Journal of Child and Family Studies

, Volume 25, Issue 11, pp 3322–3330 | Cite as

Adolescent Self-Assessment of an Outdoor Behavioral Health Program: Longitudinal Outcomes and Trajectories of Change

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


Outdoor behavioral healthcare is an increasingly popular treatment modality for adolescents, and evidence suggests that it is effective for a wide range of complex issues. The outdoor behavioral healthcare literature still faces major limitations though, and one of these limitations is that outcomes are primarily measured at only admit and discharge. This study sought to explore the trajectory of change throughout treatment, and investigate outcomes up to 18 months post-discharge. Of the 659 adolescent participants from four outdoor behavioral healthcare programs, 29 % were female, 18 % were adopted, and the average age was 16 years old. Participants were invited to complete questionnaires four times during treatment, and at 6 and 18 months post-discharge. We used multilevel modeling to explore trajectories and predictors of change during treatment, and a regression and an ANOVA to examine outcomes post-discharge. Results of the multilevel modeling supported that adolescents make significant changes during outdoor behavioral healthcare, and also contributed new findings on demographic and diagnostic predictors. Gender and the presence of a mood or anxiety disorder predicted greater rates of change during treatment. Analysis of post-discharge data at six and 18 months post-discharge suggested that clients maintain treatment effects and that gender persists in influencing outcomes. This study is the first to examine trajectories of change in outdoor behavioral healthcare, to find diagnostic variables to be relevant, and to examine self-report outcomes past 12 months post-discharge.


Outdoor behavioral healthcare Adolescents Outcomes Wilderness therapy Youth outcome questionnaire 



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

Compliance with ethical standards

This research was funded through the OBH program as part of their internal program evaluation efforts. Three of the four authors were employees of the program, and the data analyst, who was a consultant to the program (not an employee), only accessed to de-identified, aggregate-level data. Animals were not involved in this research. The OBH program obtained informed consent from each participant and explained that participation in the internal evaluation to monitor and track outcome was completely voluntary. Every participant’s parent signed a release, which stated that their child could be a part of this internal project to monitor outcomes and also gave permission for the program to use theirs and their child’s de-identified, aggregate-level data for potential professional development or research purposes.

Conflict of interest

Three of the four authors were employed by the OBH program during the evaluation. Otherwise, the authors declare that they have no other conflict of interests.


