The role of transport use in adolescent wilderness treatment: Its relationship to readiness to change and outcomes

Abstract

Purpose: When adolescents are resistant to treatment, families are faced with the challenge of how to engage them, sometimes against their will. This phenomenon has led to the use of youth transport practices by some residential programs. From a social work perspective there are ethical concerns related to the involuntary treatment of adolescents like limits to self-determination. Hence, this study of adolescent participants in a private pay wilderness therapy residential program addressed the following questions: Did youth who were transported present differently at intake than youth not transported to the program? What were the outcomes for participants who were transported to the program different compared to those not?

Methods: This study used the The University of Rhode Island Change Assessment (URICA) to measure readiness to change in youth, and the Youth Outcomes Questionnaire (Y-OQ) to measure youth functioning as reported by youth and parents. Clients attending a private pay wilderness therapy program and their parents were asked to complete these measurements at intake and discharge. Data were collected from 350 youth from 2006 to 2011 (50% male/50% female; predominately White). Of the 350 clients, 14 more clients were transported to the program than not. On average, the participants were 16 years old (range 13-19 years) and stayed at the program for about two months. Independent samples t-tests with Bonferroni corrections compared intake means and paired samples t-tests with Bonferroni corrections and effect sizes (d) were calculated comparing means pre and post.

Results: At intake, youth reported no significant differences across escort status in levels of Readiness to Change or dysfunction as measured by the Y-OQ. The parents of transported youth however reported significantly higher levels of dysfunction for their youth as shown by the Total Y-OQ scores as well as larger social problems compared to non-transported youth. At discharge both youth and parent reports showed significant increases in functioning with discharge scores within normative levels of functioning and large effect sizes. Parent reports also reflected improvements large enough to be considered clinically significant according to the YOQ’s reliable change indexes.

Implications: According to the findings, youth who were transported were perceived by their parents as more acute at intake supporting possible reasons for why parents chose to transport. Transport has been referred to as a last resort when parents have exhausted all options. The study also revealed that both groups improved similarly as measured by their Readiness to Change and YOQ scores. Put simply, transported youth did as well as non-transported youth supporting the idea that the act of transporting did not negatively affect their treatment. This is an important finding for social work practice due to the ethical questions that arise out of transporting practices. Hence transport services provide options for parents and youth who may not receive the treatment they need otherwise. Finally, wilderness therapy was shown to have positive impacts on youth participants with large effect sizes and clinically significant improvements, supporting this intervention as an important option for adolescents in need of residential treatment.

Department

Social Work

Publication Date

1-1-2014

Journal Title

The Society for Social Work and Research (SSWR) 2014 Annual Conference

Publisher

Society for Social Work and Research

Document Type

Presentation

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