News & Views -
Sep, 1999 Issue #61
Decompensation And Failure to Thrive In Wilderness Therapy And
By Michael G. Conner, Psy.D, Clinical and Medical Psychologist.
(Dr. Conner is Director of Family and Psychological Services
for SageWalk, The Outdoor School and is Director of Planning and Program Development
for Mentor Research Institute, a non-profit public health and safety
Wilderness programs for youth at risk are growing across the country in response
to a gap in health care services created by managed health care companies that do not recognize or provide services for youth at risk
with behavioral problems. Parents searching for alternatives to medicating their children for social and behavioral problems are turning
to wilderness therapy and intervention programs when “office” therapy, residential treatment and criminal justice programs fail. Wilderness
programs are becoming a first-line intervention and not just “last chance programs.”
Decompensation and the failure of students to thrive in a wilderness program
are actual, yet very infrequent events. Decompensation is a more severe, and very different problem than the failure of a student
to benefit from a particular program.
Decompensation can take many forms. Normally it will involve the onset of
more child like behavior, a complete lack of regard for hygiene, loss of bladder control while sleeping, increasingly disorganized
behavior, a dramatic change in the level of energy, or a complete loss of interest in pleasurable activities.
Failure to thrive can take many forms. Wilderness programs allow students
opportunities to respond to challenges and ordeals with a rewarding and healthy initiative. They separate students from their former
environment, removing such distractions as drugs and negative role models. No longer able to escape the consequences of their choices,
individual, environmental and social realities are made more clear to the student. When a student is unable or unwilling to take advantage
of this environment, it is considered a failure to thrive.
Failure to benefit from a particular program, which is quite different from
a failure to thrive, can be due to a variety of reasons. For instance, students may not benefit because the program’s length was not
adequate to address their problems and needs. When a student leaves a program prematurely, there is a risk that problems prior to
admission will resurface or they may become worse than before. If, on the other hand, the length of a program is increased, a student
may decompensate and fail to thrive. This can happen when the student’s psychological needs are not met, the student is overwhelmed,
and the length of the program becomes too long.
Prevention. It is possible, and in some cases is not difficult to
know in advance, that enrollment in a program may lead to decompensation or a failure thrive. Screening and monitoring procedures
are the key to prevention. Decompensation and failure to thrive are usually the result of one or both of the factors described below.
1. Screening. At times the program is unable to recognize, understand
and address an underlying or pre-existing medical problem. Sometimes prior to, or during a program, a student is taken off a needed
medication, or, is taken off an unnecessary medication, too abruptly and inappropriately. Some students enter a program on the wrong
medication(s), or have unrecognized medical problems that appear to be psychological and behavioral problems. Subtle medical problems
can contribute to a student’s behavioral problems. More common medical problems such as diabetes, hypothyroidism and seizure disorders
can also cause endocrine and neurological disorders. A surprising number of students enter programs after having been put on antidepressants
when they were simultaneously using marijuana and alcohol on a regular basis. Medical journals have begun to publish consumer research
demonstrating a growing trend in the improper evaluation and treatment of medical problems that have in turn caused psychological
and behavioral problems. Children with mental health problems are ending up in the criminal justice system.
2. Program Incompatibility. A program can be emotionally too demanding
for the resources and abilities of students whose problems are beyond that program’s scope. Some students will respond to one program
and not another. In some cases inadequate screening allows the enrollment of students whose needs surpass those for which a particular
program was designed. This can happen when a program is new, financially desperate, or if their screening process lacks a qualified
clinician. Well-intended parents may provide insufficient information to screen students adequately, sometimes due to guilt or fear
that the family may have caused the current problem. In most of such cases, parents have not received enough information from their
child’s health care professional to develop a good understanding of their child’s needs and problems. Psychological impairments, sometimes
associated with trauma, abuse or developmental delays, are common problems that can be misunderstood and go unrecognized.
Although the structure and philosophy of programs can be as different as people are different, an optimal program will both address
students’ psychological needs and provide them with challenges.
Parents, programs, educational consultants and mental health professionals
each have an important role in minimizing the risk that a child may decompensate or fail to thrive in a wilderness program. These
risks can be minimized by:
§ Working with educational consultants and mental health professionals who
are knowledgeable and have experience working with wilderness programs;
§ Consulting with a family practice physician or psychiatrist to obtain a
complete physical and medical evaluation that also includes endocrine functions, complete chemistries, as well as a drug and alcohol
§ Consulting with a clinical psychologist, and when directed, obtaining a
comprehensive interview, individual and family history, and psychological evaluation that includes personality, intelligence and neuropsychological
functions; and by
§ Looking for programs with screening procedures that include consultations
with qualified and licensed professionals with credible training and experience in diagnosis and ability to recognize medical and
I have the greatest professional enthusiasm for wilderness therapy and intervention
programs, but they are not without problems. There will always be a risk that a few students in a program may decompensate or fail
to thrive, but it can be greatly minimized if a child is admitted to a well-designed and implemented program.
Copyright © 1999, Woodbury Reports, Inc. (This article may be reproduced
without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)