Characterization and comparative analysis of adolescents admitted to Therapeutic Wilderness Programs and more traditional treatment settings.

摘要

Therapeutic Wilderness Programs (TWP) are a fast growing segment of the adolescent treatment arena. Scientific literature on TWPs shows that researchers have skipped the natural step of identifying the population of adolescents admitted for treatment. To fill the gap in TWP research, this archival study identified demographic features and distinctive foundational aspects that represent the TWP treatment population. Comparison samples were taken from two TWPs, two residential treatment centers (RTC) and an outpatient therapy clinic (OP). At each of the five sites, basic descriptive data from client records were combined to represent multiple characterizing indexes that are in common usage for description of adolescent clinical populations. Data from TWPs (n = 150) were compared to both RTC ( n = 152) and OP (n = 154) data in order to identify statistical and clinical differences across settings (primarily using chi 2 Cramer's V). Results showed significant differences (p .05) between TWP admits and RTC/OP admits in demographic (e.g. age; adoptive status), school related behavioral problems, nature and type of primary diagnoses, treatment history (psychiatric and psychological), psychosocial history, legal issues, substance use, and family dynamics descriptors. A number of differences (TWP vs. OP and TWP vs. RTC) showed a moderate to large effect size (Cramer's V ≥ .3). Important clinically significant differences include: the nature of current primary disorder (TWP admits show more externalizing); presence of a mood disorder (RTC/OP present with more mood disorders); attendance at previous outpatient treatment (RTC/OP access outpatient treatment more); admittance to previous inpatient treatment (TWPs more commonly had a single inpatient admission; RTC more commonly had more than one inpatient admittance); family communication and family adaptability (TWPs family communication and family adaptability rated lower). These client features appear to be distinct identifiers of TWP admits when compared to RTC/OP admits. Other characterization indices emerged as identifiers between TWP vs. OP (e.g. school suspension; diagnostic severity; and arrests) and TWP vs. RTC (e.g. suicidal ideation; self mutilation; and prescribed psychiatric medication) separately. Implications for researchers, clinicians, educational consultants, and families are discussed.