Surfing for Social Integration: Mental Health and Well-Being promotion through Surf Therapy among Institutionalized Young People

Abstract

The Surf-Salva Camp 2016 project aimed at promoting social inclusion, wellbeing, and mental health, as well as developing beach security values and social citizenship in children and youth in foster care institutions, through surfing (Surf-Therapy). Participants were 48 adolescents aged 10 to 16, selected from 4 foster institutions in the greater Lisbon district. Results suggest that intervention through surf therapy had a number of positive effects: exploration, effort and perseverance, problem-solving, time management, social competencies,interpersonal relationships and emotional regulation all developed among the participants throughout the project. Results support the claim that within a suitable theoretical framework, with a solid and well trained team and with adequate psychotherapeutic supervision and evaluation, Surf Therapy can be a very promising possibility in the care of at-risk young people, and policy makers should consider this suggestion in the development of policies related to vulnerable institutionalized young people.

Full text

*Corresponding author: Margarida Gaspar de Matos, Aventura Social, Wil-
liam James Research Centre, University of Lisbon, Lisbon, Portugal, Tel: +351
218811700; E-mail: margaridagaspar@netcabo.pt
Citation: Matos MG, Santos A, Fauvelet C, Marta F, Evangelista ES, et al.
(2017) Surfing for Social Integration: Mental Health and Well-Being promo-
tion through Surf Therapy among Institutionalized Young People. J Community
Med Public Health Care 4: 026.
Received: February 09, 2017; Accepted: May 29, 2017; Published: June 12,
2017
Introduction
In 2015, there were 8600 children and adolescents in residential
care in Portugal, of whom 4880 were between 10 and 17 years of age
[1]. Oriol, Sala-Roca, & Filella [2] warn that adolescents in such care
are more likely to have diculties in social development and emo-
tional skills. Studies show that institutionalized children have a higher
prevalence of behavioral problems and decits in adaptive function-
ing compared to children in the general population and the question
oen raised is the kind of developmental and social opportunities
that they may face [3,4]. e national institute for social security [1]
highlights the importance of interventions that contemplate the de-
velopment of aective and social competencies, the development of
programs adapted to the capacities and needs of these children and
young people [1].
In this regard, Surf-Salva Camp 2016 was a pioneering Portuguese
project undertaken during the summer of 2016, which aimed to con-
tribute to the promotion of wellbeing and mental health, social inclu-
sion, as well as developing beach security values and social citizenship
through lifesaving and rst-aid skills training in children and youth
in foster care institutions. Surf can be used as a therapeutic mediator,
and an increasing body of studies worldwide validate its use among
vulnerable populations [5-7].
As examples of this practice, we highlight, in Australia, the “one
wave” project (http://onewaveisallittakes.com) and the “waves for
change” project in South Africa (http://www.waves-for-change.
org), both working to promote mental health and wellbeing through
surf, the latter was conceived to work with vulnerable and homeless
youth, exposed to violence and traumatic experiences. With regard
to the “waves for change” project, which had a major inuence on the
Surf-Salva Camp 2016 project, Snelling [8] proposes the term Surf
erapy to designate the benets of the practice of surng together
with psycho educational activities when working with children and
adolescents at risk of social exclusion, as an alternative means to in-
crease psychosocial wellbeing and to reduce the risk of social exclu-
sion.
e “waves for change” was the inspiration for Surf Salva Camp
2016, when the Portuguese professional surfer José Ferreira met the
project in one of the times he was at Cape Town. Inspired and sup-
ported by “waves for change”, the Surf Salva Camp 2016 had its tar-
get dened, adapting it to local needs (vulnerable youth in foster care
homes), but sharing the main premise: to work with vulnerable youth
who have been exposed to violence and/or traumatic events with pos-
itivity and hope through a conjoint of surng and social emotional
learning [8,9]. is project besides surf training and social compe-
tence skills, also promotes beach safety through lifesaving certicates
and rst aid training [9].
