Defining A Safe Wilderness School, Therapy And Intervention Program

By: Michael Conner, Psy.D

Comprehensive Information: www.WildernessTherapy.Org
Mentor Research Institute:
E-mail: Conner@OregonCounseling.Org

Revised: May 31, 2013


Managed health care in this country has become big business. As a direct consequence, the relationship between consumers and health care providers has been increasingly eroded by dangerous cost control practices, restrictions of care, treatments based on business decisions rather than professional decisions, and finally, by managed care’s creation of incentive systems where medical and mental health service providers make more money by providing less care. The services covered by insurance or provided by HMO’s for "youth at risk" have been increasingly restricted and eliminated over the past decade. As a consequence of managed health care policies, many behavioral and social problems that children experience are being medicated rather than effectively managed or treated. Managed care companies focus on short term "cost effectiveness" and assert that psychotherapy, family therapy, or intensive and non-traditional treatment resources such as wilderness programs are not effective or not proven effective. The use of sedating antipsychotics, powerful stimulants and sedating antidepressants are increasing in America to restrain and "manage" rather than help children who are suffering and showing outward signs of confusion, anger and emotional turmoil.

Parents searching for alternatives to medicating their children for social and behavioral problems are turning to wilderness schools and intervention programs when "office" therapy, residential treatment, psychiatric hospitals and criminal justice programs fail. Out of desperation and hope, parents are turning to wilderness programs to help change the lives of their children for the better. Mental health professionals who are frustrated with inadequate change by traditional treatment programs such as residential care are exploring the wilderness therapy option. Wilderness schools are demonstrating preliminary effectiveness rates in the range of 60 to 90% in comparison to traditional treatment program in these populations that produces rates at approximately 40 to 50%. Of course the difficulty of the populations these schools work have a significant impact on outcomes rates as does the quality and effectiveness of the program.

The importance of "Defining A Safe Wilderness Intervention Program" is clear. Outdoor Schools and wilderness interventions are powerful psychological, emotional and physical interventions. More important, wilderness schools are largely unregulated in the United States and many of the people operating these schools, as well as the paraprofessionals providing services, are unlicensed and have little or no relevant training. Paraprofessionals providing most of the direct contact with children, including counseling, often have minimal or no training in medicine, crisis intervention, counseling, psychology or behavioral science  - although some have extensive experience working in wilderness schools. Supervision and services within wilderness therapy schools are usually provided by paraprofessionals. A few programs have state regulation, but this by no means provides the level of information or assurance that referring professionals and parents need to decide whether or not a child will benefit or thrive from a program. State regulations in many states are antiquated, irrelevant and bureaucratic nightmares for programs and can in some cases the regulations directly interfere with the needs of students and drive cost to unreasonable levels.

In contrast, the role and influence of professionally trained counselors, psychotherapists, physicians and psychologists will vary in these programs. Internal monitoring, supervision and oversight of wilderness programs by professionals vary considerably from state to state and from program to program. External monitoring of wilderness and traditional treatment programs are usually minimal and primarily activated by complaints or scheduled administrative reviews by state or county agencies. Often there is no regulation or review. In regulated treatment settings professionals provide oversight and supervision and have direct responsibility for the behavior of paraprofessionals. In many wilderness treatment programs, professional oversight and supervision is often minimal.

A family’s decision to enroll their child in a wilderness therapy and intervention program is personal and important. There are many programs to choose among and the choice must be well informed. It may be a blessing that managed health care and insurance companies generally do not cover wilderness treatment services, and when they do provide coverage, the financial reimbursement is small compared to the overall cost. And, because managed health care does not offer these services to families and youth at risk, they cannot control how wilderness programs are designed, and then restrict what services and the level of services offered. Parents can still "shop" for services that address their child’s needs and choose the intensity, design and values that guide the child’s wilderness treatment experience. On the continuum of education and mental health care, Wilderness Programs and Outdoor Schools are innovative, intensive and have tremendous benefits to a child's psychological and emotional growth. The lasting positive benefits can be as little as 3 to 6 months and as long as a lifetime..

