Experiences of secure transport in outdoor behavioral healthcare: A narrative inquiry

Often synonymous with wilderness therapy, outdoor behavioral healthcare (OBH) is a residential treatment in the United States for young people, more than half of whom are sent via secure transport services. While empirical evidence suggests the secure transport of adolescents to OBH does not impact quantitative outcomes, limited research exists exploring client voice and the lived experience of OBH participants. This qualitative study, utilizing narrative inquiry, builds knowledge on experiences of secure transport services from nine past OBH adolescent participants. Findings are analyzed, interpreted, and discussed through a social work and trauma-informed lens. Recommendations for ethical practice, linking with human rights, and future research are provided.

The Value of Outdoor Behavioral Healthcare for Adolescent Substance Users with Comorbid Conditions

The damage inflicted on our society by mental health and substance use issues is reaching epidemic proportions with few signs of abating. One new and innovative strategy for addressing these comorbid issues has been the development of outdoor behavioral healthcare (OBH). This study compared the effectiveness of three post-acute adolescent substance use situations: OBH, treatment as usual (TAU), and no structured treatment (NST). The simulated target population was 13-17 years old with comorbid substance use and mental health issues. When costs were adjusted for actual completion rates of 94% in OBH, 37% in TAU, and $0 for NST, the actual treatment costs per person were $27 426 for OBH and $31 113 for TAU. OBH also had a cost–benefit ratio of 60.4% higher than TAU, an increased Quality in Life Years (QALY) life span, societal benefits of an additional $36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument.

A Qualitative Gender Analysis of Women Field Guides’ Experiences in Outdoor Behavioral Healthcare: A Feminist Social Work Perspective

Rationale: Social work has long supported activity-based group work for young people. One such approach includes outdoor behavioral healthcare (OBH), also known as wilderness therapy, which often employs nonclinical field staff to lead outdoor activities as part of the overall treatment model. Although men and women both serve as field guides, the culture of OBH has historically been male-dominated, at times obscuring the voices and perspectives of female staff in the field. For this reason, a feminist social work lens was employed in order to engage in a qualitative gender analysis of women field guides’ experiences in OBH. Methods: Focus groups were used in this study to better understand gender as experienced by individuals who identify as women working as field guides in OBH. Findings: Results indicated that women experienced gender at intrapersonal, interpersonal, and program levels in ways that contributed to both empowerment and obstacles to leadership roles and longevity in the field. Identified needs included training for all staff on gender, women in leadership roles, and all women’s spaces. Practice Considerations: Implications for social work practice are discussed, aimed at supporting women’s development and creating work environments most conducive to learning and growth for staff and clients alike.