In Europe, more specically in the United Kingdom, there exists
“the wave project” (https://www.waveproject.co.uk), whose authors
report seven factors that interact and motivate a change among the
individuals of the target population, who were young people facing
mental health problems and social exclusion: 1) the sea provides a
Matos MG, et al., J Community Med Public Health Care 2017, 4: 026
DOI: 10.24966/CMPH-1978/100026
HSOA Journal of
Community Medicine and Public Health Care
Research Article
Margarida Gaspar de Matos1,2,3*, Anabela Santos1, Cristiana
Fauvelet1, Francisco Marta4, Ema Shaw Evangelista4, José
Ferreira4, Miguel Moita4, Tim Conibear5 and Matt Mattila5
1Aventura Social, University of Lisbon, Lisbon, Portugal
2William James Research Centre/ISPA, Lisbon, Portugal
3ISAMB/Lisbon University, Lisbon, Portugal
4Portuguese Association of Pedagogy and Mental Health, Lisbon, Portugal
5Waves for Change, Cape Town, South Africa
Surfing for Social Integration:
Mental Health and Well-Being
promotion through Surf Ther-
apy among Institutionalized
Young People
Abstract
The Surf-Salva Camp 2016 project aimed at promoting social in-
clusion, wellbeing, and mental health, as well as developing beach
security values and social citizenship in children and youth in foster
care institutions, through surng (Surf-Therapy). Participants were
48 adolescents aged 10 to 16, selected from 4 foster institutions in
the greater Lisbon district.
Results suggest that intervention through surf therapy had a num-
ber of positive effects: exploration, effort and perseverance, prob-
lem-solving, time management, social competencies, interpersonal
relationships and emotional regulation all developed among the par-
ticipants throughout the project.
Results support the claim that within a suitable theoretical frame-
work, with a solid and well trained team and with adequate psycho-
therapeutic supervision and evaluation, Surf Therapy can be a very
promising possibility in the care of at-risk young people, and policy
makers should consider this suggestion in the development of poli-
cies related to vulnerable institutionalized young people.
Keywords: At-risk adolescents; Mental health; Quality of life; Psy-
chosocial risk; Social inclusion; Surf; Surf therapy; Wellbeing

Citation: Matos MG, Santos A, Fauvelet C, Marta F, Evangelista ES, et al. (2017) Surng for Social Integration: Mental Health and Well-Being promotion through
Surf erapy among Institutionalized Young People. J Community Med Public Health Care 4: 026.
• Page 2 of 6 •
J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal
DOI: 10.24966/CMPH-1978/100026
Volume 4 • Issue 1 • 100026
restorative environment; 2) individuals feel a connection with nature
when they are in or by the sea; 3) surng guarantees a sensory expe-
rience that assists in learning and promotes resilience; 4) a culture of
acceptance allows young people to feel included; 5) recognition and
positive reinforcement help in the development of a positive self-con-
cept and self-esteem; 6) the existence of people with reference models
proved to be benecial; 7) regular contact between the participants
and the instructors led to the building of trust and fostered learning
[6].
Other projects exist that use the same paradigm of surf therapy
with other populations, appearing in literatures sometime with oth-
er designations as “ocean therapy” [10], “surf medicine” [11] or “in-
tervention through surng” [12]. On one hand, there are projects
focussing on children and youth with developmental disorders and/
or other disabilities, which sometimes are under the umbrella of
“adapted surf ”. ese projects assessment validated surf therapy as a
way to decrease internalised symptoms and increase self-condence,
self-esteem, social skills, motivation about physical activity, [5,12,13]
self-control, cooperation, responsibility, involvement [14] and social
inclusion [12]. On the other hand, there are projects working through
surf with addiction disorders, with war veterans with posttraumatic
stress disorder, depression [10] and combat-related poly-trauma [11],
validating surf therapy as a relevant form of holistic treatment.
Based on the projects mentioned above, the main objective of
Surf-Salva Camp 2016 was the implementation of a surf camp for
vulnerable adolescents with psychosocial risk, where group dynam-
ics, lifesaving and rst aid skills training were added as part of the
surng experience. In combination with surf practice and the benets
of contact with nature within a therapeutic environment integrated by
a multidisciplinary team. It was hypothesized that the 1) participants
on Surf-Salva Camp 2016 would have decreased values on behavioural
problems and 2) the majority of the participants would feel that had
learned surng skills, self-regulation strategies, social and emotional
skills and feel part of the group.
