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The Evidence Base for Private Therapeutic Schools, Residential Programs, and Wilderness Therapy Program

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Ellen Behrens at Westminster College
Ellen Behrens
John Santa at Montana Academy
John Santa
  • Montana Academy
Michael Gass at University of New Hampshire
Michael Gass
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Private Therapeutic Programs, p. 1
The evidence base for
private therapeutic schools, residential programs, and wilderness therapy programs
Ellen Behrens, Ph. D., Canyon Research & Consulting
John Santa, Ph. D., Montana Academy
Michael Gass, Ph. D., University of New Hampshire
Members of the Standing Research Committee of
The National Association of Therapeutic Schools and Programs
In the past 25 years adolescent risk factors have dramatically increased. Approximately one-third
of public high school students fail to graduate (National Center for Higher Education
Management Systems, 2006). Drug use is rampant in middle and high school. More children
have been diagnosed with mood, anxiety, attention, substance, and behavior disorders than ever
before (Substance Abuse and Mental Health Services Administration, 2006). Alarmingly large
percentages of youth participate in high-risk behaviors, such as carrying weapons and attempting
suicide (Centers for Disease Control and Prevention, 2007).
Unfortunately during this period of heightened need, mental health systems have experienced an
unprecedented decline in intensive services for high-risk youth. This decrease in the availability of
adequate mental health services has been driven by a paradigm shift to crisis stabilization and
medication management designed to manage care and contain costs for insurance companies.
These real and palpable problems have led to a rapid growth of private therapeutic programs.
Private therapeutic schools, residential programs, and wilderness therapy programs are aimed at
serving the complex needs of struggling adolescents and their desperate families who have not been
helped by palliative remedies offered by outpatient therapy or short-term psychiatric
hospitalization. Enrollment in these programs is typically preceded by complex and intensive
academic, legal, substance abuse, behavioral, emotional, and familial problems when the
adolescents’ caregivers (e.g., parents, guardians, teachers, therapists) are unable to provide adequate
support. In most cases, youth treated in private therapeutic programs return home after receiving
individual and family therapy designed to facilitate their return. The National Association of
Therapeutic Schools and Programs (NATSAP) (www.natsap.org) is the primary professional
association serving private therapeutic schools, residential programs, and wilderness therapy
programs. Its member programs typically consist of “brick and mortar” programs (e.g., therapeutic
residential programs) and outdoor-based therapeutic programs. Most NATSAP member programs
are independently owned and licensed by appropriate state agencies.
The Evidence
In the past 10 years, a growing body of evidence has accumulated documenting the effectiveness of
private therapeutic schools, residential programs, and wilderness therapy programs. This body of
research is comprised of studies led by university faculty with the oversight of federally recognized
institutional review boards. Collaborative studies have been conducted among NATSAP member
programs as well as at individual NATSAP programs.
There are five major research initiatives that, combined together, provide a growing base of
research support for private therapeutic programs. These research initiatives are particularly
ambitious: many use large samples, longitudinal designs, multiple research sites, multiple reporters,
and “gold standard” outcome measures.
Private Therapeutic Programs, p. 2
Initiative # 1
The Outdoor Behavior Healthcare Research Cooperative (OBHRC) (www.obhrc.org) is a
research collaborative comprised of several wilderness therapy programs who are NATSAP
member organizations. It is currently located at the University of New Hampshire and is operated
by several research scientists. In the last decade, these researchers have generated over 100
published research studies based on outdoor programs addressing the needs of youth.
Two foundational studies within this initiative systematically explored youth outcomes in outdoor
programs. The first was conducted at seven OBHRC wilderness therapy programs
(http://obhrc.org/publications.php). Using the Youth Outcome Questionnaire (YOQ, Burlingame,
Wells, & Lambert, 1995), a commonly used measure of outcomes in mental health treatment, Keith
Russell, Ph.D. (2002, 2003a) found statistically and clinically significant reductions of behavioral
and emotional symptoms of youth immediately following treatment. A one year follow up study
with a random sample of these youth found that, on average, the gains made during the program
had been maintained.
