Selection Of A Wilderness Therapy
By: Michael Conner, Psy.D
Mentor Research Institute:
Revised: June 30, 2002
Each day, thousands of teenagers lose interest in their education,
skip school, refuse to work or do their chores, become involved with drugs and drop out of
school. Many become involved in criminal activities. Nearly all of them will eventually
come to the attention of law enforcement. The following are a few alarming facts.
- Mental health problems affect one in every five young people
at any given time (U.S. Department of Health And Human Services, Substance Abuse and
Mental Health Services Administration, Center for Mental Health Services).
- An estimated two-thirds of all young people with mental health problems
are not getting the help they need (U.S. Department of Health And Human Services,
Substance Abuse and Mental Health Services Administration, Center for Mental Health
- Recent studies show that, at any given time, as many as one in every 33 children may
have clinical depression. The rate of depression among adolescents may be as high as one
in eight (Center for Mental Health Services).
There is a growing consensus among mental health professionals that it is the business
of health care to deny care. In a previous article I wrote that
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 health cares 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 HMOs 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.
Parents searching for alternatives to medicating their children for
social and behavioral problems are turning to wilderness therapy programs when
"office" therapy, residential treatment, psychiatric hospitals and criminal
justice programs fail. Parents seek out wilderness therapy programs to help change their
family and child's life for the better. In some cases, parents are trying to save
their child's life from drugs, dangerous sexual activity, child abuse,
criminal influences and other form of
Determining whether or not a particular child will benefit from a wilderness
therapy program is the most important decision that a parent can make. Wilderness
therapy programs have developed over the past 10 years as alternatives to traditional
"treatment" approaches that are failing or inadequate to the challenge of
adolescent behavioral problems. Even though wilderness therapy programs are growing in
acceptance and research is under way, they must be investigated carefully. There are a
number of challenges facing parents.
Many parents exploring the wilderness therapy option have not yet received
comprehensive mental health services for their child. Selecting a wilderness therapy
program requires that parents understand how these programs work. They must investigate a
range of programs thoroughly, and they must select a program that has the resources to
meet the needs of their child.
How to Select a Wilderness Therapy Program
Selecting a wilderness therapy program is not easy and parents should be suspicious of
programs that will admit children without thoroughly screening a child and without giving
parents necessary information about the program. Providing adequate information is a
professional and ethical obligation that is commonly referred to as "informed
consent." In order for parents to give consent to allow their child to be enrolled,
they must be fully informed about the program's structure, their policy and procedures,
the benefits and risks, the potential problems that students and parents may encounter, as
well as a range of potential outcomes. Many wildness therapy program do not routinely give
this level of information. Parents should take an active and assertive role in becoming
Parents and health care professionals need a systematic approach to investigate and
evaluate wilderness therapy programs. The reason is simple. Wilderness programs are
powerful psychological, emotional and physical interventions. Wilderness therapy programs
are not the same in terms of philosophy, duration, structure, or the degree of clinical
focus. In addition to being different, wilderness therapy programs can have the same
success rates, but they can be successful for different reasons and with different
problems. Selecting a wilderness therapy program can be accomplished by
Identifying wilderness therapy programs that are safe.
Identifying the child's problems or potential problems.
Identifying programs that have the resources to address the child's
problems or potential problems.
Identifying your goals and the most likely outcome from a program.
The above four step process can be followed by parents, a child's
caregiver, or by mental health professionals and educational consultants making referrals.
Consultation with a mental health professional or educational consultant that is
personally familiar with wilderness programs is highly recommended.
1. Identifying Wilderness Therapy Programs That Are Safe
The importance of "Defining A Safe Wilderness Intervention Program" is
obvious. Outdoor schools and wilderness interventions are powerful psychological,
emotional and physical interventions. A safe program will have
- A clearly defined program and operational structure
- Detailed policy and procedures
- Staffing and equipment appropriate to your child's level of need
- Educated, licensed, trained and experienced people directing and providing necessary
For detailed information on what constitutes a safe wilderness program, see "Defining A Safe Wilderness School, Therapy And Intervention Program" at
2. Identifying The Child's Problems or Potential Problems
There are three categories of problems. They are behavioral, psychological and
medical. Determining the category of problems that your child is experiencing will help
you identify the best program for you child.
