Results from Open Results from Open Sky’s Outcome Sky’s Outcome

ResearchResearch

Joanna Bettmann, Ph.D, Joanna Bettmann, Ph.D, LCSWLCSW

Open Sky Wilderness Open Sky Wilderness TherapyTherapy

December, 2009 December, 2009

Outline of the Outline of the PresentationPresentation

Why do research?Why do research? Defining wilderness therapyDefining wilderness therapy Existing outcome research into Existing outcome research into

wilderness therapywilderness therapy Open Sky’s outcome research on Open Sky’s outcome research on

adolescents and young adultsadolescents and young adults

Why do research?Why do research?

There are at least There are at least 10,000 adolescents in 10,000 adolescents in wilderness treatment wilderness treatment each year (Cooley, each year (Cooley, 1998)1998)

Thus, we must have research which shows that wilderness therapy is effective

What is Wilderness Therapy?What is Wilderness Therapy?

Russell (2003) defines wilderness Russell (2003) defines wilderness therapy as a “type of program that therapy as a “type of program that works to address problem behaviors. works to address problem behaviors. . .through a variety of therapeutic . .through a variety of therapeutic and educational curricula in outdoor and educational curricula in outdoor environments. [This] process is environments. [This] process is facilitated by licensed professionals” facilitated by licensed professionals” (p. 3). (p. 3).

What wilderness therapy is What wilderness therapy is notnot: : Challenge coursesChallenge courses Adventure based therapyAdventure based therapy Boot CampBoot Camp (Russell, 2001)(Russell, 2001)

What do we already know What do we already know about the effectiveness of about the effectiveness of

wilderness therapy?wilderness therapy? Using the Youth Outcome Questionnaire, Russell Using the Youth Outcome Questionnaire, Russell

(2003) studied 858 adolescent clients and their (2003) studied 858 adolescent clients and their parents in 7 different wilderness therapy parents in 7 different wilderness therapy programs: he found significant gains made programs: he found significant gains made during treatment which was largely maintained during treatment which was largely maintained at 1 –year follow-upat 1 –year follow-up

Russell (2005) followed up at 2 years with 88 Russell (2005) followed up at 2 years with 88 parents from the original sample and 47 parents from the original sample and 47 adolescents: gains made during treatment were adolescents: gains made during treatment were largely maintained 2 years after wilderness largely maintained 2 years after wilderness programprogram

Harper, Russell, Cooley & Cupples (2007) Harper, Russell, Cooley & Cupples (2007) conducted a quantitative, longitudinal study of conducted a quantitative, longitudinal study of 252 adolescents at Catherine Freer: showed 252 adolescents at Catherine Freer: showed positive improvement after 21-day wilderness positive improvement after 21-day wilderness programprogram

Bettmann (2007) studied changes in the Bettmann (2007) studied changes in the attachment relationships of 93 adolescents in attachment relationships of 93 adolescents in wilderness treatment: showed adolescents less wilderness treatment: showed adolescents less angry at parents following treatmentangry at parents following treatment

Other recent wilderness Other recent wilderness therapy therapy

outcome researchoutcome research Cook (2008) completed a qualitative study of 13 male Cook (2008) completed a qualitative study of 13 male

adolescents in a year-long residential wilderness therapy adolescents in a year-long residential wilderness therapy programprogram

Eikenæs, Gude & Hoffart (2006): compared a 6-day Eikenæs, Gude & Hoffart (2006): compared a 6-day wilderness treatment versus standard inpatient wilderness treatment versus standard inpatient hospitalization for adults with avoidant personality hospitalization for adults with avoidant personality disorderdisorder

Gillis, Gass & Russell (2008): studied the effectiveness of Gillis, Gass & Russell (2008): studied the effectiveness of project adventure’s behavior management programs for project adventure’s behavior management programs for male offenders in residential treatmentmale offenders in residential treatment

Jones, Lowe & Risler, (2004): studied 24 boys in wilderness Jones, Lowe & Risler, (2004): studied 24 boys in wilderness treatment compared to 11 in group homes (in Juvenile treatment compared to 11 in group homes (in Juvenile Justice system)Justice system)

Sklar, Anderson & Autry (2007) studied 15 at-risk youth Sklar, Anderson & Autry (2007) studied 15 at-risk youth who participated in an 8-day therapeutic wilderness canoe who participated in an 8-day therapeutic wilderness canoe triptrip

Caulkins, White & Russell (2006) qualitatively studied the Caulkins, White & Russell (2006) qualitatively studied the role of backpacking and physical exercise in 6 adolescent role of backpacking and physical exercise in 6 adolescent girls in a wilderness therapy programgirls in a wilderness therapy program

