- Those experiencing significant psychosocial problems in adolescence and young adulthood are at higher risk for psychological disorder (Pottick, Bilder, Vander Stoep, Warner, & Alvarez, 2008). Compared to peers, these individuals struggle to complete school, fit with social roles, and acquire occupational skills necessary for adulthood (Pottick et al., 2008). Providing effective treatment intervention during this time is essential. Scholars have noted the need for "aggressive efforts to design developmentally appropriate, effective services and to increase their availability to young adults with mental disorders" (Pottick et al., 2008, p. 387).
Otherwise known as wilderness therapy, outdoor behavioral healthcare (OBH), is a form of adventure-based counseling utilizing traditional counseling techniques in natural outdoor settings. Wilderness therapy programs help build success-oriented identities for clients by increasing self-concept, internal locus of control, self-confidence and improved interpersonal and social skills (Hill, 2007; Russell, Gillis, & Lewis, 2008).
Little empirical evidence currently exists documenting long-term post-discharge effects of OBH for young adult clients. This in part due to OBH initially serving predominately adolescents and only recently beginning to serve a larger young adult population, as well as challenges with attrition in the research that has been completed. Increases in young adult clients utilizing OBH underscores the importance of rigorous outcome research to assess efficacy and inform programming.
The purpose of the two studies presented in this dissertation were to determine when and how change occurs for young adults (N = 186) during and after outdoor behavioral healthcare treatment.
The focus of Study 1 was to evaluate changes in young adult participants' psychosocial functioning, over time, from treatment intake to 18-months post discharge. The research questions guiding this repeated measures longitudinal design study were focused on examining changes to overall psychosocial functioning, distress symptoms, interpersonal relationship, and social role performance from intake to 18 months post-treatment.
Three-piece time-trend Hierarchical Linear Modeling (HLM) results indicated participants varied in their starting points and rates of change over time. On average, participants started high on symptomatology and showed statistically and clinically significant reductions across all scales while in-treatment. In addition, it took five weeks before meaningful change was reported and participants reporting greater initial distress experienced more dramatic improvements. Post discharge, treatment gains were maintained up to 18 months.
Study 2 was intended to build upon findings from study one. A two-step HLM approach was used to model the influence of age, gender, therapist assignment, primary diagnosis, and length of stay on the overall psychosocial functioning of young adults from OBH intake to 18 months follow-up. First, main effect results were assessed to understand if there were systematic differences over time resulting from the covariates. Next, by time interactions were examined to determine change trajectory differences associated with the covariates. Results indicated no differences at intake, or in change trajectories, for participants while in treatment or post-discharge. These findings suggest participants benefited similarly regardless of age, length of stay, gender, therapist, or primary diagnosis.
Findings from the present studies coupled with previous OBH findings with adolescent populations (Behrens, Santa, & Gass, 2010; Russell et al., 2008; Tucker, Smith, & Gass, 2014) and adults (Hoag, Massey, Roberts, & Logan, 2013) furthers OBH as an effective treatment approach.