This article is one of a series of papers intended to help families, educational consultants and mental health professionals recognize and begin to understand the problems and potential consequences inherent in wilderness schools, therapy and intervention programs. Students enrolled in wilderness programs face the possibility of serious physical and psychological injury, or loss of life, when risk factors are denied, misunderstood, not recognized, ignored, or not addressed. Wilderness Programs and Outdoor Schools are no more dangerous than any therapeutic boarding school or residential treatment based program. All programs, schools and summer camps that work with children have some degree of risk.  Many public schools may have an even greater level of risk in that student carry weapons on campus and the level of supervision can range from minimal to none.

This article is based on a review of the operations of four distinctly different structures in outdoor and wilderness therapeutic programs and on confidential interviews with employees, former employees, graduates and parents of graduates from those programs. Three programs had 30, 60 and 90 days approximate fixed lengths of treatment designs. Two additional programs were designed as an "open ended" programs with a single flat fee regardless of the duration in the program.

This article is intended to help readers to understand what could be considered critical risk and decision factors when selecting a wilderness program. At present, the programs with which I have had contact and many other wilderness treatment companies are struggling to understand and address the concerns identified here. This paper has been written to promote discussion between parents, consumers, professionals, paraprofessionals and the owners of wilderness programs. No statement contained here is intended to explicitly or implicitly imply that any single program is dangerous or unsafe. Usually there are numerous factors to consider that can mitigate or minimize an otherwise high risk or potentially dangerous situations. Again, the goal of this review is to foster awareness and to create discussion.

Critical Factors

An effective drug and alcohol screening program for all employees.

Drug abuse is unfortunately common in the United States today. Drug affected employees are dangerous in outdoor or wilderness programs. As many as half of the people who apply for jobs in wilderness and outdoor programs use both marijuana and alcohol. Random and frequent drug screening is essential. Employees should be drug tested an average of 3 times a month during their first 3 months of employment. Continued random testing can assure compliance with responsible program standards.. Testing by a clinically competent laboratory is essential. A competent laboratory can detect whether a clinical sample has been altered or the testing subject has ingested a substance that would alter a body fluid sample. People using illegal drugs are not appropriate to work with youth at risk. Costs for drug screening are minimal when compared to the risks with drug involved employees.

A complete reference and criminal background screening of employees.

Up to 5% of the people who apply for entry level positions as field staff are wanted by the police or have criminal backgrounds that involve destructive, violent or other serious criminal behavior. Routine and thorough background checks are the best way to reduce the risk that students might be abused or influenced by sociopathic and inappropriate values. A routine screening procedure is the best deterrent. Finger print and background investigation using law enforcement data bases are essential. The cost per background check is minimal.

A written policy and procedure that proscribes inappropriate and abusive practices by employees.

Parents and professionals referring to wilderness and outdoor programs should ask for a summary of program policies and procedures that describe appropriate as well as inappropriate and unacceptable behavior by staff. Program descriptions of inappropriate or illegal behavior should include:

  • Physical abuse is prohibited. This would include striking or pushing students, denial of basic comforts such as warmth, movement, reasonable access to hygiene or timely elimination.

  • Emotional abuse or neglect is prohibited. Demeaning and derogatory language including yelling at students to "break them down" or to gain control and compliance can be very damaging.

  • Inappropriate or excessive use of force or restraint is prohibited. There are numerous programs and certification procedures by which trained staff can achieve control and compliance when students become dangerous or destructive. Use of pain compliance or inappropriate hold techniques must be strictly avoided. Training is essential. 

  • Inappropriate or unwarranted isolation, restraint or long term restraint of a student is prohibited. Such procedures are high risk procedures. Students’ reactions can be extreme and lead to decompensation. The ability to restrict movements is not high in a wilderness setting and physical restraints can lead to bad outcomes.

  • Sexualized behavior, sexual relations with students and sexual abuse is prohibited. Such behavior is illegal in most circumstances and highly damaging in all circumstances.

  • Deprivation of food and water is prohibited. Under no circumstances should students be denied necessary nutrients as punishment. Students should have access to healthy diets with adequate calories including nutritional supplements.

  • Deprivation of emotional, social and other psychological needs is prohibited. Such consequences or punishments are extremely controversial and would almost never be appropriate in an outdoor setting. The risks associated with subsequent behavior are high.

  • Denial of medical care or attention is prohibited. This more than any issue is critical to the health and safety of students. Prior to admission, many students have lived stressful and often self-harming lives. Sexual activity, drug use and poor health habits are such that some students may require treatment for problems ranging from bronchitis, to pneumonia, pelvic inflammatory disease, venereal disease, and ear or sinus infections.

