Abstract
Background
Outdoor Behavioral Healthcare (OBH) has arisen to fill a gap in mental health treatment. While research shows large positive changes in adolescent self-reports, little is known about predictors of change, longitudinal outcomes, and parent-reports of change.
Objective
This study sought to identify treatment outcomes up to 18 months post-discharge and predictors of change for parents of adolescent clients in OBH treatment.
Methods
Parents of 659 adolescents from four OBH programs were invited to complete questionnaires at intake, discharge, and 6 and 18 months post-discharge. A regression was conducted to examine change during treatment, and a multilevel model to examine trajectories of change post-treatment.
Results
OBH participants entered treatment with clinically significant levels of emotional and behavioral dysfunction, made significant change during the program, and discharged within the “normal” range of functioning. Post-discharge scores indicated that clients remained in the “normal” range of functioning 6 and 18 months post-discharge. The regression analysis found that parent intake scores and attachment disorders were predictive of in-treatment change. The MLM found that parent perceptions of treatment gains and adoption status were significant predictors of functioning post-discharge.
Conclusions
Results are in-line with previous research suggesting that OBH may be helpful to adolescents experiencing a wide range of presenting problems, and adds new insights as well. Parent-reports parallel the dramatic changes in adolescent self-reports documented throughout OBH literature; data up to 18 months post-treatment shows healthy functioning per the parent perspective; and adoption and attachment appear to play a role in outcome trajectories.
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References
Association for Experiential Education (AEE). (2014). Accreditation standards for outdoor behavioral healthcare programs. Boulder, CO: Association for Experiential Education.
Becker, S. P. (2010). Wilderness therapy: Ethical considerations for mental health professionals. Child & Youth Care Forum, 39, 47–61.
Behrens, E. N., Santa, J., & Gass, M. A. (2010). The evidence base for private therapeutic schools, residential programs, and wilderness therapy programs. Journal of Therapeutic Schools and Programs, 4, 106–117.
Bettmann, J. E., Russell, K. C., & Parry, K. J. (2013). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22, 1039–1050.
Burlingame, G. M., Wells, M. G., Hoag, M. J., Hope, C. A., Nebeker, R. S., Konkel, K., et al. (1996). Manual for youth outcome questionnaire (Y-OQ). Stevenson, MD: American Professional Credentialing Services.
Burlingame, G. M., Mosier, J. I., Wells, M. G., Atkin, Q. G., Lambert, M. J., Whoolery, M., & Latkowski, M. (2001). Tracking the influence of mental health treatment: The development of the Youth Outcome Questionnaire. Clinical Psychology and Psychotherapy, 8, 361–379.
Burlingame, G. M., Wells, M. G., Cox, J. C., Lambert, M. J., Latkowski, M., & Justice, D. (2005). Administration and scoring manual for the Y-OQ. Wharton, NJ: American Professional Credentialing Service.
Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York, NY: Routledge.
Hoag, M. J., Massey, K. E., Roberts, S., Logan, P., & Poppleton, L. (2011). What changes in wilderness therapy: Moving beyond outcome. Paper presented at the meeting of the Utah Regional National Association of Therapeutic Schools and Journals, Provo, UT.
Hoag, M. J., Massey, K. E., Roberts, S. D., & Logan, P. (2013). Efficacy of wilderness therapy for young adults: A first look. Journal of Residential Treatment for Children and Youth, 30, 294–305.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.
Lewis, S. F. (2013). Examining changes in substance use and conduct problems among treat- ment-seeking adolescents. Child and Adolescent Mental Health, 18, 33–38.
Magle-Haberek, N., Tucker, A., & Gass, M. (2012). Effects of program differences with wilderness therapy and residential treatment center (RTC) programs. Residential Treatment for Children and Youth, 29, 202–218.
Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Study-Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.
Merikangas, K. R., He, J., Burstein, M. E., Swendsen, J., Avenevoli, S., Case, B., & Olfson, M. (2011). Service utilization for lifetime mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 1, 32–45.
National Alliance on Mental Illness (2014). Facts on children’s mental health in America. Retrieved June 18, 2014 from http://www.nami.org/Template.cfm?Section=federal_and_state_policy_legislation&template=/ContentManagement/ContentDisplay.cfm&ContentID=43804.
Norton, C. L., Tucker, A., Russell, K. C., Bettmann, J. E., Gass, M. A., Gillis, H. L., & Behrens, E. (2014). Adventure therapy with youth. Journal of Experiential Education, 37(1), 46–59.
Russell, K. C. (2003). Assessment treatment outcomes in outdoor behavioral healthcare using the Youth Outcome Questionnaire. Child & Youth Care Forum, 32(6), 355–381.
Russell, K. C. (2005). Two years later: A qualitative assessment of youth-well-being and the role of aftercare in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 34(3), 209–239.
Russell, K., & Sibthorn, J. (2004). Hierarchical data structures in adventure education and therapy. Journal of Experiential Education, 27(2), 176–190.
Russell, K. C., Gillis, H. L., & Lewis, T. G. (2008). A five-year follow up of a nationwide survey of outdoor behavioral healthcare program. Journal of Experiential Education, 31(1), 55–77.
Singer, J. D., & Willet, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York, NY: Oxford University Press.
Tucker, A., Zelov, R., & Young, M. (2011). Four years along: Emerging traits of programs in the NATSAP practice research network (PRN). Journal of Therapeutic Schools and Programs, 5(1), 10–28.
Tucker, A., Javorski, S., Tracy, J., & Beale, B. (2013). The use of adventure therapy in community-based mental health: Decreases in problem severity among youth clients. Child & Youth Care Forum, 42(2), 155–179.
Tucker, A. R., Smith, A., & Gass, M. A. (2014). How presenting problems and individual characteristics impact successful treatment outcomes in residential and wilderness treatment programs. Residential Treatment for Children and Youth, 31, 135–153.
Wells, M., Burlingame, G., Lambert, M., Hoag, M., & Hope, C. (1996). Conceptualization and measurement of patient change during psychotherapy: Development of the outcome questionnaire and the youth outcome questionnaire. Psychotherapy, 33(2), 275–283.
Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York, NY: Basic Books.
Acknowledgments
This research was funded through Second Nature Wilderness Programs and Evoke Therapy Programs.
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Combs, K.M., Hoag, M.J., Roberts, S.D. et al. A Multilevel Model to Examine Adolescent Outcomes in Outdoor Behavioral Healthcare: The Parent Perspective. Child Youth Care Forum 45, 353–365 (2016). https://doi.org/10.1007/s10566-015-9331-0
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DOI: https://doi.org/10.1007/s10566-015-9331-0