Welcome to IECA’s resource library, where you can download research, white papers, podcasts, and articles for all specialties, including school, college, therapeutic, learning disabilities, international, and the business of independent educational consulting.

This page is frequently updated so visit here often. If you would like us to include a document or materials in this section that you think your colleagues would benefit from, please contact Sarah Brachman at [email protected].

Four Ways to Help Families With a Special-Needs Child Plan for the Future 

By Rob Wrubel, Partner, Cascade Investment Group

A family of four that I know has two parents and two children. One child is physically disabled and in a wheelchair, visually impaired, and has developmental disabilities. The other child is typical and does not have any special needs. These parents embrace both children with love, they have passion for each day, and they believe life is better for them with each of their children in it. But they do have extra stress, worries, and fears about the future for their daughter with special needs, particularly as they also consider their other child’s college aspirations.

Parents and caretakers of people with intellectual and developmental disabilities (I/DD) or other special needs live with more stress than most families, but there are several steps they can take to reduce their fear of the future and their daily worry. Independent educational consultants (IECs) and other professionals who work with those families can have a significant impact by just helping families understand a few basic concepts and working with them as part of a team to produce positive outcomes.

1. Encourage families to make time to plan for the future. Thousands of thoughts stream through our heads each day—some are meaningful, some are bad 80s songs we can’t shake (thank you, Duran Duran). Planning starts the moment a person stops the music, takes a deep breath, and writes down what he or she wants to have happen in the future. For many families, sitting down to think about the future is difficult and they must rely on professionals to move forward as they think about educational needs and other future steps for their children. IECs are crucial to that effort because they can support families in the process of intentionally working on what is important in their lives. This step can create anxiety and a sense of loss that you can help them overcome by directing them toward desired outcomes and appreciation of the positive aspects of their lives.

2. Be aware of benefit program basics. Most IECs are working with families while children are still in school, and families will be very involved in just getting kids through their education. It’s never too early for parents to be thinking about adulthood, however. IECs should be aware that adults with intellectual and developmental disabilities (I/DD) who have qualifying disabilities have access to government provided benefit programs that can make the difference between a high quality of life and one lived on the margins of existence. The two most important programs are Supplemental Security Income (SSI) and Medicaid.

SSI provides a monthly income benefit to an individual of $750 per month in 2018 and some states add extra to this. To receive the benefit, the person must have a qualifying disability, have low earnings, and not have more than $2,000 in countable resources— bank accounts, investments, and other items readily turned into cash count as resources. A primary residence and vehicle are excluded.

IECs may wish to advise clients that the process to receive SSI starts with a visit to the local Social Security office. A person must be 18 years or older and families should prepare by assembling documents to show that the disability means the person will not likely be able to find gainful employment and to prove the lack of resources for the person applying. Medical and school records are helpful in showing the disability.

Medicaid also provides a variety of supports, including medical benefits and programs often called comprehensive services. SSI is generally the gateway for those benefits so getting and maintaining SSI is a high priority. Finally, some people with I/DD receive Medicare and Social Security Disability Insurance (SSDI) payments, which are worth inquiring about.

3. Organize for emergencies. There’s no way to predict when emergencies will occur, but there are steps to take to make them easier to handle. IECs often speak with families about “back up” and Plan B programming, but it is worth also encouraging families to work with their financial planner and attorney to be prepared for contingencies. Families should put together a binder or file folder with important documents so someone else can step in to help when necessary. Those files should include legal documents (wills, trusts, powers of attorney, guardianship papers, and the like), financial resources information, and important medical information. The goal is to make it easy to have someone else help if the parent or a loved one cannot. Families can let the attorney and others know about the IEC’s involvement so that they can continue to serve the child if parents are unable to. IECs are often crucial to the continuity of care.

4. Encourage the family to build a strong team. Special-needs planning outcomes improve when family members and their advisors work as a team. Financial planning, legal, tax and other family advisors each have expertise and a different vantage point when providing advice. Federal benefits can provide families with tens of thousands of dollars of support each year, freeing up funds for education and other goals. Families will also want to investigate setting up a special-needs trust and ABLE Act accounts. A special-needs trust is the foundational element of planning. The trust allows families to have money available to create a higher quality of life than is available through government subsistence programs alone. ABLE Act accounts are a new tool that lets a person receiving SSI have access to funds and build savings without creating a countable resource.

IECs should seek to build relationships with related professionals who have expertise in special-needs planning. There is no specific designation for that type of planning, so just keep asking the financial, legal, and tax advisors in your community to advise you about who specializes in that area and you will soon find the leading advisors in your region.

Families rely on your expertise to achieve their life’s goals and bring their dreams into existence. Special-needs planning integrates the work of families, complex government systems, and caring, competent professionals. By helping some of your clients start the planning process, you can help an adult with an intellectual or developmental disability lead the highest quality of life possible.

Rob Wrubel can be reached at [email protected] or 719-632-0818.

Program Descriptions for Teens with Emotional or Behavioral Disorders

Boarding Schools (Emotional Growth, Therapeutic)

These schools generally provide an integrated educational milieu with an appropriate level of structure and supervision for physical, emotional, behavioral, familial, social, intellectual, and academic development. They grant high school diplomas or award credits that lead to admission to a diploma granting secondary school. Each school will vary in their approach to the emotional and behavioral needs of the child and we urge parents to review this approach with the professional that has been working with their child to ensure appropriate placement. Placement at these boarding schools can range from 12 months to two years depending on the program’s therapeutic components.

Outdoor Behavioral Health (Wilderness Programs and Outdoor Therapeutic Programs)

Most outdoor behavioral health programs subscribe to a variety of treatment models that incorporates a blend of therapeutic modalities, but do so in the context of wilderness environments and back country travel.  The approach has evolved to include client assessment, development of an individual treatment plan, the use of established psychotherapeutic practice, and the development of aftercare plans. Outdoor behavioral health programs apply wilderness therapy in the field, which contains the following key elements that distinguish it from other approaches found to be effective in working with adolescents: 1) the promotion of self-efficacy and personal autonomy through task accomplishment, 2) a restructuring of the therapist-client relationship through group and communal living facilitated by natural consequences, and 3) the promotion of a therapeutic social group that is inherent in outdoor living arrangements.

Residential Treatment Centers

The focus of these programs is behavioral support. Medication management and medical monitoring is generally available on-site. These facilities treat adolescents with serious psychological and behavior issues. Most are Joint Commission (JCAHO) accredited. These facilities provide group and individual therapy sessions. They are highly structured and offer recreational activities and academics. Specialty residential treatment centers will include psychiatric and behavioral hospitals as well as eating disorder treatment centers.

Small Residential Programs

Small residential programs are designed to serve fewer than 30 students in nurturing, often family-like settings. Small residential programs offer a holistic therapeutic milieu, which is based upon the relationships formed and the social dynamics created in small, intimate environments. They offer appropriate levels of structure and supervision for the emotional, social, and academic development of their students.  These programs often incorporate life skills training, academic instruction, outdoor adventure, recreation, and family involvement into an experiential living environment. Small residential programs often maintain an area of specialty for the students they serve.

Transitional Independent Living/Young Adult Programs

These programs are designed for young people over 18 needing a safe, supportive environment and life skills training as they transition into adulthood. Many offer access to 12-step programs and may have a psychiatric component. Generally they will offer educational programs that are linked to community colleges or universities, or provide schooling at their location. Volunteering, employment arrangements, community service, and re-integration into the community at large are general components of the programs. Many operate on a small residential model and transition to a community based, independent living apartment model.

IECA acknowledges with appreciation the National Association of Therapeutic Schools & Programs who developed these descriptions.

Breaking up Is Hard to Do: Addiction and Attachments

By John W. Tucker, Executive Director, Vista Taos Renewal Center

There is a great George Thorogood song called, “I Drink Alone.” When I was 16, it seemed clever. Looking back on it now, I understand it through a much different lens. In the song, George declared that he “drinks alone, with nobody else. You know when I drink alone, I prefer to be by myself.” What he drinks, we quickly learn, is also who he drinks with. There’s Jack Daniel, his buddy “Weiser,” Johnnie Walker, and his brothers Blackie and Red. And together they drink alone, with nobody else. Many brands of alcohol take on personalities, implicitly or explicitly. As a marketing strategy, it’s brilliant. It is not a mistake that street drugs are referenced as people: Molly, Mr. Brownstone, Mary Jane…The language reflects the experience of the user. They are not merely taking a drug; they are entering into a relationship.

Within the treatment industry, many are beginning to see addiction through the lens of attachment. We have all worked with young clients who defend marijuana with a passion and vigor usually reserved for the defense of a friend. Many of us have seen young heroin addicts, fully aware of the physical devastation wrought upon them, yet, unable to break free, much like those caught in an abusive relationship. An ostensive definition of addiction (not an exclusive one) may be that addiction occurs when attachment to substances becomes stronger than the attachment to people.

Understanding Attachment

Attachment rests on the experience of the predictability of primary caregivers. In utero we become accustomed to our mother’s voice, the rhythm of her breath, and her heartbeat. As infants we reach out to the world to find patterns, order. As toddlers we experience our primary caregivers as permanent, unchanging, and predictable. Secure attachment continues to develop as the child experiences a caregiver’s return after short absences. The caregiver’s predictable, pattered emotional responses further strengthen the attachment. The securely attached child can then generalize the process of attachment to other people with whom they come in contact. Attachment is an act of faith. We never know for certain the intentions of another. Yet, as a tribal, social animal whose young require many years of rearing, the process of attachment is necessary for survival. It is because of this that we experience attachment as a need. Attachment is beginning to be seen not as a secondary drive but as fundamental as sex, thirst, and hunger. With regard to mental health, the degree to which a person can regulate their own emotions is determined by the length and strength of their earliest attachment experiences.

As evidence of the internal intentions and motivations of others, we can only rely on what we see and hear, what someone does and what they say. From this data we draw our conclusions. Yet in every perception there is a lifetime of memories. This data is filtered and distorted by previous experience. Some may experience the sarcasm of another as witty; others as a hurtful personal attack. Some of us see the attention of another as proof that we are their best friend ever in the whole wide world and we are going to do everything together; others see it as a brief opportunity to connect before ways are parted once again.

Similarities Between Attachment and Addiction

The neurology of attachment mirrors that of addiction. In both, specific structures in the brain, amygdala, and hippocampus, as well as certain neurotransmitters and hormones (dopamine, serotonin, norepinephrine are involved as well as the hormone oxytocin). Recall an early love or attraction, how it crowded out and pushed aside other parts of your being, filling the void left behind. Remember the impulse, the impatience, the anticipation. Recall the soothing, the comfort, the intense presence of the moment. It fades. For some, fear, doubt, and anxiety invade. A future without this connection seems to lack meaning. Friends may use reason and logic to comfort us; in the moment it falls flat. They fear the loss the harder we hang on. We begin to confuse need for this relationship with the need to survive. We begin to recall, with euphoria, the peak experiences. For others, a new search for the intensity of that connection begins. With focus and purpose, we know we will succeed. The addict’s relationship with the substance of addiction is similar if not identical.

For an adolescent or young adult client whose attachment to substances often occurs simultaneously with sexual attachment and bonding, addiction treatment must be considered within the wider context of the attachment and relationship to others. A client may see others as unpredictable, judgmental, and disloyal; their substance of choice fills this void. It possesses with certainty that which we doubt in others. This is precisely where the “personality” of a program and the specific presumptions upon which the treatment approach rests are important. To understand a relationship, one must understand the needs it serves. To understand addiction, an exclusive relationship, one must understand that the needs it serves, deeply wired and neurologically significant.

John Tucker can be reached at [email protected]

Using Research to Help Select the Best Therapeutic Program for Clients

By Michael Gass, Ph.D., LMFT, University of New Hampshire

Selecting and recommending the best therapeutic program for clients is the objective of every Independent educational consultant (IEC). Until now this process has been somewhat subjective, dependent upon an IEC’s past experiences with programs, the strong marketing efforts of therapeutic programs, and often times anecdotal or hearsay evidence of program outcomes. Until now, the use of more objective and third-party-evaluated evidence has been sorely lacking.

Organizations such as NATSAP (National Association for Therapeutic Schools and Programs) and OBHC (Outdoor Behavioral Healthcare Council) have recently devoted the time and resources to establish various research projects to assist IECs and their clients. This has led to establishing rich sources of additional information to provide even more appropriate placements for clients. Objective research data benefits IECs by:

(a) Informing an IEC’s knowledge of specific programs’ efficacy with particular types of students, enhancing their program recommendations and their confidence in these recommendations; and

(b) Providing IECs with the ability to share with and educate parents on the types of programs (ideally across levels of care) that have demonstrated the best outcomes for a child such as their own; and outcome data on specific programs, providing additional credibility to both the IEC as well as the parents in the program they ultimately choose.

Client-Centered Outcome Research
Positioned by itself, research can often be impractical for clients. When determining the best fit for their child, “p < .05” statistical values contain little solace for parents who wish to know the answers to questions such as:

“Will the program work for my child?”

“Will my child be safe?”

“How can I tell a good program from a bad one?”

“Is the program worth the money I’m going to spend?”

While not the only source of information on these critical questions, recent developments of research in the areas of client outcomes, risk management, program accreditation, and cost-benefit analyses have greatly enhanced the ability of IECs to help clients make proper placement decisions. Such efforts to center research results around the needs of clients have made these research mechanisms invaluable in the decision-making process.

Effective Client Treatment
In terms of program effectiveness, NATSAP participating programs have led the way with the development of a Practice Research Network (PRN). This research database contains outcome data from 59 programs and 3,000 clients with data acquired at intake, discharge, six-month follow-up, and 12-month follow-up. As seen in Figure 1, with enough data, effective programs can show their ability to take clients in therapeutic need, assist them in achieving healthy changes, and maintain such changes for up to one year following program discharge.

Programs that have accumulated appropriate amounts of data in the database should also be able to show their effectiveness with clients presenting specific issues (e.g., show how successful this program is with adolescent girls with eating disorders, depression issues, and suicidal ideation). And finally, not only are these researched programs able to tell clients whether their programs produce statistically significant changes in the child, but also whether or not they produce clinically significant changes (e.g., “Was the therapy treatment effective, so the client no longer possess the criteria for the diagnosis?”) as well as practically significant changes (e.g., “Gains from the treatment approach were large, with 85% of the group experiencing positive changes, 14% remaining unchanged, and less than 1% regressing during treatment.”).

Risk Management
In the 1990s, the wilderness therapy field was sometimes an inappropriately dangerous place for clients. But since that time, a number of professional programs have bonded together to radically change the field and create a level of safety that distances the professional practices of outdoor therapy from past inappropriate practices. In fact, programs belonging to OBHC have demonstrated that their participants were about two times less likely to visit an emergency room for an injury incurred than the average American adolescent engaging in various activities. Figure 2 [on page 12] illustrates the comparison of OBHC injury rates to those of other common activities.

One example comparison is that injuries during high-school football games are over 328 times more common than injuries experienced in OBHC programs. Note that IECs should be careful not to over generalize these figures to all wilderness therapy or outdoor behavioral healthcare programs. But all programs should be able to show their accident/incident rates for at least the past 10 years of operation.

Program Accreditation
Recently, the OBHC invited the Association of Experiential Education (AEE) to jointly embark upon an expansion of their existing standards to better reflect the field’s current practices. This resulted in the creation of a detailed set of ethical, risk management, and treatment standards created by longstanding leaders in OBH, adventure therapy, and wilderness programming. OBH Accreditation is a voluntary credentialing program for OBH providers, where a third-party team of experts in the field scrutinizes programs. Accredited OBH programs have demonstrated that they operate at or above industry-leading standards of ethical care, treatment evaluation, and risk-management practices.

New and Expanding Ways IECs Can Play Key Roles in the Research Process

One exciting and new initiative is to include IECs in the research process, allowing them to play a key role in furthering the field as well as improving services for their clients. No group of professionals is better positioned to collect valuable research data. The ability to track client progress from the initial inquiries of parents to the final conclusion of services is the domain of independent educational consultants alone. Recent efforts by NATSAP have been joined by the Best Notes and Outcome Tools companies to assist IECs in the data-collection process. Nearly a dozen IECs have already joined this exciting initiative and expanded their ability to demonstrate to clients—in statistical, clinical, and practical ways—how they are improving in their treatment outcomes. Interested IECs are encouraged to contact the OBH Council, NATSAP, Best Notes or Outcome Tools to see the ease, practicality and efficacy of these processes.

Michael Gass can be reached at [email protected]

From LD to ED: Learning Differences and Co-morbid Therapeutic Issues

By Marcia Brown Rubinstien, M.A., IECA (CT)

If you see a client with a diagnosed learning disability who claims to be completely free of co-morbid social, emotional, or behavioral issues, you should close your office and enjoy a happy retirement. Your work is done. However, since most of you reading this article are presumably still working, it’s important to understand the unholy alliance of LD and counterproductive behavior that is both the boon and the bane of a special needs practice.

Dr. Don Dresher, director of the Center for Research on Learning at the University of Kansas, believes that “Learning is an emotional, visceral, affective experience before it’s a cognitive one.“ It comes as no surprise, then, that children, adolescents, and adults with LD show increased risk for co-occurring anxiety, depression, and even suicide. In fact, some psychologists believe that the anxiety of being a different learner can start as early as kindergarten, when teachers, parents, siblings, and peers notice that a child can’t keep up.

Children with LD are often frightened by the differences they notice when comparing themselves to peers who learn typically. Some compensate with severe separation anxiety, some are plagued by nightmares. Others develop school phobia. Many students with LD find ways to deflect attention from their learning issues through impulsive and inappropriate behaviors. Compounded by teasing and frustration, the learning disability becomes the governing force which determines a child’s emotional well-being. By the time children with LD enter middle school—that developmental incubator committed to commonality—they work hard to carefully conceal differences from clothing to cognitio. Those who are not successful in masquerading as typical often adopt extreme presentations of self that indicate their disdain for the norm.

Once thought to be the domain of the stupid or sluggish, learning differences are now recognized empirically as variations in neurobiology that cause brains to process information differently. When the only brains available for exploration were found in cadavers or in jars of formaldehyde, it was difficult to understand the workings of neurological diversity. Today, however, modern science, like Functional MRI and similar technology, has shown us that learning disabilities are direct consequences of atypical neurobiology. Differences in structure affect the brain’s ability to receive, process, store, respond to, and communicate information. New awareness of brain function clarified by modern science has helped us understand that LD is not related to IQ and can affect all levels of cognitive ability.

To understand why therapeutic issues are so often co-morbid with learning disabilities, we must examine the persistent and counterproductive differences that LD can generate across the full range of a child’s coping mechanisms, including expressive and receptive language skills, compensatory behaviors, motivation, and social adaptation.

First, it is important to remember that all humans have uniquely structured brains. The differences among us determine who will be a math wizard, who a gifted orator, who an intuitive empath, and who has a built-in GPS that orchestrates directional genius. These differences are accepted, and even celebrated, when they are positive and productive. However, differences which cause discrepancies or delays between age-appropriate expectations and accomplishments are disdained.

The process for determining whether or not a child has a specific learning disability is part of the problem. Federal guidelines require lengthy and detailed observations by parents, teachers, and diagnostic professionals. Unfortunately, children whose learning issues already predispose them to frustration, exclusion, and bullying, must undergo a lengthy process of prodding, poking, and public scrutiny before they can receive services to remediate exasperating deficits. A group of diagnostic professionals must monitor a child’s pattern of strengths and weaknesses to determine who is eligible for services. Data must demonstrate that the child received appropriate instruction in regular education settings, delivered by qualified personnel.

To complicate matters, everyone’s learning process is unique. Learning disabilities vary in scope and severity from person to person. In endless manifestations, LD affects each person differently across a range of fundamental developmental tasks, such as reading, writing, understanding math, listening, speaking, reasoning, and reading social cues.

Dyslexia serves as a great example of the way learning differences can be a hothouse for the development of co-morbid emotional problems. Most education professionals, even those who do not claim expertise in the field of LD, are familiar with the concept of dyslexia, commonly considered a difficulty with reading. Dyslexia seems easy to understand and observe. In fact, many of us who think we understand dyslexia even joke about it when we inadvertently reverse a letter or misspell a word.

It is unnerving to learn, however, that even experts trained to define and categorize LD have trouble standardizing the description of dyslexia. Some define it simply as a learning disability affecting reading. But when we consider the multiple abilities that must combine to produce fluent reading, we realize that dyslexia is actually an impairment of the ability to interpret spatial relationships or to integrate auditory and visual information. With this in mind, we begin to understand how a child who is frustrated by reading in class might be equally frustrated by interpreting playground rules or peer culture.

Samuel Orton, one of the first researchers to describe the emotional aspects of dyslexia, discovered that dyslexics develop anxiety because of their constant frustration and confusion in school. Some become fearful and avoidant of new events. Unfortunately, avoidance of situations that might highlight their problems—like reading aloud or preparing homework—can be interpreted by schools as laziness or oppositional behavior. This lack of understanding causes the dyslexic to feel frustrated and angry. Unresolved anger can cause depression. Some students with LD-related depression implode privately, but we are all frighteningly aware of what can happen when such a student explodes publicly.

IECs who counsel students with diagnosed learning disabilities must be acutely aware that cognitive difficulties are rarely confined to the classroom. They must take care to understand diagnostic assessments and specific issues in order to make the right match between the student and a recommended school or program.

Whether or not LD is indicated in parent or school reports, it is critical to take a thorough history before considering placement. Learn to ask what behaviors or incidents prompted educators to label a child “unmotivated” or “oppositional.” Be sensitive to the possibility that behavioral disturbances are simply another manifestation of learning difficulty.

To complicate matters even more, some people have a single, isolated learning problem that has minimal impact while others have several overlapping disabilities. When a parent tells you, “She used to have LD in third grade, but that’s over now,” don’t disregard the information. Learning disabilities are lifelong conditions that should be recognized as a factor in the journey of every individual diagnosed.

To make a placement that honors the individual and not the disability, IECs must remember that the appropriate school or program will recognize a student’s deficits as well as his or her assets, will encourage self-advocacy, will support a positive self-concept, and will anticipate problems before they occur. The best environment for a student with LD and therapeutic issues will minimize competition and encourage collaborative learning.

In today’s competitive world, learning differences are living differences. They don’t exist in a cognitive vacuum, and they can’t be encapsulated in an isolated area of the brain. Though the LD/ED combo can be complex and perplexing, it can be solved through the fundamental technique of good educational consultation—one step at a time. Remember, though, that some of your students will skip up that step, while others run and fall. Make sure to keep a first aid kit in your office—stocked amply with both literal and figurative Band-Aids.

Marcia Rubenstein can be reached at [email protected]

Wilderness Therapy Models

By Jenney Wilder, MSEd, IECA (UT)

Wilderness therapy is founded on the philosophies of educator Kurt Hahn’s Expeditionary Learning and is now world-renowned as the Outward Bound model, where value is imparted by group participation, embracing challenge and immersing into the natural world. Wilderness therapy adds to this foundation by including professional therapists responsible for attending to participants’ treatment plans. In more explicit terms, Dr. Keith Russell’s brilliant 1999 dissertation defined wilderness therapy as including “a sense of adversity and challenge confronting the client; the use of natural reward and punishment allowing authority figures to step back from the role of the provider of consequences; a peer mentoring process; a feeling of group development; physical exercise from hiking and wilderness living; time for reflection; an emphasis on self-care and personal responsibility; skill mastery, particularly primitive skills and the making of fire; and a strong therapeutic relationship between the client and staff.” There remains inconsistency in the research of what precisely does or does not constitute wilderness therapy, but programs continue to objectively analyze and bolster anecdotal claims of what is happening “in the woods.”

In fact, individual programs and the industry’s associations now seek to prove which experiences, lengths of immersion, models, specific diagnoses, etc., are the critical aspects that generate “efficacy.”

And why does this matter to you? Well, for therapeutic independent educational consultants (IECs), despite the wide variation in delivery models of wilderness therapy, the daily presentation of the model, the program’s academic/emotional curriculum, and your deep knowledge of the client are the three key aspects to making a recommendation to the “right” wilderness therapy program.

Nomadic Model

Nomadic means that a group intends to remain self-sufficient, works toward group accomplishments and that the student will be responsible for packing his/her own equipment in a fitted backpack for the duration of their wilderness experience. Hygiene occurs in the field. Food (and often, “city” water) is resupplied periodically for the group and, unless a medical emergency comes up, the student is immersed in as complete a “wilderness experience” (24/7 for the entire enrollment) as the program can manage.

The therapist for the student drives out to the field for formal weekly group and individual therapy sessions. The therapist may or may not stay overnight with the group. The model and training matter, however, when the therapist leaves since much of the therapeutic tension and treatment plan challenges occur outside of therapy days and during the experiential aspects, beyond the direct observation of the therapist. For this reason, the instructors/field staff act as critical contributors in the treatment team.

Nomadic wilderness therapy programs might have adventure therapy aspects (ropes course, rappelling, mountaineering, whitewater rafting experiences) built in as brief interventions or as part of the natural progression hiking from one location to another but use the routine and friction that naturally develops in small group living to enhance a challenging, safe therapeutic milieu.

Base Camp

In a base camp model, the adolescent or young adult will return to a base camp, generally weekly for a shower, to meet with the therapist and to replenish food supplies. This is a place for the student and the group to refuel, metaphorically and literally. The base camp usually has modern plumbing (including toilets, showers), rudimentary beds, and a location-specific programming. Base camps usually provide time and logistical convenience for written work and are often the locale for visits from parents and other professionals (e.g., psychological evaluators).

