Research on Outdoor Behavioral Healthcare (OBH)

Outdoor Behavioral Healthcare Council

Over the last 20 years, research in wilderness therapy (often referred to as Outdoor Behavioral Healthcare, or OBH) has grown considerably in numbers and professionalism. While a number of programs and institutions have contributed to this promising research base, the Outdoor Behavioral Healthcare Council (OBHC), formed in 1997, has been a driving force for research and evaluation. PROGRAM joined the OBH Council in YEAR.

The OBH Council works with Outdoor Behavioral Healthcare Research Cooperative (OBHRC), whose purpose is to carry out comprehensive independent research and provide credible, objective information to the field. OBHRC has grown to include 12 full and affiliate research scientists with over 200 studies conducted in the field about the behavioral healthcare. Below is a summary of a few of OBHRC’s specific research areas. Follow the links to learn more about the research and work of the OBHC and the OBHRC.

The actual safety of participants in OBH Programs

Public perception of outdoor behavioral healthcare programs often misconstrues “wilderness therapy” as potentially dangerous and unsafe. This perception can often be linked to a lack of knowledge regarding this innovative method of treatment, unfamiliarity with the extensive risk management techniques used in such programs, the inappropriate practices of less developed yet seemingly similar programs, and the vulnerable and problematic states of many clients.

While no treatment can guarantee the total safety of any child, adolescents participating in OBHC programs are actually at less risk than adolescents not participating in these programs. In 2012, the average American adolescent was two times more likely to visit an emergency room than their counterparts in OBH programs.

Continue reading at: OBH is Safer than Being at Home for the Average Teen or OBHRC Risk Management

Effectiveness of OBH

Recent research produced by the Outdoor Behavioral Healthcare Research Cooperative (OBHRC) supports that OBH is effective at improving overall functioning of youth, reducing the use of abusive substances, and engaging resistant clients. A few outcomes with demonstrated statistical, clinical, and practical significance in the research are highlighted below.

  • Clients enter OBH programs with high clinical dysfunction.
  • Clients make dramatic improvements in emotional and behavioral functioning while in OBH treatment.
  • Clients maintain improvements up to six and 12 months post-OBH treatment.

Ongoing research of OBH’s impact on youth well-being affirms these findings and is discovering more about how and why OBH works. For more information, read more on the OBHC research page here, or on the OBHRC page here.

Accreditation

In partnership with the Association of Experiential Education (AEE), OBH Council is engaged in the most stringent accreditation process in the field. This accreditation program helps to identify programs of high quality. AEE has 25 years of experience in adventure-program accreditation and has invested over $1 million in refining the process. Programs holding OBH Accreditation have been rigorously evaluated by an independent review body and have successfully demonstrated that they maintain the industry’s highest standards of quality, safety and effectiveness. More information can be found here in the coming months.

 

 

 

 


Relapse Prevention in the Canyons: Training ourselves to be aware of and deal with Triggers

Relapes Prevention - Dealing with TriggersRelapse prevention is an important topic in substance abuse treatment. At Legacy Outdoor Adventures one topic of relapse prevention we focus on is education, awareness of, and how to deal with triggers.

What are triggers? Triggers are things that induce an emotional response in us that can lead to obsessive thought or behavior around drugs and alcohol. A trigger could be a smell that we associate with using. A trigger could also be seeing someone who we associate with using or going to a place we used to use. It could be hearing a song we have listened to while using. Triggers often appeal to the senses. There are also emotional triggers. Something that creates stress, anxiety, anger, or depresses us can be a trigger. When using drugs or alcohol all the time, all of these things can create a conditioned response that makes an addict obsess and crave drugs and alcohol.

