Meta-analysis of Treatment Outcomes Measured by the Y-OQ and Y-OQ-SR Comparing Wilderness and Non-wilderness Treatment Programs



Monitoring youth treatments requires outcome instruments sensitive to change. The Y-OQ and the Y-OQ-SR measure behavioral change during psychological treatment.


The focus of this study was to compare treatment progress of youth in studies using the Youth Outcome Questionnaire (YOQ) or the Youth Outcome Questionnaire Self Report (YOQSR) in wilderness and non-wilderness treatment programs.


Seventy-six manuscripts were examined. Inclusion criteria were (a) contained a version of the YOQ, (b) implemented mental health treatment, (c) contained sufficient data to obtain an effect size, and (d) had at least two data points (e.g., intake and termination). The final number of studies included for the Y-OQ was 15 and for the Y-OQ-SR was 11.


Random effects model results, for studies using the YOQ, indicated a large (Cohen in Psychol Bull 112(1):155, 1992) effect size (g = .98, 95 % CIs [.71, 1.26]). The YOQ-SR results also indicated a large effect size (g = .80, 95 % CIs [.63, .96]). Treatment setting demonstrated a difference between wilderness and non-wilderness programs. For the Y-OQ (parent/guardian observation) effect sizes were higher for wilderness programs Qbetween = 91.82, df = 1, p < .001 and for the Y-OQ-SR (adolescent’s self report) effect sizes were higher for non-wilderness programs Qbetween = 8.62, df = 1, p = .003.


Treatment programs for youth using the Y-OQ and Y-OQ-SR to measure behavioral change, are indicating strong and positive effects from pre to post testing. Clinicians should consider routinely monitoring progress of their clients to better understand changes between pre and post testing.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3


Y-OQ studies are identified with a single asterisk* and Y-OQ-SR with a double asterisk**. Studies included in both the Y-OQ and Y-OQ-SR analyses and are identified with a triple asterisk***

  1. Albright, A., Michael, K., Massey, C., Sale, R., Kirk, A., & Egan, T. (2013). An evaluation of an interdisciplinary rural school mental health programme in Appalachia. Advances in School Mental Health Promotion, 6(3), 189–202.

    Article  Google Scholar 

  2. Behrens, E., & Satterfield, K. (2011). A multi-center study of private residential treatment outcomes. Journal of Therapeutic Schools and Programs, 5(1), 29–45.

    Google Scholar 

  3. 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(8), 1039–1050.

    Article  Google Scholar 

  4. Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2005). Comprehensive meta-analysis (Version 2) [Computer software]. Englewood, NJ: Biostat.

    Google Scholar 

  5. Borenstein, M., Hedges, L., Higgins, J., & Rothstein, H. (2009). Introduction to meta-analysis. West Sussex: Wiley.

    Book  Google Scholar 

  6. Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of adventure therapy outcomes and moderators. The Open Psychology Journal, 6(1), 28–53.

    Article  Google Scholar 

  7. Brown, G. S., Burlingame, G. M., Lambert, M. J., Jones, E., & Vaccaro, J. (2001). Pushing the quality envelope: A new outcomes management system. Psychiatric Services, 52(7), 925–934.

    Article  PubMed  Google Scholar 

  8. Burggraf, S. B. (1998). The efficacy of family preservation services for adolescents in the prevention of out-of-home placement and acute symptom reduction. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 9919732).

  9. Burlingame, G., Cox, J., Wells, G., Latkowski, M., Justice, D., Carter, C., & Lambert, M. (2005). The administration and scoring manual of the Youth Outcome Questionnaire. Salt Lake City, Utah: OQ Measures.

    Google Scholar 

  10. Burlingame, G., Earnshaw, D., Hoag, M., Barlow, S., Richardson, S., Donnell, A., & Villani, J. (2002). A systematic program to enhance clinician group skills in an inpatient psychiatric hospital. Journal of Group Psychology, 52(4), 555–587.

    Google Scholar 

  11. Burlingame, G., Wells, A., Lambert, M., & Cox, J. (2004). Youth Outcome Questionnaire: Updated psychometric properties. In M. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (3rd ed., Vol. 2, pp. 235–274). Mahwah, NJ: Lawrence Erlbaum Associates.

    Google Scholar 

  12. Christensen, N. E. (2008). Effects of wilderness therapy on motivation and cognitive, emotional, and behavioral variables in adolescents. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3297749).

  13. Clark, J. P. (2002). The effects of wilderness therapy on the perceived psychosocial stressors, defense styles, dysfunctional personality patterns, clinical syndromes, and maladaptive behaviors of troubled adolescents. Unpublished doctoral dissertation, George Fox University, Newberg, OR.

  14. Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155.

    Article  PubMed  Google Scholar 

  15. Combs, K. M., Hoag, M. J., Roberts, S. D., & Javorski, S. (2015). A multilevel model to examine adolescent outcomes in outdoor behavioral healthcare: The parent perspective. Child & Youth Care Forum, 45(3), 353–365.

    Article  Google Scholar 

  16. Dunham, J. B. (2009). Examining the effectiveness of functional family therapy across diverse client ethnic groups. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3380076).

  17. Dunn, T. W., Burlingame, G. M., Walbridge, M., Smith, J., & Crum, M. J. (2005). Outcome assessment for children and adolescents: Psychometric validation of the Youth Outcome Questionnaire 30.1 (Y-OQ®-30.1). Clinical Psychology & Psychotherapy, 12(5), 388–401.

    Article  Google Scholar 

  18. Duval, S., & Tweedie, R. (2000). Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463.

    Article  PubMed  Google Scholar 

  19. Ellis, P. D. (2010). The essential guide to effect sizes: An introduction to statistical power, meta-analysis and the interpretation of research results. United Kingdom: Cambridge University Press.