There are three different subtypes of base camp wilderness: adventure therapy, backpacking, and horticulture therapy. All three of these different models use the wilderness in different ways to effect change. Adventure therapy might involve different experiences where the student will be in a car getting from point A to point B to have the mountain biking, skiing, hiking, or climbing experience. Most base camp backpacking programs will have the student come back to the base camp for hygiene and programming that is tied to the base camp specifically. Horticulture therapy allows the participant to experience and see change using a sustainability and botanical parallel. In this model, students practice stewardship, develop practical skills focused very clearly on a community’s future benefit, and do not move out of the camp for the duration.

Many base camp programs provide excitement via peak experiences to invite self-reflection. Several programs report that their base camp model becomes a home-like experience for the adolescents and young adults, meaning their maladaptive behaviors from home emerge and become overt at the base camp.

Integrated

A less discussed model of wilderness therapy includes programs that incorporate wilderness as the first phase of their model. There are not a lot of these programs, but they are an option to consider for clients who may not transition well or just need less time in the interventional wilderness therapy program to effect necessary changes. It is always hard, before the intervention, to predict the length of time needed. Programs that have a wilderness component can always resend the student to the wilderness therapy portion of the program if they need a tune-up during their process.

Therapeutic IECs understand the nuance and differences between these models in general; the expertise comes in constantly assessing the therapist and model specialization related to their client’s need. IECs must stay informed about the new wilderness diversity available for treating autism spectrum disorder, sensitively helping with trauma assessment, programs designed to work with whole family systems or clinically complex clients, and those trained to confront substance abuse and assessment. Knowing how to tease out what is needed for the client and family and speak about why a model (therapist and program) is being recommended is the expertise that therapeutic IECs bring to an initially confusing and complex dynamic.

Jenney Wilder can be reached at [email protected]

Residential Anxiety Treatment

By Don Vardell, executive director, Mountain Valley Treatment Center

According to the National Institute of Mental Health, eight percent of US teens suffer from an anxiety disorder during their school-age years, with symptoms typically beginning at age six. Only 18 percent of these teens seek mental health treatment. As this statistic will no doubt increase, the need for specialized anxiety treatment in outpatient and residential environments will grow. Although outpatient therapy can achieve results for some, a short-term and intensive residential treatment environment is warranted when the anxiety causes major interruptions in daily living, such as repeated school or social avoidance. A specifically focused residential treatment center or RTC can provide comprehensive and consistent clinical interventions and support that can’t be achieved in a home-based community setting.

Many parents of children with debilitating anxiety can trace the start of symptoms to elementary school, but often don’t find effective help until early adolescence, when academic requirements become more challenging. As a result, families resort to managing the anxiety and behaviors in accommodating ways that unknowingly make it worse. Although many teens in RTCs have had outpatient therapy, their results have been limited, because many community-based clinicians are not well-versed in effective treatment modalities for anxiety disorders. Additionally, the work to “retool” the family to stop accommodating their child’s anxiety may be difficult to do consistently in a nonresidential setting.

Anxiety and related disorders, such as phobias and OCD, are treated with cognitive behavioral therapy (CBT) approaches, specifically exposure and response prevention or ERP, a treatment technique that was developed to help people effectively confront their fears. When people are fearful of something, they tend to avoid the feared objects, activities, or situations. Although this avoidance might help to reduce feelings of fear in the short term, it can exacerbate such feelings in the longer term, sometimes generating behaviors that become detrimental to everyday life and well-being.

Exposure therapy is designed to help break the pattern of avoidance and fear. Gradual exposure to the feared objects, activities, or situations in a safe and nurturing environment can help adolescents  decrease avoidance, recognize irrational thoughts and behaviors related to fears, and engage in healthier and more fulfilling activities and relationships. Although ERP can be implemented in an outpatient setting, a controlled and focused residential treatment environment can provide better results for severe anxiety. ERP in a residential setting will in some ways look similar to what may have been done with an experienced therapist at home—gradual and repeated exposure to the anxiety causing stimulus, time for habituation to occur, and anxiety symptoms decreasing—however, a residential environment allows for repeated in-vivo (real world) and more intense exposures where cumulative data can be collected. An RTC also ensures a greater number of professionals will be working with the adolescent and family system, which is hard to achieve with home-bound teens.

When a family and independent educational consultant (IEC) have determined that a residential placement is needed, a program with a structure and model that supports the delivery of ERP should be considered. A comprehensive and specialized anxiety treatment program that utilizes ERP would typically include:

• Multiple and extended ERP groups weekly where students receive education about ERP and participate in exposure activities

• Cohort work on exposure scenarios where two or more students can develop an exposure plan for similar fears

• Intra- and intersession exposure work with a trained therapist or specialist and opportunities to “rehearse” confronting fears in vivo

• Data collection during the exposure assignments that includes cumulative rating of the anxiety (scale of 1–10), documenting and communicating thoughts, describing physical sensations, and acknowledging safety behaviors

• Exposure work supplemented by weekly individual and family therapy.

Although a program that specializes in anxiety with a strong clinical component is paramount, the programmatic structure of a residential program should also be fun and include an environment to support exposure therapy. Consider whether the program includes experiential and recreational activities to develop skills and explore passions and other evidenced-based elements to help with anxiety, such as mindfulness activities like yoga, nutrition education and healthy meals, and fitness and outdoor activities. Programs should also have the ability to support the academic needs of the student.

Terminology

As a student and family become immersed in a residential treatment experience, they will pick up a new vocabulary. The following are examples of terminology related to activities used in specialized anxiety treatment:

Fear Hierarchy. A list of a student’s phobic situations and objects ordered from the least to the most fear-provoking. Early on in residential treatment, a therapist will work with a student to develop their Hierarchy to inform the gradual exposure therapy plan.

Safety Behaviors. Actions to prevent disaster that inadvertently prevent the disconfirmation of maladaptive threat beliefs. Safety behaviors can “work” for a student, but they will not effectively expose them to the feared situation; therefore, they do not help the student develop healthy coping strategies for the feared object or situation. For example, someone who has a fear of public speaking may develop a safety behavior, such as having to wear a certain article of clothing before the presentation, but will not develop the ability to make a presentation without the clothing article, thus continuing the cycle of anxiety around public speaking.

SUDS (Subjective Units of Distress Scale). A relative measure of anxiety, usually on a scale of 0–10. Each student develops their own scale based upon their personal physiological, cognitive, and behavioral symptoms when faced with an anxiety-provoking situation. This scale is used during exposure therapy to track habituation and desensitization to fear stimuli.

Interoceptive Exposure Therapy. An exposure therapy process commonly used to treat Panic Disorder. During interoceptive exposure, a person purposefully and systematically induces the physical symptoms of panic and anxiety, absent from any actual fear stimuli. This assists in promoting desensitization to the uncomfortable (and feared) physiological symptoms that often play a role in the development of panic attacks.

Imaginal Exposure. Exposure to the fear stimuli through a discussion about the stimuli, conjured images of the feared stimuli, or thoughts of the feared stimuli aided by written or recorded verbal material. This process allows people to slowly face their fears with a greater sense of control and safety. Imaginal exposure is often used as an entry into exposure therapy when a person is highly fearful and avoidant. Imaginal exposure can also be effective in treating fears that cannot be readily reproduced (e.g., anxiety associated with a past experience or a specific person or place). A student with a fear of vomiting (Emetaphobia) will be exposed to situations where he/she vomited by writing a story about the situation, gradually adding more information about the situation/scenario, and identifying rituals associated with avoiding those situations. Exposing the student to sounds of vomiting; fake vomit; and actually replicating a vomiting situation, such as emitting water out of the mouth, will support the exposure work.

Habituation. Describes the process of anxiety reduction (achieving physiological homeostasis) over time without the use of safety behaviors or avoidance of the feared stimuli. Experiencing anxiety habituation in the face of a fear stimulus is believed to help develop new learning in regards to the actual threat (or lack thereof) posed by a certain object or situation.

Intrasession habituation describes achieving habituation during a single exposure therapy challenge. For example, a SUDS peak rating of 8 out of 10 and a final SUDS rating of 4 out of 10 when a person is exposed to a fear stimulus.

Intersession habituation describes achieving habituation between exposure therapy challenges, thereby reducing the unwanted fear response or distress during the subsequent exposure challenge. For example, “Yesterday when I saw the dog, my anxiety peaked at 8 out of 10. Today when I saw the dog, my anxiety only peaked at 6 out of 10.”

In Vivo Exposure. Simply putting the student in real-world situations that will evoke the fear multiple times whereby the self-rating of the student’s anxiety will reduce.