Methods
Participants
e Surf Salva Camp 2016 project included 48 adolescents (70.8%
boys) between 10 and 16 years of age, with a mean age of 13 years
(SD = 1.7). It was a convenience sample including adolescents in a
situation of vulnerability and psychosocial risk, living in institutions
providing temporary or permanent residential care, with which a
partnership had been established. ere were four of these institutions
whose young people were included in three Surf Salva Camps.
Procedure
e Surf-Salva Camp 2016 took place on Carcavelos beach (Cas-
cais) between June 21st and September 8th 2016, with 3 camps at dier-
ent dates. In each Camp, 8 morning sessions were held twice a week
each with duration of 4 hours, before the Camps began, individual
meetings were held between the care institutions and the association
responsible for the project, which included the formal presentation of
the project, a description of the objectives, mission, and values.
e sessions included 1) activities to promote social and emotional
skills, 2) group cohesion activities, 3) surng training, 4) awareness
actions for an active safety culture at the beach along with training
with lifesaving and rst aid skills and 6) group reection activities.
e multidisciplinary team were constituted by the camp coordi-
nator (a psychologist), two specialized technicians (psychology and
sociology areas), and three surf instructors. Additionally, there were
two training agents for the lifesaving and rst aid skills training from
Instituto de Socorro a Náufragos (for more detailed information see
Matos, Santos, Fauvelet, & Aventura Social [15]).
e surf camp program, designed by the multidisciplinary team,
combined the practice of surng, social emotional learning and the
contact with water, to create a mental health and wellbeing setting
based on logic of respect, care, learning and relationships builder. Surf
therapy as a new alternative therapy was meant possible by the follow-
ing factors:
1. A multidisciplinary team, combining psychologists and surf in-
structors
2. Planning and presenting a structure session that oers security,
but at the same time allows each individual to express him/her-
self according to his/her needs and/or possibilities in each session,
practicing an attitude of respect for the self and freedom of choice
3. e relationship technician-youth made possible because of the
adequate ratio adults-adolescents
4. e social integration factor that allowed the adolescents to experi-
ence their peer-relationship diculties but also to overcome them
5. e characteristics of a privileged relaxing setting as the water is,
but also all the details that beach has within like sound, olfactory
and sensorial information
6. e learning of social and emotional competencies alongside with
a challenging physical activity like surf is, which is healthy lifestyle
promoter and very rewarding in terms of self-esteem and self-e-
cacy, that can be transformed in internal strengths
7. e reection activities that allowed the youth to make cognitive
restructuring process when trying to think and solve problems in
alternative ways
Instruments
At the beginning and at the end of each camp an evaluation of
the impact of the Surf-Salva Camp 2016 was carried out concerning
the areas considered relevant and/or at risk for the target. e initial
assessment consisted of the Strengths and Diculties Questionnaire
(SDQ) [16,17] applied to young people and their tutor or legal guard-
ian. SDQ is a measure that seeks to assess emotional characteristics
and externalizing behaviors [16]. It consists of 25 items divided equal-
ly by 5 subscales: pro-social behavior, hyperactivity, emotional prob-
lems, behavior, and relationship [16]. e answers to each item are
given on a basis of a 3-point scale (1-not true until 3-certainly true),
corresponding high scores to more emotional and behavioral dicul-
ties [16]. is questionnaire refers to the events of the last six months,
although for this study it was used as a time reference last week.
In the nal assessment, besides SDQ, we used the youth experienc-
es survey (Hansen & Larson, 2002 translated and adapted by Matos
et al., 2015 and adapted to this work by Matos, Santos, Fauvelet, and
Social Adventure [18-20]). e completion of the scales took place
during the time of the session, in order to ensure that the adolescents
had help in understanding the questions, if necessary.
Data analysis
A rst analysis included 29 of the initial 48 youngsters, 17 of
whom were male (58.6%) and by means of raw descriptive data (%),

Citation: Matos MG, Santos A, Fauvelet C, Marta F, Evangelista ES, et al. (2017) Surng for Social Integration: Mental Health and Well-Being promotion through
Surf erapy among Institutionalized Young People. J Community Med Public Health Care 4: 026.