  • Forcing students to eat or take fluids is prohibited. Students will often lose their appetites or refuse food in protest when they enter a program. Such behavior is often oppositional defiance of program requirements. Health risks of refusing food are usually extremely low. Force feeding a student is not only unnecessary but illegal.

  • Restriction or denial of necessary communication with family and other designated responsible persons is prohibited. Mail and the right to communicate is essential for parents to keep in touch with their child and to monitor the child’s progress. Mail is for practical purposes the best way to maintain communication.

A policy that outlines appropriate response to routine, urgent and emergency mental health or medical problems.

Serious or life threatening medical and mental health injuries and problems in outdoor treatment programs are not usually the result of "accidents". In most situations, "accidents" are the result of avoidable errors, negligence or incompetence. In nearly all situations there are numerous warning signs which can prompt action in a responsive or timely manner. Awareness of safety issues and training staff to think proactively in terms of "What if?" is the best deterrent. In addition to the ability to think in terms of "what if?", a safe program will have a clear and documented understanding of appropriate and essential responses by field staff and program management. A safety and risk management policy and procedure is a necessary part of any program. Safety and risk management involves the proactive assessment of near accidents and accidents with follow-up training and awareness enhancement of staff. Conscientious and responsible behavior on the part of staff must be supported and maintained through hiring practices, monitoring program activities, staff supervision as well as routine safety, medical and mental health training.

Policies and procedures should cover

  • Injuries, physical complaints and symptoms.

  • Dispensing, monitoring, changing and discontinuing medications.

  • Unusual, strange, or bizarre behavior.

  • Angry, aggressive, self-harming, threatening, violent or suicidal behavior.

  • Decompensation, failure to thrive and other forms of regressive behavior.

  • Medical crisis and emergencies (ex. dehydration, heat stroke, hypothermia, sprains, lacerations, etc…).

  • Unusual and unexpected weather or potential natural disasters (ex. lightning storms, cold snaps, wind storms, snow storms, wild fires, floods, extreme heat conditions, etc...).

  • Situations in which a student "runs" from the program, leaves without permission, becomes lost or is missing.

Admissions are supervised and screened by an experienced, qualified and licensed mental health professional.

Many parents exploring the options of wilderness and outdoor therapeutic programs have not received comprehensive mental health services for their children. Prior to exploring the wilderness program option, parents have often experienced frustrating encounters with insurance companies, HMO’s, or mental health or medical providers. Parents are often not well informed by their health care providers and lack a clear understanding of their child’s problems. Understanding the child’s needs and clarity about the information necessary to identify and select an appropriate program for that child is essential to informed parental choice. Determining whether or not a particular child will benefit from a particular wilderness program is the most important focus of any pre-admission process. The structure of the program and the therapeutic activities must be appropriate. The intensity, duration, frequency and type of therapeutic activities must be matched with the specific needs of a potential student. Primary concerns are to avoid decompensation, failure to thrive and failure to benefit.

The idea that any one program can serve the needs of all prospective students is absurd. Placing a student in an appropriate program and assuring there will be a clear therapeutic plan will be more certain if oversight for admissions is the responsibility of an experienced, qualified and licensed mental health professional.

At a minimum,

  • The program should identify the consulting medical care providers where physical and medical care will be provided.

  • The medical screening should be outlined. A minimum medical screening would include a physical examination, blood work, complete chemistries, as well as a drug and alcohol screening.

  • The student's intake process should include a comprehensive biological, psychological and social interview including individual and family history.

  • The procedure by which psychological evaluations would normally used should be identified. Intensive evaluations normally include personality, intelligence, achievement and neuropsychological functions.

  • Programs should publish position papers or policies and procedures if they accept or may encounter students with emotional or psychiatric problems.

  • Screening procedures should conducted by or include consultation with qualified and licensed professional who has credible training and experience in diagnosis as well as recognizing medical and psychological differential diagnosis issues.

(See Screening Procedures for Wilderness Programs - Coming Soon)

Clinical, family and therapeutic activities in the program are supervised by an experienced, qualified and licensed professional with training in psychological, social and behavioral science.

