Wilderness Programming
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Therapeutic wilderness programs are a very important early step in treatment and/or a change process. When followed by a longer term emotional growth, school, therapeutic school, or treatment program, they tend to be enormously effective.  (Please note that what follows here does not all apply to long term outdoor therapy programs such as those operated by Eckerd and Three Springs.  They, too, have an important place, but are different from the wilderness programs under discussion here). 

With use of any residential programming, especially wilderness programming, remember the following from our Guidelines on Length of Stay:

Use of residential placement of any kind is like using a powerful medicine that has both significant benefits and negative side effects.  We expect referral sources, schools, and programs to join with us in alerting parents that by using residential placement, the parents are exposing their son or daughter to "side effects"  they must be prepared to address before their son or daughter returns home, even for visits. We caution parents to beware of the credibility of program admission and marketing staff who fail to communicate this up front – and beware the programs they represent.

With very rare exceptions, short term wilderness programs do not result in permanent change by themselves. Their very powerful benefit depends usually depends upon their use in tandem with a longer term program or school.  Programs that claim success in permanent change on a stand-alone basis should be challenged to provide outcome studies proving the change. We doubt that you will get them.

Wilderness helps to assess and prepares students for a process of change.  For many (not all) it does that job very well.  It does not generally complete the change process.  Exceptions might be young people who are fully engaged in the process of deciding to go to wilderness, those with an extraordinarily strong emphasis on family intervention, and those where a “rite of passage” experience is the primary goal.  However, even with those exceptions, there is no way to ensure that any particular young person going to wilderness will not need further intervention and support following wilderness.

No parent should ever send their son or daughter to wilderness unless they are financially and emotionally prepared to support long term residential intervention.  We challenge either the judgment or the integrity of any wilderness program – or referral service – encouraging any parent to send a wilderness program in confidence that their son or daughter will be able to return home successfully to a positive lifestyle following a single stay in wilderness if their life was seriously disrupted before that.   

Wilderness programming that includes intensive family therapy, coupled with service by one of the home transition services, shows promise of greatly reducing the percentage of young people needing long term residential intervention.  Early indications are positive that each by itself (intensive family work during the young person’s stay in wilderness and a home based wrap-around transition service) has increased the potential for young people to return directly home from wilderness and to do so successfully.  When they are combined – we look forward to that – we anticipate some very good outcomes for many – maybe even a majority – of those who prior to that have needed long term placement in a special school or treatment center.  But even with that promise, parents need to be prepared for a recommendation that residential follow up is important.  Except when a young person is requesting wilderness by his own initiative, we recommend against use of wilderness 100% of the time for families that would be unwilling or unable to follow wilderness with further residential care or schooling, in the case of a recommendation for residential follow up from the wilderness program.  When the young person is forced into wilderness against his or her will, residential follow up is the norm, not the exception.  Parents who force their son or daughter into wilderness for a "wake up call" or a punishment, committed to having them return home after wilderness misconceive the impact of wilderness. 

Wilderness programs can be an extremely effective tool in impacting clients whose behavior is out of control, behave with a sense of entitlement, or need to be taken out of their comfort zone for therapeutic reasons. However, too many people (professionals and others) use wilderness placements almost reflexively for any young person needing therapy. Despite its benefits, wilderness needs to be applied with thought and discrimination.

One characteristic of wilderness programming that warrants more attention that it gets is that it d0es induce a certain amount of anxiety or apprehension in the people served.   This raises the question for any person we anticipate sending to wilderness whether or not adding to anxiety is a good thing.  It is not likely to be a good thing for people with anxiety disorders.  We believe that wilderness as a modality is seriously over-used for the very young (age 13 and under) and for young people on the autism / PDD spectrum or with non verbal learning disability (NVLD).  Note that many consider NVLD part of the autism / PDD spectrum.  We don’t totally rule out wilderness for those categories, but it must be approached with great caution if not to be counter-productive for many young people. Even when the autism/PDD/ NVLD spectrum, and young age are  not at issue, wilderness should be approached with discrimination and not  just reflexively.

