Abstract
Background
There is an increasing need to identify effective mental health treatment practices for children and adolescents in community-based settings, due to current mixed findings of existing interventions. This study looked at adventure therapy (AT) as a viable option to meet this need.
Objective
Using a sample of 1,135 youth from a community-based mental health center, this study addressed the following questions: (1) Is AT an effective treatment modality for youth compared to traditional counseling? (2) How do changes in problem severity associated with participation in AT-based interventions compare with those associated with traditional counseling across gender, age, primary diagnosis, and race? (3) What are the predictors of changes in problem severity in clients?
Methods
In this exploratory non-equivalent groups quasi-experimental design study, pre- and post- mean scores of problem severity as reported by youth’s primary clinician were compared by type of treatment and client characteristics. Treatment and client characteristics were used as predictors of changes in problem severity.
Findings
Participants in AT had significant reported mean decreases in problem severity larger than those of clients not involved in counseling with an adventure component with larger decreases in female and African American clients. AT and psychological counseling were found to be significant predictors of decreases in problem severity; however, length of counseling, not length of AT, was a significant predictor.
Discussion
These findings suggest that community-based AT may be a viable treatment for youth in community settings; yet these findings should be interpreted with caution due to several study limitations.
Similar content being viewed by others
References
Alegria, M., Atkins, M., Farmer, E., Slaton, E., & Stelk, W. (2010). One size does not fit all: Taking diversity, culture and context seriously. Administration and Policy in Mental Health and Mental Health Services Research, 37(1), 48–60. doi:10.1007/s10488-010-0283-2.
Alvarez, A. G., & Stauffer, G. A. (2001). Musings on adventure therapy. The Journal of Experiential Education, 24(2), 85–91.
Ayers, C., & Shavel, D. (1997). Adventure programming & prevention of adolescent problem behaviors: Applying research and the public health model. In Deeply rooted, branching out, 1972–1997. Annual AEE international conference proceedings. (ERIC Document Reproduction Service No. ED 414125). Retrieved from ERIC Database.
Becker, S. P. (2010). Wilderness therapy: Ethical considerations for mental health professionals. Child & Youth Care Forum, 39, 47–56.
Berman, D. S., & Davis-Berman, J. (1995). Adventure as psychotherapy: A mental health perspective. Journal of Leisurability, 22(2), 21–28.
Bernstein, B. E. (2012). Conduct disorder. Medscape reference: Drugs, diseases and procedures. Retrieved from http://emedicine.medscape.com/article/918213-overview.
Bickman, L. (2008). A measurement feedback system (MFS) is necessary to improve mental health outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 47(10), 1114–1119. doi:10.1097/CHI.0b013e3181825af8.
Bringewatt, E., & Gershoff, E. (2010). Falling through the cracks: Gaps and barriers in the mental health system for America’s disadvantaged children. Children and Youth Services Review, 32, 1291–1299.
Caulkins, M. C., White, D. D., & Russell, K. D. (2006). The role of physical exercise in wilderness therapy for troubled adolescent women. The Journal of Experiential Education, 29(1), 18–37.
Chang, Y., Liu, S., Yu, H., & Lee, Y. (2012). Effect of acute exercise on executive function in children with Attention Deficit Hyperactivity Disorder. Archives of Clinical Neuropsychology, 27(2), 225–237.
Child Welfare Information Gateway (2007). Trauma-focused cognitive behavioral therapy: Addressing the mental health of sexually abused children. Washington, DC: US Department of Health and Human Services. Retrieved from http://www.childwelfare.gov/pubs/trauma/.
Cohen, J. (1987). Statistical power of analysis for the behavioral sciences (2nd ed.). Hillsdale, NH: Erlbaum.
Cole, D. A., Hoffman, K., Tram, J. M., & Maxwell, S. E. (2000). Structural differences in parent and child reports of children’s symptoms of depression and anxiety. Psychological Assessment, 12(2), 174–185. doi:10.1037/1040-3590.12.2.174.
Cooper, J. L. (2008). Towards better behavioral health for children, youth and their families: Financing that supports knowledge (Unclaimed Children Revisited, Working Paper No. 3). Retrieved from http://www.nccp.org/publications/pub_804.html.
Davis, D., Ray, J., & Sayles, C. (1995). Ropes course training for youth in a rural setting: “At first I thought it was going to be boring…” Child and Adolescent Social Work Journal, 12(6), 445–463.
de Arellano, M. A., Ko, S. J., Danielson, C. K., & Sprague, C. M. (2008). Trauma-informed interventions: Clinical and research evidence and culture-specific information project. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.
