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Results from Open Sky

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Title: Results from Open Sky


1
Results from Open Skys Outcome Research
  • Joanna Bettmann, Ph.D, LCSW
  • Open Sky Wilderness Therapy December, 2009

2
Outline of the Presentation
  • Why do research?
  • Defining wilderness therapy
  • Existing outcome research into wilderness therapy
  • Open Skys outcome research on adolescents and
    young adults

3
Why do research?
  • There are at least 10,000 adolescents in
    wilderness treatment each year (Cooley, 1998)
  • Thus, we must have research which shows that
    wilderness therapy is effective

4
What is Wilderness Therapy?
  • Russell (2003) defines wilderness therapy as a
    type of program that works to address problem
    behaviors. . .through a variety of therapeutic
    and educational curricula in outdoor
    environments. This process is facilitated by
    licensed professionals (p. 3).
  • What wilderness therapy is not
  • Challenge courses
  • Adventure based therapy
  • Boot Camp
  • (Russell, 2001)

5
What do we already know about the effectiveness
of wilderness therapy?
  • Using the Youth Outcome Questionnaire, Russell
    (2003) studied 858 adolescent clients and their
    parents in 7 different wilderness therapy
    programs he found significant gains made during
    treatment which was largely maintained at 1 year
    follow-up
  • Russell (2005) followed up at 2 years with 88
    parents from the original sample and 47
    adolescents gains made during treatment were
    largely maintained 2 years after wilderness
    program
  • Harper, Russell, Cooley Cupples (2007)
    conducted a quantitative, longitudinal study of
    252 adolescents at Catherine Freer showed
    positive improvement after 21-day wilderness
    program
  • Bettmann (2007) studied changes in the attachment
    relationships of 93 adolescents in wilderness
    treatment showed adolescents less angry at
    parents following treatment

6
Other recent wilderness therapy outcome research
  • Cook (2008) completed a qualitative study of 13
    male adolescents in a year-long residential
    wilderness therapy program
  • Eikenæs, Gude Hoffart (2006) compared a 6-day
    wilderness treatment versus standard inpatient
    hospitalization for adults with avoidant
    personality disorder
  • Gillis, Gass Russell (2008) studied the
    effectiveness of project adventures behavior
    management programs for male offenders in
    residential treatment
  • Jones, Lowe Risler, (2004) studied 24 boys in
    wilderness treatment compared to 11 in group
    homes (in Juvenile Justice system)
  • Sklar, Anderson Autry (2007) studied 15 at-risk
    youth who participated in an 8-day therapeutic
    wilderness canoe trip
  • Caulkins, White Russell (2006) qualitatively
    studied the role of backpacking and physical
    exercise in 6 adolescent girls in a wilderness
    therapy program
  • Russell Harper (2006) studied restraint,
    runaway, illness and injury incidents over 4
    years of OBHIC member programs

7
Research shows positive outcomes for wilderness
treatment
  • Improved mental health symptomology
  • Sense of accomplishment
  • Increased self-esteem
  • Sense of empowerment
  • Better access to feelings
  • Improved relationships
  • Improved communication skills
  • Improved drug alcohol awareness
  • Improved coping skills
  • Awareness of behaviors
  • (Bettmann, 2007 Russell, 2001, 2003, 2005
    Russell, Hendee, Phillips-Miller, 2000)

8
Adult Outcome Research Sparse
  • Hyer (1996) study of adult participants of
    Outward Bound program. Participants reported
    gains in self-esteem, problem-solving and
    behavior change
  • Goldenberg (2005) study of adult participants of
    another Outward Bound program. Participants
    reported improved self esteem, confidence and
    interpersonal skills.
  • Asher, Huffaker McNally (1994) study of adult
    abuse survivors on 3-day wilderness therapy trip.
    Study reports participants developed trusting
    relationships and utilized problem-solving
    skills.
  • Little research on adult outcomes (Kelly, 2006
    Paxton, 2000)

9
Problems in Wilderness Outcome Research
  • Poor treatment definition (Russell, 2001)
  • Few outcome studies, few in peer-reviewed
    literature
  • No accounting for programmatic elements or
    delivery
  • Open Skys study attempts to ameliorate these
    flaws in the literature

10
Open Sky Outcome Research Three Years of
Conclusive Data
  • Data gathered from all students and their
    parents/stepparents/caretakers
  • Data gathered on the first day of Open Sky
    program, last day of Open Sky program, 3 months
    after, 6 months after, 12 months after, and 24
    months after
  • This is an exploratory study to answer the
    questions is this wilderness treatment
    effective? What factors are associated with
    positive outcomes?