    Book  Google Scholar 

  20. Erickson, C. J. (2008). The effectiveness of functional family therapy in the treatment of juvenile sexual offenders. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3330001).

  21. Frensch, K. M., & Cameron, G. (2002). Treatment of choice or a last resort? A review of residential mental health placements for children and youth. Child & Youth Care Forum, 31(5), 307–339.

    Article  Google Scholar 

  22. Gass, M. A., Gillis, H., & Russell, K. C. (2012). Adventure therapy: Theory, research, and practice. New York, NY: Routledge/Taylor & Francis Group.

    Google Scholar 

  23. Hagan, J. D. (2002). An alternative therapy for the behaviorally challenged youth: The efficacy of wilderness therapy programs. Unpublished doctoral dissertation, University of Toledo, Toledo, OH.

  24. Harper, N. J. (2007). A mixed methods examination of family involvement in adolescent wilderness therapy. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3287816).

  25. Knorth, E. J., Harder, A. T., Zandberg, T., & Kendrick, A. J. (2008). Under one roof: A review and selective meta-analysis on the outcomes of residential child and youth care. Children and Youth Services Review, 30(2), 123–140.

    Article  Google Scholar 

  26. Lambert, M. J. (2013). Outcome in psychotherapy: The past and important advances. Psychotherapy, 50(1), 42–51.

    Article  PubMed  Google Scholar 

  27. Lambert, M. J. (2015). Progress feedback and the OQ-system: The past and the future. Psychotherapy, 52(4), 381–390.

    Article  PubMed  Google Scholar 

  28. Lester, M. C. (2012). The effectiveness of client feedback measures with adolescents in an acute psychiatric inpatient setting. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3522254).

  29. Lipsey, M. W., & Wilson, D. B. (2001). Practical meta-analysis. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  30. Lowe, T. A. (2005). The effectiveness of Anasazi: A wilderness treatment program. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3192842).

  31. Magle-Haberek, N. A., Tucker, A. R., & Gass, M. A. (2012). Effects of program differences with wilderness therapy and residential treatment center (RTC) programs. Residential Treatment for Children & Youth, 29(3), 202–218.

    Article  Google Scholar 

  32. McClendon, D. T., Warren, J. S., Green, K. M., Burlingame, G. M., Eggett, D. L., & McClendon, R. J. (2011). Sensitivity to change of youth treatment outcome measures: A comparison of the CBCL, BASC-2, and Y-OQ. Journal of Clinical Psychology, 67(1), 111–125.

    Article  PubMed  Google Scholar 

  33. Mick, E., Biederman, J., Pandina, G., & Faraone, S. V. (2003). A preliminary meta-analysis of the child behavior checklist in pediatric bipolar disorder. Biological Psychiatry, 53(11), 1021–1027.

    Article  PubMed  Google Scholar 

  34. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., The PRISMA Group. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Retrieved from

  35. 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.

    Article  Google Scholar 

  36. Olson-Morrison, D. L. (2009). Maltreated children in residential treatment: Reviewing treatment frameworks, predicting outcomes, and defining progress and success. Unpublished doctoral dissertation, The University of Utah, Salt Lake City, Utah.

  37. Ridge, N. W. (2007). The reliability, concurrent validity, and factor structure of the Youth Outcome Questionnaire Self-Report. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3567761).

  38. Robinson, K. E. (2000). Outcomes of a partial-day treatment program for referred children. Child & Youth Care Forum, 29(2), 127–137.

    Article  Google Scholar 

  39. Russell, K. (2003). An assessment of outcomes in outdoor behavioral healthcare treatment. Child & Youth Care Forum, 32(6), 355–381.

    Article  Google Scholar 

  40. Russell, K. C. (2006). Evaluating the effects of the Wendigo Lake Expedition program on young offenders. Youth Violence and Juvenile Justice, 4(2), 185–203.

    Article  Google Scholar 

  41. Slonim, D., Shefler, G., Gvirsman, S. D., & Tishby, O. (2011). Changes in rigidity and symptoms among adolescents in psychodynamic psychotherapy. Psychotherapy Research, 21(6), 685–697.

    Article  PubMed  Google Scholar 

  42. Turner, J. S. (2009). Social support interactions in therapeutic adventure education programs. Doctoral dissertation, University of Georgia. Retrieved from

  43. Wells, M. G., Burlingame, G. M., & Rose, P. M. (2003). Youth outcome questionnaire self-report. Wilmington, DE: American Professional Credentialing Services.

    Google Scholar 

  44. Woolley, C. C. (2004). Changes in child symptomatology associated with animal-assisted therapy. Doctoral dissertation. Available from ProQuest dissertations and theses database (UMI No. 3157804).

  45. Zelov, R., Tucker, A. R., & Javorksi, S. (2013). A new phase for the NATSAP PRN: Post discharge reporting and transition to the network wide utilization of the Y-OQ 2.0. Journal of Therapeutic Schools and Programs, 6(1), 6–19.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Harold L. Gillis Jr..

Ethics declarations

Conflict of interest

Gillis, Speelman, Linvillem Bailey, Kalle, Oglesbee, Sandlin, Thompson, and Jensen declare they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Gillis, H.L., Speelman, E., Linville, N. et al. Meta-analysis of Treatment Outcomes Measured by the Y-OQ and Y-OQ-SR Comparing Wilderness and Non-wilderness Treatment Programs. Child Youth Care Forum 45, 851–863 (2016).

Download citation


  • Youth Outcome Questionnaire
  • Y-OQ
  • Y-OQ-SR
  • Wilderness therapy
  • Adventure therapy
  • Treatment outcomes
  • Meta-analysis