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Bowen PhD Final Seminar 2016

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Title:
Adventure Therapy: Treatment Effectiveness and Applications with Australian Youth

Abstract:
This final seminar reviews the original contribution of Bowen’s (2016) PhD thesis to the field of adventure therapy. This thesis advances understanding of the therapeutic uses and treatment effectiveness of adventure therapy by systematically reviewing the efficacy of adventure therapy programs internationally (Study 1), providing an up-to-date profile of Australian outdoor adventure intervention programs for youth (Study 2), examining the efficacy of the Wilderness Adventure Therapy® model of clinical treatment for Australian youth (Study 3), and examining the efficacy of the PCYC Bornhoffen Catalyst program for Australian youth-at-risk (Study 4). Findings from this thesis strongly support the assertion that adventure therapy should be in the suite of therapeutic interventions that operate in diverse service settings across Australia. For more information, see http://www.danielbowen.com.au/research/PhD

Primary supervisor: Assistant Professor James Neill
Supervisory panel member: Professor Anita Mak

Title:
Adventure Therapy: Treatment Effectiveness and Applications with Australian Youth

Abstract:
This final seminar reviews the original contribution of Bowen’s (2016) PhD thesis to the field of adventure therapy. This thesis advances understanding of the therapeutic uses and treatment effectiveness of adventure therapy by systematically reviewing the efficacy of adventure therapy programs internationally (Study 1), providing an up-to-date profile of Australian outdoor adventure intervention programs for youth (Study 2), examining the efficacy of the Wilderness Adventure Therapy® model of clinical treatment for Australian youth (Study 3), and examining the efficacy of the PCYC Bornhoffen Catalyst program for Australian youth-at-risk (Study 4). Findings from this thesis strongly support the assertion that adventure therapy should be in the suite of therapeutic interventions that operate in diverse service settings across Australia. For more information, see http://www.danielbowen.com.au/research/PhD

Primary supervisor: Assistant Professor James Neill
Supervisory panel member: Professor Anita Mak

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Bowen PhD Final Seminar 2016

  1. 1. Daniel Bowen Doctor of Philosophy in Clinical Psychology University of Canberra (2012 – 2016) Adventure Therapy: Treatment Effectiveness and Applications with Australian Youth Primary Supervisor: Assistant Professor James Neill Secondary Supervisor: Professor Anita Mak PhD including Publication Final Seminar 29th July 2016 www.danielbowen.com.au/research/PhD
  2. 2. Presentation Overview Context of Project Definition of Adventure Therapy Aims and objectives of Thesis Contribution of the Thesis Overview of Studies 1-4 Implications Strengths and Limitations Conclusion
  3. 3. Context of Project • Ensuring that young people get the best possible start in life is central to the health, social inclusion, and productivity agendas of the Australian Government • At the forefront of a broad range of intellectual and professional agendas is the issue of what to do with ‘youth-at-risk’, and the need to protect, monitor, and sustain young people on the path to responsible adulthood • Current evidence suggests that youth health, education and crime is an important problem within Australia • Developing and using innovative preventative and intervention strategies which can effectively improve the health and well-being of young Australians is imperative.
  4. 4. Definition of Adventure Therapy (Bowen, 2016; Adapted from Pryor, 2009) Adventure Therapy (AT) involves: “use of small groups, nature-contact, adventure activities, and therapeutic processes to create opportunities for psychological change in participants, usually with the purpose of supporting an individual (or family) to move towards greater health and well-being.”
  5. 5. Aims of the Thesis Broadly, this project aimed to: • Consolidate and advance understanding of the therapeutic uses and treatment effectiveness of adventure therapy • Provide insight into the utility and therapeutic outcomes of Australian AT programs for youth Objectives:  Study 1: Examine the efficacy of adventure therapy programs  Study 2: Provide an up-to-date description of outdoor adventure intervention (OAI) programs and practices in Australia  Study 3: Examine the efficacy of the Wilderness Adventure Therapy model of clinical treatment  Study 4: Examine the efficacy of the PCYC Bornhoffen Catalyst program
  6. 6. Contribution of the Thesis • A comprehensive meta-analysis of the efficacy of adventure therapy programs around the world (Study 1) • A descriptive analysis of Australian outdoor adventure interventions (OAI) for youth based on a national survey of program managers and leaders (Study 2) • A research evaluation of the efficacy of the Wilderness Adventure Therapy® model of clinical treatment for Australian youth (Study 3) • A mixed methods evaluation of the efficacy of the PCYC Bornhoffen Catalyst program for Australian youth-at-risk (Study 4) Note - Each study has an associated peer-reviewed publication which is freely and openly available
  7. 7. Study 1 Meta-Analysis of AT Program Outcomes and Moderators Publication Status: Published Bowen, D. J., & Neill, J. T. (2013). A meta-analysis of adventure therapy outcomes and moderators. The Open Psychology Journal, 6, 28-53. doi: 10.2174/1874350120130802001
  8. 8. Broadly, this study aimed to:  Examine the efficacy of adventure therapy programs internationally through a meta-analysis of outcomes and moderators – There are currently no published meta-analyses directly concerned with adventure therapy across the life span.  Provide valuable insight regarding the utility and therapeutic outcomes of AT programs – In the 21st century, it is necessary for rigorous research to document the effect of adventure therapy programs, and analyse the contributing factors. • For: Boards, treatment facilities, funding bodies, policy makers and consumers. Study 1: Introduction Meta-Analysis of AT Program Outcomes and Moderators
  9. 9.  Established selection criteria – AT program; reported pre/post outcomes, 1960 or later; English  Completed a comprehensive search – Identified and obtained studies were included or excluded based on the selection criteria.  Data was extracted from included studies via a Coding Manual (Adapted from George (2011) and Wilson & Lipsey (2000))  Analysis (calculation of effect sizes) was completed using Comprehensive Meta-Analysis - Version 2  Additional comparisons were conducted to explore the existence of potential moderators Study 1: Method Meta-Analysis of AT Program Outcomes and Moderators
  10. 10. Based On:  2,908 effect sizes  From 206 unique samples located within 197 studies  Published between 1967 and 2012 Effect Sizes Pertain To: Treatment Group No. & % Adventure Therapy 2,275; 78.2% Alternative Therapy 335; 11.5% No Therapy 298; 10.3% Time Comparison No. & % Base-Pre 55; 1.9% Pre-Post 2,274; 78.2% Post-Follow-Up 579; 19.9% Study 1: Results Meta-Analysis of AT Program Outcomes and Moderators
  11. 11. Based On:  Participants: ~ 17,728 (M = 86.1; SD = 148.3 per study)  Gender: male (62.5%) and female (37.5%)  Age: between 9 and 64 years (M = 16.9; SD = 7.0)  Program location: USA (78%), Australia (13%), Canada (3%), Asia (3%), NZ (2%), & Europe (1%)  Program Model: Ropes/Challenge/Adventure-Based (42%), Expedition (27%), Mixed (21%), Base Camp (5%), Residential (4%), & Outpatient (1%).  Program length: 1-534 days (M = 63.5 days; SD = 148.0)  Mean time b/w Base-Pre: 20.8 days (SD = 15.3)  Mean time b/w Post-Follow-up: 181.4 days (SD = 276.0) Study 1: Results Meta-Analysis of AT Program Outcomes and Moderators
  12. 12. Overall Effect Sizes for Treatment Group by Time Comparison Interpreting Effect Size: 0.20 (small), 0.50 (medium), 0.80 (large) Study 1: Results Meta-Analysis of AT Program Outcomes and Moderators
  13. 13. Comparison of Different Types of Therapy Note: 1) As there are several noteworthy differences between adventure therapy and more traditional forms of psychotherapy, comparison of meta-analytic findings is problematic and should be interpreted with caution, and 2) as confidence intervals overlap, there are no significant differences between treatment types.
  14. 14.  Most substantial and robust meta-analysis of adventure therapy program outcomes to date.  Confirms that overall adventure therapy is moderately effective in facilitating positive short-term change.  On average appears to be maintained in the long-term.  Heterogeneity of outcomes indicates considerable variability, although little of variance appears to be explained by the measured moderators. Study 1: Discussion/Conclusion Meta-Analysis of AT Program Outcomes and Moderators
  15. 15. Study 2 Profile of OAIs For Youth in Australia Publication Status: Published Bowen, D. J., Neill, J. T., Williams, I. R., Mak, A. S., Allen, N. B., & Olsson, C. A. (2016). A profile of outdoor adventure interventions for young people in Australia. Journal of Outdoor Recreation, Education and Leadership.
  16. 16. Justification:  There is a lack of knowledge and understanding about current OAI programs in Australia (Pryor, 2009) Research Questions: 1. What are the characteristics of Australian outdoor adventure interventions for youth? 2. What are the perceived outcomes and benefits from participating in Australian outdoor adventure interventions for youth? Study 2: Introduction Profile of OAIs for Youth in Australia
  17. 17. Methodology:  National data set collected by Outdoor Youth Programs Research Alliance’s (OYPRA, 2011) – Survey collected information from program leaders (Part 1; N = 211) and managers (Part 2; N = 177) about the characteristics and qualities of outdoor programs offered to young people  Subset was selected on the basis of the main purpose or goals of the program – Programs which aimed to address problem behaviours (e.g., poor school attendance, drug use, depression)  Subset included 98 leaders and 24 managers Study 2: Method Profile of OAIs for Youth in Australia
