University of California Berkeley

Transcription

1 University of California Berkeley DEPARTMENT OF RECREATIONAL SPORTS 2301 Bancroft Way Berkeley, CA camps.berkeley.edu Dear Parent/Guardian: Thank you for your interest in the Social Skills Track 2 within Blue Camp for teens that have complete 8 th 12 th grades. Blue Camp, the flagship program at Cal Youth and Outdoor Programs, and we have a unique social skills program for high school students and early college students with social skills deficits. This program parallels the Campers-In-Leadership Training (CILT) program and Counselors-In-Training (CIT) program at Blue Camp. The goal is to integrate the teens into the most age appropriate and skill level program to work along side typically developing peers. Your teen will be assessed and, if accepted, placed into either the CILT or CIT program and be on the social skills track. Your teen will be aware that he or she is receiving extra support but will not be identified directly to peers as being in a separate track. Our goal is to provide as much integration as is appropriate for your teen. Many of the teens on the social skills track have Nonverbal Learning Disabilities, Asperger's, or High Functioning Autism. This program is not designed for teens that require one-on-one support, are non-verbal, inflexible, or have a below average verbal IQ. Camp is a place where your child can be safe and have a fun summer while improving and practicing his or her social interactions and decreasing social anxiety. Your child will also learn basic leadership and work related skills he or she can apply in any situation. At camp we emphasize sports and recreation instruction for various skill levels and interweave pro-social values throughout the curriculum. The Social Skills Program is customized to meet the needs of your teen. Mini lectures and training sessions occur each day and teens get support applying their new skills. A completed application will include the following documents. If you can send them electronically that would help. All Applicants please complete online at 1. Completed Intake Questionnaire to be filled out by online parent or guardian. If you have an older teen, I would encourage you to have them do it with you or give you input. You can download this form from our social skills camp page as a word document to make it easier to complete. 2. Permission to Exchange Information Form - allowing our social skills staff to speak to teachers or other professionals you designate to determine if this camp is an appropriate placement and to coordinate services if necessary. To expedite the contact between professionals, give them a copy of the signed form as well. If your teen is over 18, they need to sign the release form and add you as a person we can share more personal information with. There is a separate permission form for adult applicants. Page 1 of 3

2 3. Behavioral Expectations Form signed, if your teen is over 18, they should also sign the form online If you are new to our camps, please also include: 4. IEP or 504: Not all children in our camps will been in special education but if your child has an IEP or 504 it will help us to see at least the service page as well as any social goals is the most helpful. We don t need the entire IEP. For returning campers please a note to update us on any changes. 5. Current Diagnostic Assessment: This might be a psychoeducational evaluation or neuropsychological evaluation. We do realize that all children that are appropriate for our camp may not have had an evaluation but this is a useful tool, especially since we require children in this camp to have at least an average testable verbal cognitive IQ. We do not expect you to get testing completed to come to this camp so let us know if your child has not been tested. If you prefer not to send this via you can send the summary page and bring the assessment to the interview. 6. Recommendation Letter (optional): A letter/ from a teacher or therapist indicating the child s current strengths and weaknesses, what the child has primarily been working on in regards to social skills development, and specific goals we can focus on in this program. This is not meant to add pressure to your child s team, just to loop the teacher into the support structure. If it is easier, please add the teacher s name to the permission form and we can give the teacher a call. It can be as simple as an with some goals. We don t want this to hold up your application so feel free to submit it later. We do realize how busy school professionals are. Interview (new campers to SST 2 only) Once these materials are reviewed and your teen is identified as a possible fit with this program we will contact you and your teen to schedule an in-person meeting. We typically schedule several meetings in one day since we bring in staff who will be working with the camp in the summer. These visits are typically towards the end of March and April. Teens then will ultimately be selected based on their fit with this program. Please if you have any questions about the program or if you would like to hear from parents in the program. is the quickest method of contact and I can call you back if you would prefer to speak with someone on the phone. Payment Once you attend the interview and are offered a position, we will send you a link and an enrollment code to be able to sign-up electronically Session Dates (2 week camps) Grades 8-13 Dates Time and Day Fee 6/29-7/10* Monday - Friday $695 7/13-7/24 Monday - Friday $695 7/27-8/8 Monday - Friday $695 *No Camp on July 3rd Page 2 of 3