Category I - Behavior Problems. Most of the problems that children
demonstrate are purely behavioral. The behavior can take many forms. Most behavioral
problems are learned and children continue to act this way because they want to live this
way, the behavior has become a strong habit or reaction tendency, or they simply don't
want to change their behavior. The core behaviors include those in which the child may be
Category II - Psychological Problems. Psychological problems can be
the result of the child's behavior, traumatic experiences, or genetic problems that are
inherited. In some cases, a child is born with genetic differences that may look
like a different temperament, a greater need for stimulation, impulsive tendencies, threat
sensitivity, mood states that are above or below those of other children, or there may be
differences in intellectual functioning. Psychological problems can surface without reason
or they can be the result of high levels of stress, alcohol and drug abuse, or trauma in a
child's life. The most common problems to the least common problems that children
- Differences in Intellectual functioning
- Alcohol or substance abuse disorder
- Major depression or dystymia (major and minor)
- Anxiety related problems (general, panic, phobia, obsessions
- Adjustment reactions or Post Traumatic Stress Disorder
- Persistent delusional or perceptual problems related to past drug abuse
- Eating Disorders (bulimia, anorexia, bingeing)
- Bipolar disorder (manic depression) or cyclothymia (lesser manic depression)
- Schizoaffective disorder, Schizophreniform or schizophrenia
Category III - Medical Problems. Children may have additional problems
that are of a physical or medical nature. As a matter of routine practice, medical
care professionals frequently do not screen for medical problems that can influence a
child's behavior, mood, emotionality or state of mind. While most of these problems
are infrequently the cause of problems, they can contribute to or exacerbate problems that
children have. Medical problems that can be overlooked include
- Insulin abnormality (diabetes)
- Abnormal brain activity or brain wave (EEG)
- Alcohol & other drug abuse
- Early brain injury or damage
Failing to recognize a medical problem or failure to provide the appropriate treatment
can reduce the likelihood of a program succeeding and in some cases can result in
of decompensation or a failure to thrive while the child is in the program. The
program's expectations of a child, the necessity of medical attention or monitoring, and
appropriate concern for necessary follow-up care can be crucial services for children who
have special needs.
A Word About Medications
Parents exploring wilderness therapy programs frequently have children who are placed on
medications which are used primarily as a "behavioral restraint". Medications
used to treat seizure disorders and manic depression are frequently used to sedate and
limit destructive and impulsive behavior that is the result of a behavioral
A common problem is the use of antidepressants to treat "depressed" behavior
that is really the result of a low level thyroid that was not recognized. Some children
who supposedly have attention deficit problems without hyperactivity have been found to be
in an early stage of diabetes.
Most of the medication problems are the result of parents taking their child to
physicians who are not trained in psychiatry or by taking their child to a psychiatrist
who is not trained in adolescent or child psychiatry. It is a common practice in managed
health care to require family physicians to try and treat psychiatric problems. Referring
"out" to psychiatrists is considered an extra cost and not necessary in the view
of managed health care - especially if the child seems to get better (or the parents think
the child is better). Working with adolescents who have psychological problems is not the
same as working with adults. Many children with impulsivity and anger will "look
better" if they are placed on an antidepressant that has sedation as a side-effect. In
many cases, the drugs used on children and adolescents are not yet approved by the Federal
Food and Drug Administration. Many drugs that are being used on children were designed for
adults and have not been tested on children. The long term effects are not known.
The most common problems that children experience are behavioral, but there may be
psychological or medical issues. The fact that a medication changes behavior does
not mean the problem is psychological or medical.
Here are examples of common problems that are faced when a students is
enrolled in a wilderness program.
The child is enrolled with a behavioral problem that is currently being sedated or restrained with medications
that have a tranquilizing or sedating side-effects. For example,
children who are depressed and angry
at their parents following a divorce are frequently placed on
The child is placed on an antidepressant for an an unrecognized hormonal or neurological
problem that is the real cause. For example, children who are
overweight, hypothyroid and hypoglycemic can end up
being placed on antidepressants like Prozac and Paxil.
