Wilderness program effectiveness

[Troll Control]

These are some items from the Surgeon General's report.  Some of them should sound awfully familiar - this is the position statement of most of the posters on this site.

Outpatient treatment:
"Newer outpatient interventions (e.g., case management, home-based therapy) that were developed more recently for youth with severe disorders are provided with greater frequency (i.e., daily) in the home, school, or community."

What it is used for:
"...applied to problems such as anxiety, depression, or withdrawal (internalizing problems) or to hyperactivity and aggression (externalizing problems) (Kazdin, 1996)."

The results:
"The major findings indicated that the improvements with outpatient therapy are greater than those achieved without treatment; the treatment is highly effective..."


Compare this to residential treatment:
"Residential treatment centers are the second most restrictive form of care (next to inpatient hospitalization) for children with severe mental disorders."

What it is used for:
"The types of treatment vary widely; the major categories are psychoanalytic, psychoeducational, behavioral management, group therapies, medication management, and peer-cultural. Settings range from structured ones, resembling psychiatric hospitals, to those that are more like group homes or halfway houses. While formerly for long-term treatment (e.g., a year or more), RTCs under managed care are now serving more seriously disturbed youth for as briefly as 1 month for intensive evaluation and stabilization."

The results:
"...failure to learn behavior needed in the community; the possibility of trauma associated with the separation from the family; difficulty reentering the family or even abandonment by the family; victimization by RTC staff; and learning of antisocial or bizarre behavior from intensive exposure to other disturbed children (Barker, 1998)."

"Although removal from the community for a time may be necessary for some, there is evidence that highly targeted behavioral interventions provided on an outpatient basis can ameliorate such behaviors (Brestan & Eyberg, 1998). For children in the second category (i.e., those needing protection from themselves because of suicide attempts, severe substance use, abuse, or persistent running away), it is possible that a brief hospitalization for an acute crisis or intensive community-based services may be more appropriate than an RTC."


I'm not sure how it could be any more clear.  This is a common-sense, mainstream view of the flow of mental health care.  

Residential treatment is at best mildly effective and at worst terribly damaging.  The most positive treatment results with the fewest collateral problems come from treatment in the community and a higher level of care should be needed only in extreme circumstances.

Most of the "program parents" out there are paying top dollar for the most irresponsible and ineffective "treatment" that money can buy.  

It's a damn shame that an industry that pushes involuntary residential treatment in one-size-fits-all franchised teen warehouses be allowed to operate at all, but it's even more of a shame that they've gotten some of you to believe that this is the only choice you have or your kid will be "dead, insane or in jail."

[Anonymous]

On 2006-06-12 16:14:00, Dysfunction Junction wrote:

"These are some items from the Surgeon General's report.  Some of them should sound awfully familiar - this is the position statement of most of the posters on this site.



Outpatient treatment:

"Newer outpatient interventions (e.g., case management, home-based therapy) that were developed more recently for youth with severe disorders are provided with greater frequency (i.e., daily) in the home, school, or community."



What it is used for:

"...applied to problems such as anxiety, depression, or withdrawal (internalizing problems) or to hyperactivity and aggression (externalizing problems) (Kazdin, 1996)."



The results:

"The major findings indicated that the improvements with outpatient therapy are greater than those achieved without treatment; the treatment is highly effective..."





Compare this to residential treatment:

"Residential treatment centers are the second most restrictive form of care (next to inpatient hospitalization) for children with severe mental disorders."



What it is used for:

"The types of treatment vary widely; the major categories are psychoanalytic, psychoeducational, behavioral management, group therapies, medication management, and peer-cultural. Settings range from structured ones, resembling psychiatric hospitals, to those that are more like group homes or halfway houses. While formerly for long-term treatment (e.g., a year or more), RTCs under managed care are now serving more seriously disturbed youth for as briefly as 1 month for intensive evaluation and stabilization."



The results:

"...failure to learn behavior needed in the community; the possibility of trauma associated with the separation from the family; difficulty reentering the family or even abandonment by the family; victimization by RTC staff; and learning of antisocial or bizarre behavior from intensive exposure to other disturbed children (Barker, 1998)."



"Although removal from the community for a time may be necessary for some, there is evidence that highly targeted behavioral interventions provided on an outpatient basis can ameliorate such behaviors (Brestan & Eyberg, 1998). For children in the second category (i.e., those needing protection from themselves because of suicide attempts, severe substance use, abuse, or persistent running away), it is possible that a brief hospitalization for an acute crisis or intensive community-based services may be more appropriate than an RTC."