Mean scores on Y-OQ at Admission, Discharge, and 12 Months After Discharge for
Adolescent Self Reports and Parent Assessments (Russell, 2002a, p. 29)
Rater
Sample Size
Admission
Discharge
12 Months After
Discharge
Adolescent
621
71.80
50.58
37.70
Parent
560
99.04
55.10
42.84
In a second foundational study within this initiative, Russell (2005) followed the same sample of
youth two years later and found they had maintained therapeutic progress initiated by treatment.
Furthermore, according to youth self-report data, these youth continued to improve after leaving the
program. In fact, the majority of parents and youth indicated they were doing well and parents
believed that their son or daughter could not have begun their recovery without the initial impact of
the wilderness treatment.
As with many initial quantitative studies designed to determine basic effectiveness of programming,
Dr. Russell’s work did not include various control groups that would help determine more precisely
the reasons and generalizability of the strong positive effects obtained with wilderness intervention.
Qualitatively, parents obviously did not need control groups to attest to the degree of positive
changes produced by several weeks of wilderness intervention. Dr. Russell’s work begins to
empirically document these positive effects.
Initiative # 2
Ellen Behrens, Ph.D. (2006) conducted another major, IRB-approved research initiative at nine
“brick-and-mortar” NATSAP programs owned by Aspen Education Group. Generated by repeated
surveys of nearly 1000 youth and their parents, these results were presented at the American
Psychological Association Annual Conference in 2006. Employing standardized measures of
psychosocial functioning developed by Achenbach (2001), the study found strong positive effects
of treatment on internalizing problems (i.e., depression, anxiety, attention), problematic external
behaviors (i.e., aggression, rule breaking), and overall functioning. In addition, youth academic
functioning and youth family relationships improved significantly during treatment. A study that
Private Therapeutic Programs, p. 3
followed the youth for 12 months after treatment found that the positive treatment effects were
maintained (Behrens, 2007; Behrens & Satterfield, 2007).
Problem Severity
0
10
20
30
40
50
60
70
80
90
100
Admission Discharge 3 Mo Post 6 Mo Post 12 Mo Post
Parent
Youth
These data are perhaps most striking when considered in terms of changes in youth level of
functioning. By the end of residential treatment and one year after treatment, the majority of the
youth demonstrated clinically significant improvement by shifting from the abnormal (or clinical)
range to the normal range of behavioral and psychological functioning. These results are especially
remarkable when considered in the context of other evidence-based treatments. For example, the
maintenance of gains after private residential treatment is more favorable than those reported with
two of the most highly acclaimed evidenced-based treatments for youth (i.e., Multi-systemic
Therapy and Functional Family Therapy) (see Fonagy, Target, Cottrell, Phillips & Kurtz, 2002;
U.S. Department of Health and Human Services, 2001).
Percentage of Youth in normal, moderate, and severe ranges of functioning at admission,
discharge, and one year after discharge
Normal
Moderate
Severe
Private Therapeutic Programs, p. 4
Initiative # 3
In collaboration with the University of Arkansas, Sarah Lewis, Ph.D. coordinated a program
evaluation initiative at Aspen Education Group’s wilderness therapy programs (Dixon, Leen-
Feldner, Ham, Feldner, Lewis, in press; Lewis, Rogers, Dixon, Barreto, Leen-Feldner, & Daniels,
2007; Rogers, Dixon, Barreto, Farrell, Daniels & Lewis, 2007; Rogers, et. al., 2007). This
longitudinal outcome study used the Treatment Outcome Package (TOP) questionnaire (Krause,
Seligman, & Jordan, 2005) to measure changes in participating youth. The study confirmed the
findings generated by the evaluation initiatives of Russell (2003a, 2005): wilderness therapy was
associated with statistically significant positive changes in overall functioning. Youth in the
study experienced significant decreases in suicidal ideation, anxiety, depression, substance abuse,
social conflict, sleep disruption, violence, as well as an overall reduction in externalizing
behaviors such as impulsivity, defiance, and hostility. Furthermore, these youth demonstrated
improvements in work and academic functioning during the follow-up portion of the study.
