Child & Youth Care Forum

, Volume 45, Issue 3, pp 353–365 | Cite as

A Multilevel Model to Examine Adolescent Outcomes in Outdoor Behavioral Healthcare: The Parent Perspective

  • Katie Massey CombsEmail author
  • Matthew J. Hoag
  • Sean D. Roberts
  • Stephen Javorski
Original paper



Outdoor Behavioral Healthcare (OBH) has arisen to fill a gap in mental health treatment. While research shows large positive changes in adolescent self-reports, little is known about predictors of change, longitudinal outcomes, and parent-reports of change.


This study sought to identify treatment outcomes up to 18 months post-discharge and predictors of change for parents of adolescent clients in OBH treatment.


Parents of 659 adolescents from four OBH programs were invited to complete questionnaires at intake, discharge, and 6 and 18 months post-discharge. A regression was conducted to examine change during treatment, and a multilevel model to examine trajectories of change post-treatment.


OBH participants entered treatment with clinically significant levels of emotional and behavioral dysfunction, made significant change during the program, and discharged within the “normal” range of functioning. Post-discharge scores indicated that clients remained in the “normal” range of functioning 6 and 18 months post-discharge. The regression analysis found that parent intake scores and attachment disorders were predictive of in-treatment change. The MLM found that parent perceptions of treatment gains and adoption status were significant predictors of functioning post-discharge.


Results are in-line with previous research suggesting that OBH may be helpful to adolescents experiencing a wide range of presenting problems, and adds new insights as well. Parent-reports parallel the dramatic changes in adolescent self-reports documented throughout OBH literature; data up to 18 months post-treatment shows healthy functioning per the parent perspective; and adoption and attachment appear to play a role in outcome trajectories.


Outdoor behavioral healthcare Adolescents Outcomes Wilderness therapy Youth outcome questionnaire 



This research was funded through Second Nature Wilderness Programs and Evoke Therapy Programs.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Katie Massey Combs
    • 1
    • 3
    Email author
  • Matthew J. Hoag
    • 1
    • 3
  • Sean D. Roberts
    • 1
    • 4
  • Stephen Javorski
    • 2
    • 5
  1. 1.Second Nature Wilderness ProgramsSanta ClaraUSA
  2. 2.College of Health and Human ServicesUniversity of New HampshireDurhamUSA
  3. 3.Evoke Therapy ProgramsSanta ClaraUSA
  4. 4.Cascade CrestBendUSA
  5. 5.Faculty in the Child and Youth Care DepartmentVancouver Island UniversityNanaimoCanada

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