11
Comparing Open Sky Results to other Wilderness
Therapy Programs
  • This graph shows that teens graduating from
    Open Sky have done better at graduation and one
    year later than teens who go to other wilderness
    therapy programs.

12
The Open Sky model of wilderness therapy
  • Holistic focus treating the whole person
  • Typically one group of 7 clients with 3 staff
  • Masters or Doctoral level counselors visit 2
    days/week to provide sophisticated
    individual/group psychotherapy
  • Counselors talk with families on the phone,
    create individualized treatment plans, coordinate
    family treatment
  • Organic, whole foods diet
  • Daily activities group hikes, group
  • therapy, learning primitive skills, experiential
    curriculum, meditation, yoga
  • Initial medical and clinical screening, ongoing
    naturopathic treatment
  • Psychiatric consultations as needed

13
Open Sky Outcome Research Measurements/Questionna
ires
  • Adolescent Measures
  • Youth Outcome Questionnaire (YOQ) (Burlingame,
    Wells Lambert, 1995)
  • Adolescent Attachment Questionnaire (West, Rose,
    Spreng, Sheldon-Keller Adam, 1998)
  • Adolescent Relapse Coping Questionnaire (ARCQ)
    (Myers Brown, 1996)
  • University of Rhode Island Change Assessment
    (URICA) (McConnaughy, Prochaska Velicer, 1983)
  • Young Adult Measures
  • Outcome Questionnaire-45 (OQ) (Lambert
    Burlingame, 1996)
  • University of Rhode Island Change Assessment
    (McConnaughy, Prochaska Velicer, 1983)
  • Adult Attachment Scale
  • Addictive Disorders Screen Revised (Howatt,
    2006)
  • Psychological Separation Inventory (Hoffman,
    1984)

14
Open Sky Study Teen Numbers
  • Gender
  • 100 male students (47.6)
  • 110 female students (52.4)
  • Average number of days in the program
  • 63.07 days
  • Average age at admit 15.81 years old
  • Age range is 13-17 years old
  • Did you go on to Aftercare after Open Sky?
  • 122 yes (67)
  • 60 no (33)

15
Open Sky Study Teen Characteristics
  • Race
  • 158 white students (85.9)
  • 24 students of color (13.2)
  • Adopted
  • 32 adopted students (18)
  • 146 non-adopted students (82)
  • Clinical Issues in all Teen Students
  • Substance Abuse or Dependence 70.6 of all teen
    students
  • Depressive Disorders/Anxiety Disorders/Bipolar
    Disorders 72.7
  • ADHD/Oppositional Defiant Disorder/Disruptive
    Behavior 61.8

16
Summary of Open Sky Teens Mental Health Distress
  • The next few slides present the results of the
    Youth Outcome Questionnaire (YOQ) results, which
    report on adolescents mental health distress and
    how it changed as a result of the program

17
The Youth Outcome Questionnaire (YOQ) What does
it specifically measure?
  • Emotional distress (anxiety, depression, fear,
    hopelessness, self-harm)
  • Physical distress (headaches, dizziness,
    stomachaches, nausea, etc.)
  • Relationship issues with parents, other adults,
    peers (attitude, cooperativeness, aggressiveness,
    arguing)
  • Social problems (conduct, aggression, truancy,
    runaway, sexual problems, vandalism)
  • Behavioral problems (ability to organize,
    complete tasks, inattention, hyperactivity)
  • Other items (paranoia, obsessions and
    compulsions, hallucinations, delusions, suicidal
    ideation, mania, eating disorder )

18
Open Sky Parent of Teen Results Over Time
  • This graph shows that parents of Open Sky teens
    report their children improve emotionally and
    behaviorally by graduation from Open Sky and
    these improvements remain steady over the course
    of a year.

