Wilderness program effectiveness

[TheWho]

Atomic Ant,  My intent is not to piss people off but to add balance to a heavily one-sided forum.  I don?t see it as twisting or spinning but merely adding a different perspective using first hand experience and existing data.
I actually agree with everything your wife (Ex) said.  The studies are inconclusive because you cant really have a controlled study with some kids going to TBS and others not going because you could not get 2 control groups which are exactly the same because each of us is so different and there are so many variables to begin with.  The other way to look at this would be to compare large samples of kids over time, but this would be a problem because TBS?s change their programs and evolve over time (so these variables would have to be considered).
There is data available from the public sector (School system) but even comparing that to TBS would be met with scrutiny because the kids at TBS would not be a representative cross section of kids like the public schools would be.  The TBS kids would be considered a select group and therefore could not be compared to the general population of public schools.

My analogy with taking the school bus was a simple demonstration that voluntary and involuntary are relative terms.  There is hand cuffing a child and dragging him off and then there is ?You have 2 options go live with aunt Martha for the summer or attend SUWS wilderness?.  In one scenario he may live in rage for 6 weeks and come out worse off in the other he may grow from it and get back on track.

So are wilderness programs/TBS?s the right thing for our kids?  We need to talk to people, research different programs, read testimonials (understanding they are the best of the best), read here at fornits most of which are of those that had a poor experience, read reports and try to give our children choices and options.

I think a person taking the position that every kid does poorly or every kid does well is irresponsible and smacks of having an agenda and will not benefit the parents or the kids.

[Anonymous]

My intent is not to piss people off but to add balance to a heavily one-sided forum

This is what all the wackos and trolls say.

[RobertBruce]

On 2006-06-10 13:27:00, TheWho wrote:

"Atomic Ant,  My intent is not to piss people off but to add balance to a heavily one-sided forum.  I don?t see it as twisting or spinning but merely adding a different perspective using first hand experience and existing data.

I actually agree with everything your wife (Ex) said.  The studies are inconclusive because you cant really have a controlled study with some kids going to TBS and others not going because you could not get 2 control groups which are exactly the same because each of us is so different and there are so many variables to begin with.  The other way to look at this would be to compare large samples of kids over time, but this would be a problem because TBS?s change their programs and evolve over time (so these variables would have to be considered).

There is data available from the public sector (School system) but even comparing that to TBS would be met with scrutiny because the kids at TBS would not be a representative cross section of kids like the public schools would be.  The TBS kids would be considered a select group and therefore could not be compared to the general population of public schools.



My analogy with taking the school bus was a simple demonstration that voluntary and involuntary are relative terms.  There is hand cuffing a child and dragging him off and then there is ?You have 2 options go live with aunt Martha for the summer or attend SUWS wilderness?.  In one scenario he may live in rage for 6 weeks and come out worse off in the other he may grow from it and get back on track.



So are wilderness programs/TBS?s the right thing for our kids?  We need to talk to people, research different programs, read testimonials (understanding they are the best of the best), read here at fornits most of which are of those that had a poor experience, read reports and try to give our children choices and options.



I think a person taking the position that every kid does poorly or every kid does well is irresponsible and smacks of having an agenda and will not benefit the parents or the kids."

Cindy, Cindy, Cindy, please dont tell me youre giving up so easy? Come on back to the HLA thread and accept your shame. See you over there real soon.

[Anonymous]

From the Journal of Child and Adolescent Group Therapy, vol. 10, no. 1, published in 2000, and likely written a bit (as it usually takes time to get articles accepted into such journals) ...

The national rate of recidivism for an adolescent placed in an institution for rehabilitation is 65% (Pommier and Witt 1995). Because this rate is so high, the mental health and judicial systems are interested in treatment and rehabilitation alternatives that can produce lower rates of recidivism. For this reason, the studies that evaluate the ef?cacy of adventure therapy programs have looked mainly at the issue of recidivism along with the many factors such as self esteem or locus of control that contribute to lower rates of recidivism. As a result, the small group interpersonal interactions that characterize adventure therapy, and directly contribute to it?s positive effects, have been overshadowed by rates of recidivism and data from clinical scales.

In some cases the literature provides only blanket statements such as, ?Across  the board these programs seem to be successful.  . . . we see lowered rates of recidivism,? (Golins, 1978, p. 26). However, such anecdotal responses can usually be backed up with evidence from empirical studies. Kelley and Baer (Wright, 1983) conducted a thorough and respected study in this area, involving 120 adolescent offenders. The treatment group participated in a twenty-six day therapeutic Outward Bound course and the control group received the routine treatment of institutionalization or parole (Wright, 1983). Nine-months following treatment, they found that only 20% of the treatment group in comparison to 34% of the control group had recidivated. At the one year mark, the treatment group?s rate of recidivism held at 20% whereas the control group?s had risen to 42%. In their long term follow-up, ?ve years after the experiment, 38% percent of the treatment group had recidivated in comparison to 58% of the control group (Wright, 1983).

