An Analysis of the Effect of the RedCliff Ascent Wilderness Program

By Steven Aldana, Ph.D.*
(Brigham Young University)
E-mail: steve_aldana@byu.edu

For more information about RedCliff Ascent: www.RedCliffAscent.com

Do wilderness therapy programs really help adolescents with behavioral difficulties? A recent study answers questions about positive changes in program graduates and the long-term impact on teenagers who complete the programs.

Wilderness programs such as RedCliff Ascent are relatively new forms of therapy that have not been subjected to the same outcome and effectiveness evaluations that have previously been performed on traditional mental health therapies. There is a substantial body of literature on how to assess mental health outcomes and what to expect from various therapies; however, evaluations of wilderness programs are not a part of that literature. In order to evaluate the effectiveness of the RedCliff Program, independent researchers have completed the first of several effectiveness studies which can directly answer the following questions: What percentage of program graduates can demonstrate significant clinical change? What long term impact does program participation have on teens who complete the program?

How Was It Done?
A number of participants of an outdoor therapy program were identified to provide data for the outcome study. All teens that started the program within a several week period were included. Parent reported measures of their teenagers mental health were gathered the day after their son or daughter was admitted into the program. Follow-up measures were taken 6 months later. Though most teenagers completed the program in 5-12 weeks, it was determined that long-term effectiveness measures would be more representative of long-term change if the study cohort were to experience several months of community living after completing the program. Of the original cohort of 64 sets of parents, 91% completed both the baseline and six-month measures.

To measure program effectiveness, an instrument called the Youth Outcome Questionnaire (Y-OQ) was selected. By definition, the Y-OQ is a parent reported measure of a wide range of troublesome behaviors, situations, and moods which commonly apply to troubled teenagers. It has demonstrated validity and reliability and has shown high clinical sensitivity and specificity. It is currently used in a variety of therapy settings nationally: inpatient, residential, outpatient, day treatment, and has become the "gold standard" for measuring youth mental health outcomes. The instrument assesses six different sub-scales: psychosomatic, interpersonal relations, intra-personal, social problems, behavioral disorders, and critical items (behaviors that require immediate medical attention ei. hallucinations and suicide). Each of the six sub-scales are used to calculate a total Y-OQ score.

Lets Put This in Perspective.
Figure 1 demonstrates the initial baseline Y-OQ scores which were collected from several inpatient and outpatient programs, in addition to the wilderness program and teenagers living in the community. The average wilderness program participant had Y-OQ scores similar to teens initiating both inpatient and outpatient treatment programs. As shown, teens living in the community had very low scores averaging 23.2 points. Due to the value of a standardized instrument, we are able to compare the level of functioning of youth entering these different treatment modalities in comparison to the community norm.

Did the Program Work?
The change in Y-OQ scores that occurred to the average wilderness program participant from baseline to six-month follow-up is shown in Figure 2; baseline scores were cut by almost half. Outcome findings from other mental health therapies have shown that a 13 point decrease in Y-OQ scores is considered reliable and clinically significant. For the participants in this evaluation, 53 of 58 or 91.4% demonstrated at least a 13 point drop and were considered to have experienced significant clinical change. Effectiveness evaluations of other inpatient, residential, and outpatient therapies have also shown that youth who have follow-up Y-OQ scores at or below 46 can be clinically labeled "recovered". In this wilderness program, 28 of the 58 students or 47% demonstrated Y-OQ follow-up scores of 46 or less. In other words, 47% of the teenagers in this cohort were considered to be clinically recovered six months after starting the program. How do these rates of recovery compare to recovery rates of other traditional therapies? Y-OQ data is currently available on the effectiveness of inpatient, residential, day treatment, and outpatient settings. In a report that combined the overall results of these different treatments, researchers reported that each of the therapies were able to demonstrate some improvement in Y-OQ scores (#4). The average recovery rate across all of these therapies was approximately 22%. Figure 3 compares the percent of wilderness program participants who were recovered at six months with the approximate rate of recovery for other teenagers immediately after completing non-wilderness type therapies.

Another notable outcome was the unusually low amount of deterioration which occurred over the six month period. Reviews of the mental health literature have repeatedly shown that 10-12% of all patients, regardless of whether or not they are receiving treatment, will deteriorate with time. Based upon this rate of deterioration, 10-12% of the 58 teenagers (6-7 students) in the study cohort could normally be expected to worsen during the six months of the study; however, close inspection of the data revealed that only two members of the cohort were worse after six months, and only three failed to demonstrate significant clinical improvements. This very low level of deterioration is atypical of most mental health therapies.

From this outcome study, it is possible to imply that 91% of youth who complete the program may expect to experience significant clinical improvement in mental health status, and almost half may be fully recovered six months after initiating the program. Because the study design was not a randomized clinical trial, it is impossible to prove that the program is solely responsible for these improvements in mental health. Despite this limitation, it is obvious that the program is responsible for most, if not all of the dramatic improvements demonstrated.

1. American Professional Credentialing Services LLC, Youth Outcomes Questionnaire,(1996).
2. Wells, M.G., et al. (1996). Conceptualization and measurement of patient change during psychotherapy: Development of the Youth and Adult Outcome Questionnaires, Psychotherapy: Theory, Research, and Practice, 33(2),275-283.
3. Tingey, R., et al. (1996). Clinically significant change: Practical indicators for evaluating psychotherapy outcome. Psychotherapy Research, 6(2),144-153.
4. Berrett, K.M., (August, 1998) Youth Outcome Questionnaire (Y-OQ): Item sensitivity to change. Paper presented at the Annual Meeting of the American Psychological Association. San Francisco, CA.

This research was conducted by Dr. Steven G. Aldana, a research design specialist and professor in the College of Health and Human Performance of Brigham Young University. Inquiries regarding this research may be directed to him by email or phone: steve_aldana@byu.edu (801)378-2145