Russell & Harper (2006) studied restraint, runaway, illness Russell & Harper (2006) studied restraint, runaway, illness and injury incidents over 4 years of OBHIC member and injury incidents over 4 years of OBHIC member programs programs

Research shows positive Research shows positive outcomes for wilderness outcomes for wilderness

treatmenttreatmentImproved mental health Improved mental health symptomologysymptomologySense of accomplishmentSense of accomplishmentIncreased self-esteemIncreased self-esteemSense of empowermentSense of empowermentBetter access to feelingsBetter access to feelingsImproved relationshipsImproved relationshipsImproved communication skillsImproved communication skillsImproved drug & alcohol Improved drug & alcohol awarenessawarenessImproved coping skillsImproved coping skillsAwareness of behaviorsAwareness of behaviors

(Bettmann, 2007; Russell, 2001, 2003, 2005; (Bettmann, 2007; Russell, 2001, 2003, 2005; Russell, Hendee, & Phillips-Miller, 2000)Russell, Hendee, & Phillips-Miller, 2000)

Adult Outcome Research: Adult Outcome Research: SparseSparse

Hyer (1996): study of adult participants of Hyer (1996): study of adult participants of Outward Bound program. Participants reported Outward Bound program. Participants reported gains in self-esteem, problem-solving and gains in self-esteem, problem-solving and behavior changebehavior change

Goldenberg (2005): study of adult participants of Goldenberg (2005): study of adult participants of another Outward Bound program. Participants another Outward Bound program. Participants reported improved self esteem, confidence and reported improved self esteem, confidence and interpersonal skills.interpersonal skills.

Asher, Huffaker & McNally (1994): study of adult Asher, Huffaker & McNally (1994): study of adult abuse survivors on 3-day wilderness therapy trip. abuse survivors on 3-day wilderness therapy trip. Study reports participants developed trusting Study reports participants developed trusting relationships and utilized problem-solving skills.relationships and utilized problem-solving skills.

Little research on adult outcomes (Kelly, 2006; Little research on adult outcomes (Kelly, 2006; Paxton, 2000)Paxton, 2000)

Problems in Wilderness Problems in Wilderness Outcome ResearchOutcome Research

Poor treatment definition (Russell, Poor treatment definition (Russell, 2001)2001)

Few outcome studies, few in peer-Few outcome studies, few in peer-reviewed literaturereviewed literature

No accounting for programmatic No accounting for programmatic elements or deliveryelements or delivery

Open Sky’s study attempts to Open Sky’s study attempts to ameliorate these flaws in the literatureameliorate these flaws in the literature

Open Sky Outcome Open Sky Outcome Research: Three Years of Research: Three Years of

Conclusive DataConclusive Data Data gathered from all students and Data gathered from all students and

their parents/stepparents/caretakerstheir parents/stepparents/caretakers

Data gathered on the first day of Data gathered on the first day of Open Sky program, last day of Open Open Sky program, last day of Open Sky program, 3 months after, 6 Sky program, 3 months after, 6 months after, 12 months after, and 24 months after, 12 months after, and 24 months aftermonths after

This is an exploratory study to answer This is an exploratory study to answer the questions: is this wilderness the questions: is this wilderness treatment effective? What factors are treatment effective? What factors are associated with positive outcomes?associated with positive outcomes?

Comparing Open Sky Comparing Open Sky Results to other Results to other

Wilderness Therapy Wilderness Therapy ProgramsPrograms

This graph shows that teens graduating from Open Sky This graph shows that teens graduating from Open Sky have done better at graduation and one year later than have done better at graduation and one year later than teens who go to other wilderness therapy programs.teens who go to other wilderness therapy programs.

The Open Sky model The Open Sky model of wilderness therapyof wilderness therapy

Holistic focus: treating the whole Holistic focus: treating the whole personperson

Typically one group of 7 clients with 3 Typically one group of 7 clients with 3 staffstaff

Masters or Doctoral level counselors Masters or Doctoral level counselors visit 2 days/week to provide visit 2 days/week to provide sophisticated individual/group sophisticated individual/group psychotherapypsychotherapy

Counselors talk with families on the Counselors talk with families on the phone, create individualized treatment phone, create individualized treatment plans, coordinate family treatmentplans, coordinate family treatment

Organic, whole foods dietOrganic, whole foods diet Daily activities: group hikes, group Daily activities: group hikes, group

therapy, learning primitive skills, therapy, learning primitive skills, experiential curriculum, meditation, experiential curriculum, meditation, yogayoga