3 While this is not an exhaustive list, it may help you make a preliminary assessment about your teen's readiness for the program. Guidelines for first time SSTA Teens: 1. Must want to be a staff member at Blue Camp and feel motivated to grow in this role. 2. Must be able to accept coaching and follow directions under supervision. 3. Must be able to follow directions even when supervisor is not there for up to 20 minutes 4. Must like children or sports. 5. Must be willing to engage in non-personal interest related activities with peers for at least 10 minutes. 6. Must be ready to understand the social context of their role: can take on staff identity to the extent they understand and demonstrate that they are responsible for the safety and participation of younger campers, and must understand they are not cultivating friendships with campers but are instead present to support teachers. 7. Must be ready to follow the fundamental principal that "camp is for the camper" and that the needs, interests, and participation of the camper must come before that of the staff during class time. 8. Must have stamina to work without breaks for at least an hour. Once these materials are reviewed and your child is identified as a possible fit with this program we will contact you and your child to schedule a meeting or phone interview. Campers will ultimately be selected based on their fit with this program. Please if you have any questions about the program or if you would like to hear from parents in the program. is the quickest method of contact and I will always call you back. Sincerely, Jennifer H. Selke, Ph.D. Director jenn8@berkeley.edu Page 3 of 3

4 UC Berkeley Social Skills Camp Intake Questionnaire THIS IS A SAMPLE OF WHAT QUESTIONS ARE ASKED ON THE ONLINE FORM. PLEASE COMPLETE THE FORM ONLINE AND USE THIS TO GATHER DATA. COMPLETE ONLINE: Thank you for taking the time to complete this form completely and accurately. This information will assist our staff in assessing your child s fit with our program. If your child is accepted into our camp, this information will be utilized by the staff who will work directly with your child. It is a word document to make it easy to edit. If accepted into the program you will be given an enrollment CODE to fill-out and register via our online registration system. IDENTIFYING INFORMATION Child s Full Name: Sex: Age as of July 1 st : Current School: Grade in the Fall: Name of Parent/Guardian Contact Best Phone to Call: SOCIAL SKILLS TRACK Bears/Grizzlies (completed grade 3rd 7th) Has your child been at Blue Camp before? If so, what program were they in and when? Will your child know other children at camp. If so, who? Please describe your child s school placement. Specifically, is your child in a special needs or mainstream setting. How much support do they receive on a daily basis? MEDICAL INFORMATION While there is a place on the camp registration form for this data, we find it helpful to have it on this form with the other documentation about your child. Does your child have any medical conditions? If so, please describe. Does your child have any known allergies bees, peanuts, etc? Please describe.

5 UC Berkeley Social Skills Program: Intake Questionnaire page 2 of 4 Has your child even been diagnosed with a developmental or psychological disorder? If so, please specify. Is your child currently taking any medications? Please specify. At the time that camp starts, will your child be undergoing any medication changes? If so, please describe. Sometimes, we have treats for the campers. Do we have your permission to give your child food? STRENGTHS AND CHALLENGES What are some of your child s strengths and interests? What are your child s most significant challenges? BEHAVIOR How does your child behave at her/his best? How does your child behave when stressed or upset? SOCIAL FUNCTIONING Please describe the situations in which your child is socially successful. Please describe your child s social challenges. Please note, if your child is diagnosed with a specific developmental disorder you need not describe symptoms characteristic of that disorder. Instead, please describe areas of social interaction that are particularly challenging for your child. Has your child ever had a play date? For older children, has your child ever hung out with another child outside of the school setting? If so, please describe. Does your child initiate play dates or social get-togethers? To your knowledge, how does your child spend lunchtime during the school year? MOTOR COORDINATION Would you describe motor coordination as a strength or weakness for your child? Please describe your child s gross motor skills. Please describe your child s fine motor skills.

6 UC Berkeley Social Skills Program: Intake Questionnaire page 3 of 4 LONG TERM GOALS Please let us know three of the long term goals that you are currently working on HOPES FOR CAMP If your child participates in our program, please let us know two or three hopes you have for their experience at camp, keeping in mind that camp is a brief time period VERBAL AND PHYSICAL AGGRESSION Even well behaved children can make poor choices. When was the last time that your child engaged in verbal or physical aggression? Please describe. How often do incidents like this occur? Has this ever been a more significant problem in the past? Has it become more concerning recently? Likewise, all children can become overwhelmed and act out. When was the last time that your child had an emotional outburst? Please describe. How often do incidents like this occur? Has this ever been a more significant problem in the past? Has it become more concerning recently? EXTRA TIPS ABOUT YOUR CHILD What teaching strategies work well for your child? What teaching strategies are ineffective for you child? Do you currently utilize a reinforcement system at home or at school? If so, please describe. Please describe any additional considerations our staff should be aware of.