I'm not sure how it could be any more clear.  This is a common-sense, mainstream view of the flow of mental health care.  



Residential treatment is at best mildly effective and at worst terribly damaging.  The most positive treatment results with the fewest collateral problems come from treatment in the community and a higher level of care should be needed only in extreme circumstances.



Most of the "program parents" out there are paying top dollar for the most irresponsible and ineffective "treatment" that money can buy.  



It's a damn shame that an industry that pushes involuntary residential treatment in one-size-fits-all franchised teen warehouses be allowed to operate at all, but it's even more of a shame that they've gotten some of you to believe that this is the only choice you have or your kid will be "dead, insane or in jail."



 


"

Nice of you to add emphasis not in the original.  Also clever of you to omit in your "results" excerpt the words preceeding, which say that these are some of the risks [- risks which it would seem can be addressed].  The report also notes that "For most children (60 to 80 percent), gains are reported in areas such as clinical status, academic skills, and peer relationships."

I do agree with you that addressing the issues at home and/or in the child's local community is the first choice, but that is another matter.  Not all communities have appropriate resources available, and for some that have the resources, they don't have the capacity to meet the demand.

"One size fits all franchised warehouses are bad for most.  One size fits all (absent the franchise or warehouse) won't be right for most either, and may be damaging for some as well.  But that doesn't address the fact that a good wilderness program can be of outstancding benefit for a good many.

[Anonymous]

On 2006-06-12 11:13:00, Anonymous wrote:

"http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec7.html#treatment"

Thanks for the link.  

Actually the Surgron General's report DID NOT say that residential treatment was ineffective.  It said that "there is only weak evidence for their effectiveness", as well as that there were only three controlled studies of which they named only two.  The studies were published in 1974 and 1978, which is over a quarter century ago.  It would be good to have more current research, but I can't create it here.  Still what I've seen still doesn't come out negative specifically on wilderness.

They also said "The outcomes of not providing residential care are unknown", and "An intensive long-term program such as an RTC with a high staff to child ratio may be of benefit to some children".

A major problem with using the report in looking at one type of facility is that they group a wide range of things ranging from structured ones, resembling psychiatric hospitals, to those that are more like group homes or halfway houses in the group.  No differentiation of behavior mod warehouses from government-run boot camps or either from wilderness programs.  And that doesn't even get to diffentiating between types of boarding school approaches or wilderness program styles.

Anyway, no negativity, although appropriate caution.

[Deborah]

On 2006-06-12 06:55:00, S wrote:

"http://www.passagestorecovery.com/family.htm



JOIN N TELL US !



MAYBE U COULD B ON STAFF THERE ?"

Who runs the Sweat Lodges?
How are they ran? Who trained the staff?
Any Native Americans on staff?

Only Breakfast & Dinner- Hiking and sweating and No Lunch? How many calories per day?

[MightyAardvark]

Why would the presence of Native Americans be an issue Debs?

...it does not require a majority to prevail, but rather an irate,
tireless minority keen to set brush fires in people's minds..

--Samuel Adams

[Anonymous]

hi-yuh hi-yuh hi-yuh...o

oops, sorry- wrong forum.

[TheWho]

"One size fits all franchised warehouses are bad for most. One size fits all (absent the franchise or warehouse) won't be right for most either, and may be damaging for some as well. But that doesn't address the fact that a good wilderness program can be of outstancding benefit for a good many.

This is a very good point.  The programs themselves are becoming more and more ?Results Driven? and therefore are not accepting kids who they feel will not benefit or do well in their program.  The programs are also slowly becoming more and more specialized (not one size fits all) over time which should result in an increase in effectiveness over the next decade.

[Anonymous]

BTW, "weak evidence" is frequently scientist speak for "it doesn't work."

Not always, but frequently.

Sometimes, it means there has been little research done.  Sometimes it means there has been substantial research and it's clear that if something "works" at all, the effects are small enough to be negligible.

Scientists phrase things very carefully.  They speak in code, and you don't know what they really mean unless you know how to translate the code.

"Strong evidence" usually means: "We've proved it, dammit."

"Weak evidence" usually means: "Our best professional opinion is that whatever it is is flat wrong."

"Weak evidence" is a term usually not used when the body of research is just not sufficient to draw a conclusion.  If there is a gap where nobody has bothered to research a particular question, usually they just say that.