This week at Legacy we worked on creating awareness around the things that trigger us and tools to help deal with them. We incorporated this with a canyoneering adventure. Canyoneering is descending technical slot canyons by hiking, down climbing, and rappelling through the canyon. It requires teamwork and good communication to navigate and descend the canyon safely and efficiently. After gathering all the equipment we needed to descend the canyon we began our approach hike from the trailhead. The first half mile of the hike was flat and did not offer much of a challenge. Then we came to a trail that lead straight up hill where we would gain 700 feet in elevation over the course of ¾ mile. At this point we sat down and took our packs off and had a discussion about triggers. We defined what triggers are, what experiences people have had being triggered, and what specific things trigger us. We then talked about specific tools we use to fight triggers. Then we introduced the idea of a trigger buster. A trigger buster is a tool to interrupt the internal response that the trigger causes and reconnects us with our purpose in living a life of meaningful recovery. The trigger buster starts with awareness that we are being triggered. Then we take a deep breath to calm ourselves and slow down our thoughts. Then we have a mantra that we tell ourselves that connects us to our purpose. After explaining what a trigger buster was we all took a few minutes in silent meditation to think about our trigger buster and develop a personal mantra or saying that we would tell ourselves when things got tough that would connect us back to our purpose. Everyone shared their saying out loud and we began the hike up hill. When the hike got tough we encouraged each other to take a deep breath and say your mantra. “Be Strong” “God, grant me the serenity.” I have the freedom to choose to be me.” “I am capable of dealing with hard times in positive ways.” “I want to make my Grandpa and family proud.” These were some of the mantras the members of the group shared.

The most fear, stress, and anxiety inducing thing encountered canyoneering is often the rappels and because of this response that it creates we wanted to use the rappels to practice our trigger busters. When each member was half way down the rappel his partner below would take him on belay so he could let go of the rope with both hands. With both hands free of the rope each member practiced taking a deep breath and saying their mantra. One group member stated that he realized the purpose of this exercise and saw the value in it. “If I can learn, practice, and condition myself to practice a trigger buster while hanging off the side of a cliff on a rope I will be able to do it when I am tempted by something in my regular life. But I know I have to practice it so it becomes my natural response to dealing with stuff when it comes up.”

This canyoneering adventure proved to be a successful one. Not only did we have a great time hiking, exploring, rappelling, climbing and celebrating recovery but we also learned about addiction, triggers, and how we deal with triggers.  The canyon helped create a meaningful setting for us to teach and talk about relapse prevention and having meaningful recovery.

Working with triggers in wilderness therapy

 


Wilderness Therapy Programs Less Risky Than Daily Life, UNH Research Finds

March 28, 2012

Wilderness Therapy Programs Less Risky Than Daily Life, UNH Research Finds

DURHAM, N.H. – Adolescents participating in wilderness and adventure therapy programs are at significantly less risk of injury than those playing football and are three times less likely to visit the emergency room for an injury than if they were at home, a new study by University of New Hampshire researchers finds. These findings, based on an analysis of risk management data from 12 programs providing outdoor behavioral healthcare in 2011, were reported in the latest issue of the Journal of Therapeutic Schools and Programs.

“After ‘does this program work?’, the question most asked by people considering adventure therapy is ‘will my child be safe?’” says Michael Gass, professor of outdoor education in the kinesiology department at UNH, who wrote the article with lead author Stephen Javorski, a UNH doctoral student. “While no one can guarantee the unconditional safety of any child, we can now show the relative risk levels for adolescents. This study shows there is actually less risk to participants on wilderness therapy programs, when they are conducted correctly, than to adolescents in their normal everyday activities.”

Adventure therapy, described as the prescriptive use of wilderness adventure experiences to improve the mental health of clients, primarily serves adolescents and is often seen as a treatment of “last resort” for these youth, who typically present with three or more dysfunctional behaviors such as depression, substance abuse, and suicidal ideologies. Gass, a leading expert in the field, estimates that there are more than 200 such programs nationwide ranging from multimillion dollar programs to individual counselors who might informally take a group or class into the woods.

For this study, Gass and Javorski looked at incident and illness data collected by the 12 adventure therapy programs that comprise the Outdoor Behavioral Health Industry Council for 2011. Analyzing injuries that required a client be removed from regular programming for more than 24 hours – including injuries treated in the field as well as those that required evacuation to a medical facility — the adventure therapy programs had an injury rate of .11 injuries per 1,000 days in 2011, or one injury for every 9,091 client-days. The estimated national average rate of injuries for adolescents treated in U.S. hospital emergency rooms was three times that rate (.38 per 1,000 days).