Initiative #4
Michael Gass, Ph.D. and colleagues (2009) provided a summary of preliminary analyses of the
NATSAP Outcomes Research Project. The Project involves systematic data collection from more
than 33 NATSAP programs examining the status of participants at the beginning of treatment in
residential or wilderness settings, at the conclusion of treatment, and one-year post discharge. This
large-scale study has currently collected more than 1200 participant surveys using either the Youth
Outcome (Burlingame et al., 1995) or Achenbach (Achenbach, 2001) assessments of psychiatric
and behavioral symptoms. Preliminary analysis indicates strong positive effects of program
intervention with large statistically significant reductions in both psychiatric and behavioral
symptoms from admission to discharge. The data collection process is ongoing and later analyses
will allow for a more detailed and prescriptive assessment of the effect of different types of
program intervention on a range of specific presenting problems. This large-scale database is
located at the University of New Hampshire and will be available to investigators who have various
research questions.
Initiative #5
A number of other published, well-designed studies have been conducted at single NATSAP
member programs. For example, one study conducted at The Menninger Residential Treatment
Program with a sample of 123 youth found that parents and youth reported a significant decline in
problems from admission to 3 months after completing the program, and these gains from treatment
lasted up to 12 months after completing the program (Leichtman, Leichtman, Barber, & Neese,
2001).
Another published study, conducted at Alpine Academy, employed a strong control group design
and found families reported significant improvement in child behavior, parental effectiveness, and
parent–child relationships when compared with similar difficulties in families who were referred
for the service but not served (Lewis, 2005). These changes were maintained on assessments three
months after discharge.
Wediko Children's Services, another NATSAP member program, has participated in numerous
research projects with Jack Wright, Ph.D. of Brown University and Audry Zakriski, Ph.D. of
Connecticut College. These studies examined adaptive and contextually based behavior for youth
Private Therapeutic Programs, p. 5
in residential treatment (Wright & Zakriski, 2003; Zakriski, Wright, & Parad, 2006; Zakriski,
Wright, & Underwood, 2005).
Nick Hong, Ph.D. and his colleagues (Hong & Santa, 2007; Hong & McKinnon, 2009; Hong, 2010)
at Montana Academy conducted a series of studies demonstrating marked increases in parent
ratings of their child’s maturity over the course of treatment, and these gains persisted one year
after discharge. They also demonstrated that over the course of treatment school performance
improved markedly, psychiatric and behavioral symptoms dissipated, and parents increased positive
warmth and decreased negative emotional control of their children.
Joanna Bettmann, Ph.D. has produced a series of valuable studies on the positive influences of
wilderness therapy on attachment issues for both adolescents and adults (Bettmann, 2007; Bettmann
& Jasperson, 2008; Bettmann, Demong, & Jasperson, 2008). Her work demonstrates how
wilderness therapy programs can aid in the treatment of insecure attachment cycles.
Conclusions
Private therapeutic schools, residential programs, and wilderness therapy programs possess a solid
and growing research base. This collective body of research demonstrates that participating youth
improve significantly during treatment and these improvements continue after youth return home.
These findings are based on several different research programs of study: studies that were large
scale, multi-center, and longitudinal, conducted by nationally recognized university researchers,
and reviewed by federally recognized institutional review boards. Further research of course is
needed, and encouraged, that will include a variety of control conditions aimed at refining the
explanations of the powerful treatment effects that have been revealed.
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... Despite the documented positive influences programs such as this can have on human wellbeing (e.g., Behrens, Santa, and Gass 2010;Bowen, Neill, and Crisp 2016;Kilburn 1999), there is very little understanding of the ecological impacts associated with these frequent, extended, and year-round types of backcountry programs (Russell and Hendee 2000a). Thus, there is a lack of understanding regarding which programmatic activities can cause impacts, and what might be done in the future to mitigate impacts in GSENM and other protected, predominantly backcountry areas. ...