7 UC Berkeley Social Skills Program: Intake Questionnaire page 4 of 4 What makes your child s day? Mail, drop off, fax form to: Dr. Jennifer H. Selke, Social Skills Camp, University of California, Berkeley, Attention: Customer Service Center, 2301 Bancroft Ave., Berkeley, CA scrainfo@berkeley.edu tel: CAMP (2267) fax:

8 University of California Berkeley DEPARTMENT OF RECREATIONAL SPORTS 2301 Bancroft Way Berkeley, CA camps.berkeley.edu BEHAVIORAL EXPECTATIONS AT CAMP SOCIAL SKILLS TRACK FOR TEEN PROGRAMS Applicant: Birthdate: It is our goal to do as much as possible to ensure your teen has a safe and fun time at camp. You will receive a tip sheet/handbook to prepare your teen for camp. To best serve you, your teen, and the other campers, we have developed a list of behavioral expectations and essential functions necessary to attend camp. You know your child best. Please take a moment to read over the information below to make sure there is a good fit for your child in this program. We understand that it is normal for this population of teens to sometimes be shy, have difficulty initiating interaction with the group etc. This is what we will work on at camp. Your teen will be expected to check him/herself into camp in the morning without parent assistance and they need to be able to find their way around the camp site without assistance once they are familiarized with the facility. Teens in this program must be able to work effectively in small groups with some adult supervision but not one-on-one support. This involves being able to share and cope with the give-and-take of small group activities. Teens who have difficulty with this may find the camp environment overwhelming. Successful teens will also be able to stay with the group when required as well as be able to follow simple directions without supervision. Teens who are prone to leave the group or wander cannot be supervised effectively in this environment. Participants cannot be physically or verbally aggressive or melt-down when upset. Because this is a camp where the teens will be around younger children, they must not be aggressive, use derogatory language, or be likely to harm or grab others. Teens who have a low frustration tolerance for younger children, or a constantly changing environment will be better served in a different type of program. This program offers a variety of activities and we do our best to ensure that these activities benefit the participant s growth while allowing them to have fun. Some teens may not be as physically active as others and may not like all sports. We expect them to try all activities and we will coach them to help out and assist instructors. We have found tremendous growth in our participants willingness to try new things because of their exposure at camp. Teens who continuously refuse to participate throughout the day and who do not respond to our modifications and accommodations may not be best suited for the program. If you have any questions, please do not hesitate to contact Dr. Selke at 510/ (cell) or jenn8@berkeley.edu (preferred). Teens who engage in behaviors which result in safety risks to other campers and pull the staff away from group supervision are not a fit for this program. We are not set up to provide one-to-one supervision. If your teen acts in such a manner, we will work, with parent support, to stop the behaviors. If they cannot be managed, your teen will not be able to come back to camp. There are no refunds. By signing or typing your name on this form you are stating that your teen is appropriate for this program and you have reviewed this with them. Parent/Guardian Signature (typing name is OK for submission) Relationship Date Signed Applicant Signature (typing name is OK for submission) Parent/Guardian Phone

9 University of California Berkeley DEPARTMENT OF RECREATIONAL SPORTS 2301 Bancroft Way Berkeley, CA camps.berkeley.edu PERMISSION TO EXCHANGE CONFIDENTIAL INFORMATION- SOCIAL SKILLS PROGRAM Child s Full Name: I give my permission for U. C. Berkeley Social Skills Camp Director, Assistant Director, and staff working directly with my teenager to exchange verbal information concerning the child listed above. This is to determine proper placement in the summer camp and/or progress during camp. Possible professionals that might be helpful for list are teacher, psychologist, outside service providers, etc. Reports required for camp should be submitted by the parents or guardians. The following people are available for consultation from February 1, October 1, 2015 name position contact number and name position contact number and name position contact number and name position contact number and Parent/Guardian Signature Relationship Date Signed (typing your name indicates a digital signature if submitting electronically) Parent/Guardian Contact number (preferred) Mail, drop off, fax form to: Dr. Jennifer H. Selke, Social Skills Camp, University of California, Berkeley, Attention: Customer Service Center, 2301 Bancroft Ave., Berkeley, CA tel: CAMP (2267) fax:

10 University of California Berkeley DEPARTMENT OF RECREATIONAL SPORTS 2301 Bancroft Way Berkeley, CA camps.berkeley.edu PERMISSION TO EXCHANGE CONFIDENTIAL INFORMATION- SOCIAL SKILLS TRACK FOR APPLICANTS WHO ARE 18 YEARS OR OLDER, OR WILL TURN 18 BEFORE OCTOBER 1, 2015 Adult Applicant: Birth date: I give my permission for U. C. Berkeley Social Skills Camp Director, Coordinator, and my job coach to exchange verbal information concerning myself. This is to support placement in the summer camp and/or progress during camp. Possible professionals that might be helpful for list are teacher, psychologist, outside service providers, etc. It is helpful is you include your parents or guardians. As an adult, we will not disclose personal work information with someone without your permission. You have my permission to speak with the following people February 1, October 1, 2015 name position/role contact number & fax name position/role contact number & fax name position/role contact number & fax name position/role contact number & fax Adult Participant Signature (typing your name indicates a digital signature if submitting electronically) Date Signed (preferred) Mail, drop off, fax form to: Dr. Jennifer H. Selke, Social Skills Camp, University of California, Berkeley, Attention: Enrollment Center, 2301 Bancroft Ave., Berkeley, CA jenn8@berkeley.edu tel: CAMP (2267) fax: