Michael Gass, PhD, LMFT
University of New Hampshire
Selecting and recommending the best program for clients is the objective of every educational consultant or referring professional. Until now this process has been somewhat subjective, dependent upon a referrer’s past experiences with programs, the strong marketing efforts of therapeutic programs, and often times anecdotal or hearsay evidence of program outcomes. Until now, the use of more objective and third-party-evaluated evidence has been sorely lacking.
Recently however, organizations such as the OBH Council (Outdoor Behavioral Healthcare Council) and NATSAP (National Association for Therapeutic Schools and Programs) have devoted the time and resources to establish various research projects to assist families and consulting professionals. This has led to the establishment of rich sources of additional information to provide even more appropriate placements for clients. The purpose of this article is to inform referring professionals of these informative research initiatives, showing how to access the strength of this research and combine it with the already strong decision mechanisms consultants use in assisting their clients.
Client-Centered Outcome Research
Positioned by itself, research can often be impractical for clients. When determining the best fit for their child, statistical values contain little solace for parents who wish to know the answers to questions such as:
“Will the program work for my child?”
“Will my child be safe?”
“How can I tell a good program from a bad one?”
“Is the program worth the money I’m going to spend?”
While not the only source of information on these critical questions, recent developments of research in the areas of client outcomes, risk management, program accreditation, and cost-benefit analyses have greatly enhanced the ability of families, through the experienced help of educational consultants or other referring professionals to make sound placement decisions. Such efforts to center research results around the needs of clients have made these research mechanisms invaluable in the decision-making process.
Effective Client Treatment
With regard to program effectiveness, NATSAP has led the way with the development of a Practice Research Network (PRN) for participating programs. This research database contains outcome data from more than 59 programs and 3000 clients with data acquired at intake, discharge, six-month follow-up, and 12-month follow-up. As seen in Figure 1, with enough data, effective programs can show their ability to take clients in therapeutic need, assist them in achieving healthy changes, and maintain such changes for up to one year following program discharge.
Programs that have accumulated appropriate amounts of data in the database should also be able to show their effectiveness with clients presenting specific issues (e.g., show how successful this program is with adolescent girls with eating disorders, depression issues, and suicidal ideation). And finally, not only are these researched programs able to tell clients whether their programs produce statistically significant changes in the child, but also whether or not they produce clinically significant changes (e.g., “Was the therapy treatment effective, so the client no longer possess the criteria for the diagnosis?”) as well as practically significant changes (e.g., “Gains from the treatment approach were large, with 85% of the group experiencing positive changes, 14% remaining unchanged, and less than 1% regressing during treatment.”).
In the 1990s, the wilderness therapy field was sometimes an inappropriately dangerous place for clients. But since that time, a number of professional programs have bonded together to radically change the field and create a level of safety that distances the professional practices of outdoor therapy from past inappropriate practices. In fact, programs belonging to OBHC have demonstrated that their participants were about two times less likely to visit an emergency room for an injury than the average American adolescent at home. Figure 2 below illustrates the comparison of OBHC injury rates to those of other common activities.
One example comparison is that injuries during high-school football games are over 328 times more common than injuries experienced in OBHC programs. Note that interested parties should be careful not to overgeneralize these figures to all wilderness therapy or outdoor behavioral healthcare programs. But all programs should be able to show their accident/incident rates for at least the past 10 years of operation.
Recently the OBH Council invited the Association of Experiential Education (AEE) to jointly embark upon an expansion of their existing standards to better reflect the field of wilderness therapy’s current practices. This resulted in the creation of a detailed set of ethical, risk management, and treatment standards created by longstanding leaders in OBH, adventure therapy, and wilderness programming. OBH Accreditation is a voluntary credentialing program for OBH providers, where programs are scrutinized by a third-party team of experts in the field. Accredited OBH programs have demonstrated that they operate above industry standards of ethical care, treatment evaluation and risk-management practices.
New And Expanding Ways Referring Professionals Can Play Key Roles In The Research Process
One exciting and new initiative is to include consultants and referral professionals in the research process, allowing them to play a key role in furthering the field as well as improving services for their clients. No group of professionals is better positioned to collect valuable research data. The ability to track client progress from the initial inquiries of parents to the final conclusion of services is the domain of educational consultants and referring professionals alone. Recent efforts by NATSAP have been joined by Best Notes’ Outcome Tools organization to assist educational consultants and referring professionals in the data-collection process. Nearly a dozen of these have already joined this exciting initiative and expanded their ability to demonstrate to clients–in statistical, clinical, and practical ways–how they are improving in their treatment outcomes. Interested educational consultants and referring professionals are encouraged to contact the OBH Council, NATSAP, Best Notes or Outcome Tools to see the ease, practicality and efficacy of these processes.