Outdoor Behavioral Healthcare Research Articles

Adolescent Wilderness Therapy: The Relationship of Client Outcomes to Reasons for Referral, Motivation for Change, and Clinical Measures

Outdoor behavioral healthcare is a specific model and industry utilizing wilderness therapy (WT), a residential treatment approach comprised of outdoor travel and living for youth experiencing mental health, substance use, and behavioral concerns. We present data from 6417 participants about reasons for referral, admission, and discharge scores from the Youth-Outcome Questionnaire (Y-OQ), youth interest and commitment to treatment, reliable change scores, and the relationship between these variables. One-third of youth entered WT with sub-clinical scores, varying levels of client motivation and voluntariness in relation to clinical outcomes, a diverse range of presenting problems without clear indication of specialized treatment planning, and differing responses to treatment by referral reason. Identifying those not responding to WT and those at risk of deterioration from the time of admission requires further investigation to improve client outcomes for this treatment modality. Recommendations include placing increased importance on accurate and thorough screening and assessment, utilizing baseline and routine outcome monitoring, reducing coercion, and considering specialized intervention.

Correction to: Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

Correction to: Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

Effects of an Eight-Week Wilderness Adventure Program on Body Composition and Mental Health of Adolescents

Background: Little is known about the effects of outdoor behavioral healthcare on participants’ body composition or about the relationship between body changes and indicators of mental health. Purpose: The purpose of the current study was to compare body and mental health changes in adolescents in an 8-week adventure therapy program. Methodology/Approach: In this observational study, we analyzed pre- and posttest weight, body composition, and psychological dysfunction in male and female adolescent participants ( N = 112) in an adventure therapy program. Body composition variables were assessed using bioelectrical impedance analysis. Psychological dysfunction was measured using the Youth Outcome Questionnaire (YOQ). We also analyzed the relationship between body changes and changes in YOQ scores. Findings/Conclusions: Overall, from entry into the program (pre) to time of discharge (post), body weight, BMI, and body fat percentage significantly decreased ( ps ≤ .0014). Likewise, all YOQ variables significantly improved (scores reduced) over the course of the study ( ps ≤ .0003). Changes in body composition and YOQ score were not associated. Implications: Adolescent participation in adventure therapy is significantly associated with improvements in BMI, body weight and composition, and psychological dysfunction. However, changes in body composition and psychological dysfunction do not appear to be associated.

Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

Can Involuntary Youth Transport into Outdoor Behavioral Healthcare Treatment Programs (Wilderness Therapy) Ever Be Ethical?

Experiences of secure transport in outdoor behavioral healthcare: A narrative inquiry

Often synonymous with wilderness therapy, outdoor behavioral healthcare (OBH) is a residential treatment in the United States for young people, more than half of whom are sent via secure transport services. While empirical evidence suggests the secure transport of adolescents to OBH does not impact quantitative outcomes, limited research exists exploring client voice and the lived experience of OBH participants. This qualitative study, utilizing narrative inquiry, builds knowledge on experiences of secure transport services from nine past OBH adolescent participants. Findings are analyzed, interpreted, and discussed through a social work and trauma-informed lens. Recommendations for ethical practice, linking with human rights, and future research are provided.

A Closer Look at Involuntary Treatment and the Use of Transport Service in Outdoor Behavioral Healthcare (Wilderness Therapy)

Outdoor behavioral healthcare (OBH or wilderness therapy) is an out-of-home adolescent treatment option serving tens of thousands of youths annually for behavioral, substance, and mental health issues in the United States. About half of OBH participants attend involuntarily and are transported by services specialized for “uncooperative” youth. Transportation has been argued by some researchers to have little impact on youth in treatment, and Tucker and colleagues found little difference in outcomes between not transported and transported youth. Ethical and empirical concerns arise from these findings, and we apply a critical perspective to address these concerns. Specifically, we examined the claim in OBH research that being transported has no significant bearing on client treatment outcomes. We propose that the findings of no difference were random, rather than systematic, because they were constructed on a post hoc measure of perceived voluntariness. To demonstrate, we used data from OBH to construct five different measures of voluntary/involuntary, also fabricated post hoc. All five operationalizations resulted in statistically significant differences across a variety of social and psychological outcomes, demonstrating inconsistencies across the findings. Further independent and rigorous research is called for in OBH to understand the use and ethics of forced transportation, coercion, and involuntary treatment.