Initial medical and clinical screening, Initial medical and clinical screening, ongoing naturopathic treatmentongoing naturopathic treatment

Psychiatric consultations as neededPsychiatric consultations as needed

Open Sky Outcome Open Sky Outcome Research: Research:

Measurements/QuestionnaiMeasurements/QuestionnairesresAdolescent Adolescent

MeasuresMeasures Youth Outcome Youth Outcome

Questionnaire (YOQ) Questionnaire (YOQ) (Burlingame, Wells & (Burlingame, Wells & Lambert, 1995)Lambert, 1995)

Adolescent Attachment Adolescent Attachment Questionnaire (West, Rose, Questionnaire (West, Rose, Spreng, Sheldon-Keller & Spreng, Sheldon-Keller & Adam, 1998)Adam, 1998)

Adolescent Relapse Coping Adolescent Relapse Coping Questionnaire (ARCQ) Questionnaire (ARCQ) (Myers & Brown, 1996)(Myers & Brown, 1996)

University of Rhode Island University of Rhode Island Change Assessment Change Assessment (URICA) (McConnaughy, (URICA) (McConnaughy, Prochaska & Velicer, 1983)Prochaska & Velicer, 1983)

Young Adult Young Adult MeasuresMeasures

Outcome Questionnaire-45 Outcome Questionnaire-45 (OQ) (Lambert & (OQ) (Lambert & Burlingame, 1996)Burlingame, 1996)

University of Rhode Island University of Rhode Island Change Assessment Change Assessment (McConnaughy, Prochaska (McConnaughy, Prochaska & Velicer, 1983)& Velicer, 1983)

Adult Attachment ScaleAdult Attachment Scale Addictive Disorders Screen Addictive Disorders Screen

–Revised (Howatt, 2006)–Revised (Howatt, 2006) Psychological Separation Psychological Separation

Inventory (Hoffman, 1984)Inventory (Hoffman, 1984)

Open Sky Study: Teen Open Sky Study: Teen NumbersNumbers

GenderGender 100 male students (47.6%)100 male students (47.6%) 110 female students (52.4%)110 female students (52.4%)

Average number of days in the programAverage number of days in the program 63.07 days63.07 days

Average age at admit = 15.81 years oldAverage age at admit = 15.81 years old Age range is 13-17 years old Age range is 13-17 years old

Did you go on to Aftercare after Open Sky?Did you go on to Aftercare after Open Sky? 122 = yes (67%)122 = yes (67%) 60 = no (33%)60 = no (33%)

Open Sky Study:Open Sky Study:Teen CharacteristicsTeen Characteristics

RaceRace 158 white students (85.9%)158 white students (85.9%) 24 students of color (13.2%)24 students of color (13.2%)

AdoptedAdopted 32 adopted students (18%)32 adopted students (18%) 146 non-adopted students (82%)146 non-adopted students (82%)

Clinical Issues in all Teen StudentsClinical Issues in all Teen Students Substance Abuse or Dependence = 70.6% of all teen Substance Abuse or Dependence = 70.6% of all teen

studentsstudents Depressive Disorders/Anxiety Disorders/Bipolar Disorders Depressive Disorders/Anxiety Disorders/Bipolar Disorders

= 72.7%= 72.7% ADHD/Oppositional Defiant Disorder/Disruptive Behavior ADHD/Oppositional Defiant Disorder/Disruptive Behavior

= 61.8% = 61.8%

Summary of Open Sky Summary of Open Sky Teens’ Mental Health Teens’ Mental Health

DistressDistress

The next few slides present the The next few slides present the results of the Youth Outcome results of the Youth Outcome Questionnaire (YOQ) results, which Questionnaire (YOQ) results, which report on adolescents’ mental health report on adolescents’ mental health distress and how it changed as a distress and how it changed as a result of the programresult of the program

The Youth Outcome The Youth Outcome Questionnaire (YOQ): What does Questionnaire (YOQ): What does

it specifically measure?it specifically measure? Emotional distress (anxiety, depression, fear, Emotional distress (anxiety, depression, fear,

hopelessness, self-harm)hopelessness, self-harm) Physical distress (headaches, dizziness, stomachaches, Physical distress (headaches, dizziness, stomachaches,

nausea, etc.)nausea, etc.) Relationship issues with parents, other adults, peers Relationship issues with parents, other adults, peers