... Wilderness therapy has the potential to be a viable option for individuals who might be less responsive to traditional clinical, or indoor methods of treatment (Lariviere et al. 2012). During this type of therapy, participants learn the skills needed to travel and live in the wilderness through extended periods of time spent in the outdoors (Tucker et al. 2016), which have been linked to improved psychological well-being for youth and adults (Behrens, Santa, and Gass 2010;Gass, Gillis, and Russell 2012;Hoag, Massey, Roberts, and Logan 2013;Norton et al. 2014). Research suggests that these types of programs are increasing on public lands (Ewert, Attarian, Hollenhorst, Russell, and Voight 2006;Hoag, Combs, Roberts, and Logan 2016;Russell and Hendee 2000b), and according to the National Association of Therapeutic Schools and Programs (NATSP), there are more than 20 of these accredited programs facilitating wildernessbased therapy in protected areas across the United States (NATSP 2015). ...
... Wilderness therapy clearly has a place in our protected areas, and research has demonstrated the positive impact these programs can have on human health and well-being (Behrens, Santa, and Gass 2010;Bowen, Neill, and Crisp 2016). But, without sustainable practices, these programs have the potential to damage the environments that promote well-being. ...
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Studies demonstrate that wilderness therapy programs can be bene cial for participants; however, little research has explored the ecological impacts of these programs. A prominent wilderness therapy organization utilizes vast tracts of the Grand Staircase-Escalante National Monument (GSENM) for programming. This study examines the speci c ecological impacts stemming from the program in GSENM, concurrently with a content analysis of the training procedures administered by the organization. Results emphasize the need to improve education, training, and mitigation measures to minimize impacts stemming from this and other wilderness therapy programs in GSENM, as well as other wilderness areas in which these programs operate.
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... A variety of wilderness therapy outcome studies have provided initial evidence of efficacy (Behrens, Santa, & Gass, 2010;Behrens & Satterfield, 2007;Hoag, Burlingame, Reedy, Parsons & Hallows, 1999;Hoag, Savicki & Burlingame, 2001;Lewis, 2007;Russell, 2003Russell, , 2005Russell, , 2007Tucker, Zelov, & Young, 2011;Young & Gass, 2010). These studies have shown a sharp reduction in symptoms for adolescents during the time they are in wilderness therapy, as well as continued improvement in mental health over the course of the year following therapy. ...
... As in our sample, the improvement in parent scores was nearly two times greater than that reported by clients (Russell, 2003). Other studies using measures other than the Y-OQ ® have reported significant change over the course of OBH treatment (Behrens et al., 2010). ...
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... Further notable studies have examined the longitudinal impacts of different outdoor therapies for functioning (DeMille et al., 2018), behavioural and emotional outcomes (Behrens et al., 2010) and substance abuse (Lewis, 2013), finding improvements can last for at least a year after treatment. Parent-perceived functioning of adolescents post-outdoor behavioural therapy treatment has been shown to persist for at least 18 months (Combs et al., 2016). ...
Bridging the evidence gap: A review and research protocol for outdoor mental health therapies for young Australians
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  • Nov 2023
Internationally, over 60% of all lifetime cases of mental health disorders are identified as emerging by 25 years of age. In Australia, young people (aged 16–24 years) report the highest prevalence of mental health problems. Acceptability of mainstream services for young people is a concern, particularly for clients 18–25 years, heterosexual males and certain marginalised communities. With unaddressed distress in young people a precursor to poor, potentially lifelong mental ill-health trajectories, the provision of acceptable, and accessible mental health services remains a critical system imperative. Outdoor therapies, such as outdoor talking therapies, present an option for increasing the breadth of mental health interventions available to young people. Reported benefits of outdoor therapies include improved self-esteem and confidence, positive and negative affect, stress reduction and restoration, social benefits, and resilience. As outdoor therapies draw on multidisciplinary skillsets, this modality has the potential to expand services beyond existing workforce capacities. However, there are evidence gaps that must be addressed before mainstreaming of this treatment modality can occur. Here we overview the existing evidence base for outdoor talking therapies, as a form of outdoor mental healthcare, to determine their appropriateness as an effective and efficient treatment modality for young people with psychological distress in Australia and elsewhere. We then propose a research protocol designed to determine the acceptability, efficacy and efficiency of ‘outdoor talking therapies’. Our aim is to help address identified youth mental healthcare service shortages in Australia, and potentially support the health of our mental healthcare workforce.