Eagle, H., Gordon, J., & Lewis, L. (2000). The effects of a public school system’s one day adventure experience. Fifth Biennial Research Symposium Proceedings: Coalition for Education in the Outdoors.
Fletcher, T. B., & Hinkle, J. S. (2002). Adventure based counseling: An innovation in counseling. Journal of Counseling and Development, 80(3), 277–285.
Forgan, J. W., & Jones, C. D. (2002). How experiential adventure activities can improve students’ social skills. Teaching Exceptional Children, 34(3), 52–58.
Gass, M. A. (1993). Foundations of adventure therapy. In M. A. Gass (Ed.), Adventure therapy: Theoretical applications of adventure programming (pp. 3–10). Dubuque, IA: Kendall/Hunt Publishing Co.
Gass, M. A., & Gillis, L. H. (2010). Treating juveniles in a sex offender program using adventure-based programming: A matched group design. Journal of Child Sexual Abuse, 19(1), 20–34.
Gass, M. A., Gillis, L. H., & Russell, K. (2012). Adventure therapy: Theory, research and practice. New York: Routledge Press.
Gillis, H. L., Gass, M., & Russell, K. (2008). The effectiveness of project adventure’s behavior management programs for male offenders in residential treatment. Residential Treatment For Children & Youth, 25(3), 227–247. doi:10.1080/08865710802429689.
Glass, J. S., & Myers, J. E. (2001). Combining the old and the new to help adolescents: Individual psychology and adventure-based counseling. Journal of Mental Health Counseling, 23(2), 104–114.
Harper, N., & Russell, K. (2008). Family involvement and outcome in adolescent wilderness treatment: A mixed-methods evaluation. International Journal of Child and Family Welfare, 1, 19–36.
Harper, N. J., Russell, K. C., Cooley, R., & Cupples, J. (2007). Catherine Freer wilderness therapy expeditions: An exploratory case study of adolescent wilderness therapy, family functioning, and the maintenance of change. Child & Youth Care Forum, 36(2–3), 111–129. doi:10.1007/s10566-007-9035-1.
Herbert, J. T. (1998). Therapeutic effects of participating in an adventure therapy program. Rehabilitation Counseling Bulletin, 41(3), 201–216.
Hernandez, M., & Hodges, S. (2003). Crafting logic models for systems of care: Ideas into action making children’s mental health services successful (Vol. 1). Tampa, FL: University of South Florida, The Louis de la Parte Florida Mental Health Institute, Department of Child & Family Studies.
Hunter, S. B., Ramchand, R., Griffin, B. A., Suttorp, M. J., McCaffrey, D., & Morral, A. (2011). The effectiveness of community-based delivery of an evidence-based treatment for adolescent substance use. Journal of Substance Abuse Treatment, 43(2), 211–220. doi:10.1016/j.jsat.2011.11.003.
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, 12–19.
Jones, C., Lowe, L., & Risler, E. (2004). The effectiveness of wilderness adventure therapy programs for young people involved in the juvenile justice system. Residential Treatment for Children & Youth, 22(2), 53–67. doi:10.1300/J007v22n02_04.
Kimball, R., & Bacon, S. (1993). The wilderness challenge model. In M. A. Gass (Ed.), Adventure therapy: Theoretical applications of adventure programming (pp. 11–41). Dubuque, IA: Kendall/Hunt Publishing Co.
Kutash, K., & Duchnowski, A. J. (2004). The mental health needs of youth with emotional and behavioral disabilities placed in special education programs in urban schools. Journal of Child and Family Studies, 13(2), 235–248.
Lagerberg, D. (2005). Physical activity and mental health in schoolchildren: A complicated relationship. Acta Paediatrica, 94, 1699–1705.
Leadbeater, B. J., Kuperminc, G. P., Blatt, S. J., & Hertzog, C. (1999). A multivariate model of gender differences in adolescents’ internalizing and externalizing problems. Developmental Psychology, 35(5), 1268–1282. doi:10.1037/0012-1649.35.5.1268.
LeCroy, C. W. (2007). Problem solving and social skills training groups for children. In T. Ronen & A. Freeman (Eds.), Cognitive therapy in clinical social work practice (pp. 285–300). New York, NY: Springer Publishing.