  18. 18. Organisational Characteristics:  Programs were most often provided by: – Not-for-profit organisations (43%), followed by school/education (17%), community (13%), government organisations (7%), business/corporate (11%), religious (6%), and health (3%)  Respondents represented organisations from all states and territories – Program managers worked for organisations in Victoria (34%), South Australia (24%), New South Wales (12%), Queensland (12%), Tasmania (6%), Northern Territory (6%), Western Australia (3%), and the Australian Capital Territory (3%) Staff Characteristics:  Approximately two thirds of program leaders were male (63%)  Approximately half of the leaders were 18 to 40 years of age (54%), about a quarter (26%) were between 41 and 50 years, and 20% were aged 50+  Most or all field staff held relevant qualifications, including: – Outdoor education (26%), other education/teaching (26%), outdoor recreation/instruction (24%), mental health (21%), youth work (17%), community work (7%), physical education (5%), and other (40%) Study 2: Results Profile of OAIs for Youth in Australia
  19. 19. Program Design Characteristics:  The duration of Most or All programs was: – Less than 1 day (19%), 1 day (6%), 2 to 4 days (42%), 5 to 7 days (24%), 1 to 2 weeks (18%), and 2 weeks (29%)  Most programs were overnight journey based (57%), followed by: – Overnight hard-top programs (24%), day programs (18%), and overnight base-camp programs (13%)  The main mode of travel for journey-based programs was hiking (50%), followed by: – Canoeing (15%), cycle touring (13%), kayaking (9%), other (9%), and rafting (4%)  The most popular activity was hiking (50%), followed by: – Continuous ropes challenge courses (37%), canoeing (30%), initiative exercises (30%), environmental activities (28%), rappelling (23%), pioneer/bush/camp skills (23%), and giant swing/zip line (22%)  The most common theoretical frameworks featured in the program were: – Experiential learning (73%), challenge by choice (54%), facilitated reflection (52%), natural consequence (51%), and social learning (30%) Study 2: Results Profile of OAIs for Youth in Australia
  20. 20. Participant Characteristics:  Ranged in age from 8 - 22 years old (Mdn = 14, M = 14.0)  Programs ranged in size from 6 - 360 participants (Mdn = 27, M = 51.3, Mode = 8) – With similar numbers of males (Mdn = 11, M = 28.5) and females (Mdn = 11, M = 21.9).  Between 1 - 46 leaders were involved in each program (Mdn = 5, M = 6.5, Mode = 2) – Including male leaders (Mdn = 3, M = 3.94) and female leaders (Mdn = 2, M = 3.24).  Programs were most often conducted with mixed-gender groups (56%) – Boys-only groups were less common (18%), and no program managers indicated that most of their programs were for girls only  Participants were referred from: – School/education organisations (36%), community organisations (26%), government organisations (14%), not-for-profit organisations (10%), health organisations (10%), religious organisations (2%), and businesses/corporations (2%) Study 2: Results Profile of OAIs for Youth in Australia
  21. 21. Results:  Prototypical group: – Lead by a male who had worked in the sector for 10 or more years and who held a tertiary qualification – Approximately 10 participants, co-educational, with a staff to student ratio of 1:4  Most common type of program: – Takes place over two to four days in the outdoors – Involves adventure activities (hiking, continuous ropes challenge courses, and canoeing), – Involves group activities requiring team work, cooperation, mutual support and communication – Involves the intentional involvement of program leaders as a basis of learning. Study 2: Results Profile of OAIs for Youth in Australia
  22. 22. Results:  Surveyed staff perceived: Program leaders believed that:  The benefits lasted long-term (years) or lifelong (lasted forever). Study 2: Results Profile of OAIs for Youth in Australia Main Program Goals Main Program Outcomes Addressing problem behaviours Fun/enjoyment/recreation Personal development Personal development Social development Social development Fun/enjoyment/recreation Addressing problems behaviours
  23. 23. Study 3 The Effectiveness of Wilderness Adventure Therapy (WAT) Publication Status: Published Bowen, D. J., Neill, J. T., & Crisp, S. J. R. (2016). Wilderness adventure therapy effects on the mental health of youth participants. Evaluation and Program Planning.
  24. 24. Study 3: Introduction The Effectiveness of Wilderness Adventure Therapy (WAT)  WAT®, pioneered by Dr Simon Crisp, is a theoretically designed approach using evidence-based practice  However, to date, research evaluation findings have not been formally published Research questions: 1. What is the efficacy of WAT? 2. How do the effects of WAT compare to other forms of adventure therapy? 3. How do the effects of WAT compare to other forms of therapy?
  25. 25. Program:  Established in 1992 as a component of Australia's first clinical adolescent day-program at the Austin Health, Child and Adolescent Mental Health Service (Vic, Australia)  Manualised, 10-week, part-time program  Includes 7 day-based adventure activities (e.g., bushwalking, abseiling, cross country skiing, & white water rafting)  Includes 2 & 5 day outdoor expeditions  Parents, teachers and support workers participate in 8 AT- based sessions  Follow-up includes liaison with other agencies, group re-union, and school or placement outreach follow-up Study 3: Introduction The Effectiveness of Wilderness Adventure Therapy (WAT)
  26. 26. Participants:  Completed 1 of 8 WAT interventions in 2000 and 2001  36 adolescents: – 21 females & 15 males – Aged between 12-18 years (M = 14.6)  Self-report data collected: – pre-program, post-program and at three-month follow-up Measures Included: Study 3: Method The Effectiveness of Wilderness Adventure Therapy (WAT)  Resilience Questionnaire  Beck Depression Inventory  Youth Self Report  Coopersmith Self Esteem Inventory  C.O.R.E Family Functioning Questionnaire  Life Attitudes Schedule
  27. 27. Study 3: Results The Effectiveness of Wilderness Adventure Therapy (WAT) Short- & Longer-Term Effect Sizes for All Participants (n = 36) * indicates ES is statistically significant. An increase signifies improvement Note. All Short-term ES are within aged-based AT meta-analytic benchmarks, except Suicidal-Proneness which is lower than expected Outcome ES % Change ES % Change Resilience 0.49*  24 -0.30  15 Depression 0.46*  22 0.00 0 Behavioural & Emotional Functioning 0.36  18 0.03  2 Self-Esteem 0.26  13 0.06  3 Overall 0.26*  13 -0.06  3 Family Functioning 0.12  6 -0.58*  28 Suicidal-Proneness -0.06  3 0.43*  21
  28. 28. Study 3: Results The Effectiveness of Wilderness Adventure Therapy (WAT) Statistically Significant Short-Term Effect Sizes & AT Meta-Analytic Benchmarks for all Participants (n = 36)
  29. 29. Study 3: Results The Effectiveness of Wilderness Adventure Therapy (WAT) Statistically Significant Short- Term Effect Sizes & AT Meta-Analytic Benchmarks for Clinical Range Participants
  30. 30. Study 3: Results The Effectiveness of Wilderness Adventure Therapy (WAT) Depressive Symptoms for Participants in the Clinical (n = 23) and Non-Clinical (n = 13) Range Before Treatment
  31. 31. Study 3: Results The Effectiveness of Wilderness Adventure Therapy (WAT) YSR Means for Most Severe Mental Health Symptom for Participants Before Treatment (n = 36)
  32. 32. Discussion/Conclusion:  The overall short-term effect size was small, positive, and statistically significant (0.26)  For the most part, short-term changes were retained at a three-month follow-up  Most of the short-term effects were within the age-based meta-analytic adventure therapy benchmarks  Participants in clinical symptom range pre-program reported large to very large, statistically significant improvements  Findings suggest some promise that WAT interventions may offer a viable alternative treatment modality to more traditional psychotherapeutic approaches for youth at-risk  More in-depth investigation would help to better understand what works and what could be improved Study 3: Discussion/Conclusion The Effectiveness of Wilderness Adventure Therapy (WAT)