19
Comparing Open Sky Parent and Teen Scores Over
Time
  • This graph shows that Open Sky teens report they
    improve emotionally and behaviorally from the
    first day to the last day at Open Sky and that
    these improvements in mental health are steadily
    maintained over time.

20
Summary of Adolescent Relapse Coping
Questionnaire
  • The next few slides present the latest results of
    the Adolescent Relapse Coping Questionnaire
    (ARCQ) which predicts future substance use by
    measuring substance abuse recovery skills

21
Adolescent Relapse Coping Questionnaire (ARCQ)
What does it specifically measure?
  • Higher scores of abstinence-focused thoughts of
    drugs and alcohol predict less substance abuse at
    1 year after treatment.
  • Lower scores of self critical thoughts correlate
    with less substance use, better coping, and
    higher self-esteem and self-efficacy

22
Open Sky Teens Recovery from Substance Abuse
  • This graph shows that Open Sky teens report
    an increase in Abstinence-Focused Coping skills,
    meaning that they gain skills for resisting
    substance abuse while at Open Sky and maintain
    those gains for a year after treatment.

23
Summary of Adolescent and Young Adult Readiness
to Change
  • The next few slides present the latest results
    of teen and young adult readiness for change as
    measured by the University of Rhode Island Change
    Assessment (URICA)

24
University of Rhode Island Change Assessment
(URICA) What does it specifically measure?
  • The URICA assesses how ready and willing a person
    is to change the problem(s) in ones life.
  • Higher scores mean more readiness and willingness
    to change ones life.

25
Open Sky Teen Readiness and Willingness to Change
Over Time
  • This graph shows that Open Sky teens
    attitudes about his/her readiness to change their
    problems improves over time.
  • This graph also shows that these improvements
    steadily increase up to one year after Open Sky
    graduation, indicating increased willingness to
    face problems and make changes.

26
Open Sky Adult Readiness and Willingness to
Change Over Time
  • This graph shows that Open Sky adults
    attitudes about changing their problems improves
    from first day to graduation day.

27
Open Sky Study Young Adult Numbers
  • Total number of participants 114
  • Gender
  • Male 68.4
  • Female 31.6
  • Age
  • Average 20 years old
  • Range 17-29 years old
  • Number of days in program
  • Range 4-83
  • Average 54.73 days
  • Go on to aftercare after Open Sky
  • Yes 64.3
  • No 35.7

28
Open Sky Study Young Adult Characteristics
  • Adopted
  • Yes 14.4
  • No 85.6
  • Race
  • White 92.3
  • Students of color 6.6
  • Clinical Profiles of all Young Adult Students
  • Substance abuse/dependence 71.2
  • Depressive Disorders/Anxiety Disorders/Bipolar
    Disorders 88.1
  • ADHD/Oppositional Defiant Disorder/Disruptive
    Behavior 40.7

29
The Adult Outcome Questionnaire (OQ) What does
it specifically measure?
  • Emotional distress (anxiety, depression, fear,
    hopelessness, self-harm)
  • Relationships (satisfaction with, as well as
    problems in interpersonal relations)
  • Social role (assesses level of dissatisfaction,
    conflict, distress and inadequacy in tasks
    related to employment, family roles and leisure
    life)

30
Open Sky Adult Levels of Distress Over Time
  • This graph shows that Open Skys young adults
    report improved mental health by the end of Open
    Sky treatment.

31
What factors have been found to effect Open Sky
Teen and Adult success?
  • Open Sky teens who go on to aftercare tend to
    sustain better mental health and behavior over
    time.
  • Open Sky is equally effective for all genders and
    races.
  • Open Sky is effective for adolescents and young
    adults.
  • Open Sky is effective for people with a wide
    range of problems including
  • mood, behavioral, relational, and substance use
    problems.
  • Adopted teens and their parents tend to disagree
    more than non-adopted families on levels of
    mental health distress upon arrival.

32
Teen Reported Differences in going to Aftercare
vs. going Home
  • This graph shows that teens who go to
    aftercare after Open Sky report fewer mental
    health problems than teens who went home after
    Open Sky.

