Transcript Slide 1

Results from Open Sky’s
Outcome Research
Joanna Bettmann, Ph.D, LCSW
Open Sky Wilderness Therapy
December, 2009
Outline of the Presentation
Why do research?
 Defining wilderness therapy
 Existing outcome research into wilderness
therapy
 Open Sky’s outcome research on adolescents
and young adults
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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
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What is Wilderness Therapy?
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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).
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What wilderness therapy is not:
Challenge courses
 Adventure based therapy
 Boot Camp
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(Russell, 2001)
What do we already know about the
effectiveness of wilderness therapy?
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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
Other recent wilderness therapy
outcome research
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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
adventure’s 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
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)
Adult Outcome Research: Sparse
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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)
Problems in Wilderness
Outcome Research
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Poor treatment definition (Russell, 2001)
Few outcome studies, few in peer-reviewed
literature
No accounting for programmatic elements or
delivery
Open Sky’s study attempts to ameliorate these
flaws in the literature
Open Sky Outcome Research: Three
Years of Conclusive Data
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Data gathered from all students and their
parents/stepparents/caretakers
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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
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This is an exploratory study to answer the
questions: is this wilderness treatment
effective? What factors are associated with
positive outcomes?
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.
The Open Sky model
of wilderness therapy
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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
Open Sky Outcome Research:
Measurements/Questionnaires
Adolescent Measures
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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
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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)
Open Sky Study: Teen Numbers
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Gender
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Average number of days in the program
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63.07 days
Average age at admit = 15.81 years old
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100 male students (47.6%)
110 female students (52.4%)
Age range is 13-17 years old
Did you go on to Aftercare after Open Sky?
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122 = yes (67%)
60 = no (33%)
Open Sky Study:
Teen Characteristics
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Race
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Adopted
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158 white students (85.9%)
24 students of color (13.2%)
32 adopted students (18%)
146 non-adopted students (82%)
Clinical Issues in all Teen Students
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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%
Summary of Open Sky Teens’
Mental Health Distress
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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
The Youth Outcome Questionnaire
(YOQ): What does it specifically measure?
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Emotional distress (anxiety, depression, fear, hopelessness, selfharm)
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 )
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.
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.
Summary of Adolescent Relapse
Coping Questionnaire
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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
Adolescent Relapse Coping
Questionnaire (ARCQ): What
does it specifically measure?
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Higher scores of abstinence-focused
thoughts of drugs and alcohol predict
less substance abuse at 1 year after
treatment.
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Lower scores of self critical thoughts
correlate with less substance use,
better coping, and higher self-esteem
and self-efficacy
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.
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)
University of Rhode Island
Change Assessment (URICA):
What does it specifically
measure?
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The URICA assesses how ready and willing a
person is to change the problem(s) in one’s life.
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Higher scores mean more readiness and
willingness to change one’s life.
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.
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.
Open Sky Study: Young Adult
Numbers
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Total number of participants =114
Gender
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Age
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Average = 20 years old
Range = 17-29 years old
Number of days in program
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Male = 68.4%
Female = 31.6%
Range 4-83
Average = 54.73 days
Go on to aftercare after Open Sky
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Yes = 64.3%
No = 35.7%
Open Sky Study: Young Adult
Characteristics
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Adopted
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Race
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Yes = 14.4%
No = 85.6%
White = 92.3%
Students of color = 6.6%
Clinical Profiles of all Young Adult Students
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Substance abuse/dependence = 71.2%
Depressive Disorders/Anxiety Disorders/Bipolar Disorders = 88.1%
ADHD/Oppositional Defiant Disorder/Disruptive Behavior = 40.7%
The Adult Outcome
Questionnaire (OQ): What does it
specifically measure?
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Emotional distress (anxiety, depression, fear,
hopelessness, self-harm)
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Relationships (satisfaction with, as well as problems in
interpersonal relations)
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Social role (assesses level of dissatisfaction, conflict,
distress and inadequacy in tasks related to employment,
family roles and leisure life)
Open Sky Adult Levels of
Distress Over Time
This graph shows that Open Sky’s young adults report improved
mental health by the end of Open Sky treatment.
What factors have been found to
effect Open Sky Teen and Adult
success?
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Open Sky teens who go on to aftercare tend to sustain better mental health
and behavior over time.
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Open Sky is equally effective for all genders and races.
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Open Sky is effective for adolescents and young adults.
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Open Sky is effective for people with a wide range of problems including
mood, behavioral, relational, and substance use problems.
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Adopted teens and their parents tend to disagree more than non-adopted
families on levels of mental health distress upon arrival.
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.
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.
Open Sky Conclusions
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There is strong evidence that Open Sky
Wilderness Therapy works
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Open Sky is effective for a range of clinical
diagnoses, ages, genders and characteristics
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Preliminary evidence from Open Sky study
suggests that aftercare offers a protective factor
in long term success following wilderness
therapy treatment
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For more information
about this study, contact:
Joanna Bettmann, PhD, LCSW
Open Sky Research Director
[email protected]
801-587-7600
www.openskywilderness.com