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... For children in the MHOA class, the school context appeared to be more problematic compared to other classes. For youth in residential care whose primary behavioral issues include disruptions in school, residential programs that offer on-campus schooling may be a preferred option ,with some evidence of effectiveness (Behrens, Santa, & Gass, 2017). ...
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... The current average cost of one of these programs is $6316 per month (McKay 2017). NATSUP publishes nearly all research and data points about this industry in the Journal of Therapeutic Schools and Programs, whose articles demonstrate their own programs' efficacy in reducing behavioral problems and/or substance abuse for up to 2 years afterward (Behrens et al. 2010;Behrens and Satterfield 2017). ...
Troubled Affluent Youth’s Experiences in a Therapeutic Boarding School: The Elite Arm of the Youth Control Complex and Its Implications for Youth Justice
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  • Crit Criminol
Criminology focuses on street crime and crimes of the poor. Surveys, however, indicate that deviance among middle- and upper-class youth is widespread, and that their experience of social control is not researched, despite its importance for a more complete understanding of youth justice. This study provides insight into a mostly unregulated private troubled teen industry, relying on interviews and a survey of affluent youth sent to a therapeutic boarding school. The main sections of this article explore the wide variety of behaviors that caused youth to be sent to the program, the key aspects of their experiences, and the very mixed outcomes. (All participants graduated high school and most completed college, but many others committed suicide or overdosed.) While a degree and the lack of a criminal record ultimately benefited these privileged youth, the strong-arm rehabilitation tactics of this kind of total institution are a problematic model to use to advance youth justice.
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... Both assessments are sensitive to emotional, behavioral, and relational changes that occur over periods of time (Wells et al., 1996). The National Association of Therapeutic Schools and Programs (NATSAP) and affiliated treatment programs have collected OQ and Y-OQ data from thousands of participants pre-treatment, upon discharge, and at post-treatment follow-ups and have found that significant and lasting positive change does occur in therapeutic residential treatment (Behrens, Santa, & Gass, 2010). Utilizing the OQ and/or Y-OQ in addition to the PTGI can add information and understanding of the relationship and patterns between mental health outcomes and posttraumatic growth. ...
Posttraumatic Growth and Residential Therapy: Cultivating Environments that Support and Facilitate Posttraumatic Growth and Positive Well-being
Article
  • Jan 2018
Residential therapy is intended for those needing mental health crisis intervention. The well-being of these people cannot be overlooked and should take an active role in the treatment process, especially for those struggling with the symptomology of posttraumatic stress. By utilizing both positive psychology and posttraumatic growth theory and practice, participants in residential therapy may strengthen personal well-being thus encouraging the posttraumatic growth process. Focusing on positive affect, engagement, relationships, meaning, and achievement can stimulate and support posttraumatic growth in an intentional setting such as residential therapy. This will shift treatment goals and outcomes away from deficit diagnosis and recovery and, instead, prioritize healthy well-being practices, strength development, and encourage growth opportunities.
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... The adolescent OBH and RTC research suggests that adolescents and/or their parents report significant improvement from the point of admission to the point of discharge for emotional, behavioral, academic, family, and substance abuse problems in RTC and OBH programs (Behrens, 2006;Behrens, 2011;Behrens, Santa, & Gass, 2010;Behrens & Satterfield, 2007;Bettmann, Tucker, Behrens, & Vanderloo, 2016;Russell, Gillis, & Lewis, 2008;Tucker, Norton, DeMille, & Hobson, 2016a;Tucker, Paul, Hobson, Karoff, & Gass, 2016b). Furthermore, the research suggests that adolescents maintain gains up to one year post-discharge (Behrens, 2011;Tucker et al., 2016a;Tucker, Smith, & Gass, 2014;Tucker, Zelov, & Young, 2011;Zelov, Tucker, & Javorski, 2013). ...