33
Parent Reported Differences of Teens who go to
Aftercare vs. go Home
  • This graph shows that parents of teens who go
    on to aftercare after Open Sky believe their
    children do better over time than parents of
    teens who went home after Open Sky.

34
Open Sky Conclusions
  • There is strong evidence that Open Sky Wilderness
    Therapy works
  • Open Sky is effective for a range of clinical
    diagnoses, ages, genders and characteristics
  • Preliminary evidence from Open Sky study suggests
    that aftercare offers a protective factor in long
    term success following wilderness therapy
    treatment

35
Open Sky Research References
  •  Asher, S.J., Huffaker, G.Q., McNally, M.
    (1994). Therapeutic considerations of wilderness
    experiences for incest and rape survivors. Women
    Therapy, 15 (3/4),
  • 161-174.
  • Autry, C.E. (2001). Adventure therapy with girls
    at-risk responses to outdoor
  • experiential activities. Therapeutic Recreation
    Journal, 35(4), 289-306.
  •  Berman, D.S. Anton, M.T. (1988). A wilderness
    therapy program as an alternative to
  • adolescent psychiatric hospitalization.
    Residential Treatment for Children Youth, 5(3),
  • 41-53.
  •  Bettmann, J.E. (2007). Changes in adolescent
    attachment relationships as a response to
  • wilderness treatment. Journal of the American
    Psychoanalytic Association, 55 (1), 259-265.
  • Burlingame, G.M., Wells, M.G. Lambert, M.J.
    (1995). The Youth Outcome Questionnaire.
    Stevenson, MD American Professional
    Credentialing Services.
  •  Caulkins, M.C., White, D.D., Russell, K.C.
    (2006). The Role of physical exercise
  • in wilderness therapy for troubled adolescent
    women. Journal of Experiential Education, 29(1),
    18-37.
  •   Conner, M. (2007, March 5). An Overview of
    wilderness therapy programs. Retrieved from
    http//www.wildernesstherapy.org/Wilderness/Wilder
    nessProgramOverview.html
  •  
  •  
  •  

36
Open Sky Research References
  •  Connor, D.F., Miller, K.P., Cunningham, J.A.,
    Melloni, R.H. (2002). What does getting
  • better mean? Child improvement and measure of
    outcome in residential treatment Electronic
    version. American Journal of Orthopsychiatry,
    72 (1), 110-117.
  • Cook, E.C. (2008). Residential wilderness
    programs the role of social support in
    influencing self-evaluations of male
    adolescents. Adolescence, 43(172), 751-773.
  •  Cooley, R. (1998). Wilderness therapy can help
    troubled adolescents. International Journal of
    Wilderness, 4(3), 18-21.
  •  Courtney, M.E. (2000). Research needed to
    improve the prospects for children in out-of-home
  • placement. Children and Youth Services Review,
    22 (9/10), 743-761.
  •  Curry, J.F. (1991). Outcome research on
    residential treatment Implications and suggested
    directions. American Journal of Orthopsychiatry,
    61 (3), 348-357.
  •  Edwards, J.K. (1994). Children in residential
    treatment How many, what kind? Do we really
  • know? In G. Northrup (Ed.), Applied research in
    residential treatment (pp. 85-99). New York, NY
    The Haworth Press, Inc.
  •  Ekineas, I., Gude, T., Hoffart, A. (2006).
    Integrated wilderness therapy for avoidant
    personality disorder. Nord J Psychiatry, 60(4),
    275-281
  • Ewert, A.W., McCormick, B.P., Voight, A.E.
    (2001). Outdoor experiential therapies
    implications for tr practice. Therapeutic
    Recreation Journal, 35(2), 107-122.
  •  