• Page 3 of 6 •
J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal
DOI: 10.24966/CMPH-1978/100026
Volume 4 • Issue 1 • 100026
Youth Experiences Survey at Surf-Salva Camp 2016
Youth Institutional Tutors Camp Team Staff
Yes No Yes No Ye s No
F F F F F F
(%) (%) (%) (%) (%) (%)
Exploration
Tried doing new things 28 (96.6) 1 (3.4) 27 (96.4) 1 (3.6)
Tried a new way of acting 22 (75.9) 7 (24.1) 24 (82.8) 5 (17.2) 28 (96.6) 1 (3.4)
Did things that he/she does not do anywhere else 24 (82.8) 5 (17.2) 26 (89.7) 3 (10.3)
Identity
Started thinking about the future 20 (64.5) 9 (29.0) 10 (34.5) 19 (65.5) 24 (82.8) 5 (17.2)
Started thinking about self 20 (64.5) 9 (29.0) 24 (82.8) 5 (17.2) 27 (93.1) 2 (6.9)
Felt that he (or she) can make a difference 24 (82.8) 5 (17.2) 16 (55.2) 13 (44.8) 22 (75.9) 7 (24.1)
This was a positive experience 24 (82.8) 5 (17.2) 22 (71) 7 (22.6)
Thought about ethnic or racial heritage 11 (42.3) 15 (57.7) 5 (17.2) 24 (82.8)
Goals
Set goals 23 (79.3) 6 (20.7) 26 (89.7) 3 (10.3) 27 (93.1) 2 (6.9)
Learned ways to achieve goals 26 (89.7) 3 (10.3) 26 (89.7) 3 (10.3) 28 (96.6) 1 (3.4)
Learned how to consider obstacles 22 (75.9) 7 (24.1) 25 (86.2) 4 (13.8) 26 (92.9) 2 (7.1)
Learned how to include others in the plan 16 (55.2) 13 (44.8) 24 (82.8) 5 (17.2) 27 (93.1) 2 (6.9)
Effort
Put all energy into this activity 28 (96.6) 1 (3.4) 27 (93.1) 2 (6.9) 28 (96.6) 1 (3.4)
Learned to push him/herself 25 (86.2) 4 (13.8) 27 (93.1) 2 (6.9) 28 (96.6) 1 (3.4)
Learned that hard work pays off 28 (96.6) 1 (3.4) 29 (100) 27 (93.1) 2 (6.9)
Learned to focus attention 25 (86.2) 4 (13.8) 26 (89.7) 3 (10.3) 28 (96.6) 1 (3.4)
Problem solving
Observed others solving problems 19 (65.5) 10 (34.5) 23 (79.3) 6 (20.7) 23 (79.3) 6 (20.7)
Learned to make plans 19 (65.5) 10 (34.5) 20 (69.0) 9 (31.0) 27 (93.1) 2 (6.9)
Tried creative problem solving 18 (64.3) 10 (35.7) 20 (74.1) 7 (25.9) 23 (79.3) 6 (20.7)
Time management
Learned about organizing time 21 (72.4) 8 (27.6) 17 (60.7) 11 (39.3) 27 (93.1) 2 (6.9)
Learned about setting priorities 22 (75.9) 7 (24.1) 18 (64.3) 10 (35.7) 27 (93.1) 2 (6.9)
Practiced self-discipline 22 (75.9) 7 (24.1) 18 (64.3) 10 (35.7) 27 (93.1) 2 (6.9)
Emotional regulation
Self-control 22 (75.9) 7 (24.1) 17 (58.6) 12 (41.4) 25 (86.2) 4 (13.8)
Dealt with fear and anxiety 23 (79.3) 6 (20.7) 19 (65.5) 10 (34.5) 27 (93.1) 2 (6.9)
Handled stress 20 (69.0) 9 (31.0) 22 (75.9) 7 (24.1) 27 (93.1) 2 (6.9)
Learned to relax 23 (79.3) 6 (20.7) 22 (75.9) 7 (24.1) 25 (86.2) 4 (13.8)
Learned that his/her emotions affect others 20 (69.0) 9 (31.0) 21 (72.4) 8 (27.6) 26 (89.7) 3 (10.3)
Learned when to express emotions 20 (69.0) 9 (31.0) 17 (58.6) 12 (41.4) 24 (82.8) 5 (17.2)
Stress
Felt stress in this activity 4 (13.8) 25 (86.2) 3 (10.3) 26 (89.7) 13 (44.8) 16 (55.2)
Felt pressure 7 (24.1) 22 (75.9) 2 (6.9) 27 (93.1) 7 (24.1) 22 (75.9)
Negative peer interaction
Negative inuence 6 (20.7) 23 (79.3) 1 (3.4) 28 (96.6) 5 (17.2) 24 (82.8)
Felt bullying 3 (10.3) 26 (89.7) 1 (3.4) 28 (96.6) 4 (13.8) 25 (86.2)
Social exclusion
Felt like he/she doesn’t belong 3 (10.7) 25 (89.3) 4 (13.8) 25 (86.2)
Felt excluded 4 (13.8) 25 (86.2) 1 (3.4) 28 (96.6) 2 (6.9) 27 (93.1)
There were cliques in this activity 11 (40.7) 16 (59.3) 2 (7.4) 25 (92.6) 12 (41.4) 17 (58.6)

Citation: Matos MG, Santos A, Fauvelet C, Marta F, Evangelista ES, et al. (2017) Surng for Social Integration: Mental Health and Well-Being promotion through
Surf erapy among Institutionalized Young People. J Community Med Public Health Care 4: 026.