Adams (Berman and Berman, 1989) found similar results with an adolescent inpatient psychiatric population. His follow-up study was conducted twenty-eight months after the treatment group had participated in a thirty day wilderness program, and the control group had participated in the standard hospital program. He found that those in the wilderness program had a recidivism rate which was 15% less than those in the standard program (Berman and Berman, 1989). These studies show that adventure therapy in a wilderness setting is not a panacea for this population, yet at the same time they demonstrate that adventure therapy consistently and signi?cantly proves to be more effective than the routine treatment of these adolescents.



Also ... Wright (1983) evaluated the effects of a
twenty-six day adventure therapy program on the self-esteem, self-ef?cacy, locus
of control, and problem solving skills of delinquent adolescents. Through the
use of quantitative and empirical measures he found that the 21 participants in
the treatment group showed statistically signi?cant increases in self-esteem, self-
ef?cacy, and internality (locus of control) in comparison to the 26 adolescents in
the control group (Wright, 1983).

[Oz girl]

I have a question here? wouldnt it be tricky to compare the sucess rate of a wilderness therapy programme with a prison. One has kids who have all done something criminal. The other has some kids who  may have been sent there through thhe criminal system and many kids who are sent there by their families for a variety of reasons. In the event that the Wilderness therapy had a higher on paper sucess rate, surely the fact that some kids had not broken the law in the first place (or been caught) and therefore are unlikely to again would have some bearing on the stats.
Are the non criminal kids automatically eliminated from the study?

[TheWho]

Yes, I was thinking the same thing, but as I reread it I saw that the study included 120 offenders, some went to wilderness others went to prison or parole and tracked their progress for several years.
They didn't include kids who were not in trouble with the law in the study.

[Badpuppy]

On 2006-06-10 14:38:00, Anonymous wrote:

"From the Journal of Child and Adolescent Group Therapy, vol. 10, no. 1, published in 2000, and likely written a bit (as it usually takes time to get articles accepted into such journals) ...



The national rate of recidivism for an adolescent placed in an institution for rehabilitation is 65% (Pommier and Witt 1995). Because this rate is so high, the mental health and judicial systems are interested in treatment and rehabilitation alternatives that can produce lower rates of recidivism. For this reason, the studies that evaluate the ef?cacy of adventure therapy programs have looked mainly at the issue of recidivism along with the many factors such as self esteem or locus of control that contribute to lower rates of recidivism. As a result, the small group interpersonal interactions that characterize adventure therapy, and directly contribute to it?s positive effects, have been overshadowed by rates of recidivism and data from clinical scales.



In some cases the literature provides only blanket statements such as, ?Across  the board these programs seem to be successful.  . . . we see lowered rates of recidivism,? (Golins, 1978, p. 26). However, such anecdotal responses can usually be backed up with evidence from empirical studies. Kelley and Baer (Wright, 1983) conducted a thorough and respected study in this area, involving 120 adolescent offenders. The treatment group participated in a twenty-six day therapeutic Outward Bound course and the control group received the routine treatment of institutionalization or parole (Wright, 1983). Nine-months following treatment, they found that only 20% of the treatment group in comparison to 34% of the control group had recidivated. At the one year mark, the treatment group?s rate of recidivism held at 20% whereas the control group?s had risen to 42%. In their long term follow-up, ?ve years after the experiment, 38% percent of the treatment group had recidivated in comparison to 58% of the control group (Wright, 1983).



Adams (Berman and Berman, 1989) found similar results with an adolescent inpatient psychiatric population. His follow-up study was conducted twenty-eight months after the treatment group had participated in a thirty day wilderness program, and the control group had participated in the standard hospital program. He found that those in the wilderness program had a recidivism rate which was 15% less than those in the standard program (Berman and Berman, 1989). These studies show that adventure therapy in a wilderness setting is not a panacea for this population, yet at the same time they demonstrate that adventure therapy consistently and signi?cantly proves to be more effective than the routine treatment of these adolescents.







Also ... Wright (1983) evaluated the effects of a

twenty-six day adventure therapy program on the self-esteem, self-ef?cacy, locus

of control, and problem solving skills of delinquent adolescents. Through the

use of quantitative and empirical measures he found that the 21 participants in

the treatment group showed statistically signi?cant increases in self-esteem, self-

ef?cacy, and internality (locus of control) in comparison to the 26 adolescents in

the control group (Wright, 1983).