37
Open Sky Research References
  • Foster, E.M. (2002). Modeling child and
    adolescent psychiatric hospital utilization A
    framework for examining predictors of service
    use. Childrens Services Social Policy,
    Research Practice, 5 (3), 151-173.
  •  Gillen, M.C., Balkin, R.S. (2006). Adventure
    counseling as an adjunct to group counseling in
    hospital and clinical settings. The Journal for
    Specialists in Group Work, 31(2), 153-164.
  •  Gillis, H.L., Gass, M.A., Russell, K.C.
    (2008). The Effectiveness of project
    adventure. Residential Treatment for Children and
    Youth, 25(3), 227-247.
  •  Goldenberg, M., McAvoy, L., Kenosky, D.B.
    (2005). Outcomes from the components of an
    Outward Bound Experience Electronic version.
    Journal of experiential education, 28 (2),
    123-146.
  • Goodrich, W. (1994). Research issues in
    adolescent inpatient psychiatry. In Ghuman,
    H.S.,
  • Sarles, R.M. (Eds.), Handbook of adolescent
    inpatient psychiatric treatment (pp. 277-292).
    New York, NY Brunner/Mazel Publishers.
  •  Gorske, T.T., Srebalus, D.J., Walls, R.T.
    (2003). Adolescents in residential centers
    characteristics and treatment outcome. Children
    and Youth Services Review, 25(4), 317-326.
  • Harper, N., Cooley, R. (2006). Parental reports
    of adolescent and family well-being following a
    wilderness therapy intervention an exploratory
    look at systemic change. Journal of Experiential
    Education, 29(3), 393-396.

38
Open Sky Research References
  •  Harper, N.J., Russel, K.C., Cooley, R.,
    Cupples, J. (2007). Catherine freer wilderness
    therapy expeditions an exploratory case study of
    adolescent wilderness therapy, family
    functioning, and the maintenance of change. Child
    Youth Care Forum, 36, 111-129.
  •  Harper, N., Scott, D.G. (2006). Therapeutic
    outfitting enhancing conventional adolescent
    mental health interventions through innovative
    collaborations with a wilderness experience
    programme. Therapeutic Communities, 27(4),
    548-570.
  •  Hill, N.R. (2007). Wilderness therapy as a
    treatment modality for at-risk youth a primer
    for
  • mental health counselors. Journal of Mental
    Health Counseling, 29(4), 338-349.
  •  Hoffman, J.A. (1984). Psychological separation
    of late adolescents from their parents. Journal
  • of Counseling Psychology, 31 (2), 170-178.
  •  Howatt, W.A. (2006). Addiction screening tools
    vs. addiction clinical measures Introducing the
  • Addiction Disorder Screen (ADS) -7. Counselor,
    7 (1), 48-53.
  • Hyer, L., Boyd, S., Scurfield, R., Smith, D.,
    Burke, J. (1996). Effects of Outward Bound
    experience as an adjunct to inpatient PTSD
    treatment of war veterans Electronic version.
    Journal of Clinical Psychology, 52 (3), 263-287.

39
Open Sky Research References
  •  Jones, C.D., Lowe, L.A., Risler, E.A. (2004).
    The effectiveness of wilderness adventure therapy
  • programs for young people involved in the
    juvenile justice system. Residential Treatment
    for Children and Youth, 22(2), 53-67.
  •  Kaptian, J. (2003). Blazing new trails
    adventure therapy for adolescents with eating
    disorders.
  • American Journal of Recreation Therapy, 41-44.
  •  Kelly, V.A. (2006). Women of courage a personal
    account of a wilderness-based experiential group
    for survivors of abuse Electronic version.
    Journal for Specialists in Group Work, 31 (2),
    99-111.
  •  Larson, B.A. (2007). Adventure camp programs,
    self-concept, and their effects on behavioral
    problem adolescents. Journal of Experiential
    Education, 29(3), 313-330.
  •  Lyons, J.S., Libman-Mintzer, L.N., Kisiel, C.L.,
    Shallcross, H. (1998). Understanding the mental
    health needs of children and adolescents in
    residential treatment. Professional Psychology
    Research and Practice, 29(6), 582-587.
  • McConnaughy, E.N., Prochaska, J.O., Velicer,
    W.F. (1983). Stages of change in psychotherapy
    Measurement and sample profiles. Psychotherapy
    Theory, Research and Practice, 20, 368-375.
  • Myers, M.G., Brown, S.A. (1996). The
    Adolescent Relapse Coping Questionnaire
    Psychometric validation. Journal of Studies on
    Alcohol, 57, 40-46.