The term "weak evidence" is the second most damning thing any scientist will ever say about any theory or assertion.  The only thing stronger is "no evidence," and that label is very rarely applied.  In practice, "weak evidence" is what scientists say when anyone speaking plainly would say, "It's bullshit."

The things that scientists label "weak evidence" in formal papers are the same things that, if you're a student or someone they know and they're speaking off the record, they'll say flat out, "It's bullshit."

Scientist-speak is like diplomat-speak and lawyer-speak.  The words they use frequently mean different things from what they'd mean in plain English.

[Anonymous]

On 2006-06-13 08:35:00, Anonymous wrote:

"BTW, "weak evidence" is frequently scientist speak for "it doesn't work."



Not always, but frequently.



Sometimes, it means there has been little research done.  Sometimes it means there has been substantial research and it's clear that if something "works" at all, the effects are small enough to be negligible.



Scientists phrase things very carefully.  They speak in code, and you don't know what they really mean unless you know how to translate the code.



"Strong evidence" usually means: "We've proved it, dammit."



"Weak evidence" usually means: "Our best professional opinion is that whatever it is is flat wrong."



"Weak evidence" is a term usually not used when the body of research is just not sufficient to draw a conclusion.  If there is a gap where nobody has bothered to research a particular question, usually they just say that.



The term "weak evidence" is the second most damning thing any scientist will ever say about any theory or assertion.  The only thing stronger is "no evidence," and that label is very rarely applied.  In practice, "weak evidence" is what scientists say when anyone speaking plainly would say, "It's bullshit."



The things that scientists label "weak evidence" in formal papers are the same things that, if you're a student or someone they know and they're speaking off the record, they'll say flat out, "It's bullshit."



Scientist-speak is like diplomat-speak and lawyer-speak.  The words they use frequently mean different things from what they'd mean in plain English.





"

OK, though i'd have thought it was more of "there may be something, but not enough to convince", else i'd have said no evidence.  anyway, if there is no evidence (at least that they found) it works, why, in the same section, did they write "For most children (60 to 80 percent), gains are reported in areas such as clinical status, academic skills, and peer relationships."?

Incidentally, the same report also says there are 3 studies of a particular type, summarizes one, and then says the only other one ...  That accounts for 2, what about the third?

[Deborah]

On 2006-06-13 04:08:00, MightyAardvark wrote:

"Why would the presence of Native Americans be an issue Debs?

...it does not require a majority to prevail, but rather an irate,
tireless minority keen to set brush fires in people's minds..

--Samuel Adams

"

As you said in another thread:
Exactly, a lot of the stuff that these hellholes call "manipulation" is really perfectly interaction. It's important though to undertand that the "Teenhelp" industry makes a habit of hijacking the terminology of legitimate psychology and twisting it to fit a totally different agenda.

First, I agree with you. When a kid is persistent with his/her pleas or attempts to ?negotiate? the thing they want, it is labeled manipulation. Parents don?t want to be bothered with rational discourse, negotiation, or debate. Kid is supposed to accept No without explanation or discussion. Parents are ?afraid? of being manipulated because they can?t hold a firm line.
One of the top reasons my son spent 20 months in pergatory. Did they 'cure' him? Nope, much to his father's distress I'm sure. As he has aged, it's seen as drive, assertiveness,one of the 7 characteristics of successful people.

Now to the Native issue. Just as programs have hijacked and twisted psych terms, so have many of the programs co-opted and bastardized Native culture and spirituality. Vision Quest and Sweat Lodges are considered sacred ceremonies and only to be conducted by a recognized and traditionally trained person.
 
?more than 100 years of forced assimilation (brainwashing) of the Lakota, Dakota and Nakota peoples, our ways of praying and conducting ceremonies have also been desecrated, contaminated, profaned, misused and abused.
When a way of living means the survival of a nation of people, then is it harsh to ask that  some respect be shown to those peoples' lifeways? (I cannot even say "religion" because that concept is too shortsighted and narrow.)
 The total destruction of the people's lifeways was the reason for taking away the language, banning the "religion" and stopping the singing of sacred songs, besides destroying the sources of economics. Destroying the total lifeways of a nation of people would destroy those people as a nation. They would no longer be Lakota, Dakota, Nakota but would be ... tahdah: American. That is what happened.
When I was much younger, I heard elders talking about a time when the non-Indians were going to come to indigenous people and say, "Teach us how to pray." And I remember the sadness in their voices as they continued by saying, "They took everything and now they want our way of praying."
In the sixties, the hippies were among the first in the Southwest to begin appropriating Indian lifeways, as if the Creator told them to do this. Then it spread like wildfire until by the 1990s there were pictures in major international magazines of Sun Dances being held in Germany. with only white people. The disrespect knew no bounds.

