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.


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.





Tribute to Nita Hooker During the Annual Loa Fund Fundraiser

LOA Fund Chair of Directors, Derek Daley, started working as a wilderness therapy field instructor more than a decade ago. As a young field guide Derek was unaware of the high costs of wilderness therapy. In his naiveté he enthusiastically shared his experiences and growing confidence in the power of wilderness therapy to a group who had children or loved ones in need of treatment. His persuasive presentation brought several people to apply for treatment only to find that the high costs associated with intensive therapy in the wilderness were prohibitive.  Derek’s surprise and embarrassment sparked a determination to make a difference by finding ways to make wilderness therapy more accessible to economically disadvantaged clients.


After raising $120,000 and providing scholarships for wilderness therapy treatment for several clients, the LOA Fund hosted a charity and fundraising event on Thursday, April 18th in Provo, Utah. The event was well attended and participants heard personal stories from three LOA Fund recipients.


The audience listened attentively as each young man shared pieces of his own story. All three experienced a loss of control over their substance use that resulted in incarceration, destruction of their most valued relationships and the deep loss of personal confidence and identity. Their loved ones knew that they needed help and, without the help of the LOA fund, would have been unable to finance wilderness therapy. The Legacy Outdoor Adventure alumni explained that other rehab options hadn’t worked and that what they gained in the wilderness was what they really needed.


Honor was paid to Nita Hooker, wife of the late Keith Hooker who played a key role in developing risk management practices for wilderness therapy and adventure therapy since its genesis. Nita Hooker and the Hooker family continue to be strong supporters of the field of wilderness therapy, and were major contributors to the scholarships awarded to the young men who spoke at the event.


The final speaker of the evening, Butch Scott, shared the story of his late son Jake who lost the battle of addiction. After maintaining sobriety for 6-months and experiencing the restoration of his confidence, the speaker’s son took a fatal combination of drugs and lost his life. The tragic story grounded the good feelings of the evening with the realization that, for addicts, everyday must include the determination and commitment to holding strong to the principles of sobriety.


The event was catered by “Catering for the Cause” who provides job opportunities to people in recovery and also helps raise money to provide scholarships to financially challenged clients. Many of the employees of Catering for a Cause were alumni from treatment programs who attended the event. The tone and feeling of the event was reflective, optimistic, and had the feeling of a family reunion.
The event was counted as a success by Derek Daley and is the first of many to come.


Wilderness therapy group raises money for scholarships

PROVO — On Thursday night, Dr. Keith Hooker was honored for his 40 years of work and service in the Utah medical community at a fundraising dinner for the Legacy Outdoor Adventures Fund. Held at the Provo City Library, Derek Daley, founder of the LOA Fund, honored Hooker, who died of cancer in June, by presenting a plaque to his wife, Nita. All proceeds went to the LOA Fund, which provides scholarships for wilderness therapy for people suffering from addiction and mental illnesses.

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).

Our Older Teen Program has a New Name; Legacy Protégé

In order to help differentiate its young adult program from its adolescent program, Legacy Outdoor Adventures has named its adolescent program Legacy Protégé. Beginning in the fall of 2012, Legacy Protégé has been treating 16-17 year old boys who are dealing with substance abuse and co-occurring mental health issues, using the same basic model that has proven to be effective with our young adult clients. The model includes a weekly therapeutic adventure integrated into the profound wilderness experience, the application of Motivational Interviewing techniques to invite clients to identify and address their ambivalence, daily practice and mastery of self-awareness skills, and both a substance abuse counselor and a therapist working individually with each client.
The Legacy team selected the name Protégé, which refers to one who is guided down a path by a wise, experienced mentor, because it accurately reflects the Legacy practice of assigning a seasoned, caring mentor from the guide team to walk beside and guide each protégé. Research and observation suggest that the therapeutic alliance between mentor and mentee is a powerful change agent in guiding young people over the threshold to responsible adulthood.

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 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.