"

I would like to locate and read the studies. I would like to know the sample size an the Adams study. It is likely that the treatment group was not as ill as the control group. 15% is not much of a difference in a small sample size. Was this voluntary compliance? If it was, the differance could be the motivation of the patients?  How well were the subjects matched? It is exceeding unlikely that a wilderness therapy program any effect on psychiatric hospitalization. What was the standard program? Did the same therapists treat the treatment group and control group? Were the medications and diagnoses matched? What care was given after the standard post hospitalization care? Was there a differance in family support and parenting skills? Did socioeconomic status or I.Q. affect the results?

In the Kelley and Baer Study without looking at it, we have a skewed population because part of the control group was institutionalized. You have more conduct disorder and anti-social personality disorder in the control group. Poorer outcomes to be expected. Let me see if I can find this study online without going to a research library.[ This Message was edited by: Badpuppy on 2006-06-11 14:37 ]

[Troll Control]

The Who wrote:

So continuing along the same line of thinking it seems you agree that ?Least restrictive? is a relative term depending on the individual.

Yes, this is true.  And residential treatment should be considered only for the 1% or fewer of cases that are both seriously mentally ill and violent or suicidal.  That's it.

Programs and "wilderness therapy" are forms of residential treatment.  The children in them do not need to be there.  Most of these kids haven't been diagnosed by a professional at all and the ones that have been are usually labeled "LD" or "ODD" - neither of which conditions (ODD is very often used as a convenient label, BTW, as over 90% of ODD cases are under the age of 10) require residential care.

One step further:  If a child did indeed meet the very stringent criteria for residential placement, programs and WT would be woefully inadequate to meet their treatment needs.

So yes, you do understand the basic concept, but your misinterpretation of how it is applied shows abject ignorance of the subject matter.  This is what I keep telling you - you don't fully understand the debate and this is why your "arguments" and "analogies" are dismissed out of hand by people like AA, AA's ex (and many others) and myself who already know better than the tired, canned line you are regurgitating.

You seem to continuously miss one salient point.  People who are educated, trained professionals in the arena of mental health don't need studies proving ineffectiveness as we are fully equipped through education and experience to make value judgements on the effectiveness and appropriateness of treatment.  You, Who, clearly are not equipped to make such discernment and it is painfully obvious.

[AtomicAnt]

On 2006-06-10 15:48:00, TheWho wrote:

"Yes, I was thinking the same thing, but as I reread it I saw that the study included 120 offenders, some went to wilderness others went to prison or parole and tracked their progress for several years.

They didn't include kids who were not in trouble with the law in the study."

Outward Bound, the program mentioned in the study, only takes volunteers. Those that went to Outward Bound chose to go there instead of going to a traditional JDC or other alternative. OB does not accept 'escorted' kids. If you want to view Outward Bound as a program, then I would agree that you have found a good one. They are not run like a boot camp and they don't use the coersive pursuasion techniques.

Keep in mind programs specifically advertise to parents of 'at risk' or 'pre-delinquent' teens. In some sense, they are billing themselves as a means to prevent actual delinquency and so comparing 'at risk' teens to delinquents is not so valid. But again, how do you measure a preventive program's success? You have no idea if the 'at risk' teen will ever become delinquent or just grow out of it.

[Oz girl]

This outward bound thing looks excellent from its website. This is why i am fast becoming against wildreness "programmes" which just seem to (from what i have so far seen) be designed to punish/reform convicted felons or force other kids to "modify" their behavour and in some cases make a profit from being punitive or "therapudic".

I noted that the outward bound programme was marketed to the kids not to the parents. I also noted that it is a not for profit org. This is what i was getting at earlier. This outward bound thing could possiblydo what "the programmes" claim they are there for by building confidence, giving families a break from each other and having kids achieve something in a fun setting. It is not about "modifying behavour" or stripping kids of basic privileges to create the perfect kid, it is about engaging young peole and bringing out their best. This seems to be exactly where the for profit progammes fail because even the"good" ones seem to focus on the negatives.

[Badpuppy]

If anything the Outward Bound Program bolsters the arguement that when kids are having fun they are lot easier to connect to. Voluntary complance is a very powerful ethical and practical distinction. It actually is run more like a teen summer camp, than a Wilderness Therapy program. Interestingly enough, they manage to run their program without food deprivation, forced physical labor, or exercise used as torture to break kids. This program really doesn't belong in the typical Wilderness Therapy Class.

The typical use of a WT program is to make kids compliant so they will be more manageable in residential treatment. I believe 80% of the kids are being sent away after wilderness.

