Outdoor behavioral healthcare (OBH) programs subscribe to a multimodal treatment approach within the context of wilderness environments and backcountry travel to facilitate progress toward individualized treatment goals. The approach incorporates the use of evidence-based clinical practices including individual client assessment, individual and group psychotherapy conducted and/or supervised by licensed clinicians, and the development of individual treatment and aftercare plans. The myth of the “continuum of care” talked about by behavioral healthcare experts that consists of services in schools, outpatient, inpatient, day treatment, and accessible residential facilities is a growing concern among behavioral healthcare experts and presupposes the demand for services like OBH. The growing demand and increased awareness of OBH services makes the evaluation and assessment of outcomes critical.

The four specific aims that guided this study were to assess: 1) the readiness and motivation to change problem behaviors of adolescent clients at admission and discharge, including treatment satisfaction at discharge; 2) client’s substance use histories and the prevalence of substance use disorders at admission, discharge, and followup; 3) depression, anxiety, and stress symptoms at admission, discharge, and follow-up; 4) and the therapeutic alliance between client-to-client and client-to-therapist and two distinct periods during the treatment process. A total of 872 clients were involved in the study. The median treatment length was 49 days; the study population was predominantly male (68%) and Caucasian (81%), with one-third being female and approximately 15% representing other ethnic origins. Three-quarters of all clients received some type of substance use diagnosis (75.2%), one-fifth were diagnosed with only a mental health diagnosis, and one-half were dual diagnosed with both a substance use and a mental health diagnosis. Three-quarters of all clients in this sample had tried at least some form of outpatient counseling services prior to OBH.

Readiness to change results at admission suggested that 44% of the sample demonstrated a lack of action on addressing any problem issues in their lives, and were not actively thinking about any personal problems they may have had. They were merely going through the motions and maintaining the status quo. An additional 30% of the sample was characterized as being reluctant to take action on a problem, although they had begun to think about it to some degree. Almost one-third (28%) of the sample were in the participating profile and demonstrated an active participation to address issues they personally felt were important to their well-being. At discharge, 90% of the sample had shifted to either an active participation or a maintenance profile, suggesting a shift to actively working on issues that may have brought them to treatment.

Depression, anxiety and stress domains showed significant improvement for males and females from admission to the six-month follow-up period and remained in the mild category for both genders at 6 months, suggesting maintenance or continued improvement in these domains after treatment. No significant differences were found between those that utilized inpatient or outpatient services for aftercare across these three domains. Regarding substance use frequency outcomes at six months, it appears that OBH treatment may be an effective treatment for reducing the frequency of substance use, especially the more serious substances, following the intervention. This is evidenced by the data that showed significant reductions in frequency of use across the range of mental health diagnoses and aftercare types used following treatment. However, though use was significantly reduced, as much as half the sample of adolescents had reported using substances in the previous three months. Those clients who were currently in residential aftercare reported significantly less use than did those in outpatient settings.

Study participants were asked at 6 months post-treatment to rate their relative satisfaction with the treatment process. The majority (67%) would recommend the program to friends in trouble, and 58% stated their problems were a great deal better, with 33% stating they were somewhat better. Over 60% said they would return to the program if they ever had a need, while 23% said they would not. When asked about aftercare plans and their value to helping them post-treatment, over 80% said they remembered staff assisting them with their aftercare plan, and 70% said the plan was helpful.

I gratefully acknowledge the technical reviewers of this publication. While their comments, suggestions, and insights helped us greatly improve the document, they bear no responsibility for the final presentation. I also gratefully acknowledge Nevin Harper, Jonathan Sweet, Marta Fahrenz, and Michael Walsh for their help in working with the publication. Administrative staff at each program also plays a critical role in helping to gather data, and I appreciate their commitment to the project. Finally, and most importantly, I would also like to thank all the adolescents and their families for their active participation in the evaluation.

• Peer Reviewers Rob Cooley, Ph.D., Catherine Freer Wilderness Therapy Expeditions, Albany, Oregon



• Thomas J. Doherty, Psy.D., Clinician and Supervisor, Catherine Freer Wilderness Therapy, Portland, Oregon



• Alan Ewert, Ph.D., Professor, Patricia and Joel Meier Outdoor Leadership Chair, Department of Parks and Recreation Administration, Indiana University, Bloomington, Indiana



• Michael Gass, Ph.D., Professor, University of New Hampshire, Durham, New Hampshire



• Lee Gillis, Ph.D., Professor, Department of Psychology, Georgia College and State University, Milledgeville, GA



• Gil Hallows, Chairman, Outdoor Behavioral Healthcare Industry Council, Loa, Utah



• Mike Merchant, Chief Operating Officer, Anasazi Foundation, Mesa, Arizona



• Sandy Newes, Ph.D. Clinical Supervisor, Phoenix Outdoor, Asheville, North Carolina

• Anasazi Foundation, Mesa Arizona


• Aspen Achievement Academy, Loa Utah


• Catherine Freer Wilderness Therapy, Albany Oregon


• OMNI Youth Services, Buffalo Grove, Illinois


• Redcliff Ascent, Springville, Utah