I find it ironic that the same culture that economically devastated Natives, forced their children into white boarding schools (programs), stripped them of their traditional customs and spirituality, now co-opt Native culture/ spirituality in brainwashing programs for their own children. And, for profit. These ceremonies were never for profit. No money was/is exchanged.

While sweating is not unique to Natives, and not all Natives conducted Sweat Lodges, they all had some method of purging toxins from the body. The tribe I?m descended from chose a more gentle approach- lounging in hot springs. The Lakota and others preferred a more intense method.

Why do the programs call them Sweat Lodges?  Hold Vision Quests? Issue Native names? Smudge with sage sticks?

Finns knew the value of sweating. Why not put in a sauna and teach the value of eating well and sweating?
Why not hold communion and/or baptize them?
Would it be appropriate for a staff member to do either?

I would like to think that their use of Native spirituality was an admission that it has value. I think it?s more to do with- Nostalgia sells.

My new-agey neighbor sent her kid to Skyline Journey, in spite of warnings, because she felt he had a ?spiritual connection? with the owner of the program- from a past life. SJ was shut down after his death and they opened a new program called Distant Drums. The family had some connection with the BIA (I believe it was).The mom excused his death as "karma".  :scared:

It sickens me to think that these kids may believe they are having a traditional Native experience, and/or that they will make a negative association with things Native (or nature in general) due to the deplorable conditions they are forced to live in at programs.

As for Vision Quest, another Native ceremony- Natives would shutter to know how white people were conducting them in programs-. which bears no resemblance to a Native Vision Quest. It?s disrespectful.
Again, Natives don?t hold a patent on going into the woods to reflect, re-evaluate, and envision the future of one?s life- programs could do this without implying that it?s Native. I have to question how much value would be derived from being forced to participate. Did you see the 14 yr old kid in Brat Camp? He was shaking and crying for his mother. He was not properly prepared. If it were done traditionally, his parent, siblings, and other family would have been there supporting him. He also would not have been forced to stay out if he weren?t ready for the passage- it's okay, you can try again next month/year. I noticed they didn?t force him to do rock climbing, but they did leave him alone in the desert to deal with his fears. Sorry, that?s just sadistic. And given that this was the final ?challenge?, I?m sure it made a strong impression and worked to keep him in line after he returned home. Who would want to be returned to such sadistic torture. I?d sure tow the line. It served the adults purposes. I feel certain it didn?t serve him at all.

I would want to know who is running the Sweat Lodge, how they had been trained, who monitors the kids to ensure they don?t overheat. Ignorant people have died in sweats? and saunas. Given the lackadaisical attitude toward providing kids needs in programs, I consider this to be highly risky. I personally would not allow my child to participate in a Sweat Lodge with any stranger. I would want to know their background and experience and what values they were going to impress upon my child in the process.

To the program person- how far do you take this? Do the kids sing and pray? Do kids on VQ make prayer ties? etc.etc.etc. Is there a Native on staff or consulting?
And I'm still curious, why no Lunch? How many calories in Breakfast and Dinner?

[TheWho]

Saw this today,  She found her daughter in the midwest, in the back of the van with skin heads (she is Jewish) injecting drugs.  Talk about just in time.  Anyway it was a short interview, but looks like a good book.

Check it out.


http://www.abcnews.go.com/GMA/Books/sto ... 525&page=4

[Anonymous]

On 2006-06-13 10:32:00, TheWho wrote:

"Saw this today,  She found her daughter in the midwest, in the back of the van with skin heads (she is Jewish) injecting drugs.  Talk about just in time.  Anyway it was a short interview, but looks like a good book.



Check it out.





http://www.abcnews.go.com/GMA/Books/sto ... 525&page=4"

Some program-vet friends of mine describe similar situations. After leaving their programs, in which they were emotionally and physically abused, they starting using to cover up all the pain they now had to deal with -- in addition to all the problems they had originally (if any) -- that never got addressed.
The irony of this book is many teens will now be going down the path her daughter was, because of this book. I have many friends from WWASPS programs and they all say they are worse off today than before they went into the program.
Of course the lady writing this book doesn't care about that though.

[Anonymous]

Note that she said hospital psych ward, not a program. She might not even know such things exist.