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... Over the last 15 years OBH has received greater scholarly attention, especially in North America. General effectiveness studies have reported on youth who participate in treatment in an OBH program improve in overall mental health functioning from admission to discharge (Clark, Marmol, Cooley, & Gathercoal, 2004;DeMille, 2015;Magle-Haberek et al., 2012;Norton, 2008;Tucker, Norton, DeMille, & Hobson, 2016), with treatment gains maintained at six-months post-treatment (Bettmann, Russell, & Parry, 2012;Tucker, Norton, et al., 2016;Zelov, Tucker, & Javorksi, 2013), one-year (Behrens, Santa, & Gass, 2010;Combs, Hoag, Roberts, & Javorski, 2016;Lewis, 2012), and 18-months post treatment (Combs et al., 2016). In addition, participants in OBH programs have reported positive physiological outcomes (DeMille, Comart, & Tucker, 2014;Tucker, Norton, et al., 2016), decreased substance use (Lewis, 2012), decreased depressive symptoms (Norton, 2010a), improvements in mood (Russell, 2005), and decreased conduct disorder behaviors (Lewis, 2012). ...
The effectiveness of outdoor behavioral healthcare with struggling adolescents: A comparison group study a contribution for the special issue: Social innovation in child and youth services
Article
  • Mar 2018
  • CHILD YOUTH SERV REV
This study examined the longitudinal impact of Outdoor Behavioral Healthcare on youth participants as reported by their parents. This analysis fills a critical gap in past research by including a Treatment as Usual (TAU) comparison group. Findings showed that youth participants who attended an Outdoor Behavioral Healthcare treatment program were, as reported by their parents, were functioning significantly better than the TAU group one year following the program as measured by the Youth Outcome Questionnaire 2.01. Youth who remained in their communities were still at acute levels of psychosocial dysfunction during the same time span. Despite some differences between the means of the treatment and TAU groups across time between gender and groups, a regression analysis revealed age and gender not to be significant predictors of improvement. The only significant predictor was participation in the treatment group.
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Theoretical Orientation Beliefs Among Adventure Therapy Professionals
Thesis
Full-text available
  • Jul 2023
Adventure therapy as a therapeutic model for the treatment of mental health has been a growing area of psychology for more than 50 years. This quantitative study was conducted to explore the theoretical orientation beliefs to clarify the theoretical framework of this therapeutic approach using Coleman’s theoretical evaluation self-test (TEST) to gather data on self-identified adventure therapy practitioners’ theoretical beliefs. Data were collected from 150 participants recruited through their membership or affiliation with adventure therapy professional organizations or social media groups. Data were analyzed using a paired t-test to determine if adventure therapy professionals have higher scores on the cognitive, ecosystems, and humanistic domains of the TEST than the domains of psychodynamic, family, biological, and pragmatic as suggested in previous research. Data were analyzed using chi-square goodness-of-fit test to determine if theoretical orientation beliefs differ depending on degree emphasis and depending on licensure among adventure therapy professionals. Analysis confirmed that adventure therapy professionals had higher scores on the cognitive, ecosystems, and humanistic domains of the TEST. However, the chi-square results indicated no difference in theoretical orientation beliefs among adventure therapy professionals regardless of degree emphasis or licensure. The findings of this research have potential implications for positive social change by being the first to identify the theoretical orientation beliefs among adventure therapy professionals, that can influence the practices and development of this field, which could lead to greater uniformity in treatment with this modality and improved patient outcomes.