  33. 33. Study 4 The Effectiveness of the PCYC Catalyst Program Publication Status: Published Bowen, D. J., & Neill, J. T. (2015). Effects of the PCYC Catalyst outdoor adventure intervention program on youths’ life skills, mental health, and delinquent behaviour. International Journal of Adolescence and Youth, 1-22. doi: 10.1080/02673843.2015.102771
  34. 34. Study 4: Introduction The Effectiveness of the PCYC Catalyst Program (PCYC Bornhoffen Adventure Development, 2011) PCYC Bornhoffen Catalyst Program:  An AT program operated by PCYC in QLD between 2012 and 2013, funded via state-based Blue Light and Proceeds of Crime Funds – Targeting: Personal and social development, within the context of reducing crime  For young people (aged 11 to 14 years) ‘at risk’ of adverse outcomes in their educational, vocational and life-course pathways  Involves a 3 day lead-in, a 9 day expedition, and a 3 day follow-up (with gaps in-between each section) Research questions:  What is the efficacy of the Catalyst program?  How do the effects of the Catalyst program compare to other forms of adventure therapy?  How do the effects of the Catalyst compare to other forms of therapy?
  35. 35. Participants: • 6 Catalyst programs completed by 53 youth Methodology & Analysis: • Quantitative: Self-Report Measures o Collected pre- and post-program (N = 36), 6-12 month follow-up (N = 29) o Youth at Risk Program Evaluation Tool; General Well-Being; Adolescent Behavioural Conduct o Short- (T1 to T2) and longer-term (T2 to T3) changes were investigated using descriptive statistics, and mean effect sizes with 95% confidence intervals. o Results were compared to meta-analytic benchmarks from Bowen & Neill (2013) • Qualitative: Semi-Structured Interviews o Semi-structured interviews were completed with 14 youth participants o Analysed using inductive thematic analysis (Braun & Clarke, 2006) Study 4: Method The Effectiveness of the PCYC Catalyst Program
  36. 36. Longer-term ES for Life Effectiveness (n = 29) Study 4: Quantitative Results The Effectiveness of the PCYC Catalyst Program
  37. 37. Longer-term ES for Mental Health (n = 28) Study 4: Quantitative Results The Effectiveness of the PCYC Catalyst Program
  38. 38. Longer-term ES for Behavioural Conduct (n = 27) Study 4: Quantitative Results The Effectiveness of the PCYC Catalyst Program
  39. 39. Six major themes were identified: Study 4: Qualitative Results The Effectiveness of the PCYC Catalyst Program Pattern Codes Descriptive Codes Overcoming challenging backgrounds Extreme circumstances; Multiple risk factors Contending with adversity Distress, Crisis, Difficulty, Challenge, Conflict Personal development Resilience, Self-belief, Self-confidence, Self- control, Self-esteem Social development Social skills, Communication, Cooperative Teamwork, Relationships Motivation to work for change Try harder, have a go, Make an effort More optimistic outlook on the future New beginnings, Goal setting, Hope
  40. 40.  Participants reported: – Small positive changes in life effectiveness, – A large long-term improvement in psychological well-being, – Some improvements in particular aspects of delinquent behaviour (e.g., Harming, Fighting, Stealing, and Vandalism), – No positive longer-term impact on psychological distress and some aspects of behaviour  Six major themes emerged from interviews with youth participants: – Overcoming challenging backgrounds, contending with adversity, personal development, social development, motivation to work for change, and optimistic future outlook  Quantitative and qualitative results support the conclusion that this program may offer a viable alternative or adjunct treatment approach to more traditional psychotherapeutic approaches for youth at-risk  More in-depth investigation would help to better understand what works and what could be improved Study 4: Discussion/Conclusion The Effectiveness of the PCYC Catalyst Program
  41. 41. Thesis: Practice Implications • AT meta-analytic findings can be used in benchmarking and monitoring program effectiveness (Study 1) • Participant age was the only significant moderator of adventure therapy programs, with stronger outcomes for older participants (Study 1) • Despite diversity in approach, the OAI profile depicts an approach for working with youth that provides an environment of change through use of small groups, contact with nature, adventure activities, and therapeutic processes (Study 2) • The use of AT to address psychological, behavioural, emotional, and interpersonal problems for youth in Australia could be improved (effects were below the international benchmark) (Study 1, 3, and 4) • WAT is as effective as traditional psychotherapy techniques for clinically symptomatic youth (Study 3) • The PCYC Bornhoffen Catalyst program offers a potentially viable alternative treatment modality to more traditional psychotherapeutic approaches for youth at-risk (Study 4)
  42. 42. Thesis: Research Implications • A more targeted survey is required to develop a comprehensive profile of adventure therapy programming in Australia • More in-depth and methodologically rigorous program evaluation with larger samples sizes is required to understand the effectiveness of adventure-based interventions and increase generalisability • Multiple imputation and maximum likelihood are recommended to handle missing data in future adventure therapy research • Future adventure therapy research should consider focusing on the clinical application of findings (rather than statistical significance) • There is a need for future mixed method research to extend understanding of adventure therapy processes and outcomes • There is a need for future research to consider the cost-effectiveness of AT as compared to alternative treatments
  43. 43. Thesis: Strengths • Addressed several major limitations of prior related meta-analyses, compared outcomes with alternative and no treatment groups, and employed additional meta-analytic analysis techniques (publication bias, meta-regression, moderator analyses) (Study 1) • Provided an up-to-date profile of Australian outdoor adventure intervention programs for youth (Study 2) • Used multiple imputation, a ‘state of the art’ technique, to deal with missing data (Study 3) • In addition to considering statistical significance, client change was also reported in terms of clinical significance (Study 3) • Completed a mixed method investigation of an Australian outdoor adventure intervention (Study 4)
  44. 44. Thesis: Limitations • Exclusively relied on participant self-report data (Studies 1-4) • Study 2 was based on a subset of data which was collected to establish a profile of Australian outdoor youth programs • Lack of random assignment to treatment conditions and the absence of a comparison group (Studies 3 & 4) • Generalisability due to adventure therapy programs differing significantly (finding from Study 1 and 2) • Generalisability due to small sample size (Studies 3 & 4) • Study 3 utilised two non-validated questionnaires
  45. 45. Conclusion • While adventure therapy is not a panacea, findings from this thesis confirm that adventure therapy has broad application for adolescents and adults for a wide range of presenting issues • This thesis provides good evidence that adventure therapy programs provide social, behavioural and psychological benefits for participants which are comparable to the majority of efficacious treatments for patients across the age span reported in the literature • Findings from this thesis strongly support the inclusion of adventure therapy as part of the suite of therapeutic interventions that operate in diverse service settings across Australia
  46. 46. Thanks for your time! Questions / Feedback? Daniel Bowen www.danielbowen.com.au/research/PhD u3079209@uni.canberra.edu.au daniel@danielbowen.com.au