Whether considering a wilderness program, a psychiatric hospital, a residential treatment program or a boarding school, it is increasingly difficult for consumers to be assured that a given therapy or treatment program is safe, effective and humane in it’s work with children and families. Government regulation and licensing of a program cannot alone provide the level of assurance that parents need. Government regulation programs provide quality assurance in only the broadest terms. Parents can find the highest level of assurance when there are experienced, qualified and licensed professionals working in the program who are professionally responsible to oversee and direct any activities that are considered therapeutic or clinical in nature. These professionals might have the title of Program Director or Program Supervisor. By virtue of their professional license and clear job descriptions, Directors or Supervisors of Clinical, Family and Therapeutic Services would be required by their job description and licensing law to follow standards of practice, ethical guidelines, state laws and administrative rules that are a condition of licensure.

For professional and legal reasons, licensed mental health professionals should not make referrals to programs that do not have licensed professionals who are responsible for admissions, evaluations and therapeutic activities. Whether it is a residential treatment program, or a wilderness therapy program, a licensed professional should be given ultimate responsibility and authority for admissions, confidentiality, standards of practice, following state laws, ethics, liability, therapy, counseling and quality assurance. These responsibilities are distinctly separate from those activities that are operational (e.g. logistics, safety, transportation, food, water, personnel, supervision and training of field staff, clothing, equipment, maintenance, coordination, maintenance). Operational responsibilities are routinely and primarily those of a Field Director or Operations Director.

A distinction between unlicensed paraprofessionals, licensed professionals who provides therapy or counseling services, and the role of a licensed Director who is responsible for these services must be clearly defined by program policies. A licensed Director or Supervisor of clinical, family and therapeutic activities for a wilderness program can be held legally responsible for program policies, procedures and the behavior of individuals providing clinical, family and therapeutic services. They are also responsible for the activities of professionals and paraprofessionals. A Director who has responsibility in title but who lacks authority within the structure of the organization is not able to function professionally. Professionals must seek authority commensurate with their professional obligations. When they are unable or not allowed to insure that professional standards will be followed, they should separate from these programs.

Under no circumstances should unlicensed paraprofessionals provide professional supervision of licensed professionals. A line of authority must be clear. Parents and professionals referring to programs must understand who is responsible for the safety and emotional well-being of their children as well as their qualifications. Honest and complete disclosure is an ethical and legal requirement. Paraprofessionals should not have ultimate responsibility for clinical and therapeutic activities.

A therapist, counselor or paraprofessional employed by the program is responsible to follow or to challenge program policies and procedures. Their scope of responsibilities are not as broad as those of a Director. A Director with a clear job description can be held responsible for negligent policies, including the absence of important policy, as well as a failure to oversee policies necessary to insure the safety and psychological well-being of students. As much as 80% of all activities and staff interactions with students are potentially therapeutic and should involve continuous evaluation. The clinical Director should

  • Supervise clinical, family and therapeutic activities in the program

  • Develop and monitor policies and procedures that insure the health, safety and progress of students while enrolled in the program

  • Have program responsibility to oversee and insure that students on medications are appropriately monitored and that medication benefits outweigh potential risks and side effects

  • Coordinate with medical professionals and insure that medical follow-up is implemented correctly

  • Insure monitoring of students for unacceptable and dangerous medication side-effects

  • Have line authority and the ability to intercede with respect to all professional and paraprofessional interactions with students.

A written program policy and procedure that is updated on a regular basis.

Policies and procedure documents provide a good assurance that a program can be held accountable for inappropriate or potentially dangerous activities and actions by employees. These procedures are only effective if staff are properly trained and when staff are required to follow program policies and procedures. Policies place expectations on the program and the staff. Failures to follow clearly defined policies and procedures give parents the opportunity to raise issues, and if necessary, bring legal actions for negligent behavior. As such, clear and thorough policies and procedures can be an excellent safety consideration. Policies and procedures should include.

  • Student rights, responsibilities and discipline. Students and parents should be given a summary document that clearly describes what is expected of students, what rights they have and how students are challenged, encouraged, helped and disciplined.

  • Methods to supervise and monitor student behavior and progress. A student's progress should be monitored and documented on a daily basis in order to insure students are thriving and to avoid decompensation or a failure to thrive. Parents should be advised as to their child's progress orally or in writing on a weekly basis. At a minimum, parents should be advised as to their child's physical, psychological and social status. Measures of progress and success should be included in weekly reports.

