This pilot study addressed the impact of a summer camp experience on at-risk middle school youth by exploring self-reported growth in skill development and resilience. Campers who attended a five-weeksummer day camp were compared to a control group who maintained typical activities throughout the summer. Results showed statistically significant differences in the campers’ belief of a good future for themselves (U = 179.40, P = 0.05). Campers reported sustained or positive growth in domains of social skills and positive values from the baseline to a six-month follow up. Three significant themes emerged from individual in-depth interviews including: (a) engagement influences skill competence, (b) the campenvironment expands positive choice and availability of positive occupations, and (c) males developed skills and resilience from informal physical activity while no equivalent existed for females. Middle school aged at-risk youth can benefit from occupation-based summer camp programs that promote active engagement in an enriched environment and sustain gains once they return to high-risk environments. This research contributes to a growing understanding of the potential contribution of occupational therapy in the design and delivery of effective summer camp experiences for at-risk youth.