Open Sky conducts research with every client and family. We believe that empirically evaluating our clients’ outcomes, in addition to their satisfaction with treatment, is critical to conducting an effective and powerful program.

Rationale for Our Research
Significant numbers of children spend their days and nights in residential and inpatient treatment, but estimates differ on the numbers. Smollar and Condelli (1990) found that, in the United States in 1986, over 100,000 children and adolescents between the ages of 10 and 19 were admitted to psychiatric hospitals, while thousands of others were placed in other out-of-home treatment centers. Goodrich (1994) asserts that “[t]he best estimates are that at least 50,000 adolescents are placed in residential treatment each year in the United States and perhaps a larger number in inpatient psychiatric hospital settings” (p. 277). Between 1969 and 1981, the number of children under 18 in out-of-home placements doubled (Wells, 1991). Even in an age of managed care (Foster, 2002), the data seem to indicate a trend towards ever-increasing numbers of out-of-home placements for adolescents.

Even while the numbers of clients in this type of treatment have increased (Edwards, 1994), research and understanding regarding children and adolescents in residential treatment has lagged (Curry, 1991). Since 1994, there is a paucity of data regarding both numbers in treatment and the efficacy of that treatment. Currently, only one large-scale study of wilderness treatment has been published in the peer-reviewed press. This study completed by Keith Russell (2003) examined the outcomes of 858 adolescents in a variety of different wilderness treatment programs. While his study contributed significantly to the literature, more research is needed to determine both the continued effectiveness of this kind of treatment and to determine for which type of clients and families this treatment is most effective.

Notably, there is little research investigating adults in wilderness programs, with most of the existing literature focusing on psychological gains through Outward Bound or other wilderness adventure programs which are not therapeutic programs (Asher, Huffaker & McNally, 1994; Goldenberg, McAvoy & Kenosky, 2005; Hyer, Boyd, Scurfield, Smith & Burke, 1996; Kelly, 2006; Paxton, 2000). While these studies consider the short-term gains of wilderness treatment, no significant research has investigated the therapeutic processes or long-term benefits of wilderness programs for adult clients (Paxton, 2000) even while adventure-based therapy programs continue to grow in popularity and size (Kelly, 2006). Wilderness and adventure therapies are increasingly used to treatment adults with behavioral and substance abuse issues. But little literature addresses wilderness or outdoor therapy models with adults (Kelly, 2006)

Open Sky’s Research Question
Open Sky conducts evaluative research with every client and family. Our research seeks to answer the question: for which clients and families is wilderness treatment most effective? We are currently conducting two studies, one with the adolescents in our program and one with adult clients.

Research with Adolescents at Open Sky
Our adolescent study is a longitudinal one-group design, following every client and family for two years after discharge. We ask adolescents to complete four questionnaires six times: at intake, discharge, 3 months after discharge, 6 months after discharge, 12 months after discharge and 24 months after discharge. The four measurements are:

Youth Outcome Questionnaire 2.0 SR (Wells, Burlingame & Lambert, 1996), which is a 64-item youth self-report survey designed to gauge general mental health and functioning.

University of Rhode Island Change Assessment (McConnaughy, Prochaska & Velicer, 1983). This 32-item, Likert-type survey is designed to assess readiness to change in mental health services clients.

Adolescent Relapse Coping Questionnaire (Myers & Brown, 1990a; Myers & Brown, 1990b; Myers & Brown, 1996). This 34-item self report measure is designed to assess temptation coping skills among adolescents with a history of alcohol and drug abuse.

Adolescent Attachment Questionnaire (West, Rose, Spreng, Sheldon-Keller & Adam, 1998), a 9-item self-report questionnaire is designed to assess adolescents’ perceptions of relationships with parents.

Parents of adolescent clients are asked to complete two measurements:

Youth Outcome Questionnaire 2.0 (Wells, Burlingame & Lambert, 1996), which is 64-item parent report survey designed to gauge youth mental health and functioning from a parent perspective. Parents are asked to complete this measurement six times (intake, discharge, 3 months after discharge, 6 months after, 12 months after and 24 months after).

Adult Attachment Scale (Collins & Read, 1990). This 18-item self report survey is designed to provide information regarding parents’ feelings about relationships, which will be useful in determining for which families wilderness treatment is most effective. Parents are asked to complete this measurement at intake only.

Research with Adults at Open Sky
Our adult study is a longitudinal one-group design, following every client and family for two years after discharge. We ask our adult clients to complete five questionnaires six times: at intake, discharge, 3 months after discharge, 6 months after discharge, 12 months after discharge and 24 months after discharge. The four measurements are:

Outcome Questionnaire 45.2 (Wells, Burlingame & Lambert, 1996), which is a 45-item youth self-report survey designed to gauge general mental health and functioning.

University of Rhode Island Change Assessment (McConnaughy, Prochaska & Velicer, 1983). This 32-item, Likert-type survey is designed to assess readiness to change in mental health services clients.