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Walking off the Mountain: Planning Aftercare Support for Adolescents in Wilderness Therapy and Their Families
Chapter
  • Mar 2017
Families frequently seek wilderness therapy hoping for a miracle when other treatment interventions have proven ineffective, and these families and their adolescent children frequently do experience powerful shifts during wilderness therapy programs. However, these therapeutic gains are not yet internalized as change, and follow-up treatment is necessary. Navigating the aftercare planning process can be confusing, emotionally fraught, and paralyzing for parents when considering the potential risks associated with not maintaining those gains. This chapter describes why most adolescents transition to longer term residential therapeutic schools and programs post-wilderness, and how that environment can actually be the safest and least restrictive. Many considerations for crafting an aftercare plan are detailed in this chapter, as well as how to safely transition an adolescent to an aftercare program. Situations are discussed in which returning home upon discharge might be recommended. Suggestions are offered for wilderness therapists and home providers regarding how to support parents making difficult aftercare decisions. And lastly, the importance of the wilderness therapy intervention is explained, even in the face of subsequent longer term residential treatment.
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Treating adolescents with attachment and adoption issues in wilderness therapy settings
Article
Full-text available
  • Jan 2008
Using therapeutic and educational activities, wilderness therapy programs provide therapeutic care within remote outdoor settings. This treatment modality has become increasingly common for adolescents facing behavioral issues, yet different programs use different theories to conceptualize treatment and intervention. The authors present John Bowlby's attachment theory as a lens for re-conceptualizing adolescent behavior in wilderness treatment, particularly with the application of attachment theory to adopted adolescents. The authors present specific recommendations for programmatic changes to accommodate adolescents' attachment needs.
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A concurrent model of the wilderness therapy process
Article
Full-text available
  • Jan 2004
Though wilderness therapy programs are growing in number and popularity, the theoretical basis for distinguishing wilderness therapy from traditional therapeutic modalities is lacking. Existing models describing the wilderness therapy process have been stage-based, meaning the process has been conceptualized as sequential and discrete. Lost in this conceptualization of the wilderness therapy process is the dynamic and interrelated nature of therapeutic factors reasoned to be present at all times and to varying degrees. To address the limitations of stage based models and the lack of a strong theoretical basis in wilderness therapy, a concurrent model of the wilderness therapy process is proposed. This proposed model consists of three factors believed to be unique to the wilderness therapy milieu: Wilderness, Physical Self, and Social Self. The constituents of each of these factors are detailed and theoretical rationale for inclusion provided. In addition hypotheses about the intensity of each of these factors are discussed as a function of the temporal progression of the wilderness experience (e.g. entrance into wilderness program, exiting wilderness program). Advantages of the proposed model as well as suggestions for model testing and refinement are included.
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The Role of Physical Exercise in Wilderness Therapy for Troubled Adolescent Women
Article
Full-text available
  • Mar 2006
This study explores the impacts of backpacking as a therapeutic process for troubled adolescent women participating in wilderness therapy. A qualitative case study approach was used to investigate the experience of six adolescent women and three female wilderness instructors at an estab- lished wilderness therapy program. Data were collected through partici- pant observation, client psychological profiles, and semi-structured inter- views. Research explored the emotional, cognitive, and physical impacts attributed to the backpacking component of the therapeutic process and the relationships between these impacts. Results revealed eight central impacts of backpacking, each of which fell into categories differentiated by dimensions of temporality, intensity, and clarity. A conceptual model captures the flow of the backpacking process and offers insight into this specific therapeutic element of wilderness therapy.
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A Five-Year Follow-Up of a Survey of North American Outdoor Behavioral Healthcare Programs
Article
  • Aug 2008
This study reports the results of a five-year follow-up survey of private-pay outdoor behavioral healthcare (OBH) programs operating in the United States and Canada. A total of 65 of 102 programs identified as meeting certain characteristics responded to the survey and identified themselves as an OBH program that utilizes a clinical treatment model that primarily uses wilderness expeditions. The goal of the study was to determine industry trends by comparing the results of this study to results generated in a 2001 survey of OBH programs. An additional goal of the study was to discuss the findings in the context of recent reports on OBH and related programs concerning program management and practice. Key findings indicate that the number of OBH programs operating appears to have increased since 2001, and that the clear majority of these programs are state-licensed and half are accredited. Family involvement in programming has decreased, as has the number of families receiving co-pay to help alleviate the costs of treatment. Field instructor training and qualifications, supervision, and oversight of daily treatment and program operation, and drug detoxification practices at admission are all issues that warrant further investigation. A conclusion is made that care should be taken by policy makers and others when making broad generalizations that implicate all OBH treatment programs, when it appears that most programs are licensed, have licensed clinicians on staff, and adhere to best practices in treatment as identified by a variety of agency and association standards.