Remarques

  • Adventure therapy involves use of small groups, nature-contact, adventure activities, and therapeutic processes to create opportunities for psychological change in participants, usually with the purpose of supporting an individual (or family) to move towards greater health and well-being.
  • Adventure therapy involves use of small groups, nature-contact, adventure activities, and therapeutic processes to create opportunities for psychological change in participants, usually with the purpose of supporting an individual (or family) to move towards greater health and well-being.

    Intentional therapeutic processes:
    Experiential learning, challenge by choice, facilitated reflection, natural consequence, and social learning
  • Gillis (1992) made the recommendation that “someone needs to conduct a meta-analysis of therapeutic aspects of adventure-challenge-outdoor-wilderness that includes the criteria of clinical significance along with traditional methods of effects size” (p. 7).

    In 1996, Gillis and Thomsen made two key points:
    That the field of adventure therapy needs to create a collective document that addresses its effectiveness and
    That clinically significant events of adventure therapy need to be examined through a massive survey of consumers. 

    In other words, Gillis has called for major quantitative and qualitative research studies to be conducted across the field of adventure therapy.

    Building on these suggestions, Neill (2003) proposed an agenda for future adventure therapy research including:
    meta-analytic investigations of specific aspects of adventure therapy programming;
    good quality and well disseminated program evaluations which utilize meta-analytic outcomes as benchmarks;
    innovative, large-scale qualitative investigations which identify and seek to be better understand clinically significant moments and processes which occur in adventure therapy programs; and
    the possible development of an international adventure therapy outcomes online database.

    Unpublished meta-analyses of interest are:
    Staunton (2003) focused on adventure therapy and therapeutic outcomes (N = 17; ES = .53).
    Baker (2011) focused on adventure and wilderness therapy, and investigated its potential moderators (N = 16). Six main areas of outcomes were reported, as well as seven potential moderators.
    George (2011) focused specifically on Outdoor Behavioral Healthcare (OBC) programs for adolescent populations (N = 25; ES = .45). OBC programs are accredited by the OBC Industry Council and require the inclusion of formally trained and licensed mental health professionals. Seven outcome categories were reported, as well as 12 potential moderators.

