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Outdoor Behavioral Healthcare: Definitions, common practice, expected outcomes, and a nationwide survey of programs. 

By Keith C. Russell and John C. Hendee

Executive Summary

Outdoor behavioral healthcare (OBH) is an emerging intervention and treatment in mental health practice to help adolescents overcome emotional, adjustment, addiction, and psychological problems.  We have identified more than 100 OBH programs currently operating in the United States, annually serving 10,000 clients and their families.  OBH programs utilize elements of wilderness therapy to help adolescents and their families, which include: immersion in an unfamiliar environment, group living with peers, individual and group therapy sessions, and educational curricula including backcountry travel and wilderness living skills, all designed to reveal and address problem behaviors and foster personal and social responsibility and emotional growth of adolescent clients.  A family systems perspective guides treatment and aims to restore family functioning and support, disrupted by the problem behaviors of the adolescent clients. 

The goal of this publication and study is to improve understanding about outdoor behavioral healthcare by parents, insurance companies, judicial authorities and social service agencies, public land management agencies, and Federal, State and local officials.  All these parties would seem to benefit from knowing more about OBH as an emerging intervention and treatment to help troubled adolescents and their families.  Thus, we define common elements of outdoor behavioral healthcare including terminology, theoretical approaches, historical origins of the practice, it’s growth over the last three decades, and the status of the OBH industry based on a survey of 116 programs meeting OBH criteria.

We classify two types of OBH programs: adjudicated and private placement programs.  Private placement programs evolved from a variety of influences over the last 30 years, including therapeutic approaches to camping, wilderness challenge programs like Outward Bound, and the integration of therapeutic professionals and processes into wilderness experiences.  Adjudicated programs grew out of need to expand traditional social services to deal with increasing adolescent delinquency and substance abuse.  Four common OBH program models are based on how and to what degree the outdoor setting is utilized: 1) contained expedition programs, where clients and the treatment team remain together on a wilderness expedition; 2) continuous flow expedition programs,  where leaders, therapists, and clients rotate in and out of on-going groups in the wilderness; 3) base camp expedition programs,  which have structured base camps in natural environments and take expedition outings from the base; and, 4) residential expedition programs, which include emotional growth schools, residential treatment centers, Job Corps Centers, youth ranches, and other therapeutic designations  that use wilderness and outdoor treatment as a tool to augment other services for resident clients. 

Our nationwide survey of OBH programs documents the nature and extent of the OBH industry, including the number and types of programs, and the types of clients they serve.  A total of 116 OBH programs were identified, with 86 participating in the survey, yielding a 74 percent response rate.  Among respondents, private placement programs outnumbered adjudicated programs more than 4 to 1, with 70 private placement compared to only 16 adjudicated programs.  More than 80 percent of all responding OBH programs were licensed by a variety of state agencies, ranging from judicial systems to departments of family and youth services.  A smaller percentage of adjudicated programs (31%) and more than half of the private placement programs (57%) were nationally certified by agencies such as the Council on Accreditation and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).