Magle-Haberek, N., Tucker, A., & Gass, M. (2012). The effects of program differences within wilderness therapy and residential treatment center (RTC) programs. Residential Treatment for Children and Youth, 29, 1–17. doi:10.1080/0886571X.2012.697433.
Marx, J. D. (1988). An outdoor adventure counseling program for adolescents. Social Work, 33(6), 517–520.
Mitten, D. (1994). Ethical considerations in adventure therapy: A feminist critique. Women and Therapy, 15(3/4), 55–84. doi:10.1300/J015v15n03_06.
Morral, A. R., McCaffrey, D. F., & Ridgeway, G. (2004). Effectiveness of community-based treatment for substance-abusing adolescents: 12-month outcomes of youths entering phoenix academy or alternative probation dispositions. Psychology of Addictive Behaviors, 18(3), 257–268. doi:10.1037/0893-164x.18.3.257.
Newman, C. (2007). The effects of aerobic exercise on childhood PTSD, anxiety, and depression. Hofstra University. Dissertation Abstracts International, 67(10-B), 6070.
Norton, C. L., & Tucker, A. R. (2010). New heights: Adventure-based groupwork in social work education and practice. Groupwork, 20(2), 24–44.
Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (1999). The Ohio youth problems, functioning, and satisfaction scales (short form): User manual. Athens: Ohio University. Retrieved from https://sites.google.com/site/ohioscales/the-manuals.
Ogles, B. M., Melendez, G., Davis, D. C., & Lunnen, K. M. (2000). The Ohio youth problem, functioning, and satisfaction scales: Technical manual. Athens: Ohio University. Retrieved from https://sites.google.com/site/ohioscales/the-manuals.
Ogles, B. M., Melendez, M. S., Davis, D. C., & Lunnen, K. M. (2001). The Ohio Scales: Practical outcome assessment. Journal of Child and Family Studies, 10(2), 199–212. doi:1062-1024/01/0600-0199.
Parfitt, G., & Eston, R. G. (2005). The relationship between children’s habitual activity level and psychological well-being. Acta Pae-Diatr, 94, 1790–1796.
Promising Practices Network on Children, Families and Communities. (2006). Incredible years. Retrieved from http://www.promisingpractices.net/program.asp?programid=134.
Roberts, B., Horwood, S., Aunger, N., & Wong, M. (1998). Adventure with adults living with psychiatric disabilities. In C. Itin (Ed.). Exploring the boundaries of adventure therapy: International perspectives. Proceedings of the 1st international adventure therapy conference: Perth, Australia (pp. 368–375). Boulder, CO: The Association for Experiential Education.
Ross, S. (2003). The therapeutic effects of an adventure challenge program on the personal empowerment of women survivors of sexual trauma. Journal of Experiential Education, 25(3), 350.
Rueger, S. Y., Malecki, C. K., & Demaray, M. K. (2008). Gender differences in the relationship between percieved social support and student adjustment during early adolescence. School Psychology Quarterly, 23(4), 496–514. doi:10.1037/1045-3830.23.4.496.
Russell, K. (2006). Evaluating the effects of the Wendigo Lake expedition program on young offenders. Youth Violence and Juvenile Justice, 4(2), 185–203.
Russell, K. (2007). Adolescent substance-use treatment: Service delivery, research on effectiveness, and emerging treatment alternatives. Journal of Groups in Addiction & Recovery, 2(2–4), 68–96.
Schoel, J., & Maizell, R. (2002). Exploring islands of healing: New perspectives on adventure based counseling. Beverly, MA: Project Adventure, Inc.
Scott, D. A., & Duerson, L. M. (2010). Continuing the discussion: A commentary on “Wilderness Therapy: Ethical considerations for mental health professionals”. Child & Youth Care Forum, 39, 63–68.
Shanahan, L., McAllister, L., & Curtin, M. (2009). Wilderness adventure therapy and cognitive rehabilitation: Joining forces for youth with TBI. Brain Injury, 23(13–14), 1054–1064. doi:10.3109/02699050903421115.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2007). The comprehensive community mental health services for children and their families program, evaluation findings: Annual report to congress 2002–2003. Retrieved from http://download.ncadi.samhsa.gov/ken/pdf/SMA03-CBE2002/CongReport20022003FINALPUBLICATION.pdf.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2008). Assertive community treatment: The evidence. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2011). Justification of estimates for appropriations committees. Rockville, MD.