  • Further Results are available (Bowen & Neill, 2013):
    Effect Sizes by Outcome Categories and Individual Outcomes for each Treatment Group
    Publication bias
    Meta-regression
    Moderator analysis




  • Conclusions
    Most substantial and robust meta-analysis of adventure therapy program outcomes to date.
    Confirms that overall adventure therapy is moderately effective in facilitating positive short-term change.
    On average appears to be maintained in the long-term.
    Heterogeneity of outcomes indicates considerable variability, although little of variance appears to be explained by the measured moderators.
  • Profile of outdoor adventure intervention programs and practices in Australia
  • Profile of OAI Programs and Practices For Youth in Australia


    Throughout Australia outdoor adventure programs take many forms, operate in a range of settings and utilise diverse practices to achieve a variety of outcomes (recreation, enrichment, training, education, prevention, early intervention, respite, treatment, recovery, palliative care). These programs range from one-day activities to week-long residential camps, and multi-week outdoor expeditions. While a growing body of research (Bowen & Neill, 2013; Pryor, 2009) demonstrates that outdoor adventure programs can affect immediate, short-term and long-term therapeutic change, there is a lack of knowledge about therapeutic adventure programs in Australia. This study, focusing on Australian outdoor adventure programs for youth, will seek to describe the nature of outdoor adventure programs that have therapeutic goals, including characteristics of organisations, staff, programs, participants, and perceived benefits and outcomes.

    Pryor (2009)
    Investigated and documented the origins and evolution of outdoor adventure interventions (OAI) in Australia
    Provided details about the core practices that link 20 distinct Australian OAI Programs
    OAI is broader in scope than AT
    Aimed to identify the common elements within the OAI experience from case study surveys
    Did this by investigating model demographics, participant demographics, participant safety-nets, model characteristics, model components, model essentials, model structure, and model processes

    What are the characteristics of Australian OAIs for youth:
    organisations,
    staff,
    programs, and
    participants?

    What are the perceived outcomes and benefits from participating in Australian OAIs for youth?

    Note: These research questions map directly onto items included in the OYPRA National Survey
  • A new survey, the National Survey of Australian Outdoor Youth Programs, was developed by the Outdoor Youth Programs Research Alliance (Williams & Allen, 2012), a group investigating the psychosocial benefits of outdoor programs for young people in Australia. The survey was designed to collect information from outdoor professionals about the characteristics and qualities of outdoor programs offered to young people. Questions focused on program characteristics and features often believed to be important for enhancing participant outcomes, such as key program elements, structure and design, goals, intended benefits and social context (Williams & Allen, 2012).

    The survey comprised two parts. Part 1 contained 90 questions for program leaders about a specific, recent (last 6 months) outdoor program on which they worked as a leader. The questions related to what took place on that specific outdoor program. Part 2 contained 85 questions for program managers about their organization, programs, and participants. See Williams and Allen (2012) for more detail. Depending on their work role, respondents could complete one or both parts. Most of the survey items were quantitative, with ordinal response options.

    Participants in the current study were a subset of program leaders (N = 98) and program managers (N = 24) of Australian outdoor camps and programs drawn from a larger study of Australian outdoor camps and programs for youth (N = 388 (leader N = 211; manager N = 177); Williams & Allen, 2012). This group was selected on the basis of the main purpose or goals of the program.

    Twenty-four out of the 177 program managers indicated that ‘most’ (33%) or ‘all’ (67%) of their organization’s programs aimed to address problem behaviours (e.g., poor school attendance, drug use, depression) as a major goal, and were thus selected for analysis in the current study. Similarly, responses were selected for inclusion from 98 program leaders who indicated that addressing problem behaviours was a ‘moderately’ (49%), ‘very’ (14%), or ‘extremely’ (37%) important goal of the program they worked on.
  • The findings of Study 2, based on responses from 98 program leaders and 24 program managers, indicated that outdoor adventure interventions are conducted by different types of organisations, utilise a wide diversity of practices, locations, duration and format, program and group sizes, physical settings, adventure activities, staff‐to‐participant ratios, and program goals. Despite this diversity, the results suggest that a typical program takes place over two to four days in the outdoors, involves adventure activities (bushwalking, ropes challenge courses, and canoeing), group activities requiring team work, cooperation, mutual support and communication, and intentional involvement of program leaders as a basis of learning (e.g., modelling appropriate ways of behaving and actively taking part in the same activities and experiences as participants). Program staff identified personal and social development and addressing problem behaviours of participants as the main program goals, and they believed that the majority of young people derived these intended developmental benefits through their participation and involvement, although perhaps not to the extent that the programs were aiming for.

    OAIs surveyed involved typical group sizes of approximately 10 participants and were mostly co-educational (although there were also some all-male programs) with a staff to student ratio of 1:4. Programs typically used a combination of experiential learning, challenge by choice, and/or facilitated reflection as a theoretical framework and used personal challenge, exposure to nature, guidance of participant experiences, and consideration of social context in the design of programs.
  • The findings of Study 2, based on responses from 98 program leaders and 24 program managers, indicated that outdoor adventure interventions are conducted by different types of organisations, utilise a wide diversity of practices, locations, duration and format, program and group sizes, physical settings, adventure activities, staff‐to‐participant ratios, and program goals. Despite this diversity, the results suggest that a typical program takes place over two to four days in the outdoors, involves adventure activities (bushwalking, ropes challenge courses, and canoeing), group activities requiring team work, cooperation, mutual support and communication, and intentional involvement of program leaders as a basis of learning (e.g., modelling appropriate ways of behaving and actively taking part in the same activities and experiences as participants). Program staff identified personal and social development and addressing problem behaviours of participants as the main program goals, and they believed that the majority of young people derived these intended developmental benefits through their participation and involvement, although perhaps not to the extent that the programs were aiming for.