Body Composition Changes in an Outdoor Behavioral Healthcare Program

Abstract This study examined the body composition changes of adolescents participating in an outdoor behavioral healthcare program. The sample was grouped by body mass index (BMI) categories of underweight, normal weight, overweight, and obese to discern the physiological changes across these categories as a result of participation. In addition, this study tested for gender differences and differences based on season of enrollment (summer vs. winter). Paired samples t tests revealed that, on average, adolescent participants moved toward healthier body compositions from intake to discharge. Specifically, underweight participants gained a significant amount of weight, predominantly composed of lean mass. Normal-weight participants stayed at approximately the same weight but gained lean mass and lost fat mass. Overweight and obese participants lost significant amounts of weight. Two-way ANOVA analyses revealed gender differences in terms of weight loss within BMI categories, yet no differences by season or b...

Critical Factors for Field Staff: The Relationship Between Burnout, Coping, and Vocational Purpose

Background: Outdoor Behavioral Health Care (OBH) programs rely on field staff (FS) for the daily management of program activities, client safety and security, assessment information, and therapeutic intervention. Purpose: Given research that indicates turnover rates among FS are high, the present study was designed to evaluate components of resilience and burnout among FS that may help OBH programs retain FS. Methodology/Approach: Confirmatory factor analysis was used to empirically examine the impact of McEwan’s Workplace Resilience Model factors on FS resilience. Findings/Conclusions: A well-fitting model was developed to explain relationships between burnout, coping skills, and purpose among FS. Important links between vocational purpose, coping, and burnout were found. Implications: This article concludes by discussing implications and recommendations for OBH programs, in support of FS retention and workplace satisfaction, including the importance of creating workplace social and physical health support systems and key characteristics of resilient FS.

Intentional Practice as a Method to Reduce the Implementation Gap Between Science and Practice in the Delivery of Trauma-Informed Residential Care

ABSTRACTChildren and young people with backgrounds of trauma, and supported in residential programs (group care, residential treatment, wilderness therapy, and outdoor behavioral healthcare), require interventions underpinned by trauma-informed science. While there is much optimism that trauma-informed services are being integrated into residential care settings, there is evidence of a science to practice gap in how these components are implemented across real-world settings. The purpose of the paper is to introduce ‘intentional practice’ and growth-focused logic modeling (Life Buoyancy Model; LBM) as a possible method to strengthen the delivery of trauma-informed services at the program level. The paper provides an overview of the modeling and describes how the approach seeks to reduce the science to practice gap in the implementation of trauma-informed service delivery. To aid this process, five core intervention components are proposed to provide a more nuanced understanding of how trauma-informed practice can be implemented. Key considerations are offered for residential care program leaders and program developers to design, refine or review the delivery of locally contextualized program models.

The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions.

The damage inflicted on our society by mental health and substance use issues is reaching epidemic proportions with few signs of abating. One new and innovative strategy for addressing these comorbid issues has been the development of outdoor behavioral healthcare (OBH). This study compared the effectiveness of three post-acute adolescent substance use situations: OBH, treatment as usual (TAU), and no structured treatment (NST). The simulated target population was 13-17 years old with comorbid substance use and mental health issues. When costs were adjusted for actual completion rates of 94% in OBH, 37% in TAU, and $0 for NST, the actual treatment costs per person were $27 426 for OBH and $31 113 for TAU. OBH also had a cost–benefit ratio of 60.4% higher than TAU, an increased Quality in Life Years (QALY) life span, societal benefits of an additional $36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument.

A Qualitative Gender Analysis of Women Field Guides’ Experiences in Outdoor Behavioral Healthcare: A Feminist Social Work Perspective

Rationale: Social work has long supported activity-based group work for young people. One such approach includes outdoor behavioral healthcare (OBH), also known as wilderness therapy, which often employs nonclinical field staff to lead outdoor activities as part of the overall treatment model. Although men and women both serve as field guides, the culture of OBH has historically been male-dominated, at times obscuring the voices and perspectives of female staff in the field. For this reason, a feminist social work lens was employed in order to engage in a qualitative gender analysis of women field guides’ experiences in OBH. Methods: Focus groups were used in this study to better understand gender as experienced by individuals who identify as women working as field guides in OBH. Findings: Results indicated that women experienced gender at intrapersonal, interpersonal, and program levels in ways that contributed to both empowerment and obstacles to leadership roles and longevity in the field. Identified needs included training for all staff on gender, women in leadership roles, and all women’s spaces. Practice Considerations: Implications for social work practice are discussed, aimed at supporting women’s development and creating work environments most conducive to learning and growth for staff and clients alike.