Addictive Disorders Screen – Revised (Howatt, 2006). This 56-item self-report instrument is designed to measure clients’ propensity for addictive behaviors, such as drugs/alcohol, internet use, workaholism, etc.

Psychological Separation Inventory (Hoffman, 1984). This 138-item self-report instrument is designed to measure psychological individuation, the ability to establish oneself as healthily independent.

Parents of adult clients are asked to complete one measurement only one time:

Adult Attachment Scale (Collins & Read, 1990). This 18-item self report survey is designed to provide information regarding parents’ feelings about relationships, which will be useful in determining for which families wilderness treatment is most effective. Parents are asked to complete this measurement at intake only.

Open Sky’s Preliminary Research Findings

After completing the first year of our data collection, our research shows that at departure from Open Sky, our students have made statistically significant reductions in the acuity and severity of mental health problems. We have further found that they maintain the gains they make with us for months afterward.

We will continue to update you on our research findings as the study progresses!

References

Asher, S.J., Huffaker, G.Q., & McNally, M. (1994). Theurapeutic considerations of wilderness experiences for incest and rape survivors. Women & Therapy, 15 (3/4), 161-174.

Collins, N.L., & Read, S.J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58 (4), 644-663.

Curry, J.F. (1991). Outcome research on residential treatment: Implications and suggested directions. American Journal of Orthopsychiatry, 61 (3), 348-357.

Edwards, J.K. (1994). Children in residential treatment: How many, what kind? Do we really know? In G. Northrup (Ed.), Applied research in residential treatment (pp. 85-99). New York, NY: The Haworth Press, Inc.

Foster, E.M. (2002). Modeling child and adolescent psychiatric hospital utilization: A framework for examining predictors of service use. Children’s Services: Social Policy, Research & Practice, 5 (3), 151-173.

Goldenberg, M., McAvoy, L., & Kenosky, D.B. (2005). Outcomes from the components
of an Outward Bound Experience [Electronic version]. Journal of experiential education, 28 (2), 123-146.

Goodrich, W. (1994). Research issues in adolescent inpatient psychiatry. In Ghuman, H.S., & Sarles, R.M. (Eds.), Handbook of adolescent inpatient psychiatric treatment (pp. 277-292). New York, NY: Brunner/Mazel Publishers.

Hoffman, J.A. (1984). Psychological separation of late adolescents from their parents. Journal of Counseling Psychology, 31 (2), 170-178.

Howatt, W.A. (2006). Addiction screening tools vs. addiction clinical measures: Introducing the Addiction Disorder Screen (ADS) -7. Counselor, 7 (1), 48-53.

Hyer, L., Boyd, S., Scurfield, R., Smith, D., & Burke, J. (1996). Effects of Outward
Bound experience as an adjunct to inpatient PTSD treatment of war veterans [Electronic version]. Journal of Clinical Psychology, 52 (3), 263-287.

Kelly, V.A. (2006). Women of courage: a personal account of a wilderness-based
experiential group for survivors of abuse [Electronic version]. Journal for Specialists in Group Work, 31 (2), 99-111.

McConnaughy, E.N., Prochaska, J.O., & Velicer, W.F. (1983). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory, Research and Practice, 20, 368-375.

Myers, M.G., & Brown, S.A. (1990a). Coping and appraisal in relapse risk situations among substance abusing adolescents following treatment. Journal of Adolescent Chemical Dependency, 1, 95-115.

Myers, M.G., & Brown, S.A. (1990b). Coping responses and relapse among adolescent substance abusers. Journal of Substance Abuse, 2, 177-189.

Myers, M.G., & Brown, S.A. (1996). The Adolescent Relapse Coping Questionnaire: Psychometric validation. Journal of Studies on Alcohol, 57, 40-46.

Paxton, T., & McAvoy, L. (2000). Social psychological benefits of a wilderness adventure program [Electronic version]. USDA forest service proceedings RMRS-P-15, 3, 202-206.

Russell, K.C. (2003). An assessment of outcomes in outdoor behavioral healthcare treatment. Child and Youth Care Forum, 32 (6), 355-381.

Smollar, J., & Condelli, L. (1990). Residental placement of youth: Pathways, alternatives and unresolved issues [Electronic version]. Children Today, 19 (6), 4-8.

Wells, K. (1991). Placement of emotionally disturbed children in residential treatment: A review of placement criteria. American Journal of Orthopsychiatry, 61 (3), 339-347.

Wells, M.G., Burlingame, G.M., & Lambertm M.J. (1996) Conceptualization and measurement of patient change during psychotherapy: Development of the Outcome Questionnaire and Youth Outcome Questionnaire. Psychotherapy: Theory, Research, Practice, Training, 33 (2), 275-283.

West, M., Rose, M.S., Spreng, S., Sheldon-Keller, A., & Adam, K. (1998). Adolescent attachment questionnaire: A brief assessment of attachment in adolescence. Journal of Youth and Adolescence, 27 (5), 661-673.