    OAIs surveyed involved typical group sizes of approximately 10 participants and were mostly co-educational (although there were also some all-male programs) with a staff to student ratio of 1:4. Programs typically used a combination of experiential learning, challenge by choice, and/or facilitated reflection as a theoretical framework and used personal challenge, exposure to nature, guidance of participant experiences, and consideration of social context in the design of programs.
  • The findings of Study 2, based on responses from 98 program leaders and 24 program managers, indicated that outdoor adventure interventions are conducted by different types of organisations, utilise a wide diversity of practices, locations, duration and format, program and group sizes, physical settings, adventure activities, staff‐to‐participant ratios, and program goals. Despite this diversity, the results suggest that a typical program takes place over two to four days in the outdoors, involves adventure activities (bushwalking, ropes challenge courses, and canoeing), group activities requiring team work, cooperation, mutual support and communication, and intentional involvement of program leaders as a basis of learning (e.g., modelling appropriate ways of behaving and actively taking part in the same activities and experiences as participants). Program staff identified personal and social development and addressing problem behaviours of participants as the main program goals, and they believed that the majority of young people derived these intended developmental benefits through their participation and involvement, although perhaps not to the extent that the programs were aiming for.

    OAIs surveyed involved typical group sizes of approximately 10 participants and were mostly co-educational (although there were also some all-male programs) with a staff to student ratio of 1:4. Programs typically used a combination of experiential learning, challenge by choice, and/or facilitated reflection as a theoretical framework and used personal challenge, exposure to nature, guidance of participant experiences, and consideration of social context in the design of programs.
  • The findings of Study 2, based on responses from 98 program leaders and 24 program managers, indicated that outdoor adventure interventions are conducted by different types of organisations, utilise a wide diversity of practices, locations, duration and format, program and group sizes, physical settings, adventure activities, staff‐to‐participant ratios, and program goals. Despite this diversity, the results suggest that a typical program takes place over two to four days in the outdoors, involves adventure activities (bushwalking, ropes challenge courses, and canoeing), group activities requiring team work, cooperation, mutual support and communication, and intentional involvement of program leaders as a basis of learning (e.g., modelling appropriate ways of behaving and actively taking part in the same activities and experiences as participants). Program staff identified personal and social development and addressing problem behaviours of participants as the main program goals, and they believed that the majority of young people derived these intended developmental benefits through their participation and involvement, although perhaps not to the extent that the programs were aiming for.

    OAIs surveyed involved typical group sizes of approximately 10 participants and were mostly co-educational (although there were also some all-male programs) with a staff to student ratio of 1:4. Programs typically used a combination of experiential learning, challenge by choice, and/or facilitated reflection as a theoretical framework and used personal challenge, exposure to nature, guidance of participant experiences, and consideration of social context in the design of programs.
  • The main goals of OAIs, according to program managers and leaders surveyed in Study 2, were addressing problem behaviours of participants, and personal and social development. Surveyed staff reported that they believed that the majority of young people derived these intended developmental benefits through their participation and involvement, and that that these benefits lasted long-term (years) or lifelong (lasted forever). If staff are correct about this claim, OAIs may be well-positioned to play a valuable role in the prevention of mental health problems, and the promotion of at-risk young people’s personal and social development in Australia.

    A further finding of Study 2 is that perhaps OAIs undersell fun, enjoyment and recreation. Although fun, enjoyment, and recreation was not rated by surveyed staff as a key goal, staff perceived this as the most notable outcome for participants.
  • Note: Secondary data analysis of pre-existing database

    The WAT intervention is a manualised, 10-week, part-time program in which participants are clinically assessed prior to inclusion (Crisp & Noblet, 2004). The program is typically run by 3 WAT practitioners for 6-8 participants, and includes an initial interview and assessment, and then a sequence of seven day-based adventure activities (e.g., bushwalking, abseiling, cross country skiing, and white water rafting) combined with a two day overnight training expedition and a five day expedition (14 programming days in total). Parents, teachers and support workers also participate in eight weekly indoor adventurous problem-solving activities incorporated within group therapy sessions.

    The WAT program structure has four components:
    Intake
    Induction and selection of clients (typically 6-8) based on the principle of ‘maximum benefit to the majority’.
    Clinical screening and assessment.
    Treatment
    Development of a therapeutic relationship and contract.
    Orientation to the program.
    Activities selected, modified and sequenced in keeping with assessments and goals formulated for each specific client cohort.
    The program has the capacity to be integrated with conventional therapies.
    Treatment goals, progress and methods are reviewed and modified regularly.
    Termination
    Termination tasks such as referral-on, crisis response, further assessments required and post-treatment case-planning.
    Client’s goals are reviewed post-treatment.
    The client is supported to identify on-going post-treatment goals and strategies.
    The client’s psycho-social supports are enlisted to assist with these goals in the post-intervention phase.
    Follow-up
    Follow-up interventions are put in place to confirm the continuance of the WAT outcomes, and troubleshoot any difficulties.
  • Note: Secondary data analysis of pre-existing database
  • ESs are also expressed as estimated percentages of participants who improved, using the Binomial Effect Size Display (BESD; Randolph & Edmondson, 2005).
    Using the BESD, an effect size of .2 is equivalent to a 10% increase in the outcome of interest, whilst an effect size of .4 is equivalent to a 20% increase in the outcome of interest.