  1. Behrens, E. N., Santa, J., & Gass, M. A. (2010). The evidence base for private therapeutic schools, residential programs, and wilderness therapy programs. Journal of Therapeutic Schools and Programs, 4(1), 106–117.Google Scholar
  2. Bettmann, J. E., Russell, K. C., & Parry, K. J. (2013). How substance abuse recovery skills, readiness to change and symptom reduction impact change processes in wilderness therapy participants. Journal of Child and Family Studies, 22, 1039–1050.CrossRefGoogle Scholar
  3. Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of adventure therapy outcomes and moderators. Open Psychology Journal, 6(1), 28–53.CrossRefGoogle Scholar
  4. Combs, K. M., Hoag, M. J., Roberts, S., & Javorski, S. (2015). A multilevel model to examine adolescent outcomes in Outdoor Behavioral Healthcare: The parent perspective. Child and Youth Care Forum Child & Youth Care Forum, 45(3), 353–365). doi: 10.1007/s10566-015-9331-0 CrossRefGoogle Scholar
  5. Gass, M. A., Gillis, H. L., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York, NY: Routledge.Google Scholar
  6. Hoag, M. J., Massey, K. E., & Roberts, S. D. (2014). Dissecting the wilderness therapy client: Examining clinical trends, findings, and industry patterns. Journal for Experiential Education, 37(4), 382–396.CrossRefGoogle Scholar
  7. Hoag, M. J., Massey, K. E., Roberts, S. D., & Logan, P. (2013). Efficacy of wilderness therapy for young adults: A first look. Residential Treatment for Children & Youth, 30(4), 294–305.CrossRefGoogle Scholar
  8. Hoag, M. J., Massey, K. E., Roberts, S., Logan, P., & Poppleton, L. (2011). What changes in wilderness therapy: Moving beyond outcome. Paper presented at the meeting of the National Association of Therapeutic Schools and Journals, Provo, UT.Google Scholar
  9. Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.CrossRefPubMedGoogle Scholar
  10. Lewis, S. F. (2013). Examining changes in substance use and conduct problems among treatment-seeking adolescents. Child and Adolescent Mental Health, 18, 33–38. doi: 10.1111/j.1475-3588.2012.00657.x CrossRefGoogle Scholar
  11. Maller, C., Townsend, M., Pryor, A., Brown, P., & St Leger, L. (2006). Healthy nature healthy people: ‘Contact with nature’ as an upstream health promotion intervention for populations. Health promotion international, 21(1), 45–54.CrossRefPubMedGoogle Scholar
  12. Magle-Haberek, N. A., Tucker, A. R., & Gass, M. (2012). Effects of program differences with wilderness therapy and residential treatment center (rtc) programs. Residential Treatment for Children & Youth, 29(3), 202–218.CrossRefGoogle Scholar
  13. Norton, C. L., Tucker, A., Russell, K. C., Bettmann, J. E., Gass, M. A., Gillis, H. L., & Behrens, E. (2014). Adventure therapy with youth. Journal of Experiential Education, 37(1), 46–59.CrossRefGoogle Scholar
  14. Russell, K. C. (2001). What is wilderness therapy?. Journal of Experiential Education, 24(2), 70–79.CrossRefGoogle Scholar
  15. Russell, K. C. (2003). Assessment treatment outcomes in outdoor behavioral healthcare using the Youth Outcome Questionnaire. Child and Youth Care Forum, 32(6), 355–381.CrossRefGoogle Scholar
  16. Russell, K. C. (2005). Two years later: A qualitative assessment of youth-well-being and the role of aftercare in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 34(3), 209–239.CrossRefGoogle Scholar
  17. Russell, K., & Sibthorn, J. (2004). Hierarchical data structures in adventure education and therapy. Journal of Experiential Education, 27(2), 176–190.CrossRefGoogle Scholar
  18. Russell, K. C., Gillis, H. L., & Lewis, T. G. (2008). A five-year follow-up of a nationwide survey of Outdoor Behavioral Healthcare program. Journal of Experiential Education, 31(1), 55–77.CrossRefGoogle Scholar
  19. Tucker, A., Zelov, R., & Young, M. (2011). Four years along: Emerging traits of programs in the NATSAP Practice Research Network (PRN). Journal of Therapeutic Schools and Programs, 5(1), 10–28.Google Scholar
  20. Tucker, A., Javorski, S., Tracy, J., & Beale, B. (2013). The use of adventure therapy in community-based mental health: Decreases in problem severity among youth clients. Child and Youth Care Forum, 42(2), 155–179.CrossRefGoogle Scholar
  21. Tucker, A. R., Smith, A., & Gass, M. A. (2014). How presenting problems and individual characteristics impact successful treatment outcomes in residential and wilderness treatment programs. Residential Treatment for Children & Youth, 31, 135–153.CrossRefGoogle Scholar
  22. Wells, M., Burlingame, G., Lambert, M., Hoag, M., & Hope, C. (1996). Conceptualization and measurement of patient change during psychotherapy: Development of the outcome questionnaire and the youth outcome questionnaire. Psychotherapy, 33(2), 275–283.CrossRefGoogle Scholar
  23. Wells, M. G., Burlingame, G. M., & Rose, P. M. (2003). Administration and scoring manual for the YOQ SR-2.0 (Youth Outcome Questionnaire-Self Report). Wilmington, DE: American Professional Credentialing Service.Google Scholar
  24. Young, M. C., & Gass, M. (2010). Preliminary data from the NATSAP research and evaluation network: Client characteristics at admission. Journal of Therapeutic Schools and Programs, 4(1), 80–105.Google Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Katie Massey Combs
    • 1
    • 2
    Email author
  • Matthew J. Hoag
    • 2
    • 3
  • Stephen Javorski
    • 4
    • 5
  • Sean D. Roberts
    • 3
    • 6
  1. 1.Second Nature Wilderness ProgramsSanta ClaraUSA
  2. 2.Evoke Therapy ProgramsSanta ClaraUSA
  3. 3.Second Nature EntradaSanta ClaraUSA
  4. 4.College of Health and Human Services, University of New HampshireDurhamUSA
  5. 5.Faculty in the Child and Youth Care Department at Vancouver Island UniversityNanaimoCanada
  6. 6.Cascade Crest TransitionsBendUSA

Personalised recommendations