Adventure therapy programs boast even stronger safety records when compared to other common activities of adolescents. Injuries during high school football games are more than 140 times greater than those in adventure therapy programs, which boast lower injury rates than snowboarding, downhill skiing, mountain biking, backpacking, and football practice.

“I’m hoping that this research will counter the public perception that these programs are dangerous,” says Javorski. “Well-managed programs are not dangerous, they’re not exposing kids to undue risk, and they’re not overusing physical restraints.”

The researchers offer several reasons for the dramatic relative safety of these programs. As the field has developed, says Gass, risk management standards have improved; he notes that the programs in the OBHIC are among the leaders in the field. And our perception of risk colors how we view the risk of “everyday” activities.

“Driving a car is more dangerous than hiking in the wilderness, particularly with trained staff,” Gass says. “These programs remove adolescents from other accepted yet higher-risk situations like driving.”

What’s more, the effectiveness of these programs makes them not just safe but saviors to parents of the very troubled adolescent clients. “Many parents say, ‘this is the one thing that can save my child,’” Gass says. He and his colleagues are researching how and why adventure therapy works, but he is confident that their potency is at the intersection of adventure programming and therapy.

“The pill that we’re offering is the positive use of stress coated by appropriate levels of care and support,” says Gass, co-author of the leading academic and training text in the field, “Adventure Therapy: Theory, Research and Practice” (Routledge, 2012).

In response to the growth in the wilderness therapy field, UNH launched the nation’s first dual social work-outdoor education degree in 2009; the two-and-a-half-year program awards both a master’s in social work and a master’s in kinesiology. Graduates of the program, administered by Gass and Anita Tucker, assistant professor of social work, are all working in the expanding field of adventure therapy.

The member-programs of the Outdoor Behavioral Healthcare Industry Council that provided incident data to this study are the Anasazi Foundation (Ariz.), Mountain Homes Youth Ranch (Utah), OMNI Youth Services (Ill.), Open Sky Wilderness Therapy (Colo.), Redcliff Ascent (Utah), Second Nature Cascades (Ore.), Second Nature Entrada (Ore.), Soltreks (Minn.), Summit Achievement (Maine), Legacy Outdoor Adventures (Utah), Outback Therapeutic Expeditions (Utah), and Wendigo Lake Expeditions: REACH (Ontario). This study was funded by the Outdoor Behavioral Healthcare Industry Council (OBHIC).


What makes a hero?

Great video by TEDEducation on the Hero’s Journey. Every client or student of wilderness therapy will recognize this pattern as their own.

 

 


Adventure Moduals

Legacy’s adventure modules are solidly based on the concepts of “Safe, Fun, and Meaningful”.  We engage our clients in activities that encourage individual participation, build group cohesion, develop self-confidence and self-efficacy, and provide meaningful challenge and a sense of accomplishment. Treatment goals are deliberately addressed through impactful adventure activities.  Adventures last 5 days followed by 2 days to stand down, engage in therapy sessions, and re-outfit for the next adventure. Some of our most common adventures include:

Technical Canyoneering:

Canyoneering is the activity of descending technical canyons by hiking and rappelling down obstacles.  People travel from around the world to go canyoneering in Legacy’s course area.  We have the equipment and expertise to guide our client teams down through some of the most spectacular canyons in the world; right here in our own backyard!  Some of our favorites include Chimney Canyon, Eardley Canyon, Little Iron Wash, Baptist Draw and Upper Chute Canyon, and our “secret” gem, Pete’s Dragon, which we scouted and pioneered ourselves.

Adventure Backpacking:

Legacy operates in some of the most spectacular mountain and desert terrain in the world.  We hike across 11,000 foot plateaus and through deep canyon gorges.  The beauty and solitude of the Sweetwater Canyon defies description.  The grandeur of the Chute of Muddy Creek leaves a powerful impression on anyone who has ever visited.  The areas where we hike and camp are the areas you see on postcards and panoramic photos of the desert southwest.