Substance Abuse and Mental Health Services Administration (SAMHSA), National registry of evidence-based programs and practices (NREPP). (2006). Dialectic behavior therapy. Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=36.
Substance Abuse and Mental Health Services Administration (SAMHSA), National Registry of Evidence-Based Programs and Practices (NREPP). (2007a). Multisystemic therapy (MST) for juvenile offenders. Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=26.
Substance Abuse and Mental Health Services Administration (SAMHSA), National registry of evidence-based programs and practices (NREPP). (2007b). Motivational interviewing. Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=130.
Substance Abuse and Mental Health Services Administration (SAMHSA), National registry of evidence-based programs and practices (NREPP). (2008). Multisystemic therapy with psychiatric supports (MST-Psychiatric). Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=17.
Substance Abuse and Mental Health Services Administration (SAMHSA), National registry of evidence-based programs and practices (NREPP). (2009). Multisystemic therapy for youth with problem sexual behaviors (MST-PSB). Retrieved from http://www.nrepp.samhsa.gov/ViewIntervention.aspx?id=46.
Thuppal, M., Carlson, G. A., Sprafkin, J., & Gadow, K. D. (2002). Correspondence between adolescent report, parent report, and teacher report of manic symptoms. Journal of Child and Adolescent Psychopharmacology, 12(1), 27–35. doi:10.1089/10445460252943542.
Tucker, A. (2009). Adventure-based group therapy to promote social skills in adolescents. Social Work with Groups, 32, 315–329.
Tucker, A.R., & Norton, C. L. (2012). The use of adventure therapy techniques by clinical social workers: Implications for practice and training. Clinical Social Work Journal. doi:10.1007/s10615-012-0411-4.
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.
Turchik, J. A., Karpenko, V., & Ogles, B. M. (2007). Further evidence of the utility and validity of a measure of outcome for children and adolescents. Journal of Emotional and Behavioral Disorders, 15(2), 119–128. doi:10.1177/10634266070150020201.
Van Dorn, R., Kosterman, R., Williams, J. H., Chandler, K., Young, M. S., Catalano, R., et al. (2010). The relationship between outpatient mental health treatment and subsequent mental health symptoms and disorders in young adults. Administration and Policy in Mental Health and Mental Health Services Research, 37(6), 484–496. doi:10.1007/s10488-010-0291-2.
Voruganti, L. N. P., Whatham, J., Bard, E., Parker, G., Babbey, C., Ryan, J., et al. (2006). Going beyond: An adventure- and recreation-based group intervention promotes well-being and weight loss in schizophrenia. Canadian Journal of Psychiatry, 51, 575–580.
Warren, J. S., Nelson, P. L., Mondragon, S. A., Baldwin, S. A., & Burlingame, G. M. (2010). Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings. Journal of Consulting and Clinical Psychology, 78(2), 144–155. doi:10.1037/a0018544.
Weiss, B., Catron, T., Harris, V., & Phung, T. M. (1999). The effectiveness of traditional child psychotherapy. Journal of Consulting and Clinical Psychology, 67(1), 82–94.
Weisz, J. R. (2004). Psychotherapy for children and adolescents: Evidence-based treatments and case examples. New York: Cambridge University Press.
Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between lab and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688–701.
Weisz, J. R., Jensen-Doss, A., & Hawley, K. M. (2006). Evidence-based youth psychotherapies versus usual clinical care: A meta-analysis of direct comparisons. American Psychologist, 61(7), 671–689.
Wilson, S. J., & Lipsey, M. W. (2000). Wilderness challenge programs for delinquent youth: a meta-analysis of outcome evaluations. Evaluation and Program Planning, 23, 1–12.
Wolf, M., & Mehl, K. (2011). Experiential learning in psychotherapy: Ropes course exposures as an adjunct to inpatient treatment. Clinical Psychology & Psychotherapy, 18(1), 60–74. doi:10.1002/cpp.692.
Zisser, A., & Eyberg, S. M. (2010). Treating oppositional behavior in children using parent-child interaction therapy. In A. E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 179–193). New York: Guilford.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tucker, A.R., Javorski, S., Tracy, J. et al. The Use of Adventure Therapy in Community-Based Mental Health: Decreases in Problem Severity Among Youth Clients. Child Youth Care Forum 42, 155–179 (2013). https://doi.org/10.1007/s10566-012-9190-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10566-012-9190-x