The child has a behavioral problem and the psychological or medical problem has not been
diagnosed. For example, the child has been treated by a counselor and
has not had a complete evaluation by a psychologist or physician.
The child has a behavioral and psychological problem for which they have been placed on
the wrong medication or too much medication. For example, the side-effects of a medication at
a particular level is that of a powerful tranquilizer that reduces angry and impulsive
The child is on three medications in which the toxic side-effects of one medication is
causing new symptoms that are being treated with a third medication.
For example, The child is may be
placed on a powerful antipsychotic tranquilizer like resperidone because of the side effects of another
medication like neurotine which is having a disorganizing effect on thought processes.
For more information on Issues that are often overlooked, see "Wilderness
Therapy: Critical Evaluation And Treatment Issues That Are Overlooked"
3. Identifying The Program's Resource To Address The Child's Problems Or
There are two area of investigation when determining whether or not a program can meet
your needs and the needs of your child. The two areas of investigation are
A. The type of wilderness therapy program
B. The unique characteristics of the individual program
Investigating these two area can be accomplished by parents, a child's
care giver, or by mental health professionals and educational consultants. Again,
consultation with mental health professionals or educational consultants who are familiar
with wilderness programs is highly recommended.
A. The Type Of Wilderness Therapy Program
Wilderness therapy program can be categorized in terms of three factors. The three
factors are duration, program structure and services.
- Fixed Length . By far, most wilderness program operate on schedules in which the
program begins on a specified date and ends after a specific duration of time. In
some cases, additional time can be negotiated on a daily rate or a set amount of money for
a fixed amount of time - usually additional weeks. Scholarships and discounts are usually
not advertised. In some cases a discount is offered on an individual basis, but there may
be no official application process.
Open Length. There are very few programs that operate with an
"open" length duration for one set fee. Once your child is enrolled in an open length program,
your child remains in the program until their problems are addressed as fully as possible
and they are ready to graduate. The duration of the program can be matched to the child's
needs. Some open length programs do offer discounts for deserving students and parents.
2) Program Structure
The following is a brief over view of components that can be used to
describe the structure of a wilderness therapy program.
Brief Assessment/Intervention. (21 to 30
days) Programs are available that offer
a 3 or 4 week assessment and intervention. The assessment is usually behavioral and the
intervention is brief. These programs offer a lower overall cost, but not necessarily on a
per day basis. In some cases, student will need to attend the program twice. More often
than other programs, the brief assessment/intervention programs tend to recommend student
attend boarding schools, retake the program or that students be placed in
transition or foster homes.
Some brief assessment programs are owned by a network of programs that include therapeutic boarding schools.
Fixed Length (45 to 60 day programs). Depending on the
program, fixed length programs provide a 45 and 60 wilderness experience. Students
the program knowing when they will graduate. The programs are highly behavioral in nature
and the clinical focus is usually minor. A few programs have qualified mental health
professionals to evaluate or monitor potential clinical problems.
Open Length. These programs operate under the philosophy that
each student will grow and learn at different rates. Students are graduated when they are
ready and students generally do not know when they will graduate. For all intents and
purposes, the average stays in these programs can range from 60 to 110 days with longer
stays up to 260 days. There is usually a minimum stay.
Programs with a "guarantee". A few program offer a
"guarantee" which is really just a contract agreement that
the program will re-admit
the student later with no additional tuition cost if the problem behavior returns or the
student relapses. Such promises can range from one to two years. There is usually an
administrative fee which is used to cover the cost of new equipment, food, transportation
and readmission costs.
Special Needs. There are only a very few programs that offer a
special needs program. These programs have a stronger clinical focus that may
include clinical evaluation and treatment services for mild developmental disorders, mild
neurological problems, depression, anxiety, obsessive compulsive disorder, or other
behavioral problems that are not severe but require intensive evaluation and intervention.
Program services are usually provided and directed by licensed and qualified mental
Emotional Growth Focus. Emotional growth programs have a
long history of providing emotionally challenging and supportive environments for
students. The programs are traditionally run by non-mental health professionals, and
in some programs, mental health professionals are not allowed to work in their programs.