(attitude, cooperativeness, aggressiveness, arguing)(attitude, cooperativeness, aggressiveness, arguing) Social problems (conduct, aggression, truancy, Social problems (conduct, aggression, truancy,

runaway, sexual problems, vandalism)runaway, sexual problems, vandalism) Behavioral problems (ability to organize, complete Behavioral problems (ability to organize, complete

tasks, inattention, hyperactivity)tasks, inattention, hyperactivity) Other items (paranoia, obsessions and compulsions, Other items (paranoia, obsessions and compulsions,

hallucinations, delusions, suicidal ideation, mania, hallucinations, delusions, suicidal ideation, mania, eating disorder )eating disorder )

Open Sky Parent of Teen Open Sky Parent of Teen Results Over TimeResults Over Time

This graph shows that parents of Open Sky teens report their This graph shows that parents of Open Sky teens report their children improve emotionally and behaviorally by children improve emotionally and behaviorally by graduation from Open Sky and these improvements remain graduation from Open Sky and these improvements remain steady over the course of a year.steady over the course of a year.

Comparing Open Sky Comparing Open Sky Parent and Teen Scores Parent and Teen Scores

Over TimeOver Time

This graph shows that Open Sky teens report they improve This graph shows that Open Sky teens report they improve emotionally and behaviorally from the first day to the last emotionally and behaviorally from the first day to the last day at Open Sky and that these improvements in mental day at Open Sky and that these improvements in mental health are steadily maintained over time.health are steadily maintained over time.

Summary of Adolescent Summary of Adolescent Relapse Coping Relapse Coping Questionnaire Questionnaire

The next few slides present the The next few slides present the latest results of the Adolescent latest results of the Adolescent Relapse Coping Questionnaire Relapse Coping Questionnaire (ARCQ) which predicts future (ARCQ) which predicts future substance use by measuring substance use by measuring substance abuse recovery skillssubstance abuse recovery skills

Adolescent Relapse Adolescent Relapse Coping Questionnaire Coping Questionnaire (ARCQ): What does it (ARCQ): What does it specifically measure?specifically measure?

Higher scores of abstinence-Higher scores of abstinence-focused thoughts of drugs and focused thoughts of drugs and alcohol predict less substance alcohol predict less substance abuse at 1 year after treatment.abuse at 1 year after treatment.

Lower scores of self critical Lower scores of self critical thoughts correlate with less thoughts correlate with less substance use, better coping, substance use, better coping, and higher self-esteem and self-and higher self-esteem and self-efficacyefficacy

Open Sky Teens’ Open Sky Teens’ Recovery from Substance Recovery from Substance

AbuseAbuse

This graph shows that Open Sky teens report an increase This graph shows that Open Sky teens report an increase in Abstinence-Focused Coping skills, meaning that they in Abstinence-Focused Coping skills, meaning that they gain skills for resisting substance abuse while at Open gain skills for resisting substance abuse while at Open Sky and maintain those gains for a year after treatment.Sky and maintain those gains for a year after treatment.

Summary of Summary of Adolescent and Young Adolescent and Young

Adult Adult Readiness to ChangeReadiness to Change

The next few slides present the The next few slides present the latest results of teen and young latest results of teen and young adult readiness for change as adult readiness for change as measured by the University of Rhode measured by the University of Rhode Island Change Assessment (URICA)Island Change Assessment (URICA)

University of Rhode University of Rhode Island Change Island Change

Assessment (URICA): Assessment (URICA): What does it specifically What does it specifically

measure?measure?

The URICA assesses how ready and The URICA assesses how ready and willing a person is to change the willing a person is to change the problem(s) in one’s life.problem(s) in one’s life.

Higher scores mean more readiness Higher scores mean more readiness and willingness to change one’s life.and willingness to change one’s life.

Open Sky Teen Open Sky Teen Readiness and Readiness and

Willingness to Change Willingness to Change Over TimeOver Time

This graph shows that Open Sky teens’ attitudes about his/her This graph shows that Open Sky teens’ attitudes about his/her readiness to change their problems improves over time. readiness to change their problems improves over time.

This graph also shows that these improvements steadily increase This graph also shows that these improvements steadily increase up to one year after Open Sky graduation, indicating increased up to one year after Open Sky graduation, indicating increased willingness to face problems and make changes.willingness to face problems and make changes.

Open Sky Adult Open Sky Adult Readiness and Readiness and

Willingness to Change Willingness to Change Over TimeOver Time

This graph shows that Open Sky adults’ attitudes about This graph shows that Open Sky adults’ attitudes about changing their problems improves from first day to changing their problems improves from first day to graduation day.graduation day.