• Page 4 of 6 •
J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal
DOI: 10.24966/CMPH-1978/100026
Volume 4 • Issue 1 • 100026
analysis was made of the perceptions of young people and sta about
the way Surf-Salva Camp 2016 aected their lives and behaviours.
is analysis included those who were able to complete a nal evalua-
tion (post-evaluation), paired with their tutors and Surf Sta.
A second analysis included 32 adolescents from the initial 48
youngsters. 20 of whom were male (62.5%). is analysis included
those who were able to complete both the initial assessment (pre-eval-
uation) and the nal evaluation (post-evaluation). Analyses included
basic descriptive analyses and comparative analysis (paired t tests).
Results
Regarding the rst analysis-youth experiences survey at Surf-Sal-
va Camp 2016, there was a positive increase regarding the subscales
eort and perseverance, problem-solving, time management, social
competences and interpersonal relationships, suggesting that the
youngsters felt that the project brought changes with regard to these
dimensions. Emotional adjustment items also increased, suggesting
that youngsters perceived that the surng had helped them. As to the
scale of negative situations, most of the youngsters reported not hav-
ing felt either stress, the negative inuence of peers or social exclusion.
Regarding the prospects for the future: “this activity made him/her
want to continue surng”, 83% of young people answered armatively
(Table 1).
ese results also strongly suggest that the competences related to
learning surng (items 38-47) and learning safety at sea (items 48-50)
were reported as a positive achievement for most of the youngsters.
Youngsters’ perceptions were corroborated by sta of the camp and
tutors from the institutions and a majority of inter-judge reliability
was highlighted grey.
According to the results of the second analysis (Table 2), there was
an improvement in the diculties perceived by the youngsters, and
these were corroborated by the sta of the Camp and the tutors of the
institutions. What is more, for overall skills, positive eects were ver-
ied. However, the latter was only true with regard to self-perception.