When visiting one well known quality program for younger kids, our consultant Tom Croke challenged the staff on the above point.  After some bobbing and weaving, the other program staff agreed with my point but said they needed to create a program for kids so that demand from parents and educational consultants for wilderness opportunities for that age group.  While they took justifiable pride in their belief that they were providing the best wilderness opportunity available for that age group, they did seem to agree that they were getting many kids for whom wilderness was not the modality of choice. 

This is not just a theoretical problem.  There is a pattern of a few participants mentally decompensating in wilderness.   One therapist in an excellent wilderness program recently told our consultant, Tom Croke, that she tends to have this happen once per month.  This situation is more concerning because wilderness programs tend not to have agreements with psychiatric hospitals to admit such wilderness programs immediately when this occurs, making it a very difficult problem to deal with safely.  This potential makes it doubly important to avoid wilderness for people at risk for decompensating and also points to the need for wilderness to develop appropriate agreements with hospitals.

Wilderness programming is effective for many participants because of the fact that it takes the participants outside of their usual comfort zone. Doing so creates a certain amount of anxiety that inspires young people who are primarily spoiled, entitled and undisciplined  (and some others) to take responsibility for finding ways to alleviate their own anxieties responsibly, by their own actions and by participating in teamwork with the rest of the group in wilderness.  In addition, adding some anxiety to the experience of an older teen can sometimes be an ingredient that produces a more insightful evaluation. But this is powerful medicine to be used in a discriminating way.  It should never be used as a punishment. It should be used when a truly therapeutic benefit that outweighs dangers and discomforts is anticipated. 

Before sending a child in any of these categories, we encourage you to check with a qualified mental health professional who knows the child well and ask whether or not the anxiety that is inevitable in a wilderness program would be constructive. 

Note that this is about therapeutic wilderness programs.  Organizations like Outward Bound and NOLS offer high quality wilderness programming for high functioning youth and adults.  That is not at issue here.  At times organizations like this have at times offered programming for youth at risk.  We have not been comfortable with the quality of such programming from these organizations for youth at risk.  We want NOLS and Outward Bound and similar organizations to stick with the work they are good at and leave the at-risk kids to others.   

As a matter of safety, we want to see every wilderness program with at least one  staff member with each group trained and certified as an EMT (or other first responder)  at all times -- that means 24-7 -- with two normally reliable means of communication with operations base. One typical means of communication would be a satellite phone and the other would be standard two way radio with repeaters so placed as to fill in all dead spots.  In some areas standard cell phones might be one means of reliable communication. Two way radios that depend upon repeaters do not count if weather conditions (snow accumulating on the repeater antenna, for example) can render it ineffective and there is not an immediate staff response at all times to maintain that as on open channel).  There also needs to be a helicopter medical evacuation capability

We want to be sure there is access to a hospital truly prepared to accept and properly treat the kinds of illnesses and injuries that might reasonably occur (including suddenly acute mental illnesses).  We know of an instance of a person sustaining multiple spinal fractures in a wilderness program in central Utah, then was transported without access to an ambulance or helicopter past two hospitals that claimed they lacked the ability to help, and was finally admitted to a large medical center over one hundred miles away.  We seek documentation that a repeat of this situation would not occur.  Wilderness programs citing access to a nearby hospital need to ensure that hospital can respond appropriately to all injuries and mental illnesses that might occur in wilderness – including on weekends. 

Overnight backpacking hikes, rock climbing, rappelling, canoeing, etc. under winter conditions are not safe and should be banned. We have known of one wilderness program that had a ritual of clients near completion of their program hiking at night on a well marked trail -- always the same trail for that event -- with staff immediately in line of sight of every participant and lanterns lighting the way. We can see that as a legitimate exception if there is a particular benefit to that activity and effective safety precautions are in place.  However, having a group bushwhack on a compass routing on a winter night (or a summer night in bad weather) is an unacceptable safety risk and is not acceptable to us.  We seek evidence of enforced policies that absolutely prevent such activities.

Feedback is invited. We will publish selected feedback.  Email:  FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last updated August 9, 2009
 
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