    Clinical range participants:
    The short-term effect for depression (BDI-II) was large, positive, and statistically significant (ES = 0.80)
    Short-term effects for 6 of the 10 mental health (YSR) subscales were positive, statistically significant, and ranged from large to very large.
    These short-term changes were retained at the 3-month follow-up
    At the 3-month follow-up, 7 out of the 10 subscale means had moved out of the clinical range.

    These results are important as they shows that participants are experiencing reduced symptoms that are clinically meaningful.

  • Clinical range participants:
    The short-term effect for depression (BDI-II) was large, positive, and statistically significant (ES = 0.80)
    Short-term effects for 6 of the 10 mental health (YSR) subscales were positive, statistically significant, and ranged from large to very large.
    These short-term changes were retained at the 3-month follow-up
    At the 3-month follow-up, 7 out of the 10 subscale means had moved out of the clinical range.

    These results are important as they shows that participants are experiencing reduced symptoms that are clinically meaningful.

  • Clinical range participants:
    The short-term effect for depression (BDI-II) was large, positive, and statistically significant (ES = 0.80)
    Short-term effects for 6 of the 10 mental health (YSR) subscales were positive, statistically significant, and ranged from large to very large.
    These short-term changes were retained at the 3-month follow-up
    At the 3-month follow-up, 7 out of the 10 subscale means had moved out of the clinical range.

    These results are important as they shows that participants are experiencing reduced symptoms that are clinically meaningful.

  • The current study contributes to the adventure therapy literature by conducting a program evaluation of the WAT, a systematically developed early intervention and clinical treatment program for adolescents.

  • Semi-structured interviews were completed with 14 youth participants towards the end of the expedition
  • Life Effectiveness
    Non-significant short-term effect: All 10 dimensions of life effectiveness
    Significant longer-term effect: 4 out of the 10 dimensions of life effectiveness (Self-Esteem, Self-Confidence, Healthy Risk-Taking, Communication Skills)
    Significant short-term effect and longer-term effect: Overall
  • Mental Health (GWB)
    Non-significant short-term and longer-term effect: Overall, Psychological Distress
    Significant short-term effect and longer-term effect: Psychological well-being (within aged-based BM)
  • Behavioural Conduct
    Non-significant longer-term effects: Overall, Stealing, Vandalism, Cheating, Vehicles, Wagging, and Drug Use
    Significant longer-term effects: Fighting and Harming (within aged-based BM)
  • Read example quotes from published manuscript!

    Six major themes were identified in the qualitative analyses. Participants reported the following salient features of their experience:
    overcoming challenging backgrounds (e.g., family problems, social problems with peers, behavioural conduct problems at school, and psychological issues);
    contending with adversity (e.g., physical, mental, emotional and social challenges which caused distress, conflict and crisis during the program);
    personal development (e.g., positive thinking, self-belief, courage, self-control, managing emotions, persistence in overcoming problems);
    social development (e.g., developing trust and respect for others, communication and cooperative teamwork skills);
    motivation to work for change (e.g., realising that an intentional effort was required to improve health and well-being); and
    a more optimistic outlook on the future (e.g., looking more positively toward the future, greater belief that lives at home and school would be improved).
  • More in-depth and methodologically rigorous program evaluation is required to demonstrate the effectiveness of adventure-based interventions
    Inclusion of a comparison or wait-list control group could be a focus of future research
    Clinical trials of adventure-based interventions tailored to homogenous client groups
    Cross-over designs with conventional treatments such as CBTs, MST, or RTPs
  • Exclusive use of self-report data:
    Future adventure-based intervention evaluation studies could triangulate self-reported data using additional data sources such as from ratings and interviews with observers such as parents and teachers. Collation of other existing data, such as school attendance and behaviour records may also be helpful.

    Dataset used for Study 2:
    Future research could build on the current study by aiming to develop a more comprehensive profile of adventure therapy programming in Australia. For example, a survey designed specifically for staff working in Australian OAIs with different types of target groups (including youth and adults), using a weighted analysis according to the number of participants, and possibly using multiple sources of data (e.g., practitioner interviews, surveys, and case studies) could help to put adventure therapy on the map of therapeutic intervention options.

    Research design:
    Inclusion of a comparison or wait-list control group could be a focus of future research, and would be necessary to demonstrate the effectiveness of adventure-based interventions.

    Generalisability due to AT programs differing significantly:
    Findings in Studies 1 and 2 demonstrated that adventure therapy programs differ significantly, and the samples included in Study 1 showed considerable variance in the means changes and large confidence intervals for the effect sizes. While some clinicians have created manualised treatment protocols for adventure therapy programs, few programs have utilised such standardised approaches to treatment. It is therefore difficult to generalise results from the current research to all adventure therapy programs.

    Generalisability due to small sample sizes:
    Further research is needed with larger samples in order to truly understand and explain the apparent diversity in adventure therapy outcomes, and the relationship between length of treatment and outcomes between adventure groups and more traditional therapy.

    Use of non-validated questionnaires:
    Where possible, existing psychometrically validated assessment tools should be used and the psychometric properties of instrumentation should be reported.


  • The inclusion of adventure therapy, an innovative prevention and intervention modality, in a coherent national strategy addressing Australians health and well-being needs has the potential to strengthen and diversify Australians access to effective support, as well as help to reduce the burden of social, behavioural and psychological problems, and improve the health and well-being of Australians.
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