However, due to the high number of children with mental health
disorders, and others who are also on
medications, these programs have slowly involved mental health as a component of their
programs. Nearly all programs today have a mental health professional who will
consult with the program or staff. These professionals may not
be licensed or qualified to get a
Evaluation and Assessment. Few program offer evaluation and
assessment services. Some programs offer behavioral assessments which are based almost
entirely on the observation of field staff or counselors. Even fewer programs will conduct
a screening based on standardized interview procedures and the use of psychological
questionnaires. Very few programs offer intensive evaluations. An intensive evaluation
would normally include personality, intelligence, academic achievement and behavioral
Counseling and Therapy. The counseling and therapy services
provided by wilderness therapy programs will vary. The level of training and licensure of
people providing therapy and counseling services will also vary from staff who have no
training or license to professionals who are highly trained, experienced and licensed.
Virtually all programs provide "counseling" and "therapy" by field
staff, but this would not qualify as professional counseling or therapy. Only a few
programs consistently provide counseling and therapy by licensed, trained and
experienced professionals. Individual and group therapy are additional
components of a counseling and therapy program that enhance the power of a program.
Therapeutic Community Activities. There are two general areas of
activities from which wilderness therapy programs operate. They are
The first, adventure based learning, involves students in activities that
may include hiking, mountaineering, camping, climbing, or river rafting. The adventures
may involve the use of a great deal of equipment or the minimal equipment necessary for
the adventure. Teamwork and individual efforts set up as activities and are contrasted.
The group, trek or expedition in these adventures face numerous challenges, trials and
ordeals which become the basis of building self-esteem, improved social and interpersonal
interactions, and self-discovery.
The second area of activity in a wilderness therapy program involves an
emphasis on outdoor camping, hiking and survival skill training. This model place students
in natural and social settings where students must face the "inevitables" of
life. Students are give supervision and
training appropriate to level of need. The goal is to help student recognize inappropriate and destructive behaviors
through an internal alignment with nature. Students are exposed to nature, the elements,
and ordeals in terms of a strategic and safe program of adversity, temptations and consequences that are based in
nature. Staff interactions are supportive and provide guidance. Punishment and abuse are
not permitted under any circumstances (but you need to confirm this
during admission). The program supports the evolution of natural, necessary and imposed
activities such as firewood gathering, food preparation,
cooking and shelter constructions that are all necessary within a primitive
group living condition. Students undergo
psychological and behavioral changes by facing the
"inevitables" of life, recognizing their potential,
appreciating the importance of family and cooperation, and by discovering that parental supervision has a important role in their life.
Academic Education. Wilderness programs tend to emphasize
non-academic outdoor education that includes camping, outdoor survival skills, teamwork,
mental health and facing the inevitable adversities of life. Only a few program
offer academic education for enrolled students. Parents and professionals referring to
wilderness therapy programs may be concerned that students do not fall behind in their
education and may also want students to improve their academic standing. In some cases,
academic achievement is really a secondary concern for parents who are dealing with their
child's behavior and psychological state of mind. There are four sources of academic
credit. The first would be free standing state accredited programs. At this time there are
no free standing state accredited programs, but accreditation in the near future is
possible for several programs who are pursuing such accreditation's. There are only a few
programs who operate alternative schools that are affiliated with State accredited school.
Such program offer fully transferable credit. The third source of accredited academic work
are the programs that are registered with the sponsoring State's Department of
Education. These programs can offer high school transferable credit, but it will be the
decision of the school offering a diploma to accept these credits. It is extremely rare
that a program's credit will not be accepted. Prior to, or immediately after admission,
parents can usually negotiate for acceptance of credits on a case by case basis. The
fourth accreditation process is found with school who provide academic curriculums through
correspondence programs sponsored by other states. These programs offer fully transferable
B. The Unique Characteristics Of The Individual Program
Identifying the unique characteristics of a program is an important step toward the
decision to place child in a wilderness therapy program. Many of the questions that
parents and referring professionals need to ask are related to the program's operation and
safety. For more information related to safety, please refer to the article
"Defining A Safe Wilderness Therapy Program" at /Wilderness/SafeWildernessPrograms.htm
The following is list of questions that can tell you a lot about programs. The answers
to these questions, and the programs ability to answer these questions, should help you
get to know the unique characteristics of programs.