e t-test of paired samples was performed to evaluate the impact
of the Surf-Salva Camp 2016 on the subscales of the Capacities and
Diculties Questionnaire (SDQ-PT), using both the self-report ver-
sions and by the parents (tutors) versions. Considering the self-report,
there is a statistically signicant decrease in the subscale behaviour
Technical skills
Purposes of warming up exercises 25 (86.2) 4 (13.8) 26 (89.7) 3 (10.3) 23 (79.3) 6 (20.7)
Learned how to prevent injury 24 (82.8) 5 (17.2) 22 (75.9) 7 (24.1) 27 (93.1) 2 (6.9)
Was able to get into water 25 (86.2) 4 (13.8) 25 (86.2) 4 (13.8) 28 (96.6) 1 (3.4)
Felt good in the water 25 (89.3) 3 (10.7) 24 (82.8) 5 (17.2) 25 (86.2) 4 (13.8)
Was able to lie on the surfboard 27 (96.4) 1 (3.6) 25 (92.6) 2 (7.4) 25 (86.2) 4 (13.8)
Step 1 28 (96.6) 1 (3.4) 24 (100) 27 (93.1) 2 (6.9)
Step 2 25 (89.3) 3 (10.7) 24 (100) 22 (75.9) 7 (24.1)
Step 3 25 (89.3) 3 (10.7) 23 (92.0) 2 (8.0) 23 (79.3) 6 (20.7)
Line up 24 (85.7) 4 (14.3) 23 (92.0) 2 (8.0) 6 (20.7) 23 (79.3)
Learned technical terms 26 (89.7) 3 (10.3) 25 (89.3) 3 (10.7)
Safety at the Sea
Learned how to help others 25 (86.2) 4 (13.8) 18 (62.1) 11 (37.9) 23 (79.3) 6 (20.7)
Learned how to be safe at the beach 25 (86.2) 4 (13.8) 20 (69.0) 9 (31.0) 25 (89.3) 3 (10.7)
Felt satisfaction about being able to help 26 (89.7) 3 (10.3) 24 (82.8) 5 (17.2) 27 (93.1) 2 (6.9)
Group skills (social competences)
To be part of the group 24 (82.8) 5 (17.2) 28 (96.6) 1 (3.4)
Team work 26 (89.7) 3 (10.3) 24 (82.8) 5 (17.2) 27 (93.1) 2 (6.9)
Help others 26 (92.9) 2 (7.1) 23 (79.3) 6 (20.7) 20 (69.0) 9 (31.0)
Shared responsibilities 24 (82.8) 5 (17.2) 22 (75.9) 7 (24.1) 22 (75.9) 7 (24.1)
Was patient with friends 27 (93.1) 2 (6.9) 22 (75.9) 7 (24.1) 25 (86.2) 4 (13.8)
Manage others inuence 22 (75.9) 7 (24.1) 22 (75.9) 7 (24.1) 22 (75.9) 7 (24.1)
Interpersonal relationships
Made friendships 22 (78.6) 6 (21.4) 24 (82.8) 5 (17.2) 20 (69.0) 9 (31.0)
Have something in common with someone 26 (89.7) 3 (10.3) 22 (75.9) 7 (24.1)
Relations with important adults
Had good relationships with adults 24 (82.8) 5 (17.2) 15 (51.7) 14 (48.3)
Had good talks with adults 19 (65.5) 10 (34.5) 19 (65.5) 10 (34.5)
Future expectations
Thought about the future 20 (69.0) 9 (31.0) 12 (41.4) 17 (58.6) 25 (89.3) 3 (10.7)
Wants to continue surng 24 (82.8) 5 (17.2) 26 (89.7) 3 (10.3)
Table 1: Questionnaire youth experiences survey at Surf-Salva Camp 2016, from youth, institutional Tutors and camp team staff (Hansen & Larson, 2002, trans-
lated and adapted by Matos et al., 2015 and adapted to this work by Matos, Santos, Fauvelet& Social Adventure [18-20]).

Citation: Matos MG, Santos A, Fauvelet C, Marta F, Evangelista ES, et al. (2017) Surng for Social Integration: Mental Health and Well-Being promotion through
Surf erapy among Institutionalized Young People. J Community Med Public Health Care 4: 026.
• Page 5 of 6 •
J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal
DOI: 10.24966/CMPH-1978/100026
Volume 4 • Issue 1 • 100026
problems between the initial evaluation (M = 8.60, SD = 1.65) and the
nal evaluation [M = 8.60, SD = 1.70, t (29) = 2.57, 0.05].
According to the evaluation of the tutors from the institutions,
there is a statistically signicant decrease in the emotional symptoms
subscale between the initial evaluation (M = 8.63, SD = 2.47) and the
nal evaluation [M = 7.63, SD = 1.50, t (29) = 2.61, p<0.05], a statisti-
cally signicant decrease in subscale behavioural problems, between
the initial evaluation (M = 8.47, SD = 2.08) and the nal evaluation
[M = 7.60, SD = 1.59, t (29) = 2.62, p<0.05] and also a statistically
signicant decrease in the total scale of diculties between the initial
evaluation (M = 37.11, SD = 5.79) and the nal evaluation [M = 34.46,
SD = 3. 61, t(27) = 2.67, p<0.05].