Adventure therapy and its impact on the functioning of youth in a community setting

ABSTRACTThe purpose of this article is to explore the impact of one type of activity-based group work, adventure therapy (AT) group practice, on youth in a community-based mental health setting. Using data collected from Adventure Works, a nonprofit outdoor behavioral healthcare and adventure therapy counseling center, this article explores treatment outcomes to identify the effectiveness of adventure therapy group interventions. AT has been identified as an effective intervention within wilderness and residential settings, but little research exists focusing on adventure therapy in a community setting. Data collected shows positive outcomes for youth participating in adventure-based group therapy. Research and practice implications are discussed.

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

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.

The Relationship Between Self-Reported Prior Drug Use and Treatment Effectiveness in Substance Use Disorder Residential Wilderness Treatment with Young Adult Males

Substance Use Disorder (SUD) is an increasingly common disorder in North America; however, there is little research on substance use disorder treatment for young adults with SUD (Zhou, et al., 2015). Enviros Shunda Creek is a ten- bed, 90-day program located in Alberta, Canada for males ages 18-24 who are diagnosed with SUD. This outdoor behavioral healthcare (OBH) program treats SUD using mindfulness-based outdoor experiences in addition to more traditional individual and group therapy. This study examined the relationship between self-reported frequency of prior drug use, measured by the Personal Involvement with Chemicals Scales (PICS), and change in treatment outcomes, measured by the Outcome Questionnaire 45.2 (OQ-45.2) and Five Facet Mindfulness Questionnaire (FFMQ). Results demonstrated clients’ PICS scores at intake to be significantly positively correlated with OQ-45.2 total scores and OQ total change scores (discharge - intake). The OQ-45.2 Symptom Distress subscale was also positively correlated with PICS intake scores as was the Symptom Distress change score. In addition, PICS scores were found to be negatively correlated with the FFMQ total score and subscale intake scores on the Act with Awareness subscale. These findings suggest that clients with higher self-reported drug use at intake enter with higher symptom distress, and less awareness of their actions, than those who score lower on the PICS. Pre-treatment drug use assessment is encouraged as is progress monitoring for programs to track clients through treatment. Further research is encouraged to determine if different pre-treatment drug use reveals different treatment trajectories, as preliminary data presented indicates the trajectories are similar. Keywords: Outdoor Behavioral Healthcare, Substance Use Disorder (SUD), OQ45.2, Personal Involvement with Chemicals Scale (PICS)

A Novel Investigation of Substance Use Outcomes in Substance-Specific Outdoor Behavioral Healthcare Programs

Substance Use Disorders (SUDs) are one of the greatest public health burdens to date. Available evidence suggests that despite the availability of evidence- based therapeutic interventions, successful recovery from alcohol and drug dependence is hard to achieve and much harder to maintain over time. Further, young adults present with unique risk factors and tend to have a less optimal response to treatment. Consequently, a novel treatment has been developed in an effort to improve outcomes for young adults with SUDs. Substance-specific outdoor behavioral healthcare (S-OBH; term developed by the author for clarity herein) may be more appealing to young adults who have resisted or responded poorly to inpatient drug and alcohol treatment, which is identified as the standard of care. The current study sought to investigate whether S-OBH interventions are equivalent to the standard of care, using a non-inferiority design. The sample was 256 young adults (Mage = 25.8) presenting for treatment at one of two experimental treatment sites or the active comparison site, residential treatment for SUDs. Primary study hypotheses were that S-OBH treatment would be associated with similar symptomatic improvements, relative to the comparison condition, particularly relevant to symptoms of SUDs and overall quality of life. Secondly, S-OBH would be associated with the maintenance of the hypothesized treatment gains during the 12-month follow up period. Findings were consistent with hypotheses, suggesting that participants evidenced significant symptomatic reductions and maintained these improvements over a 12-month follow-up period, regardless of treatment condition. Results are discussed in terms of better understanding factors associated with a positive response to SUD interventions. Keywords: substance use disorders, novel treatment, outdoor behavioral healthcare, non-inferiority design AUTHOR NOTE: The author would like to thank the study participants and several key research collaborators and personnel, including scientific consultants and graduate students at the Intervention Sciences Laboratory at the University of Arkansas, Dr. Sheneen Daniels, Alex Pena, Jack Kline, and Gil Hollows, without whom this study could not have been completed.