Expectation Violation. A concept that is highlighted when completing exposure challenges to promote new learning. This concept aims to highlight the discrepancy or mismatch between someone’s feared outcomes of an exposure challenge and the actual outcome. This concept is especially important to highlight when the person has difficulty experiencing anxiety habituation during exposure challenges.

Family Accommodation. Coping strategies the family system engages in to manage fear-provoking situations at home that actually reinforce the feared object or situation. One example is a family that eliminates green food items from the entire house because the student has a fear of green-colored food. A residential anxiety treatment program will include significant work with the family on eliminating accommodating behaviors and learning how to support the student’s exposure work during and after treatment.

No matter what treatment environment is warranted or selected, creating a collaborative network of professionals and providers will net the best outcome. Residential programs typically work alongside IECs and other referral sources as well as parents and at-home providers to support a student while at the program and through a successful transition. As awareness and impact of anxiety disorders grows, knowledge of effective and available programs should as well.

Don Vardell can be reached at [email protected] or www.mountainvalleytreatment.org

References

Wilson, Reid and Lynne Lyons. 2013. Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous & Independent Children. Arlington, VA: Health Communications Inc.

Abramowitz, Jonathan S.,  Brett J. Deacon, and Stephen P. H. Whiteside.  2011. Exposure Therapy for Anxiety: Principles and Practice. New York: The Guilford Press

Educating the LGBTQ Student in the 21st Century

By Carlton Rounds, Director of Educational Partnerships with Cross-Cultural Solutions

For nearly 30 years I have worked with young people. I have been an educational counselor for young people of many races, nationalities, abilities, and socioeconomic circumstances.

I have counseled students who are lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ); HIV positive; homeless; abused; undocumented; gifted and talented; mentally ill; and addicted. I have worked with those who are refugees, who have been affected by gangs, and who are coming out of correction facilities. Whether they are in elite prep schools, suburban public high schools, or GED programs for homeless teens in the Bronx, each student is a universe unto him- or herself. I share my story to help support your work with students in the LGBTQ community.

As acceptance for gay people gains national legal and cultural recognition, the backlash to the movement has created increased violence and painful rhetoric targeting the gay community, specifically its youth. The 24-hour media cycle exploits those conflicting narratives, barraging watchers until they are numbed to the destructive intent of the message. Although the conversations can be shocking, the fact that they are happening so publicly can be a positive thing because it exposes hateful agendas. But I have to wonder, How does a young person in the process of exploring their sexual orientation or gender identity react to this kind of constant mixed messaging? I feel fear, and I wonder if they do too.

A Safe Space

As a youth, I was very sensitive to the opinions of others and my peers. As part of my personality development, I looked to people surrounding me for role models and encouragement. For gay youth, there seemed to be only two options for self-preservation: to retreat inside or to rebel with vigor. I chose the vigorous route. Adults interpreted my teenage persona and behavior in ways that usually resulted in suggestions for me to conform (for my own safety) so that my soul could be saved or so that I would not encourage other “different” youth, like me, to question and challenge authority structures. It never occurred to anyone that it might not be me that needed to change, but instead their own behavior and beliefs.

As a sophomore in a remedial class reserved for youth who confronted the status quo, I met the educator who changed my life and my trajectory. She created a safe space in her classroom where I could escape the beatings, share my feelings openly, and engage in critical thinking about the world. She recognized something special in me, something worth nurturing and defending. She allowed me to take off the armor, breathe, and be a vulnerable teenager. She also helped me understand how profoundly gifted I was as a young man, as an activist, and as an intellectual. To be very direct, she saved my life. She understood that my resistance was actually a reflection of amazing resilience, and she became the conduit to opportunity and college.

Self-Awareness

If 1 out of 10 people are on the LGBTQ spectrum, current educators are already working with this target population with various levels of success. Like any other population that continues to experience marginalization, discrimination, judgment, or unequal treatment, a best practice for one group is likely to be a general best practice for another. For the sake of this discussion, I am going to focus on the gay community, but I feel that gay could be substituted with female, Muslim, Black, poor, disabled, foreign, and so on.

Many educators are distracted by what they can readily observe about a young person and use a visual identity marker as an initial point of reference. For identities that cannot be seen, it is necessary to engage other methods. What process do you have in place to explore apparent or unapparent aspects of identity? If you are talking to me as a White man, an easy visual marker, and I answer as a gay man, would you be aware enough to shift your focus? What are your own experiences with the diversity of human identity? How might you benefit from revisiting your own biases or opinions that are informed by your age, gender, class, race, region, religion, upbringing, or experience? Do you have someone to process this exploration with?

Curiosity and Cultural Humility

Categories and labels are traps, as are assumptions. The gay community, young and old, is incredibly diverse and always has been. If your goal is to specifically establish rapport with cultural humility when advising a young person, it is crucial to be curious and to take the time to learn. Out of respect and as evidence of authenticity, do your homework. If you feel that you are already very fluent in gay culture, you are likely mistaken. The gay community has evolved at a rapid pace, even gay people can hardly keep up with terms, attitudes, and trends.

When was the last time you read a LGBTQ  history book, and discussed it with a gay friend or colleague? When did you last visit a gay community center or gay youth group near you? If you are working with a gay young person, do you know enough to help them contextualize their experience historically? Is your gay concept outdated? Are you using gendered language rather than neutral words?

This kind of approach will not only support your work, it will strengthen your relationships with your community. Find what resonates with you about the gay community and become a real part of the narrative. Find yourself in the history, and when you do, share that connection. Go deep and disclose. If you take that risk, students are more likely to reciprocate.

Permission

For young people who identify openly as LGBTQ, it is possible to ask direct questions, but only with their permission. Many young people are engaged in an inner process of identity development and not keen to ascribe to a fixed point nor externalize it. They may disclose parts of their identity exploration with different groups, but rarely share everything with just one individual. Imagine that each young person is on a spectrum with many layers and it will take some time to sort out the nuances. If you feel like you are beyond your comfort level, do you have a diverse set of colleagues to call upon?

Language and Visual Cues

Many young people will express an emerging gay identity with words or markers that are used to test your tolerance and acceptance of people who are perceived as different, without the mention of sexual orientation. Gay people will also look for visual cues that signify safety.

Is your meeting space filled with gender-specific objects and images? Do you have a prominent and visible inclusion message in your materials and your meeting space? Does it list gay and an extensive list of other identities? Gay is only one identity and likely intersects with other identities that may not be culturally accepted or understood. Do you realize that with some youth, the word queer is now not an insult and may not refer to sexual orientation, but rather the rejection of unexplored and outdated social constructs? Asking for feedback on language in ways that are not confrontational, but rather clarifying, can be helpful.

Once again, don’t assume gender pronouns. Use neutral ones to signal that you are aware that there are people in the world other than straight people and that they deserve to be linguistically accommodated. Gender neutral language is a huge cue to gay people that you have some level of awareness and use it to include all people, not just those you think are gay. Are your terms up to date? Have you processed the emotional responses you may have to language that has been updated, revised, reclaimed, or recoded? For example, ask about my family, not my Mom and Dad, because straight kids sometimes have gay parents.

Trust

Appreciate that any young person who feels different inside—or has been made to feel different—is managing some level of alienation, anxiety, and fear. Those feelings can make it more challenging to trust another person, especially an adult who is in a position of power. For many youth who are exploring their sexual identity, they are already expecting judgment, profiling, and perhaps public exposure. For some, their college financing may hinge on successfully hiding their sexual orientation from you and their parents. If they seem afraid, trust that they are afraid for a legitimate reason. Respect the boundaries they set. You may be totally accepting, but that is about you and your world-view, and may not be shared.

Parents

Parents may have suspicions about the sexual orientation of their children, and some have likely given inconsistent messages over time about how they feel about gay people. Their level of awareness regarding this dynamic and its influence may not be very evolved, or they may feel guilt and respond by overcompensating or overprotecting. In my experience, one parent is likely to be more supportive and the other the more critical. A young person’s sexual orientation— and anything else they share in confidence— is not the property of their parents. It can be a difficult dance balancing the integrity of the relationship with your young person (the client) while still meeting the needs of the parents (your customer).

Colleges

There are many resources [see list at the end of this article] that explore how open and welcoming various universities are to gay people. Schools that have bad reputations with gay issues and safety are not viewed, in general, as socially or academically progressive, and are thus less desirable. That makes sense. If gay people are not safe, it is usually reflective of a campus atmosphere where other groups are at risk, including women, minorities of color, and international students. This can mean that to keep a high rating, colleges and universities underreport abuses, inflate reputations for diversity, and project public images that are very different than the lived reality of their students.

