This comparison group study investigated the impact of an Outdoor Behavioral Health (OBH) program on youth participants struggling with emotional and behavioral issues in their lives. OBH -- sometimes referred to as wilderness therapy – is defined as ““the prescriptive use of wilderness experiences by licensed mental health professionals to meet the therapeutic needs of clients.” OBH programs typically include extended wilderness group living experiences, adventure activities, group therapy sessions, and individual counseling. Nature is used both as a resource for engagement and as a metaphor within the therapeutic process.
Two groups of struggling adolescents (age 12 – 17) participated in this study: one group in the OBH program; the other (a control group) taking part in “treatment as usual (TAU)” interventions in the community. The two groups were similar in terms of age, gender, race/ethnicity, and severity of mental health and behavioral difficulties. There were 60 study participants in each group. The average length of treatment for adolescents in the OBH group was 80.5 days. Of the 60 participants in the control or TAU group, over half (62%) received outpatient counseling, 20% received psychiatric care, and 51% received medication as a part of their treatment program. The Y-OQ 2.01 mental health assessment tool was used to measure treatment progress of the study participants. The Y-OQ 2.01 is a 64-item parent/guardian survey designed to assess the mental health of children and youth. While the survey includes six subscales (Intrapersonal Distress, Somatic Symptoms, Interpersonal Relationships, Social Problems, Behavioral Dysfunction, and Critical Items), only the total score was used in this study. This combined score represents an overall measure of psychological functioning. Parents or guardians completed the Y-OQ 2.01 before the adolescents started their intervention program and approximately one year after they completed the program. Pre-treatment scores indicated that the two groups were functioning at similar levels of dysfunction prior to participating in their intervention program.
The after-treatment assessment results showed that adolescents completing the OBH treatment were functioning significantly better than adolescents completing TAU interventions in the community. While parent-reported assessment results indicated that both groups made clinically and statistically significant improvements, the improvements in the OBH group were almost three times larger than those for the TAU group. Males on average made larger levels of change than females in the OBH group. The difference, however, was not large enough to be considered significant. The fact that females made important gains in mental health and behavioral functioning may encourage an increase in female participation in OBH interventions and thus reduce the gender differences typically found in such programs. A finding consistent with other research relates to older adolescents making larger improvements than younger participants. Finally, although Caucasian and non-Caucasian OBH participants made significant improvement, only the non-Caucasian participants showed follow up Y-OQ 2.01 scores below the cut-off for clinical significance.
The overall results of this study support the idea that the OBH intervention was more effective in the “long run” than a treatment-as-usual intervention where clients remain in the community. This study makes an important contribution to OBH research by including a comparison group and demonstrating impressive results. “This information could be helpful in educating consumers, seeking insurance reimbursement, securing funding for research, improving reputation in the healthcare field, and advocating for OBH as an evidence-based intervention.”
Research Partner