Outdoor Behavioral Health Care: A Longitudinal Assessment of Young Adult Outcomes

This article details a 3‐year outdoor behavioral health care outcome study. Hierarchical linear modeling was used to analyze data from 186 young adults in a wilderness therapy program. Participants completed the Outcome Questionnaire–45.2 (Lambert et al., ) 6 times from Week 1 to 18‐month postdischarge follow‐up. Results indicated that clinically and statistically significant change occurred in treatment. Rates of change varied, and posttreatment scores remained stable, thus demonstrating that in‐treatment gains were maintained. Implications and recommendations for future research are discussed.

Mindfulness-Based Practice in Outdoor Behavioral Healthcare

Mindfulness-Based Practice in Outdoor Behavioral Healthcare

Adolescent Self-Assessment of an Outdoor Behavioral Health Program: Longitudinal Outcomes and Trajectories of Change

Outdoor behavioral healthcare is an increasingly popular treatment modality for adolescents, and evidence suggests that it is effective for a wide range of complex issues. The outdoor behavioral healthcare literature still faces major limitations though, and one of these limitations is that outcomes are primarily measured at only admit and discharge. This study sought to explore the trajectory of change throughout treatment, and investigate outcomes up to 18 months post-discharge. Of the 659 adolescent participants from four outdoor behavioral healthcare programs, 29 % were female, 18 % were adopted, and the average age was 16 years old. Participants were invited to complete questionnaires four times during treatment, and at 6 and 18 months post-discharge. We used multilevel modeling to explore trajectories and predictors of change during treatment, and a regression and an ANOVA to examine outcomes post-discharge. Results of the multilevel modeling supported that adolescents make significant changes during outdoor behavioral healthcare, and also contributed new findings on demographic and diagnostic predictors. Gender and the presence of a mood or anxiety disorder predicted greater rates of change during treatment. Analysis of post-discharge data at six and 18 months post-discharge suggested that clients maintain treatment effects and that gender persists in influencing outcomes. This study is the first to examine trajectories of change in outdoor behavioral healthcare, to find diagnostic variables to be relevant, and to examine self-report outcomes past 12 months post-discharge.

Outdoor Behavioral Health Care

A lack of clarity exists regarding how different clients respond to outdoor behavioral health care (OBH). In this study, specific client and treatment characteristics were assessed for 186 young adults completing an OBH therapeutic wilderness program. Clinical outcomes were measured with the Outcome Questionnaire–45.2. Hierarchical linear modeling results indicated no differences at intake, in change trajectories while in treatment, or at 6- and 18-months follow-up. Treatment gains and maintenance post-discharge were similar regardless of participant age, length of stay, gender, primary diagnosis, or therapist. Findings serve as additional support for the utility of OBH for a range of clients. Results are detailed and implications, limitations, and future research directions are discussed.

Family Therapy Techniques in Residential Settings: Family Sculptures and Reflecting Teams

Outcome data has shown that family therapy is highly effective in the treatment of many disorders including addiction, mood, and other issues. In working to make treatment as effective as possible, many residential treatment and outdoor behavioral healthcare (OBH) programs have adopted family therapy techniques for use in individual and peer group therapy settings. Some have also incorporated family members by inviting them to visit the residential setting and participate in treatment exercises. An article by Faddis and Bettmann (J Ther Sch Program 1(1): 57–69, 2006) outlines an example of this integrated approach to family sculptures and reflecting teams in a wilderness therapy setting for adolescents. This integrated technique has since come to be known as the four phase Familial Sculpting and Reflecting intervention. Most recently these methods have been expanded for use with young men ages 18–30 in an adventure wilderness therapy program. This article will examine the theoretical basis for both of these approaches, discuss the application of these techniques to residential OBH programs and review how these methods have been most recently adapted for use in another program.