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News & Views - Sep, 1999 Issue #61 

Decompensation And Failure to Thrive In Wilderness Therapy And Intervention Programs 
By Michael G. Conner, Psy.D, Clinical and Medical Psychologist.

(800) 877-1922 

(Dr. Conner is Director of Family and Psychological Services for SageWalk, The Outdoor School and is Director of Planning and Program Development for Mentor Research Institute, a non-profit public health and safety organization)

Wilderness programs for youth at risk are growing across the country in response to a gap in health care services created by managed health care companies that do not recognize or provide services for youth at risk with behavioral problems. Parents searching for alternatives to medicating their children for social and behavioral problems are turning to wilderness therapy and intervention programs when “office” therapy, residential treatment and criminal justice programs fail. Wilderness programs are becoming a first-line intervention and not just “last chance programs.”

Decompensation and the failure of students to thrive in a wilderness program are actual, yet very infrequent events. Decompensation is a more severe, and very different problem than the failure of a student to benefit from a particular program. 

Decompensation can take many forms. Normally it will involve the onset of more child like behavior, a complete lack of regard for hygiene, loss of bladder control while sleeping, increasingly disorganized behavior, a dramatic change in the level of energy, or a complete loss of interest in pleasurable activities.

Failure to thrive can take many forms. Wilderness programs allow students opportunities to respond to challenges and ordeals with a rewarding and healthy initiative. They separate students from their former environment, removing such distractions as drugs and negative role models. No longer able to escape the consequences of their choices, individual, environmental and social realities are made more clear to the student. When a student is unable or unwilling to take advantage of this environment, it is considered a failure to thrive.

Failure to benefit from a particular program, which is quite different from a failure to thrive, can be due to a variety of reasons. For instance, students may not benefit because the program’s length was not adequate to address their problems and needs. When a student leaves a program prematurely, there is a risk that problems prior to admission will resurface or they may become worse than before. If, on the other hand, the length of a program is increased, a student may decompensate and fail to thrive. This can happen when the student’s psychological needs are not met, the student is overwhelmed, and the length of the program becomes too long.

Prevention. It is possible, and in some cases is not difficult to know in advance, that enrollment in a program may lead to decompensation or a failure thrive. Screening and monitoring procedures are the key to prevention. Decompensation and failure to thrive are usually the result of one or both of the factors described below.

1. Screening. At times the program is unable to recognize, understand and address an underlying or pre-existing medical problem. Sometimes prior to, or during a program, a student is taken off a needed medication, or, is taken off an unnecessary medication, too abruptly and inappropriately. Some students enter a program on the wrong medication(s), or have unrecognized medical problems that appear to be psychological and behavioral problems. Subtle medical problems can contribute to a student’s behavioral problems. More common medical problems such as diabetes, hypothyroidism and seizure disorders can also cause endocrine and neurological disorders. A surprising number of students enter programs after having been put on antidepressants when they were simultaneously using marijuana and alcohol on a regular basis. Medical journals have begun to publish consumer research demonstrating a growing trend in the improper evaluation and treatment of medical problems that have in turn caused psychological and behavioral problems. Children with mental health problems are ending up in the criminal justice system.

2. Program Incompatibility. A program can be emotionally too demanding for the resources and abilities of students whose problems are beyond that program’s scope. Some students will respond to one program and not another. In some cases inadequate screening allows the enrollment of students whose needs surpass those for which a particular program was designed. This can happen when a program is new, financially desperate, or if their screening process lacks a qualified clinician. Well-intended parents may provide insufficient information to screen students adequately, sometimes due to guilt or fear that the family may have caused the current problem. In most of such cases, parents have not received enough information from their child’s health care professional to develop a good understanding of their child’s needs and problems. Psychological impairments, sometimes associated with trauma, abuse or developmental delays, are common problems that can be misunderstood and go unrecognized.

Although the structure and philosophy of programs can be as different as people are different, an optimal program will both address students’ psychological needs and provide them with challenges.

Parents, programs, educational consultants and mental health professionals each have an important role in minimizing the risk that a child may decompensate or fail to thrive in a wilderness program. These risks can be minimized by:

§ Working with educational consultants and mental health professionals who are knowledgeable and have experience working with wilderness programs;

§ Consulting with a family practice physician or psychiatrist to obtain a complete physical and medical evaluation that also includes endocrine functions, complete chemistries, as well as a drug and alcohol screening;

§ Consulting with a clinical psychologist, and when directed, obtaining a comprehensive interview, individual and family history, and psychological evaluation that includes personality, intelligence and neuropsychological functions; and by

§ Looking for programs with screening procedures that include consultations with qualified and licensed professionals with credible training and experience in diagnosis and ability to recognize medical and psychological differentials.

I have the greatest professional enthusiasm for wilderness therapy and intervention programs, but they are not without problems. There will always be a risk that a few students in a program may decompensate or fail to thrive, but it can be greatly minimized if a child is admitted to a well-designed and implemented program.

Copyright © 1999, Woodbury Reports, Inc. (This article may be reproduced without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)

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