There is also the issue of the lack of oversight, standards of care, and fraudulant marketing. Most parents are clueless about credentialization and the deception of this industry makes choosing a total crapshoot.

Then there is the issue of cost-effectiveness. $20,000 buys twice a week therapy with an experienced professional for two years. Is Wilderness Therapy really the most judicious choice?  PLS HELP and DJ, the points you made are excellent

[Anonymous]

When my son was 16 we sent him to Outward Bound.  That is where he learned to smoke dope and then learned the value of taking sleeping pills to "get through" the solo.  I know the programs O.B. offer vary, but we had a terrible experience.  The staff never checked the meds the kids brought with them and did not monitor sexual behavior at all.  The program backfired on us.  $4,000 for three weeks of drug reinforcement.  He had a GREAT time though.

[Deborah]

Here's what your money buys:
Woodbury Reports survey on effectiveness
http://fornits.com/wwf/viewtopic.php?to ... um=9#56579

1/3 were negative or unenthusiastic in their approval indicating they didn't feel they got their money's worth, Suggests inappropriate placements are happening too often, Suggesting that programs promised more than they could deliver....

[TheWho]

On 2006-06-11 06:17:00, Dysfunction Junction wrote:

"

The Who wrote:



So continuing along the same line of thinking it seems you agree that ?Least restrictive? is a relative term depending on the individual.

Yes, this is true.  And residential treatment should be considered only for the 1% or fewer of cases that are both seriously mentally ill and violent or suicidal.  That's it.



Programs and "wilderness therapy" are forms of residential treatment.  The children in them do not need to be there.  Most of these kids haven't been diagnosed by a professional at all and the ones that have been are usually labeled "LD" or "ODD" - neither of which conditions (ODD is very often used as a convenient label, BTW, as over 90% of ODD cases are under the age of 10) require residential care.



One step further:  If a child did indeed meet the very stringent criteria for residential placement, programs and WT would be woefully inadequate to meet their treatment needs.



So yes, you do understand the basic concept, but your misinterpretation of how it is applied shows abject ignorance of the subject matter.  This is what I keep telling you - you don't fully understand the debate and this is why your "arguments" and "analogies" are dismissed out of hand by people like AA, AA's ex (and many others) and myself who already know better than the tired, canned line you are regurgitating.



You seem to continuously miss one salient point.  People who are educated, trained professionals in the arena of mental health don't need studies proving ineffectiveness as we are fully equipped through education and experience to make value judgements on the effectiveness and appropriateness of treatment.  You, Who, clearly are not equipped to make such discernment and it is painfully obvious.
"

I hate to be the one to point this out to you but studies are written specifically for other professionals, not to the public.  Professionals rely heavily on studies to advise and treat their patients.  Learning and education does not stop with a diploma, as it has with you, but continues throughout our professional lives.  We depend on the results and recommendations of the latest studies and research, being a true professional is looked upon as fluid and a continuous process.  Any professional who states ?We don?t need studies?. Because we are educated and experienced? raises a red flag and I would take a closer look at their credentials.
Just as a short example:  There are studies which professionals spend a good part of their professional careers working on only to find they reached a dead end (or inconclusive results).  But this is valuable information and would be published so other professionals will not follow the same path in their research.  All studies are valuable, you should know this, if you are one, DJ.

Professionals in the mental health field are recommending TBS?s because they are finding them to be effective for select groups of children, they don?t recommend all schools but select ones which will benefit their patient.  You keep lumping all RTCs together and ignoring the growth and specialization that is occurring because you claim to know it all, based on your past experience.  The professionals that are making the recommendations are basing their decisions on the latest research, experience and studies Published in periodicals like JAMA.  You can?t begin to compare your expertise to theirs because you stopped growing.

Open your mind up a little and recognize that treatment options are continuously changing and I want you to keep educating yourself to keep up.  If I only had the experience of what treatment was like 10 or 20 years ago I may have a different opinion, but this is 2006 , kids needs are different and there are better solutions to choose from.

If you want to try to put HLA out of business and that makes you happy, great.  If you want to advise parents and kids, on a professional level, try to keep up, read the latest studies and attend seminars etc., don?t pretend to know it all.

[Badpuppy]

To a great many urban and suburban dwellers there is nothing of any relevance in learning to survive in the wilderness. The closest to the wilderness we will ever be, is watching the Nature Channel on high definition. The survival skills we need are hailing taxis in the rain, spotting the good mechanics, finding the best housing bargains and navigating urban transit. That is what will build our confidence, self esteem, and locus of control. I am thinking about setting up an Outward Bound in San Francisco, New York, Philadelphia, Fort Lauderdale, or Harvard Square in Boston. lol[ This Message was edited by: badpuppy on 2006-06-11 15:19 ]