Mountain Summits:

TWe have several mountain summits within our course area that serve as solid objectives for an adventurous group of young men to conquer.   Mt Hilgard (11,533 ft), Mt Ellen (11,522 ft), and Mt Terrill (11,547 ft) are some of our regular targets.  These summit adventures involve a one or two day approach hike followed by the actual summit attempt day.  The exhilaration and sense of accomplishment a young man feels standing “on top of the world” is difficult to describe.  Sharing the experience with a team of brothers makes it even more powerful.

Backpack Fishing Trips:

Boulder Mountain has over a hundred fishable lakes, most of which are accessible only by foot.  Our fishing adventures are relaxing and gratifying.  Hike, fish, camp, repeat.

Wildlife Adventures:

We plan specific adventures around wildlife observation during peak seasons.  We observe and photograph wild horses in the Link Flats area of the San Rafael Swell.  We hike into the Fishlake Mountains to call and observe rocky mountain elk during the rut in September.  We watch desert bighorn sheep jousting and head-butting during their rut in November.  There is a large free ranging herd of American bison in the Henry Mountains that we locate and observe.

Mountain Biking:

Central and southern Utah has some of the best mountain biking routes in the world.  People travel from afar to enjoy what we have at our doorstep.  We ride in the San Rafael Swell, the Henry Mountain desert, and on top of Boulder Mountain.  Riding bikes is fun but we make sure we include the meaningful part too.


Ten Years after; Gary Ferguson Interviews Former Wilderness Clients

Gary Ferguson’s Keynote speech given at the NATSAP 2008 conference in Savannah, Georgia.  In this address Gary shares the journey of the students who he wrote about in Shouting at the Sky, 10 years after they finished the program.

Gary Ferguson – Interviews Students From the Book 10 Years After AAA from Troy Faddis on Vimeo.


Is Addiction Really a Disease

Dr. Kevin Mccauley has put together a great video called “Pleasure Unwoven” about addiction and the brain. I ask all of my clients and their families to watch his video. Here is the first of eight segments from “Pleasure Unwoven” that have been put up on YouTube.

 


The “Legacy Way of Being”

The Legacy Way of BeingThe Legacy Outdoor Adventures’ core principles are comprised of four quadrants.  At the center lies a “heart at peace” surrounded by “Recovery”, “Honorable Manhood”, and “Self Awareness”. We call it a way of being because it is much more than values we strive for in moments of decision, but a constant frame of mind that comes to play in every decision we make.  As a treatment team, we try to foster this way of being in ourselves so we can provide a powerful model for our clients.

Heart at Peace

The “heart at peace” terminology comes from the Arbinger Institute.  The Anatomy Of Peace defines a heart at peace as a way we look at others.  With a heart at peace we see others not as objects, but as people with wants, dreams, strengths, and weaknesses equal to our own.  With a heart at peace we can communicate better, have more accurate empathy for others and have stronger relationships. This is something we constantly strive for and try to instill in our clients as they graduate from our program.  In order to have a heart at peace we have to understand  the antithesis, or “heart at war” and create awareness when we see others as objects.  I have personally witnessed the transformation from a heart at war to one of peace and the result is a powerful reconnection to loved ones and a new found opportunity for meaningful relationships.

 

Recovery

Legacy Outdoor Adventures prides itself in creating a foundation where recovery can happen.  Recovery means different things to different people, for many, recovery means freedom from the shackles of an addiction to substances.  Being addicted to a substance, or having a process addiction can severely stunt the growth in maturity for a young man.  For us at Legacy, recovery is not just an idea or even a task to complete and check off; it is a way of life and a way of being that keeps us vigilant against the demons we face in our lives.  The skilled substance abuse counselors at Legacy Outdoor Adventures guide the young men in the beginning steps of recovery and create a foundation for completing a 12 step program.  Through research, and extensive experience our team developed 7 keys to lasting recovery, with number one being purpose for recovery. We at Legacy Outdoor Adventures know that the path of recovery for an addict is long and arduous one, yet in the time we have with our clients we discuss their recovery in terms of being prepared with skills, a detailed relapse prevention plan and increased awareness of triggers.

