News & Views - Aug 2000 Issue #72
OBHIC RISK INCIDENT REPORT,
By Rob Cooley, Ph.D.
Catherine Freer Wilderness Therapy Expeditions
[Rob Cooley earned a Ph.D. in counseling psychology from
the University of Oregon in 1979. He specialized in family and adolescent therapy at Oregon’s Children’s Services Division and in
private practice, while taking summers off to run a white-water rafting outfit. In 1988, he combined his outdoor and therapy interests
in founding Catherine Freer Wilderness Therapy Expeditions.]
[This article was summarized from a similar article published
by The International Journal of Wilderness, published by the University of Idaho Wilderness Research Center, Vol.6:1, April 2000.
The entire article is available at: www.strugglingteens.com/opinion/]
Two years ago the members of OBHIC (the Outdoor Behavioral Healthcare
Industry Council) set out to deal with two of the most troublesome arguments against outdoor treatment: that it is not as safe or
as effective as traditional indoor psychiatric and residential treatment.
Traditional therapists and health insurance companies sometimes
voice the view that outdoor therapy is, perhaps, a little too much fun, more like a health-promoting summer camp than a serious clinical
endeavor. To provide concrete data for this discussion OBHIC is working with the University of Idaho’s Wilderness Research Center
to produce a broad based, scientifically cutting- edge treatment outcome study. Data collection is under way.
On the risk issue, there are legitimate concerns about the risk
levels in the growing wilderness treatment industry. However, there is also risk in any residential program, in school, in sports,
and, for that matter, in just getting through the teen years. Starting in 1998, the five original OBHIC programs, all from the West,
began collecting careful data on their injuries and illnesses, and collectively compiling the data from the five programs. To create
a meaningful perspective for this data, I gathered data on accidents and injuries in other outdoor activities as well as typical activities
in which adolescents participate. I translated this information in a way that would allow the risks of these various activities to
be compared, using the standard developed by NOLS (National Outdoor Leadership School) and Outward Bound, the rate of incidents per
1,000 person days.
To fit school sports injuries and automobile injuries into the chosen
format I had to make several decisions about how to translate from one activity to another. Translation errors are my own, but I believe
the results fairly accurately reflect reality and are important to all of us in the Woodbury Reports family.
OBHIC’s 1998 incident data and my original report suggest that the
injury and illness risks of wilderness treatment are well within the bounds of rates for other activities, including ordinary daily
living. Responsible wilderness treatment has less risk of injury than the best summer youth adventure camps. Downhill skiing is three
times as likely to lead to injury as outdoor treatment, and high school football practices produce 18 times as many injuries.
Since the advent of modern wilderness treatment programs a dozen
or so years ago, no responsible program has experienced a client death. Accidents being accidents, that will almost certainly change
eventually. If we assume that the fatality rate for wilderness treatment programs will be about the same as for good adolescent adventure
camps, a conservative assumption for several reasons, then the eventual fatality rate would be about the same as for commercial white-water
rafting, one-third of that for teenagers occupying motor vehicles, and about 20% higher than the fatality rate for the average teenager
living at home.
Even so, the fatality rate was very high indeed for the three outdoor
treatment programs in which four young people died in the last 10 years. All three programs were recent start-ups, with some other
fairly apparent characteristics in common, pointing to the fact that referral sources and parents need to be careful about any program
where they send children.
In 1999, OBHIC programs reported somewhat lower incident rates.
Likewise, NOLS (the National Outdoor Leadership School), a leader in both collecting and courageously publishing risk incident data,
saw a drop of more than 30% in its injury incidents between the 1980s and the mid-1990s. High school football also dropped: it had
41 injury deaths from 1982 to 1989, but only 12 in the seven years from 1990 to 1997. Apparently this was due to improved helmets,
new rules, greater concern with serious injuries, and more rapidly available treatment. It is certainly OBHIC’s hope that increased
program awareness of and improved injury treatment techniques will continue to bring down our injury incident rate.
Although it would be useful to compare injuries and deaths for outdoor
programs and indoor residential and psychiatric programs, such figures are, surprisingly, not even collected. Based on the two states
that do track fatalities (one was New York), a statistician hired by the Hartford Courant extrapolated an estimate of 50 to 250 residential
treatment deaths nationwide per year from restraints alone. Judging from those figures, possibly indoor treatment is more dangerous
than outdoor treatment.
For parents and referral sources, it might be insightful to compare
these risks with those incurred while a child is living at home. According to the National Center for Injury Prevention and Control,
the overall injury fatality rate for white 15 to 19 year olds is 1.5 deaths in 1 million days, or, about 80% what it would be if they
were in a NOLS program or, in our estimation, an OBHIC wilderness treatment program. For a troubled teenager, incurring many additional
risk factors, the chances of serious injury or death while living at home are almost certainly higher than while participating in
Based on OBHIC’s 1998 data, a 50-day program with 7 adolescents
in a group could expect a group to have about one injury, one illness, and one evacuation every third 50-day outing. As a parent of
four active children, that sounds similar to what happens to the healthy kids in my home.
There is no way we can keep our children completely safe from injury
and death; to do so, we should certainly not let them drive, or even get into a motor vehicle during their teen years. Complete safety
is an impossible goal. Instead, humans apparently calculate the risk of an activity against their perceptions of the activities’ value
Professor Gerald Wilde, a specialist in risk analysis, argues that
humans are excellent intuitive calculators of risk, but only to the degree of accuracy of the data used to make our judgments. Thus,
we may miss opportunities by over-responding to occasional sensational reports of incidents.
I hope this article will serve to extend and clarify the relevant
databases for all of us who work with the outdoor treatment field, and for those parents who entrust their adolescent children to
us for the growth and healing that outdoor adventure and treatment can provide.
[OBHIC programs which have contributed incident data for this
research are Anasazi, Aspen Achievement, Catherine Freer, Red Cliff Ascent, and SUWS.]
Copyright © 2000, Woodbury Reports, Inc. (This article may be reproduced
without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)