|
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.
Viewers, Your Help Is Needed:
I am a freelance medical journalist. Some of
the articles posted on this Web site were originally written for
health care professionals, but I believe patients/consumers may also
find value in the articles. Many of us who have chronic or
life-threatening health problems become experts on them. For that
reason, I have kept the rights to electronically post these
articles.
Additionally, I am developing new stories
specifically for this site. It is my intention to offer you
high-quality, well-researched information. Because this site
accepts no advertising, your financial support is needed to continue
this user-sponsored service.
I welcome your comments, suggestions and
financial help. You can send voluntary contributions to, or contact
me at:
HealthRising
Arline Kaplan
P.O. Box 3644
Costa Mesa , CA 92628
|
