Wilderness Programs for Children, Benefits and Risks

By Arline Kaplan © 2002 (All Rights Reserved)

A multimillion dollar industry in outdoor behavior health care camps and private boot camps has been developing over the last 20 years to satisfy what has been called "a booming market in parental desperation."

With closures of inpatient and residential treatment programs for adolescents, parents struggling with substance-abusing, emotionally disturbed children and teenagers are turning to such camps for help.  One study identified more than 100 outdoor behavioral health care programs currently operating in the United States and generating revenues upward of $200 million annually.  Most of the programs evaluated in this study were licensed by a variety of state agencies ranging from judicial systems to departments of family and youth services.  More than half of the private placement programs were nationally certified by agencies such as the Council of Accreditation and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (Russell and Hendee, 2000)

The industry has grown up to serve the kind of kids who in the 1980s and early 1990s were going to psychiatric hospitals, psychologist Robert 'Rob' Cooley, Ph.D., said in an interview.  He is chair of the eight-member Outdoor Behavioral Healthcare Industry Council (OBHIC) and director of the Catherine Freer Wilderness Therapy Expedition in Oregon.

"These are middle and upper-middle class kids who come from reasonably competent families," he said.

Cooley carefully distinguished between boot camps and wilderness therapy programs.

"A boot camp is a tough love approach," he said.  Kids are presented with adult standards and told that they had "better tow the line or else."

Private boot camps are often modeled after state-operated juvenile boot camps established for juvenile offenders considered at high risk for chronic delinquency.  According to the Koch Crime Institute White Paper Report (Zaehringer, 1998), such juvenile boot camps usually have a highly regimented schedule of discipline, physical training, work and drills, and may include an educational component, psychological counseling and drug treatment. 

In contrast, wilderness therapy programs "take a nurturing approach to kids," Cooley said.  "We are there to help them understand themselves, and to come to their own decisions about how they are going to manage their lives."

An Example Program

Using the Catherine Freer program as an example, Cooley said three staff members, usually 25 years to 35 years in age, accompany a group of seven kids on a three-week wilderness trip.  One adult is a therapist with either a masters in social work or counseling or certification in alcohol and drug counseling, another is a lead wilderness guide with first-aid training and expedition experience, and the third is usually a counseling trainee.  Psychologists provide clinical supervision. 

" In some ways, it looks similar to what you would see at a good residential program for kids," Cooley said.

The program provides two hours of group therapy daily, individual therapy daily and educational discussions on most days concerning such issues as alcohol and drug abuse, family dynamics and safe sex. 

Some of the differences from traditional programs, Cooley said, are that the kids are living out-of-doors, they are backpacking for three weeks, they are hiking four to six hours a day and they are taking care of themselves (e.g., putting up their own tents and cooking). 

"They get lots of guidance from the staff.  We don't let anybody get too cold or too hot so that they are going to be in trouble health wise, but we don't rescue them from their unwillingness to make good decisions either.  So if a kid doesn't set up tent right, and it leaks, the [kid] may have an uncomfortable, wet night.  They experience the natural consequences of their own behavior that are immediate and that are not delivered by adults," he said. 

The kids "get a lot of time to reflect in areas of great natural beauty," Cooley said.   

Another difference is the ongoing interaction with staff.

"The staff are with the kids 24 hours a day, [they] eat the same food and use the same kind of tent.  A closeness develops, and a lot of reparenting occurs," he said. 

Parents and referral sources are informed of the youths' progress through weekly progress notes, phone contact and regular discharge summaries. 

His program, like other wilderness programs in the OBHIC, does not promise that the child or adolescent will be completely cured.

"You are getting short-term treatment, and no adolescent is completely cured in three weeks or seven weeks.  What we expect to do is turn them around and get them to place where they are willing to make changes in their lives and willing to work with their parents and other adults to do that," he said.  "Any short-term residential program, including our wilderness program, is much less effective if we donÕt get good outpatient therapy to go with it.  In our program, we require that parents already be working with a therapist or that they agree to work with a therapist as soon as their child finishes the wilderness program." 

Deaths and Quality Improvement Attempts

Cooley's program is licensed by the state of Oregon as a mental health and alcohol/drug treatment program and is accredited by the Joint Commission of Accreditation of Healthcare Organizations (JCAHO), but some wilderness camps and boot camps are not well regulated and young people have died in them.  

"We have a list of 33 kids [who have died] in court-adjudicated and voluntary programs over a 10-year period. That's far too many," said Cathy Sutton, mother of a teenager who died in such a program.  On that list are 16-year-old Kristen Chase who perished of heatstroke in 1990; 16-year-old Aaron Bacon who died from a perforated ulcer after his counselors failed to get him treatment because they thought he was faking an illness; 14-year-old Anthony Haynes, who died in August of 2001 of complications of near drowning and dehydration; and Sutton's 15-year-old daughter, Michelle, who died of dehydration in 1990. 