Open Sky Study: Young Open Sky Study: Young Adult NumbersAdult Numbers

Total number of participants =114Total number of participants =114 GenderGender

Male = 68.4%Male = 68.4% Female = 31.6%Female = 31.6%

AgeAge Average = 20 years oldAverage = 20 years old Range = 17-29 years oldRange = 17-29 years old

Number of days in programNumber of days in program Range 4-83Range 4-83 Average = 54.73 days Average = 54.73 days

Go on to aftercare after Open SkyGo on to aftercare after Open Sky Yes = 64.3%Yes = 64.3% No = 35.7%No = 35.7%

Open Sky Study: Young Open Sky Study: Young AdultAdult

Characteristics Characteristics AdoptedAdopted

Yes = 14.4%Yes = 14.4% No = 85.6%No = 85.6%

RaceRace White = 92.3%White = 92.3% Students of color = 6.6%Students of color = 6.6%

Clinical Profiles of all Young Adult StudentsClinical Profiles of all Young Adult Students Substance abuse/dependence = 71.2%Substance abuse/dependence = 71.2% Depressive Disorders/Anxiety Disorders/Bipolar Disorders = 88.1%Depressive Disorders/Anxiety Disorders/Bipolar Disorders = 88.1% ADHD/Oppositional Defiant Disorder/Disruptive Behavior = 40.7%ADHD/Oppositional Defiant Disorder/Disruptive Behavior = 40.7%

Emotional distress (anxiety, depression, Emotional distress (anxiety, depression, fear, hopelessness, self-harm)fear, hopelessness, self-harm)

Relationships (satisfaction with, as well as Relationships (satisfaction with, as well as problems in interpersonal relations)problems in interpersonal relations)

Social role (assesses level of Social role (assesses level of dissatisfaction, conflict, distress and dissatisfaction, conflict, distress and inadequacy in tasks related to inadequacy in tasks related to employment, family roles and leisure life)employment, family roles and leisure life)

The Adult Outcome The Adult Outcome Questionnaire (OQ): Questionnaire (OQ):

What does it specifically What does it specifically measure?measure?

Open Sky Adult Levels of Open Sky Adult Levels of Distress Over TimeDistress Over Time

This graph shows that Open Sky’s young adults This graph shows that Open Sky’s young adults report improved mental health by the end of Open report improved mental health by the end of Open Sky treatment.Sky treatment.

What factors have been What factors have been found to effect Open Sky found to effect Open Sky Teen and Adult success?Teen and Adult success?

Open Sky teens who go on to aftercare tend to sustain better Open Sky teens who go on to aftercare tend to sustain better mental health and behavior over time.mental health and behavior over time.

Open Sky is equally effective for all genders and races.Open Sky is equally effective for all genders and races.

Open Sky is effective for adolescents and young adults.Open Sky is effective for adolescents and young adults.

Open Sky is effective for people with a wide range of problems Open Sky is effective for people with a wide range of problems including including

mood, behavioral, relational, and substance use problems.mood, behavioral, relational, and substance use problems.

Adopted teens and their parents tend to disagree more than non-Adopted teens and their parents tend to disagree more than non-adopted families on levels of mental health distress upon arrival.adopted families on levels of mental health distress upon arrival.

Teen Reported Differences Teen Reported Differences in going to Aftercare vs. in going to Aftercare vs.

going Homegoing Home

This graph shows that teens who go to aftercare This graph shows that teens who go to aftercare after Open Sky report fewer mental health problems after Open Sky report fewer mental health problems than teens who went home after Open Sky.than teens who went home after Open Sky.

Parent Reported Differences of Parent Reported Differences of Teens who go to Aftercare vs. Teens who go to Aftercare vs.

go Homego Home

This graph shows that parents of teens who go on to aftercare This graph shows that parents of teens who go on to aftercare after Open Sky believe their children do better over time than after Open Sky believe their children do better over time than parents of teens who went home after Open Sky.parents of teens who went home after Open Sky.

Open Sky ConclusionsOpen Sky Conclusions There is strong evidence that Open Sky There is strong evidence that Open Sky

Wilderness Therapy worksWilderness Therapy works

Open Sky is effective for a range of clinical Open Sky is effective for a range of clinical diagnoses, ages, genders and diagnoses, ages, genders and characteristicscharacteristics

Preliminary evidence from Open Sky study Preliminary evidence from Open Sky study suggests that aftercare offers a protective suggests that aftercare offers a protective factor in long term success following factor in long term success following wilderness therapy treatmentwilderness therapy treatment

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For more For more information about information about this study, contact:this study, contact:

Joanna Bettmann, PhD, LCSWJoanna Bettmann, PhD, LCSW

Open Sky Research DirectorOpen Sky Research Directorjoanna@openskywilderness.com

801-587-7600801-587-7600www.openskywilderness.com