Discussion
Surf-Salva Camp 2016 was an innovative project in Portugal, since
until now there was not a program working with institutionalized
youth through surf therapy. Our aim was to understand the impact of
the program on a group of adolescents between 10 and 17 years old,
living in foster care homes. It was hypothesized that the 1) participants
in Surf Salva Camp 2016 would have decreased values on behavioural
problems and 2) the majority of the participants would feel that had
learned surng skills, self-regulation strategies, social and emotional
skills and would feel part of the group. e stated hypothesis were in
line with the literature, namely results on self-management, empathy
and improved behaviour, wellbeing, social interactions and engage-
ment among youth [6].
e Surf-Salva Camp 2016 project design followed previous simi-
lar projects, namely “waves for change”, in South Africa and “the wave
project”, in the United Kingdom. Like the above-mentioned programs,
Surf-Salva Camp 2016 aimed to promote health and well-being in vul-
nerable youth. According to research in the eld, these adolescents
present a higher prevalence of diculties in social, cognitive, aective
and emotional development, as well as behavioural problems [2-4,21].
One of the dimensions that the Surf Salva Camp 2016replicated
was the integration in the community as the waves for change pro-
gram does, which includes visits to the homes of supported children
and youth [8,9]. e Surf Salva Camp 2016 project interacted with the
directors and referral educators of the adolescents, as a result there
was a growing interest in the program, as well as subsequent contacts
in the search for continuity and support in fundraising tasks.
Snelling [8] states that surf can be used as a therapeutic tool with
children and adolescents at risk of social exclusion and names this
procedure Surf-therapy, aiming at reducing social psychological
symptoms and increasing psychosocial well-being through Surf. e
Surf-Salva Camp 2016 was implemented in three camps each one with
16 participants. e sessions combined the practice of surf together
with psycho educational activities that aimed to promoted social and
emotional competencies and group cohesion.
With regard to the rst analysis, the results showed positive out-
comes as other similar projects shows [5,6,12-14]. Regarding the items
related to emotional regulation, most of the participants felt improve-
ments and reported that they did learn about social and emotional
competences, what can be a consequence of the fact that surf train-
ing was learn alongside with social emotional competencies. Group
integration had also a positive result with 89.3% of the participants
indicating that they felt included. As others similar programs have the
same outcome [6,14], one can think about the importance of group
activities, but also the importance of the individual respect climate
that was promoted though the camp. ey also reported not having
felt stress and having succeeded in establishing positive relationships
with signicant adults. ese data are in agreement with Godfrey, et
al. [6], who states that the sea provides a refreshing environment, that
subjects feel in connection with nature when they are in the sea and
this experience promotes resilience, a sense of inclusion, development
of self-concept and self-esteem, and contact that with the other par-
ticipants and coaches facilitates building trust and promotes learning.
Regarding the second analysis, which was related to the impact of
surng on maladaptive behaviours, such as hyperactivity, emotional,
behavioural and peer problems, positive results were also found. e
project “the wave” which works specically with mental health issues,
states that surf therapy is a “valuable and cost-eective way to deliv-
er mental health care” [6]. is study also validates surf therapy in
reducing problem behaviors once there was a statistically signicant
decrease in the subscale behaviour problems, in both the self-report
version and the institutions’ technicians report. According to the tu-
tors’ perception, there was also a decrease in the subscale of emotional
symptoms and in the scale referring to total diculties. e fact that
adolescents completed the instrument scales on the last camp session,
an especially emotional day, where some youngsters were more fragile,
some having cried, showing sadness because of the end of the camps
and worried about the not knowing if they would be with those people
again or if they would integrate new surf camps could be inuenced
the answer to items like “I’m oen unhappy”, “I worry a lot” or “I have
many fears”. In future surf camps it is thought that an alternative pos-
sibility will be the completion of the questionnaires the day aer the
end of the camp or at the end of the penultimate session.
ere were a number of diculties during the implementation and
evaluation of this process that must be overcome in future Camps as
for instance the diculties of interaction with the care Institutions,
the fact that the evaluation team was not present from the very begin-
ning of the project design, and also the diculties in having the evalu-
ations completed by both the participants and their tutors. Neverthe-
less, the positive impact of Surf erapy was evident at the Surf-Salva
Camp 2016, where 83% of young people, who were not always very
easy to motivate and who found it dicult at times to comply with
extra activities as reported by their tutors, responded that they want to
continue practicing Surf.