  • Minimum staff training requirements (e.g. First Aid, CPR, WFR - wilderness first responder training, radio communications, search and rescue). There has been a recurrent observation by employees in wilderness therapy programs that some companies hire some staff to "baby-sit" students. A program should not hire staff to act as "warm bodies" to keep their staff to student ratios looking good. Staff should be trained, both formally and informally on a continuing program of skill improvement.

  • Quality assurance activities and practices. Quality assurance must be the responsibility of a licensed professional who is experienced and qualified to implement a quality assurance program. Quality assurance can be implemented by paraprofessionals, but must be supervised by professionals.

  • Reporting procedures for child abuse. Child abuse reporting procedures must be provided to parents prior to enrollment. Failure to do so is unethical and even illegal in some states. In some states, a licensed professional may lose their license if they do not provide full and complete information.

  • The limitations of what can be considered confidential. Some communication may be related between student and parents by their child's therapist or counselor. Parents and students should be told in advance how information will be handled. Students and parents have confidentiality rights. These should be clearly described and outlined.

  • Minimum staff experience requirements. Staff should be screened and employed on the basis of education, interpersonal and outdoor skills. At a minimum, staff should have wilderness survival experience, training in outdoor skills, education, ideally they should have prior work experience in similar programs.

  • Risk management and safety program. Near accidents or potentially dangerous problems should be routinely investigated, reviewed and documented in order to assure that the program will be proactive in preventing further accidents or injuries. Recommendations including training as well as new policies and procedures should be implemented in timely manner.

The program provides full and complete informed consent to parents when they contact the program.

  • Staff members should identify their position and qualifications when they introduce themselves to parents and professionals who are seeking information about the program.

  • The program should clearly state the limits of privacy, confidentiality and legal privileges that protect students and parents.

  • The experience, qualifications and licensure of the person responsible for student’s medical and psychological well-being including safety must be identified.

  • The program description should clearly state any registration or license to operate as a school or treatment program and define which state laws or licensure requirements will insure responsible program operation and hold the program accountable. A brief description of what each licenses or and registration signifies and how it is regulated should be included in the written program description.

  • The program should describe procedures that will take place if a student becomes lost, walks or runs away from the program without permission from the program or parents.

Additional Risk Factors

In addition to the above factors, there are a host of considerations that can be important when considering and exploring a wilderness therapy and intervention program. This list is not exhaustive, but is fairly comprehensive.

  • Program therapeutics are clearly understood. The structure of the program and the therapeutic activities should not simply be copied from other programs. The owners and employees operating the program and providing services must understand the psychological principles and social science that underlie all therapeutic activities. The risk and benefits of therapeutic activities can not be assumed because they are common practices in other programs.

  • Comprehensive crisis intervention. Crisis interventions and evaluations of unusual or threatening behavior by students must be implemented, supervised and documented by an experienced, qualified and licensed mental health professional.   Paraprofessionals should not supervise crisis interventions and evaluations. All behavior that represents a potential high risk must be evaluated and resolved in a professional and appropriate manner.

  • Comprehensive counseling and treatment planning. There must be individual evaluation, counseling and treatment plans routinely developed for students that cover a student’s history, medical status, diagnosis if any, medications if any, problems to be addressed, educational, counseling and treatment recommendations, as well as plans for the student after they graduate.  Position papers on specific disorders are highly recommended. This should help organize and direct services in light of difficult problems.

  • Tuition is adequate and reasonable. The average cost of the program per student should not be less than $170 per day. (Based on the economics of 1999) This does not mean that parents should be charged more. This figure is based on an estimated minimum cost to provide essential services. When the cost of a program is below this level (plus or minus 15%), there can be difficulty staffing the program and providing the necessary level of training, supervision, quality assurance and support for both staff and students.

  • Timely medical screening and services. Students should not be admitted without a timely medical screening. This would involve a medical screening prior to enrollment when indicated or a medical screening within the first 2 weeks. An informal health screen prior to admission is essential to identify obvious potential problems.

  • Qualified and experienced field staff.  Instructors should have more than six months experience working in the field program or a similar program before they become Head Instructors. Head instructors should have experience working and living outdoors for extended periods in wilderness guide or leadership positions. Extensive outdoor and survival experience should be required in order for staff to work with students in harsh environmental conditions.

