Another adaptation made at Camp Yofi is to ensure that there is an "activity backpack" at areas that require waiting. For instance, at the climbing tower, where children have to wait for their turn on the tower, staff have a backpack that includes a variety of objects that children with autism often like. Bubbles, balls, coloring books and crayons, and fidget toys are some of the items provided.

An Emphasis on Safety
Most camp properties have many characteristics that make increased attention to safety mandatory to ensure the wellbeing of campers with autism. Children with autism often have no awareness of danger, so the camp staff must be hypervigilant and attentive to manage risk. One of the challenges at Camp Yofi is that as the parents become more comfortable at camp, they are more likely to spend time conversing with other parents and are distracted from their responsibility to observe and attend to their children.

Before camp begins, it is important for the autism specialist to spend time analyzing the physical environment of the camp for potential hazards and developing strategies to reduce risk. Of course, the water areas including lakes and pools must be considered. For example, during campfire and breakfast on the beach, which are both held at the lake, staff stand in a line in front of the water in the form of a human fence to ensure that no children end up in the water. Other areas to review include exits to buildings and rooms that will be used for activities. When large groups are in these areas, it is important to have staff assigned to man these exits to prevent children from wandering off unattended.

At Yofi, each group leader and activity area are equipped with first aid kits in fanny packs so that small injuries can be attended to on the spot. Gloves, first aid cream, a variety of band-aids, tissues, and hand sanitizer are included.

The Needs of the Siblings
At Camp Yofi, siblings are made to feel special, too. They participate in their own groups in the morning activities, and then share time with their families. The siblings often represent a wider age range than the children with autism so their program must include activities appropriate for children ranging in age from toddlers to teenagers. Particular attention must be paid to the program provided to the teens. Some are given the option of being a "junior counselor" if that meets their needs. Others are happy to participate with the group. This flexible grouping and programming depends upon the age distribution of the siblings during a particular camp session.

There is a special sibling lunch provided for those who are of an age for which this activity would be appropriate. Generally, young elementary through teens are included in these activities. The lunches are generally provided for the group of siblings who share activities together, but occasionally adjustments are made for the lunch if it is felt that a particular child will do better with conversation at a different level. The lunch is led by someone with experience in sibling groups, either a mental health professional (if available) or the autism expert. During these lunches, the conversation revolves around their experiences with their sibling, questions they have, and, for the teenagers, concerns about their role in their siblings' futures. Sometimes, parents do not want their sibling child to participate in the lunch, either because they do not use the "autism" word at home or they are not comfortable with the sharing of experiences.

When there is a teenage sibling group, night activities are led by the sibling counselor of that group so that they feel special and can spend time watching videos, participating in craft projects or playing games. A special evening snack is provided to them.

Support for the Families 
At Camp Yofi, a spiritual, religious family experience is an important part of the program. Many of the families express the isolation and rejection they experience from the religious organizations in their own communities; Camp Yofi allows the families to participate in religious services as a family and activities without worrying about the reactions of others in the congregation. While the camp is not designed to provide the psychological support needed in a therapeutic model, it is natural that whenever families of children with autism get together, they become their own therapeutic support group and, therefore, it is helpful to have someone on staff that is sensitive to these issues and can monitor the group of families. The NSU partnership provides post-doctoral psychology residents or graduate students in family therapy and psychology who have led parent education sessions on stress reduction, siblings, and "For Fathers Only." The autism specialist has led sessions on "Ask the Autism Expert." During all of these sessions, issues arise that may need some expertise and support from the professionally trained staff.

Families have developed their own support networks following the Camp Yofi experience. There is a list-serve that shares information about interesting programs, other resources, advocacy activities, and issues facing the families like guardianship and the development of special needs trusts. Families that live in the same general geographic area have bonded and maintained their relationships by visiting and sharing holiday and vacation time with each other.

Replication

Camp Yofi provides a powerful experience for families of children with autism. Although this model is faith-based and designed to meet the needs of children with autism, family camps can be developed in secular models to meet the needs of other special populations.

Susan Kabot is the director of Clinical Services at the Mailman Segal Institute of Nova Southeastern University. She has graduate degrees in special education and speech-language pathology, and a doctoral degree in education. Susan is a Florida-licensed, speech-language pathologist and holds the Certificate of Clinical Competence from the American Speech/Language/Hearing Association. She has been an active participant in autism-related organizations and has served on the Board of Directors of the Broward County chapter of the Autism Society of America, The Broward Autism Foundation, and the constituency board of the Miami Center for Autism and Related Disorders. She currently serves as the special needs coordinator of Camp Yofi, a family camp for families of children with autism. Her commitment to the field of autism is fueled by Michael, her adult son who has autism. The Marcus Foundation in Atlanta, Georgia, has funded the development of a manual for replication of the camp model discussed in this article. It is available by request from the author at kabot@nova.edu.

Originally published in the 2009 July/August issue of Camping Magazine.