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Research-Proven Results

Since our inception in 2006, Open Sky has collected data every year in the study of our outcomes. Our empirical research shows that Open Sky is extremely effective at helping our adolescent and young adult students, and that our students maintain these gains for months after graduating.

Learn more about the empirical research we conduct at Open Sky:

Open Sky Research Question
Empirical Research: Much More than Satisfaction Surveys
Open Sky Research Outcomes
Summary of Open Sky Research
In More Depth: Open Sky Research Rationale


Open Sky Research Question

Open Sky conducts evaluative research with every student and family. Our research seeks to answer the question: For which students and families is wilderness treatment most effective? We are currently conducting two studies: one with adolescents in our program, and one with young adult students. We are currently collecting research through the NATSAP Practice Research Network to understand our program’s effectiveness for our adolescent and adult students.

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Empirical Research: Much More than Satisfaction Surveys

Most programs conduct satisfaction surveys with their students and families at the end of treatment. Satisfaction is an important measure for customer service, but not for determining if the program is effective. Open Sky employs empirically validated research instruments to measure the success of our program, and the results prove that it works.

Our study is a longitudinal one-group design, following every student and family for one year after graduation. We ask students and parents to complete three questionnaires four times: at arrival, graduation, 6 months after graduation, and 12 months after graduation. With these data points, we can gain an understanding of our students’ progress and our program’s effectiveness over time.

Students and parents are asked to complete three questionnaires:

  • Outcome Questionnaire Family of Instruments (Burlingame et al., 2005)
    • Youth Outcome Questionnaire 2.0 SR(Wells, Burlingame & Lambert, 1996). (adolescents)
      This 64-item youth self-report survey is designed to gauge general mental health and functioning.
    • Youth Outcome Questionnaire 2.01(Wells, Burlingame & Lambert, 1996).  (parents of adolescents)
      This 64-item parent report survey is designed to gauge youth mental health and functioning from a parent perspective.
    • Outcome Questionnaire 45.2 (Wells, Burlingame & Lambert, 1996). (young adults)
      This 45-item youth self-report survey is designed to gauge general mental health and functioning.
  • Family Assessment Device – FAD-GF (Epstein, Baldwin & Bishop, 1983).
    This 12-item survey assesses the general functioning of the family system. It is comprised of scales analyzing problem solving, communication, roles, affective responsiveness, and affective involvement.
  • NATSAP Questionnaire (NATSAP Practice Research Network, 2007).
    This is a short questionnaire gathering basic information to understand our clients’ history and demographic.

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Open Sky Research Outcomes

Using the Youth Outcome Questionnaire (Y-OQ), an empirically validated instrument designed to indicate change while in treatment, our adolescent students show statistically significant improvements from arrival to departure on every subscale of the instrument: Intrapersonal Distress, Interpersonal Relations, Behavioral Dysfunction, Somatic Symptoms, Critical Items, and Social Problems.

On this instrument (where lower scores equal less mental health distress), a clinically significant drop is 13 points. Our research results show that parents perceive their child at an average score of 97 upon arrival and an average score of 35 at graduation. Open Sky students drop an average of 60 points during their stay!

Within three months, our adolescent students will go from needing intensive inpatient treatment to returning to a normal community range. This research also shows that for an entire year after graduation from Open Sky, our students are able to maintain those gains made at Open Sky and stay within the normal community range.

Using the Outcome Questionnaire (OQ), an adult version of the Y-OQ, we measured statistically substantial gains among our young adult students. A clinically significant change is 14 points, and on average our students’ scores drop over 25 points from arrival to graduation.

These findings show a clinically significant improvement in mental health symptoms which are maintained within the Community range for 6-12 months after graduation.

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Summary of Open Sky Research

Our research shows that our students are getting better across multiple dimensions and maintain these improvements well after departing Open Sky. Most of our adolescent and adult students make behavior, interpersonal, and mental health gains. These gains made while at Open Sky are maintained well beyond graduation. We will continue to research the effectiveness of Open Sky to measure the impact of what we do, so as to continue to refine our program in order to best serve our students and their families.

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In More Depth: Open Sky Research Rationale

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, p. 277) 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.” 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 toward ever-increasing numbers of out-of-home placements for adolescents.

Even as the numbers of students in this type of treatment have increased (Edwards, 1994), research and understanding regarding children and adolescents in residential treatment have lagged (Curry, 1991). Since 1994, data are scarce regarding numbers in treatment and the efficacy of that treatment. 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 the continued effectiveness of this kind of treatment and for which types of students and families it is most effective.

A study published in August 2019 (Gass, 2019) looks at the cost-effectiveness and completion rates of different treatments for comorbid substance use and mental health issues. The study found that outdoor behavioral healthcare (OBH) treatment had a “cost-benefit ratio of 60.4% higher than treatment as usual, an increased Quality in Life Years life span, societal benefits of an additional $36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument.” These results show OBH treatment options such as wilderness therapy produce longer-lasting and more cost-effective treatment than treatment as usual or no structured treatment.

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 that are not therapeutic (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 students (Paxton, 2000). This is true even as adventure-based therapy programs continue to grow in popularity and size (Kelly, 2006). Wilderness and adventure therapies are increasingly used to treat adults with behavioral and substance abuse issues; however, scant literature addresses wilderness or outdoor therapy models with adults (Kelly, 2006).

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  1. 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.
  2. Burlingame, G. M., Wells, M. G., Cox, J. C., Lambert, M. J., Latkowski, M., & Justice, D. (2005). Administration and scoring manual for the Y-OQ. Wharton, NJ: American Professional Credentialing Service.
  3. Curry, J.F. (1991). Outcome research on residential treatment: Implications and suggested directions. American Journal of Orthopsychiatry, 61 (3), 348-357.
  4. 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.
  5. 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.
  6. Gass, M., Wilson, T., Talbot, B., Tucker, A., Ugianskis, M., & Brennan, N. (2019, August 20). The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions. Substance Abuse: Research and Treatment13. doi:10.1177/1178221819870768
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. Russell, K.C. (2003). An assessment of outcomes in outdoor behavioral healthcare treatment. Child and Youth Care Forum, 32 (6), 355-381.
  13. Smollar, J., & Condelli, L. (1990). Residental placement of youth: Pathways, alternatives and unresolved issues [Electronic version]. Children Today, 19 (6), 4-8.
  14. Wells, K. (1991). Placement of emotionally disturbed children in residential treatment: A review of placement criteria. American Journal of Orthopsychiatry, 61 (3), 339-347.
  15. 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.

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Areas of Impact

Open Sky transcends traditional wilderness therapy by delivering an experience greater than the sum of its parts: treatment for the whole family, a powerful and transformative experience, a focus on total health and well-being, and an unyielding belief that everyone has the capacity to thrive.