OBHIC Research

 

In 1999, the UI-WRC formed the Outdoor Behavioral Healthcare Research Cooperative (OBHRC) at the University of Idaho supported by 12 OBH programs. Because the OBH industry lacks a consistent definition and common terminology, the first task of OBHRC was to publish consistent definitions of outdoor behavioral healthcare and to conduct a nation-wide survey of clinically-supervised therapeutic programs that use outdoor environments as a major element of treatment (Russell and Hendee, 2000).  A clear and concise definition and common terminology of OBH was established through peer review and feedback from programs nation-wide.  A comprehensive database of over 100 programs was then established by identifying respective programs which fit this definition. 

 

A nation-wide survey of OBH programs was conducted, asking programs to describe: 1)  organizational structure and history, including how long the program has been in operation, profit or nonprofit status, and number of staff;  2)  financial indicators, including number of clients served, and annual revenues;  3)  client and family treatment elements, and presumed change agents; 4) assessment models including outcome and risk assessment and; and, 5)  insurance eligibility and accreditation.  Initial findings show that most OBH programs are emotional growth boarding schools or residential drug and alcohol treatment centers that use wilderness expeditions as a tool to augment treatment services.  Other OBH programs, fewer in number, are entirely expedition-based and spend up to 60 continuous days in wilderness (the OBH program model that proposed in this study).  The findings were included in a technical report on the OBH industry (Russell & Hendee, 2000) and which will also be submitted for future publication. 

 

The first major outcome study of OBH treatment effectiveness was launched in May of 2000 and will conclude in December 2001.  A pre-post, repeated measure, one-way ANOVA research design was used to assess treatment effectiveness on a census of clients at ten-participating programs (see Table 1) surveyed over a discrete time period of June 1, 2000 to December 1, 2000 (Graziano & Raulin, 1997).  The eight program members of the Outdoor Behavioral Healthcare Research Cooperative (OBHRC) were involved in the study and are displayed below. 

 

Table 2:  Study participants in UI-OBHRC Outcome Study

Organization	Contact Person
Anasazi Foundation 1424 S. Stapley Mesa, Arizona  85204	Chief Operating Officer Mike Merchant
Ascent PO Box 230 Ruby Creek Road Naples, Idaho  83847	Program Director Brian MacInnes.
Aspen Achievement Academy PO Box 369 Loa, Utah  84747	Program Director Gilbert Hallows
Catherine Freer Wilderness Therapy Expeditions PO Box 1064 Albany, Oregon  97321	Chief Operating Officer Paul Smith
RedCliff Ascent 757 S. Main Street Springvale, Utah  84663	Program Director Steve Peterson
Summit Achievement HC 68 Box 216 Fryeburg, ME 04037	Program Director Chris Mays
SunHawk Academy 765 N. Bluff, Suite G St. George, Utah  84770	Program Director Al Bounous
SUWS 911 Preacher Creek Road Shoshone, Idaho  83352	Program Director Sue Crowell
Three Springs, Inc Operations Service Center 247 Chateau Drive Huntsville, Alabama  35801	Director of Business Dev. Hans Toecker

 

The Youth Outcome Questionnaire (Y-OQ) and the Self Report Youth-Outcome Questionnaire (SR Y-OQ) were the instruments used to track therapeutic progress of clients [Burlingame, 1995 #192].  The Y-OQ is a parent reported measure of a wide range of behaviors, situations, and moods which commonly apply to troubled teenagers, whereas the SR Y-OQ is the adolescent self-report version.  Y-OQ also includes a brief prognosis questionnaire that assesses three primary areas to determine the degree to which these risk factors may effect the change process in treatment: 1) existence and severity of family history of mental illness including both immediate and extended family;  2) current social environment including integrity and stress on the family structure and socioeconomic status; and 3) the child or adolescents’ own medical, developmental, and mental health history (Wells, Burlingame, Lambert, Hoag, & Hope, 1996a).  The six content areas assessed by the Y-OQ are illustrated in Figure 1. 

Table 2:  Six content areas assessed by the Y-OQ and SR Y-OQ. 

Content Area	Assesses
Intrapersonal Distress (ID)	Assesses change in emotional distress including anxiety, depression, fearfulness, hopelessness, and self harm.
Somatic (S)	Assesses change in somatic distress typical in psychiatric presentation, including headaches, dizziness, stomachaches, nausea, and pain or weakness in joints.
Interpersonal Relations (IR)	Assesses change in the child’s relationship with parents, other adults, and peers as well as the attitude towards others, interaction with friends, aggressiveness, arguing, and defiance.
Critical Items (CI)	Assesses inpatient services where short term stabilization is the primary change sought:  changes in paranoia, obsessive-compulsive behavior, hallucination, delusions, suicide, mania, and eating disorder issues.
Social Problems (SP)	Assesses changes in problematic behaviors that are socially related, including truancy, sexual problems, running away from home, destruction of property and substance abuse.
Behavioral Dysfunction (BD)	Assesses change in a child’s ability to organize tasks, complete assignments, concentrate, handle frustration, including items on inattention, hyperactivity, and impulsivity.

 

The Y-OQ produces internal consistency scale estimates between .74 to .93, with a total scale estimate of .96.  Test-re-test reliability, which examines the temporal stability of the information the scale is assessing, are also above .70, indicating moderately high temporal stability (Burlingame et al., 1996 for review of these estimates).  The YOQ appears to have strong internal consistency and test-re-test reliability.  The Y-OQ instrument is easily administered by staff at each OBH program and only takes ten minutes for the parents and client to complete.  The device has not shown to be too complicated or detailed for the respondent, which is an important consideration when working with adolescents (Burlingame et al., 1996). 

 

The data will be analyzed for the Y-OQ (parent assessment) and the SR Y-OQ assessment (client self report) by comparing the in-take score with the post-treatment score, as well as 3-, 6-, and 12-month intervals.  When a certain “cutoff” level has been reached, the client will have reached a normal distribution of symptoms (Wells et al., 1996a).  Evaluations of other inpatient, residential, and outpatient therapies have shown that youth who have follow-up scores of 46 or lower, and/or marked change in the dependent variable (YOQ score) is 15 percent or more, can be clinically labeled “recovered” (Berrett, 1998)[1].  It is noted that Kadera, Lambert, and Andrews (1996) used the OQ to track client progress and noted that many times clients got worse before they got better and that the course of recovery for most clients is not linear.  This means a client may leave an OBH program having reached a “normal” distribution, return to a dysfunctional range at three months, and then return to normal ranges at six- and 12-month intervals.  The results and findings from this study represent the first comprehensive study of OBH treatment effectiveness, and will serve as a preliminary study to the researched effort proposed here.