"When Michelle died, we were told we didn't do our homework—that we had a dysfunctional family and that Michelle lacked the will to live and had a death wish because of being date raped.   I thought I had done a good job of doing my homework, but what people don't know is that there are a lot of politics involved in the industry, greed, and a mentality that can't be regulated," Sutton said.  "There is a loss ratio mentality.  Some of the people in the industry will tell [those working] for them, that 'you are going to lose a few, but deal with it, because you are saving many.'  I think that is a very sick, warped mentality."

About a year after her daughter's death, Sutton started the Michelle Sutton Memorial Fund to let people know the "ups and downs, ins and outs of the wilderness industry and court-adjudicated industry as well. Many programs don't have regulations protecting the child, so I took it upon myself to put together a checklist for parents and others that were looking into sending a child to some type of program."

Sutton said her organization also has started red-flagging some programs.

"I wish the government were doing this.  I really want national legislation and regulations on these programs," she said.

She is advocating for the imposition of hefty monetary penalties on programs where a child has been injured or died in their care, jailing of abusive staff and increases in program licensing fees. 

"These people are making $14,000 to $30,000 for these kids in these programs. How about increasing costs of licenses and using the additional monies to monitor and regulate the programs," she added.

When asked about the deaths, Cooley said,  "There are always incompetent or unscrupulous operators who come into unregulated areas where they think they can make a buck.  Nearly all of the programs that have had deaths have been programs that did not choose to become licensed or otherwise regulated when they could have done so." 

Because of the deaths and reports of abuses, many states are developing specialized licensing regulations, Cooley said.

"Oregon is just completing licensing regulations for outdoor behavioral health care treatment programs, which we have been active in promoting and helping to design.  Idaho is completing regulations.  Utah has had them for some time. Most states that have wilderness programs do have some kind of state licensure," he said.  

OBHIC, according to Cooley, has been collecting data on accidents, injuries and illnesses that occur in its member programs and is also supporting effectiveness research.  Researchers at the University of Idaho are looking at outcomes using the Youth Outcome Questionnaire developed at Brigham Young University. 

"We are assessing the kids when they enter the program and immediately on discharge and also checking with their parents after the kids have been home a week.  Generally, we found the programs produced positive outcomes and are publishing the results in a technical report.  We will also be conducting three-, six- and 12-month follow-up assessments," said Keith Russell, Ph.D., leader of the Outdoor Behavioral Healthcare Research Cooperative (OBHRC).

Some attention to ethics and quality of care also is being given by behavioral health care industry itself.  Andy Anderson, executive director of the National Association of Therapeutic Schools and Programs, said the 110 members of NATSAP have agreed to support and follow a set of ethical principles and will be adopting standards of care this month (January, 2002). 

According to Sutton, some parents who have sought her advice say their child's psychiatrist has recommended wilderness programs or boot camp. 

"If a psychiatrist really feels that confident about a program and wants to recommend it, I hope it is something they would send their own children to, and I hope they have thoroughly checked out the programs," she said. 

References

Russell KC, Hendee JC (2000), Outdoor Behavioral Healthcare: Definitions, Common Practice, Expected Outcomes and a Nationwide Survey of Programs.  Technical Report #26.  Moscow, Idaho: Wilderness Research Center, University of Idaho.  Executive summary available at www.its.uidaho.edu/wrc/new_page_.  Accessed Nov. 30, 2001.

Zaehringer B (1998), Koch Crime Institute White Paper Report.  Juvenile Boot Camps: Cost and Effectiveness Versus Residential Facilities. Topeka, Kansas: Koch Crime Institute.  Available at www.kci.org.  Accessed Nov. 15, 2001.

Questions To Ask Before Selecting a Program

Some guidelines for investigating programs offered by Sutton, Cooley and Richards are:

1.  Is the program licensed by a state agency in an appropriate way (e.g., alcohol/drug treatment facility) and/or accredited by JCAHO, the Council on Accreditation or other accreditation organizations?

2.  Are licensed clinical professionals on staff?

3.  Has the staff been screened for drugs, and what types of training do they have?

4.  Have there been any deaths in the program or in any program established by the organizers?

5.  What happens to the kids after they leave the program?

6.  Have any follow-up studies been conducted?

7.  How involved are the parents in treatment process, and does the program permit child-parent contact?

8.  Does the program operate out of the country? (If yes, be wary of it, said Sutton)

9.  Is the program a member of an industry association, such as NATSAP or OBHIC?

10. Will the program freely disclose the nature of its services as well as benefits, risks and costs?

Additional Resources

1.  The University of Idaho's Wilderness Research Center has identified 100 outdoor behavioral health care programs operated in the United States, annually servicing 10,000 clients and their families.  Information on these programs can be obtained by e-mailing Richards at keithr@uidaho.edu. 

2.  NATSAP (www.natsap.org) publishes a directory of its members with information on lengths of stay, services provided and age range of clients.

3.  Sutton is building her own clearinghouse of information on programs and can be reached at (209) 602-8348.

(PT 0602)

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