40
Open Sky Research References
  •  Myers, M.G., Brown, S.A. (1990a). Coping and
    appraisal in relapse risk situations among
    substance abusing adolescents following
    treatment. Journal of Adolescent Chemical
    Dependency, 1, 95-115.
  •  Myers, M.G., Brown, S.A. (1990b). Coping
    responses and relapse among adolescent substance
    abusers. Journal of Substance Abuse, 2, 177-189.
  •  Myers, M.G., Brown, S.A. (1996). The
    Adolescent Relapse Coping Questionnaire
    Psychometric validation. Journal of Studies on
    Alcohol, 57, 40-46.
  •  Orren, P.M., Werner, P.D. (2007). Effects of
    brief wilderness programs in relation to
    adolescents' race. Journal of Experiential
    Education, 30(2), 117-133.
  •  Paxton, T., McAvoy, L. (2000). Social
    psychological benefits of a wilderness adventure
    program Electronic version. USDA forest service
    proceedings RMRS-P-15, 3, 202-206.
  •  Rosol, M. (2000, September). Wilderness therapy
    for youth-at-risk. Parks Recreation, 42-52.
  •  Russell, K.C., Hendee, J.C., Phillips-Miller, D.
    (2000). How wilderness therapy works An
  • examination of the wilderness therapy process to
    treat adolescents with behavioral problems and
    addictions. In D.N. Cole S.F. McCool (Eds.),
    Proceedings from Wilderness Science in a Time of
    Change Conference. Fort Collins, CO USDA, Forest
    Service, Rocky Mountain Research Station. (Proc.
    RMRS-P-15-vol. 3).

41
Open Sky Research References
  •  Russell, K.C. (2000). Exploring how the
    wilderness therapy process relates to
    outcomes. Journal of Experiential Education,
    23(3), 170-176.
  •  Russell, K.C. (2001). What is wilderness
    therapy? Journal of Experiential Education, 24
    (2), 70-79.
  •  Russell, K.C. (2003a). An assessment of
    outcomes in outdoor behavioral healthcare
    treatment.
  • Child and Youth Care Forum, 32 (6), 355-381.
  •  Russell, K.C. (2003b, September). Definitions,
    models, and assessing outcomes in outdoor
    behavioral healthcare. In R. Meltzer (Chair),
    Wilderness Therapy Training and Symposium.
    Symposium conducted at Naropa University,
    Boulder, Colorado.
  •  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.C., Harper, N. (2006). Incident
    monitoring in outdoor behavioral healthcare
    programs a four-year summary of restraint,
    runaway, injury, and illness rates. Journal of
    Therapeutic Schools and Programs, 1(1), 70-90.
  • Satcher, D. (2000). Mental health a report of
    the Surgeon General. Retrieved from
    http//www.surgeongeneral.gov/library/mentalhealth
    /home.htmlpreface
  •  Sklar, S.L., Anderson, S.C., Autry, C.E.
    (2007). Positive youth development a wilderness
    intervention. Therapeutic Recreation Journal,
    41(3), 223-243.
  •  

42
Open Sky Research References
  • Smollar, J., Condelli, L. (1990). Residential
    placement of youth Pathways, alternatives and
    unresolved issues Electronic version. Children
    Today, 19 (6), 4-8.
  •  Ungar, M., Dumond, C., McDonald, W. (2005).
    Risk, resilience and out-door
  • programmes for at-risk children. Journal of
    Social Work, 5(3), 319-338.
  •  U.S. Department of Health and Human Services
    (1999). Mental health A report of the Surgeon
  • General. Rockville, MD U.S. Department of
    Health and Human Services, Substance Abuse and
    Mental Health Services Administration, Center for
    Mental Health Services, National Institute of
    Health, and National Institute of Mental Health.
  • Wells, K. (1991). Placement of emotionally
    disturbed children in residential treatment A
    review of placement criteria. American Journal
    of Orthopsychiatry, 61 (3), 339-347.
  •  Werhan, P.O. Groff, D.G. (2005, November).
    Research update The wilderness therapy trail.
  • Parks Recreation, 24-29.

43
For more information about this study, contact
  • Joanna Bettmann, PhD, LCSW
  • Open Sky Research Director
  • joanna_at_openskywilderness.com
  • 801-587-7600
  • www.openskywilderness.com
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