  • Staff have diverse and valuable life experience. The program should have a wide range of life experience represented in their staff. This should include education, work experience, life experience and experience working with youth at risk. For example, at least 50% of program field instructors should be at least 25 years old. At least 25% of program staff and instructors should be at least 30 years old. There should be staff in the company who are raising families of their own. Staff who had problems similar to students can be an asset but these staff should have worked through their problems successfully so that they can be examples and role models. Cultural diversity and ethnicity are especially valuable learning resources for students. Staff with college and advanced degrees can provide a valuable perspective for students.

  • Policies should prohibit dual relationships. The program should have a clear policy that forbids employees and owners from accepting gifts, money, special business deals and from entering into financial relationships with parents while their child is enrolled. Such behavior creates a potential conflict of interest and undermines the program's ability to provide a neutral and objective perspective to one or both parents. The problem of special or dual relationships is especially difficult when students’ parents are divorced, their relationship is conflicted and custody of the child is an issue.

  • Economically feasible. The company should be well enough funded to cover their payroll and operating expenses. Under funded programs may be unable to provide the level of staffing and services necessary to insure program safety. Non-profits must disclose their financial status. For-profit companies are not required to disclose their financial status but will usually answer questions. Refusal to respond to such questions may be a warning sign of under funding.

  • Adequate liability coverage. Business and professional indemnity insurance should be comprehensive and in full force. Insurance should cover all operations, equipment and therapeutic services. Insurance limits should be a minimum of one million dollars per loss incident, 3 million dollars aggregate.

Steps That Parents, Mental Health Professionals and Educational Consultants Should Take

At some point the following information should be requested and reviewed before a student is enrolled in a program. Parents may research the issues identified above for them selves or they might obtain consultation services from an educational consultant or mental health professional who is familiar with outdoor and wilderness therapy programs. Professionals who refer to wilderness therapy programs will often have specific knowledge and experience with many types of programs. The following information should be made available from the program by mail or on the Internet. Ask for a printed copy to review. Ideally, the program should have information and documents describing

1.  The program’s policies and procedures that cover

  • Employee hiring practices including reference and background checks

  • Routine drug and alcohol screening of staff

  • Inappropriate and forbidden behavior by staff and program management

  • The exceptions and limitations of confidentiality

  • Routine, urgent and emergency medical and mental health procedures

  • Proactive responses that staff is trained to take in response to inappropriate and dangerous behavior by students

  • Admissions and screening procedures and the qualifications of the staff involved in the admission process

  • Routine and periodic program activities that take place in the field

  • Program activities and personnel that support, monitor and supervise field activities

  • Quality assurance, safety and risk management procedures that describe what will happen with regard to incidents, accidents or other behavior that would be of concern to parents

  • The procedure and time line by which parents will be notified of any accident, injury, medical problem, students leave the program, abuse or allegations of inappropriate or potentially abusive behavior

  • Communication procedures by radio and telephone. This includes procedures that will be followed in the event that a student runs, becomes lost or missing. Procedures should be outlined for situations where the program or field staff lose contact with each other or routine daily check in procedures fail

  • The risk management program, policy and procedures, threshold of risk to activate the program, committee members, review process and the procedures to document and implement recommendations

  • Psychological and psychiatric evaluation services including evaluation, testing, counseling and psychotherapy services

2.  An overview of the job description and brief resumes for

  • The Chief Executive Officer or person responsible for the overall program operation

  • Director of Field Operations, or The Chief Operations Officer

  • The Operations Manager

  • The Section Director or Field Manager

  • The Director of Family, Clinical and Therapeutic Services, or the Clinical Program Supervisor

  • The Director of Admissions or Admissions Coordinator

  • Head Instructors and Assistant Instructors

  • The quality assurance professional

  • All teachers and assistant teachers

  • Program therapists, counselors, residents or interns

  • Instructors and Head Instructor (or Field Guides)

  • Support staff including drivers, backup staff, and administrative personnel

3.  The program’s educational and therapeutic philosophy, evaluation and testing services and the use of specific therapeutic activities including

  • Medical and mental health education

  • Academic policies

  • Individual counseling or therapy

  • Group counseling or therapy

  • Trust games and activities

  • Socialization, leadership and team building

  • Initiatives, challenges and ordeals

  • Discipline, behavioral requirements, reinforcements and consequences

  • Excluded or inappropriate counseling approaches and therapy techniques

  • Testing, evaluation, assessment and interview procedures

copyright 1999 - 2002, Michael G. Conner