Sad to say, but different regions of the country have very different interpretations of what gay friendly means. There is a difference between being actively tolerated and being empowered and included. Investigating the reality of diversity on campus has to involve an organization’s entire faculty, staff, and funders. There are many masks of inclusion worn by colleges and universities that have a shameful lack of diversity hiding at upper levels of decision making.

College Essays

I support the desire for young people to explore their sexual orientation or gender identity through writing. They should never receive the message, no matter how subtle, that disclosure is somehow inappropriate. Rather, anchoring the exploration of identity and the process of self-awareness in a larger context is key. Colleges are looking for critical thinkers who can engage complex ideas and concepts. In short, being gay is not more instructive than any other minority group, it is how the student interprets their world that gives it power and relevance.

Another way to address an identity issue in the college application without having to claim any singular identity is to write about a leader in the gay community and his or her journey, impact, and strengths. You do not need to be gay to find a parallel with a gay narrative. For a young person who is still exploring, it can be very powerful to give them permission to choose another minority group that they admire. Comparing and contrasting different groups’ challenges and opportunities can show maturity and expanded thinking. Finally, it is crucial for the student to share what more they want to learn; what questions they hope to explore about themselves and the world; and how those inquiries speak directly to the college’s learning community, values, and academic strengths.

Breathe

If you do your homework, build your LGBTQ professional allies, increase your fluency with gay culture, and find your unique connection to difference, you will do great. Gay people are resilient, adaptable, and like many other minority groups, responsive to those who make the effort to authentically connect. Mistakes will happen, misinterpretations will occur, but you and your young person will survive.

Carlton Rounds can be reached at [email protected]

Resources:

Campus Pride: www.campusprideindex.org/default.aspx

“The Gay and Lesbian Guide to College Life” www.randomhouse.com/princetonreview/catalog/display.pperl?isbn=9780307945013

LGBTQ scholarships: www.finaid.org/otheraid/lgbt.phtml

Point Foundation (National LGBTQ Scholarship Fund): www.pointfoundation.org

Momentum in Outcomes-Informed Treatment

by Mike Petree, ACMHC, Research Systems Consultant, Outcome Tools

Historically, treatment programs have managed to run successful businesses without proving treatment effectiveness—at least in the private-pay mental healthcare field. It’s not that clients and professional referents aren’t asking for outcomes, as any admissions personnel can testify, it’s that the vast majority of programs have no outcomes data and no motivation to collect it unless market forces require them to do so.

When the topic of success rates arises, common responses include clever diversions, such as raising philosophical questions about what “success” really means, sharing a favorite anecdote describing one client’s success, or referring the potential customer to an ecstatic alumnus.

Today, however, a growing number of treatment programs are researching effectiveness and can respond to the question of success by authoritatively stating, “Our program works! We’ve been measuring for years.”

Current Landscape

Currently the National Association of Therapeutic Schools and Programs (NATSAP) and the Outdoor Behavioral Healthcare Council (OBHC) are working with more than 70 programs to build an outcomes database, using an electronic system called Outcome Tools to collect the data. These data are compiled in a large database and processed annually by Dr. Mike Gass and his team of researchers at the University of New Hampshire. The results, which show strengths and weaknesses in comparison to other programs, are provided to each contributor.

Although the project began with only treatment program data, several independent educational consultants (IECs) and interventionists have joined in the data collection. With their contributions, the data collected provide a richer view of the series of treatments, which often includes different programs and types of services. Referring professionals play a key role in rounding out the data set.

Participating programs, IECs, and interventionists use OutcomeTools, a web-based data collection system, to electronically administer a small battery of instruments, including the Youth Outcome Questionnaire for adolescent clients and parents; the OQ 45.2 for adult clients; the General Functioning Scale of the Family Assessment Device; and a demographic survey for clients, parents, and treating clinicians. At the basic level, these surveys are administered at admission, discharge, and 6 and 12 months postdischarge.

This battery of tools collects information about diagnostic history, treatment history, referring professionals, current symptoms, and other variables that are then correlated with the results of the OQ Measures. The OQ Measures serve as the backbone of the system and were developed specifically for measuring change. They come equipped with a clinical change index that, on the basis of the normative data used to validate the instrument, shows whether the differences in scores from one instance to the next are different enough to be considered clinical change.

IECA Involvement

IECA recently commissioned an analysis of the NATSAP aggregate to explore the differences in outcomes for clients who have and have not hired IECs. The results of that analysis will be compiled in an article authored by Dr. Stephen Javorski to be published in the summer of 2015. This analysis is the first of many future inquiries pertinent to professional referents and evidences the cooperative relationship between NATSAP and IECA. The relationship between outcomes and the involvement of a referent will be an ongoing factor in future data analysis.

The Professional Referent’s Role

Because of the influential nature of the relationship that referents have with treatment programs, IECs play a key role in forwarding their industry’s shift from practicing the art of therapeutic placement to practicing the science-informed art of placement decision making. Unlike treatment programs that can take years to shift culture and approach, IECs are nimble and swiftly adaptable players in the treatment process. IECs can learn about current research results and immediately incorporate new information into program evaluation and placement decision making.

For example, in an article in the January 2015 Child & Youth Care Forum, “The Role of Transport Use in Adolescent Wilderness Treatment: Its Relationship to Readiness to Change and Outcomes,” authors Anita Tucker, Joanna Bettman, Christine Horton, and Casey Comart examined the impact of transport services on outcomes. The sample size consisted of 350 clients. Their results showed that clients who were transported had equal or better outcomes than those who weren’t. Although hard conclusions cannot be made from this study alone, such results do provide empirical insight into the process and will have direct impact on therapeutic placement decision making.

Referents can begin to influence programs toward data collection by asking the following questions when touring programs:

1. Are you collecting and reporting outcomes data?

2. Are you involved in an aggregate outcomes research initiative?

3. What normed and valid instruments are you using to collect your data?

4. Is this process overseen by a neutral third-party entity?

Conclusion

The private-pay mental health field is moving toward outcomes-informed treatment. Aggregate databases, such as those sponsored by NATSAP and OBHC, are growing rapidly and results are influencing the treatment process. Professional referents can play a powerful role in increasing the strength of this movement by asking a few important questions when touring and assessing programs and by collecting and sharing outcomes data on their clientele.

For more information about how to become involved, please contact Mike Petree at [email protected]

Wilderness Therapy for Emerging Adults

By Judith E. Bessette, EdD, IECA (WI)

Like many of my fellow IECA members, I’ve noticed a dramatic upswing in emerging adult clients. Emerging adult is a term coined by Jeffrey Jensen Arnett, PhD, a leading expert on young people ages 18 to 25 (www.jeffreyarnett.com). With this area of need rapidly growing, it’s no surprise that programs serving emerging adults have grown as well.

Because I am especially interested in the growth of wilderness therapy or outdoor behavioral health programs, I recently posed several questions to 14 such programs—most were both adolescent and emerging adult programs and a few operated only with that older population—that offer young adult wilderness treatment:

• Why is this age group presenting with an increased need for treatment?

• What seems to be working?

• How do we know it’s working?

• What advice do programs have for parents and IECs working with emerging adults?

New Demands

In response to why programs had added emerging adult services, two themes emerged. First, the increased demand for emerging adult wilderness programming was initiated by families who had younger children who’d been successful in adolescent wilderness programs. An even more frequent reason cited for this increased demand was the economic downturn that began in 2008 that led to families putting off treatment until late in their teen’s 17th year or even until after a college experience (or two or three) had failed.

Second, although there has been more traditional treatment available for emerging adults with addiction problems for some time, wilderness options are seeing great successes in this arena. But substance abuse is only a fraction of what’s being treated. These young men and women are experiencing significant emotional problems—depression, anxiety, trauma, and attachment to name a few—and plenty are dealing with failure to launch. They need wilderness therapy that can provide a clinically intense intervention and teach both coping skills and life skills.

You may have first heard of failure to launch as a comedy starring Matthew McConaughey, but it’s no laughing matter. Arnett suggested that the changes in our culture over the last 50 years have led to a new developmental stage—the emerging adult. And just as society needed to accept the notion of adolescence over 100 years ago, we now must recognize this new developmental need. Wilderness may be just the ticket to assisting a client in working toward that launch.

Different Needs

Programs also reported that there are new factors in play that need to be addressed in working with emerging adults. Process addictions (especially screen time and pornography) are worse than ever, leading to inordinate and unhealthy levels of isolation. That isolation has contributed to a generation that has learned to objectify others, seeing them only as vehicles to be used, obstacles in their way, or irrelevancies to what they want. Wilderness programs offer emerging adults an opportunity free from distraction—that is, off the technology grid—to see the effect their life is having on others, to learn to take responsibility, to begin anew, and to build lasting and trusting relationships with family and others.