Is the person responsible for admissions and screening your child a
qualified mental health professional or are they supervised by a qualified professional?
Does the program offer an educational and academic program for your
Does the program provide parents with an overview of the policies and
How often and who provides parents with updates on their child's
Does the program provide family counseling or parent skills training
while the student is enrolled in the program?
Is there a follow-up program where the program provides support and
monitors your child's progress?
Does the program provide a brief resume or background information on all
staff who are working with your child?
Does the program provide you with the level of education, experience and
licensure of professionals providing and directing services?
Are counseling and therapy staff trained, experienced,
licensed or supervised by a licensed professional?
Can the program monitor, evaluate and dispense medications?
What level and type of assessment and evaluation service does the
Can you speak with or reach someone in the program on a daily or 24 hour
What is the graduation criteria for the program?
What is the philosophical and research basis that defines how the
What is the minimum training that staff receive and how often are staff
Does the program measure your child's behavior before and after the
4. Identifying Your Goals And The Most Likely Outcome From A Program
The fourth area of importance will depend in large part on the goals you may have for
your child's future and the likely outcome of a program. In most cases, the program you
choose will automatically define the most likely goal or outcome for your child. Programs
that are less than 30 days have a lower rate of returning students to their homes and
frequently recommend further treatment, boarding school placement or out-of-home
(foster-care) placements. Approximately 50% (or less) of these students are returned home.
Programs with a fixed length generally do not make recommendations, one way or another, that a
child should be sent home or to a boarding school. Such decisions are usually made by parents or
parents who are already working with educational consultants who specialize in working
with youth at risk. Students who graduate from open length programs are
frequently sent home unless the program and the parents feel their child has special needs that are
beyond the families ability to provide. The initial goal in an open length program, unless
otherwise set by parents, is almost always for the child to return home.
Selecting a Program
There are four areas of importance when investigating and selecting a wilderness
The first area of concern involves the cost and duration of the program, educational
opportunities, experience and licensure of the people directing and providing services,
the range of services provided, the level of supervision and guidance that students
receive, and the therapeutic group activities in the program. Follow-up and monitoring the
child's progress when they graduate can be very important to insuring success and
Secondly, the intensity, duration, frequency and type of activities students experience
must be matched with the specific needs of a potential student. Students with special
needs (psychological or potential medical problems) should be enrolled in programs that
have a clinical focus and qualified mental health professionals working with your child
who are competent to evaluate, diagnose and monitor your child's progress. The structure
and purpose of program activities must be clearly defined. Staff training is a crucial
part of a safe and effective program.
Third, the unique qualities of the program are those factor that make parents feel
comfortable and willing to entrust their child's emotional and physical well-being with
others. This would represent a match between the parent's values and expectations for
their child with the resources, attitude and philosophy of the program. Parents
should feel confident and in touch with their child's progress while they are in the
program. The program should feel caring and not impersonal.
Fourth, and finally, a credible program will have a list of
parents who have offered to speak with parents considering enrollment. The list
be "loaded" with parents who will attest to "miracles." Many parents
will tell you that their child is not perfect, is still a teenager, and still requires a
high degree of parental supervision and guidance. Children still get into trouble
and make mistakes. What most parents will tell you is that their child is far better off,
the "at risk" behavior in their child's life has dropped considerably, and that
their child has demonstrated remarkable growth. Parents should ask to speak with a parent
of a child who relapsed and did not seem to benefit from the program. Hopefully,
such parents can tell you that they felt the program did the very best they could and that
they would still recommend the program to parents with difficult children.
For more information about selecting a
program, see "Interview
Questions For Parents, Consumers and Professionals" at http://www.wilderness-programs.org/InterviewQuestions.html
Copyright 2000 to 2002, Michael G.
Conner (all rights reserved)