Subscales SDQ-PT
Self-Perceptions Tutors
Initial (X) Final (X) t p Initial (X) Final (X) t p
Emotional problems 8.64 8.54 0.27 8.61 7.65 2.6 0.05
Behavioural problems 7.47 6.63 2.39 0.05 7.77 6.84 2.1 0.05
Hyperactivity 8.62 8.2 0.97 8.74 8.42 0.69
Peer problems 7.86 7.32 1.68 7.86 7.24 1.9
Total of difculties 32.48 30.63 1.68 32.9 29.97 2.5 0.05
Table 2: Results of the SDQ-PT [16], preand post-evaluation: self-perception and institutional tutors.

Citation: Matos MG, Santos A, Fauvelet C, Marta F, Evangelista ES, et al. (2017) Surng for Social Integration: Mental Health and Well-Being promotion through
Surf erapy among Institutionalized Young People. J Community Med Public Health Care 4: 026.
• Page 6 of 6 •
J Community Med Public Health Care ISSN: 2381-1978, Open Access Journal
DOI: 10.24966/CMPH-1978/100026
Volume 4 • Issue 1 • 100026
Conclusion
According to the evaluation carried out, the intervention had a pos-
itive impact among the youth who took part. e areas of self-knowl-
edge, exploration, eort and perseverance, problem-solving, time
management, group competencies, interpersonal relationships and
emotional regulation, all developed positively throughout the project.
As for the future perspectives, the great majority expressed great inter-
est in continuing to surf. e analysis of the SDQ-PT questionnaires
suggests a signicant decrease in the variable behaviour problems
between the two assessment moments, a result corroborated by the
institutions’ technicians. In the opinion of the institutions’ technicians
there was also a signicant decrease in the subscale emotional symp-
toms and globally, in total perceived diculties.
Regarding the results obtained, it can be concluded that surng
can be used as an instrument of psychotherapeutic intervention since
our results show that it seems to be benecial for the promotion of
a healthy lifestyle, wellbeing and personal and social skills in young
people in contexts of psychosocial vulnerability.
Results suggest that this procedure, which Snelling [8] termed Surf
erapy, had a number of positive eects: as seen, exploration, eort
and perseverance, problem-solving, time management, social compe-
tencies, interpersonal relationships and emotional regulation had a
positive evolution among the participants throughout the project.
Results support the claim that within a suitable framework regard-
ing the components about surf therapy (i.e., the importance of an ad-
equate ratio adult-youth that can be 1:2 or 1:3; social and emotional
learning; lifesaving and rst aid skills training; reection activities in
group), with a constant and multidisciplinary team and with adequate
supervision and evaluation (in this project made by an expert in youth
mental health and wellbeing university professor)surf therapy can be
a very promising alternative in the psychosocial care of youth at risk.
In this regard, public policies should consider this suggestion in the
development of policies related to vulnerable institutionalized young
people.
Furthermore, it is thought that similar results could be obtained
with risk populations in younger children and projects suggestion in
the adapted surng area [5,12,13]. Concerning the impact that this
project had in social issues, future interventions should address surf
therapy when working with families in vulnerable situations and as
a prevention strategy. As the project waves for change and the wave
project, this project aim to enhance social integration in a deeper con-
cern, expanding the permanence of the surf therapy camps through-
out the year and to promoting youth employment in surf activities
related.
Acknowledgement
e authors would like to thank LIDL Portugal (nancial and pro-
moting sponsor) and the Instituto de Socorro a Náufragos (promoting
institution) for making the Surf Salva Camp 2016 possible; the au-
thors would also like to thank all of the sta from Pensamento Vivo,
namely the ones who worked in the camps, Aventura Social, FMH/
University of Lisbon; all of the sta at waves for change; and all the
young people and tutors and sta from the institutions involved: Santa
Casa da Misericórdia de Cascais (Centro de AcolhimentoTemporário
de Tercena), Associação Novo Futuro (Casas Amarela, Azul, Branca,
Laminga, Laranja, Lilás e Verde), Casa Pia de Lisboa, Santa Casa da
Misericórdia de Lisboa (Lar S. Francisco de Assis).
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