Increased screen time has also taken the place of other talent building. More and more emerging adults have very little success in or areas of competency outside of what they can do—or who they can be—online. Wilderness experiences force young adults to build talents, skill sets, and efficacy outside the computer.

In addition, the number of emerging adults diagnosed with spectrum issues is on the rise. Heroin is cheaper and more accessible than prescription drugs; in fact, many communities see its use as epidemic. Parents are having more trouble letting go. For example, some helicopter parents actually want, even expect, to go on job interviews with their emerging adults!

Although several programs talked about the importance of remaining “true to the basic tenets of wilderness therapy” in their young adult programs, they also identified a number of enhancements to their programs that have come about in just the last few years. The therapy has become much more sophisticated, and therapists as well as field staff are more highly trained. That is especially true as programs have become not only trauma-informed but are also actually treating trauma at a deep level.

Enhanced Programs

Wilderness therapy is more holistic than it once was, with components that address mind, body, and spirit. Programs are incorporating yoga, mindfulness, meditation, and even cultural immersion alongside more traditional wilderness experiences. Such additions add structure and strengthen the young adult programs. And although wilderness therapy has always honored a connection to the earth, horticulture therapy is now being used in some programs.

Several programs have also added more of an adventure therapy component to their repertoire and offer such activities as rock-climbing, rappelling, and canyoneering, which contribute to talent building and give emerging adults more skills with which to move into adulthood. There is also more emphasis on individualization versus a one-size-fits-all approach to programming and a far more collaborative attitude in working with emerging adults.

Family therapy and parent resources have also become more sophisticated as programs learn better ways to help parents develop a different kind of relationship with their emerging adult than they had with their adolescent child. Often there is a parallel process in place between the young adult in his or her work and what the wilderness therapist is doing with mom and dad.

A few programs discussed how important the concept of transition is for emerging adults as they move to the next step beyond the wilderness experience. Some programs offer opportunities for young people to participate in community experiences and then return to “the woods” to process and reflect on their experiences.

Wilderness training has always been rich in metaphor; one program likened the need for thoughtful transitioning for young adults to rehabilitating a wild bird in captivity. Suggesting that just as the bird is given structure and support to practice skills slowly, rather than simply being released on its own back into the wild, so young adults often feel that they are strong enough to fly and skilled enough to thrive immediately after leaving a wilderness program, but that sense of confidence can be a dangerous illusion without thoughtful transitioning.

Research

In 1996, several wilderness programs banded together to collaborate and share best practices. The founding programs realized the advantage of uniting to promote program standards and excellence. The original members served primarily an adolescent population, but today, the Outdoor Behavioral Healthcare Council (OBH) is 18 members strong and serves both adolescent and the emerging adult populations.

OBH partnered with the Association of Experiential Education (AEE) in 2013 to help expand AEE’s existing standards to better reflect current wilderness therapy practices and create an accreditation process for outdoor behavioral health programs. Among the various accrediting bodies, AEE stood out as the best organization to collaborate with because of its long-standing reputation in the field of experiential and adventure education, including more than 25 years of experience accrediting programs in the field.

The AEE-OBH Council partnership resulted in a detailed set of ethical, risk management, and treatment standards created by longstanding leaders in OBH, adventure therapy, and wilderness programming. To insure objectivity, AEE alone handles the actual accreditation process, which ensures a level of separation and accountability that is essential to the integrity of accreditation.

OBH has also sponsored the development of the OBH Research Cooperative (OBHRC) to facilitate research and find credible, objective information to answer the question, Does wilderness therapy work?

The work of the research cooperative is managed by the OBH Research Center, housed at the University of New Hampshire, and directed by Michael Gass, PhD, LMFT. Several research scientists work with the center, and it supports many aspects of OBHRC, including risk management, clinical research, accreditation, and insurance reimbursement, among other initiatives.

The National Association of Therapeutic Schools and Programs (NATSAP) is also involved in research endeavors. NATSAP is committed to helping its member programs  access pertinent research information and engage in the evaluation of their own programs. The organization publishes the Journal of Therapeutic Schools and Programs and manages the NATSAP Research and Evaluation Network. Go to www.natsap.org for more information.

Several studies of adolescent wilderness therapy programs have reported successful results in terms of programming effectiveness. Outcome studies have also shown that the gains made by teens in wilderness therapy are maintained over time. Similar research is now being conducted on the emerging adult population. The results for one of the first studies that demonstrates the efficacy of wilderness programming for young adults can be found at http://dx.doi.org/10.1080/0886571X.2013.852452. OBHRC also has projects going on in young adult wilderness programming. The early results of research on young adults appear to be similar to and as positive as the research for adolescents. Visit the Research section at www.obhcouncil.com to learn more.

Helpful Advice

Wilderness therapy programs working with emerging adults had some advice for both parents and IECs. Parents play an incredibly important role in young adult programming, especially in wilderness programs:

• Once young adults are over 18, they cannot be compelled to stay in treatment, so parents must be willing to find some kind of leverage to help keep their young adult engaged. Their resolve will inevitably be challenged at some point, but they need to be able to hold the line.

• Parents must be committed to treatment when it comes to working with young adults. Mom and dad have to do their own work to help the family system become stronger and healthier.

• Parents also need to understand that the emotional development of their young adult is probably limited in some way, and almost certainly if he or she has been using substances. On an emotional maturity level, they may be talking to a 14-year-old in a 19-year-old’s body.

IECs can help parents cope with all of the above and more by:

• Using soft reminders to parents that their teen or 20-something is, in fact, an emerging adult is one way to help.

• Helping parents understand their role as their child transitions into a functioning adult. Sometimes when that transition initially falls short, a parent can feel a sense of failure and attempt to compensate by over-parenting. In emerging adulthood, the parent’s role needs to shift from acting as a manager to more of a consultant. IECs can often help parents with that translation.

• Helping parents clarify the specific outcomes they are hoping for when choosing a program. IECs can encourage parents to write down their hopes and dreams and identify the hopes that are within their control and those that are outside of their control. Knowing what the parents are looking for is helpful in identifying the right program fit.

• And even though the emerging adult is that 18-going–on-14 kid, IECs can draw the young person into a dialogue about what they want and have an objective discussion that is often just not possible for parents to do.

Judi Bessette can be reached at [email protected]

Author note: Thanks to Anasazi, Aspiro, Evoke, Expedition Therapy, Legacy Outdoor, Medicine Wheel, New Vision, Open Sky, Pacific Quest, Red Oak, Second Nature, Summit Achievement, True North, and Wingate Wilderness programs for helping me write this article and special thanks to Dr. Neal Christensen, PhD, and Will White, DA, for going above and beyond!

Successful Transitions: From an RTC or Therapeutic Boarding School to a Traditional School

By Pamela Tedeschi, MSEd, IECA (MD)

Many students need therapeutic care during the middle school or early high school years, but they are not old enough for college when they graduate from the residential therapeutic school or program. Those students must be ready to complete high school in a more traditional school.

It can be difficult going back home from a therapeutic school. It is almost never a good idea for a student to go back to the same school that he or she attended before the therapeutic setting. The temptations from the old peer group can be difficult, and there may not be enough social life on the weekends. Often the best option after a therapeutic school is a traditional boarding school. Everything the student needs is on campus—e.g., classes, sports, and supervised study halls. It gives the student a fresh start in a new, welcoming community and helps him or her prepare for college living. The student is also less likely to slip into the old patterns that led to the therapeutic placement. A small independent day school may work as well as long as the student has meaningful activities after school. Unfortunately, the financial costs of attending a therapeutic school may make attending a subsequent independent day or boarding school impossible. If the student will be attending a public school, the parents should try to have the student transferred to a nearby public or charter school to give him or her a fresh start.

The Transition Team

Students have the best chance for success when the therapeutic program, the parents, the independent educational consultant (IEC), and the traditional school all work as a team. Each member of this team has responsibilities that contribute to an overall successful outcome.

Therapeutic School

The therapist and educational director at the therapeutic program should keep the IEC and the parents well-informed about the student’s progress in classes, the milieu, and therapy. The team of parents, the IEC, and the therapeutic program’s therapist and educational coordinator must agree that the student is ready to graduate and can be successful in a less restrictive environment. The educational director should carefully put together a transcript that accurately shows the student’s completed, graded courses. New testing may be needed for accommodations and for admission to an independent school.

A few additional considerations will help the student be prepared. Even if the therapeutic program’s policy is not to assign homework, when the student is getting ready to transition increasing amounts of homework should gradually be assigned. The student can complete it in a study hall or during free time so that it won’t be overwhelming to be placed in a new setting with required homework.

Students in therapeutic programs also participate in a lot of group therapy and share things that would not be appropriate in other settings. The therapist may need to help the student understand when and what to share about themselves in a less restrictive environment.