Honorable Manhood

For many who find their way to Legacy Outdoor Adventures it’s about a lack of direction.  The same seem to be stuck in a pattern of childish behaviors.  Honorable Manhood is a reachable goal for each of our clients as the wilderness teaches them what they are capable of.  Through this new found self efficacy, the clients begin to mold and envision the man they want to be; an honorable man.  An honorable man is one of values, and integrity.  He is responsible, caring, and considerate of others.  We at Legacy create an atmosphere and space where an honorable man can be made from one trying to find himself.  We challenge the clients to define their own kind of honorable manhood through individual and group therapy.  They have the opportunity to exercise these traits with group members, where the feedback is often immediate.

Self-Awareness

At Legacy we create an environment of self-awareness.  We have moments of awareness throughout each day.  We strive to give and receive immediate feedback so we can be mindful of how each of us are experienced by others.  As we increase our awareness of our emotions, thoughts, and behaviors we can begin to have influence and control over these areas of self. For instance, if I can create awareness over my emotions and the thoughts that precede those emotions I can create an opportunity to behave differently in the awareness.  This awareness is especially useful in maintaining interpersonal relationships.  If we can create awareness of how others may be experiencing ourselves, we can begin to influencing the outcome of that experience.

At Legacy Outdoor Adventures we believe in helping young men transition into honorable men by increasing their awareness and finding their heart at peace.  Whether our clients are beginning their recovery from addiction or simply finding a direction, we at Legacy pride ourselves in creating a way of being around a heart at peace.

By Mike Mills, Therapist

 


Accident Rates/Trends in Outdoor Behavioral Healthcare Industry Council (OBHIC) programs

On November 1, 2012 The Outdoor Behavioral Healthcare Industry Council (OBHIC) published their most current data on safety record of their member programs.  Legacy is proud to be a part of OBHIC and their data collection and best practices among wilderness therapy programs.  Not only does the most current study sport earlier findings that OBHIC member programs are safe; but that they are safer than most of the activities most teens and young adults engage in while at home.  Below isOBHIC injuries study a graph comparing wilderness therapy programs injury rates with other activities.

 

To read the entire study download the PDF here.


Nature and Recovery

Ray Barlow, our program/admissions director collaborated on this article that appeared in Psychology Today.  In this article Ray shares the following about his personal experience with nature and recovery:

Ray Barlow, LSAC is the Co-Founder/Program Director of Legacy Outdoors Adventures www.legacyoutdooradventures.com wilderness program in Loa, Utah that specializes in treating teens age 16-17 and young adults. The following interview with Ray illuminates the magic of nature and how lives can be transformed from this connection:

1. What are the healing qualities of exposure to nature that you have observed in your work with clients who have addictions?

There is a healing power in nature that cannot be measures nor explained, yet it is very real. Time in the wilderness seems to have a healing effect on even the deepest wounds. It is no coincidence that most of the spiritual leaders and teachers throughout time have gone to the wilderness to find healing and purpose in preparation for their life’s work. One of the gifts of the wilderness is the way it gives us an honest look at ourselves, our gifts, talents, weaknesses, character defects and our true potential are all made obvious. It is this honest look at ourselves that allows us to find love and acceptance for who we are and a vision of who we can become.

2. What are the benefits of wilderness programs for client’s recovery?

Wilderness programs help a client’s recovery by restoring their self-confidence and self-efficacy. They begin to believe once again that they can be successful in life. Simply put, the experience helps them to recapture hope in their lives.

3. Are there ways that you would suggest those in recovery integrate nature into their lives when living at home?

The use of a journal to record the wilderness experience can be a powerful tool to help one connect with that experience and the lessons learned. Meditation can also be a powerful way to connect with the wilderness even if there is very little wilderness available to someone. It is also important to plan and schedule opportunities to reconnect with nature, evaluate progress, and direction.

4. What personally lead you into the field of wilderness treatment?

As a young man struggling with the loss of my parents and dealing with my own addictions, anger and fear. I retreated to the wilderness in search of relief from the pain of life and answers to my deepest questions. Through a powerful experience that cannot be fully explained or measures I found purpose and direction in my life. I came to understand that I had gifts to give and that I could overcome my weaknesses and find joy in life. I now have the blessing and responsibility to help give others the same opportunity.

Read the full text by following link to Psychology Today.  http://www.psychologytoday.com/blog/the-high-functioning-alcoholic/201210/nature-and-recovery