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What is Wilderness Therapy?
Article
  • Jun 2001
Despite a growing number of programs operating in the United States under the guise of “wilderness therapy,” a consistent and accepted definition is lacking. Rehabilitative, outdoor-based approaches, such as “challenge courses,” “adventure-based therapy,” or “wilderness experience programs,” are often used interchangeably to describe “wilderness therapy.” This paper attempts to shed light on this issue by presenting an integrated and consistent definition of wilderness therapy to guide program design and future research efforts. Three trends in the industry are also explored which support the notion that wilderness therapy programs are searching for recognition by state agencies, national accreditation agencies, insurance companies and mental health professionals. These trends support the idea that consistent wilderness therapy practices may be emerging which support the use of a consistent definition.
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Exploring How the Wilderness Therapy Process Relates to Outcomes
Article
  • Dec 2000
Wilderness therapy is seen as a treatment option for seriously troubled adolescents not being reached by traditional forms of treatment. The research shows that wilderness therapy can improve self-perceptions, increase social adjustment, and reduce recidivism of adolescent participants. However, research on wilderness therapy has not been specific in describing how presenting problems are assessed by wilderness therapy and how therapeutic approaches relate to target outcomes. This article examines the wilderness therapy process in context to illustrate how the process related to specific outcomes for four client case studies in four wilderness therapy programs. Trends emerged from qualitative data analysis illustrating the importance of alone time and opportunity for reflection and a non-confrontive and caring approach that helped clients establish a trusting relationship with staff. Three outcomes were common across all four client case studies in the form of proposed changes: (a) a better relationship with their family, (b) abstinence from drugs and alcohol, and (c) a desire to try harder and complete school. Four-month follow-up interviews revealed clients doing well, though three had used drugs and alcohol to varying degrees, which underlines the importance of structured aftercare services.
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Evaluating the Effects of the Wendigo Lake Expedition Program on Young Offenders
Article
  • Apr 2006
This study reports an evaluative case study of Wendigo Lake Expeditions (WLE), a continuous intake, open custody program for young offenders that uses a positive youth development approach. Four objectives guided the case study: (a) describe and illustrate WLE's approach to working with adjudicated youth, (b) identify and report perceptions of the program and process, (c) assess changes in their well-being utilizing the Youth-Outcome Questionnaire (Y-OQ), and (d) track postprogram recidivism rates. Results indicated a significant improvement in youth well-being indicated by significant score reductions on the Y-OQ. Of the 40 youths contacted at the follow-up assessment, 21 (53%) had been charged with a criminal offense during this period, including those charged for administrative offences such as breaching conditions of probation, whereas 19 (47%) had not been charged. Implications of positive youth development programming for adjudicated youth are discussed.
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Relative impact of course components at Outward Bound Singapore: A retrospective study of long-term outcomes
Article
  • Dec 2008
This study examined the long-term impact of specific course components on participants who attended a 21-day Outward Bound Singapore course between 1997 and 2005. In total, 1029 questionnaires were sent out by mail. Participants were given a choice to complete the questionnaire on paper or online. A total of 318 questionnaires were successfully completed (209 by mail and 109 by the Internet) which resulted in an overall response rate of 34.29%. A series of hierarchical regressions was utilized to explore how course components contributed to participant perceptions of course long-term impact. The results assert there is long-term impact on past participants' lives, even if they participated in the course as far back as 1997. Specific course components that contributed to long-term impact were personal reflection time, group debriefing time, and outdoor activities. The course instructor was not a significant contributor to long-term impact.
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