Graduation should be at a time when the student can start a semester or school year or during the summer. Graduating from a therapeutic program in March or mid-November, for example, creates problems with schedules. A student might have to wait until the next trimester or semester to start at the new school and then will have too much time at home. Even if the student is starting at a public school, coming in halfway through a semester or a quarter means that he or she will start off missing the beginning concepts. That could be overwhelming.

Parents

Parents should work closely with the professionals to determine the appropriate time for the student to graduate. They should participate in parent workshops; set a home contract with input from the therapist and student; meet with their student’s consultant to discuss appropriate next schools; and set up a time for the student to meet with the IEC, either at the program or during a home pass.

IEC

The IEC should carefully review all available information and be in touch with the therapeutic program about the student’s progress. The IEC should determine whether the student will need a school with learning support and how often the student will need to meet with a therapist in the beginning. The student and the IEC should discuss classes and types of activities and clubs that are of interest to the student—the student will find others with similar interests and become part of the community faster if he or she gets involved. After the very structured setting of a therapeutic school, the student will have more free time and getting involved in school activities will help keep him or her busy.

The IEC must listen to the parents’ expectations while also helping them learn about various school options. If the student will be attending an independent school, the IEC must be sure that the school is willing to take a student who is graduating from a therapeutic program. Some schools will accept students on an individual basis, depending on why the student was in a therapeutic setting and whether the student can be successful. Some schools have a blanket policy of never accepting such students. It is important that the school is open to considering the student and has supports in place, such as a counselor and learning support services. The IEC must make sure the school knows the student’s academic strengths and other talents and how the student would be involved in the school life. It is regrettable when a director of admissions only focuses on the therapeutic issues in the interview rather than getting to know the student.

The IEC should help the student and parents prepare for what is expected in the admission process and what to look for and ask during the visit and interview. If it is a boarding school, the IEC should determine whether the school has an appropriate counselor. If not, do students meet with therapists from the community? Is transportation provided or does the therapist come to campus? Transcripts and testing should be shared. If the admission committee has all of the information and accepts the student, the IEC should feel satisfied that the school will work with the student.

Traditional School

The last part of the team is the traditional school. Students from a therapeutic placement usually do best in a smaller school where they can get more-individual attention. The admission department, learning support director (if needed), and counselor should communicate with the IEC and the therapeutic school. They must ensure that the school can meet the needs of the student academically and socially and can get the student involved in the community. The student’s advisor must be carefully chosen. Questions that must be answered include, What classes does the student need to graduate? Will the student need to take classes over the summer? What nonacademic interests does the student have? What worked best at the therapeutic school? What causes stress?

Each student coming from a therapeutic school must be viewed as an individual. Therapeutic issues should not be the focus of the interview with the director of admission. The student coming from a therapeutic school has made mistakes, grown, and is ready to be involved in the new school or the IEC would not be considering a less restrictive environment. Just because one student from a particular therapeutic program flourished or failed at this school, does not mean the next student will follow the same path.

Best Results

There are no guarantees that any student will be 100% successful—he or she is still a teenager, after all. But a student who graduates successfully from a therapeutic program with supportive parents, an invested IEC, and both the therapeutic school and traditional school as part of the transition team has the best chance to assimilate into the new school.

Pamela Tedeschi can be reached at [email protected]

Expressive Therapies in Mental Health Work

Expressive Therapies in Mental Health Work

By Malissa Morrell, ATR-BC, LMFT, Director of Expressive Therapies at La Europa Academy

Through the ages, creativity and healing have been closely linked in human tradition. Medicine men, shamans, priests, priestesses, and other community healers often relied heavily on the power of song, spoken word, art, and even dance in their work. Instinctively, humans seem to recognize that creativity can play an important role in wellness.

Recently creative therapies have had strong exposure in the press and social media. With stories that include clear demonstrations of efficacy in clinical research trials and the boom in “art therapy” adult coloring books, popular culture seems to be turning toward the healing power of the arts. Musician David Bowie, who died of cancer in 2016, offers one example. His final album, Blackstar, is now recognized as a farewell album, written and recorded while the musician was secretly dying from cancer. It even includes a song titled “Lazarus.” Kate Middleton, the Duchess of Cambridge, is the official royal patron of an art therapy program in England. And actress Meryl Streep captured headlines because of an awards acceptance speech in which she quoted the late actress Carrie Fisher—a powerful mental health advocate and multitalented artist—as saying, “Take your broken heart, make it into art.”

Well that sentiment splashed all over social media for a few days, but what does it really mean to take a broken heart and turn it into art? How can we infuse the arts into mental health programming in the most effective and ethical way possible?

Standardizing Expressive Therapy Practice

For decades, professionals have worked to establish training and credentialing standards for the various creative and expressive therapies. These include art therapy, music therapy, dance/movement therapy, poetry therapy, psychodrama, and sand tray therapy. Professional associations, credentialing bodies, program accreditation, and ever-improving research have worked to legitimize and standardize expectations for these various professions and ensure that clients and patients are receiving the best possible care.

Currently, there is a push across the country to create licensure and title protection recognition for many of the expressive therapies. Because of the vast similarities in training and accreditation, creative therapists who graduate from certain master’s programs are becoming eligible for counseling licensure in many states. That opens the door for increased oversight as well as funding sources, such as insurance, and training opportunities

But why does all the training and credentialing even matter? Ancient healers didn’t need a license to perform their healing work, and many of us have experienced moments of insight or understanding from our own engagement in the arts. I often say that although it isn’t difficult to “stumble into” an insight, healing moment, or powerful reflection during personal art-making, working with a trained art therapist has the potential to maximize those healing moments.

Through understanding how various mediums, rhythms, body systems, and brain functions work together, creative therapists can select activities and design interventions for maximum benefit. We can also recognize important diagnostic and dynamic material as it emerges from a client’s creative work. Those of us who have the right training can translate and communicate those dynamics into traditional clinical language and become an important part of any treatment team.

The Future of Expressive Therapies

Despite economic recessions, political infighting about health care coverage, and the flood of do-it-yourself therapies attempting to capitalize on the magic of creativity, the future for expressive therapies seems good. Mental health care is increasingly in the spotlight and more and more important discussions about stigma and funding are happening at various levels of government and education.

Many universities, graduate programs, and training outlets, however, have recognized that although most expressive therapists are highly employable, not many job openings are titled “art therapist,” “music therapist,” and so on. Some graduate schools have begun to offer dual degrees: students take all the coursework needed for mental health licensure (such as counselor, marriage and family therapist, and the like.) while also getting the courses needed for board certification in their modality. Those double-threat therapists are qualified for any mental health job and can advocate their way into using their creative therapy skills within the construct of their mental health position. That way, expressive therapists who also have a counseling license can find employment in schools, mental health clinics, hospitals, retirement homes, hospice, residential programs, and other places where their specialties can bring value and marketability to their employers.

Benefits of Expressive Therapies

When all is said and done, incorporating expressive therapists into your team may bring a richer, more comprehensive understanding of a client’s strengths, weaknesses, and progress. It can also put a spin on therapy work that is needed for those clients who have had many years of therapy or treatment. All too often, those clients come equipped with the verbal skills needed to avoid, distract, and defend against the very work they need to do. For example, a young client once pouted at me during an art therapy group before exclaiming, “I hate art therapy!” She continued, “You get me all relaxed because I’m just playing around with paint, but then I actually have to look at my issues and they just stare back at me. I hate it!” As research continues to improve and demonstrate clear benefits, it’s important to consider a comprehensive, credentialed approach to creativity, wellness, and healing.

Malissa Morrell can be reached at [email protected]

Expressive Therapy Modalities

Each profession has its own set of standards, but here is an overview of the requirements for the most popular expressive therapies.

Music therapy is the only expressive therapy that allows someone to practice with a bachelor’s degree. It is also one of the best-researched expressive therapies, with practitioners using everything from enzymes in saliva to blood oxygen levels to measure what happens when clients are engaging with music therapists. When all the required education, supervised hours, and exams are complete, music therapists earn the title of MT-BC (board-certified music therapist).

Art therapy requires a master’s degree in art therapy, and art therapists can either be registered (ATR) or board certified (ATR-BC). Education at an accredited art therapy program includes classes in psychopathology, human development, therapy techniques, studio art, and research. Art therapists work with individuals, families, or groups to help clients put “unsayable” things into words.

Dance/movement therapy also requires a master’s degree and many hours of postgraduate supervision to achieve board certification as a BC-DMT. Dance/movement therapists must also become proficient in psychopathology, human growth and development, research, and movement observation.

[From IECA’s Insights newsletter, February/March 2017]