"The data used in this essay came from the Woodbury Reports Directory, "Places for Struggling Teens™ - 03/04 - 14th Edition" recently renamed "The Parent Empowerment Handbook."

The Parent Empowerment Handbook™ shows that over the past several years, the parent choice industry has seen dramatic growth. A vast network of youth interventions have emerged, representing a national array of alternatives and choices for parents who are seeking help for their children.

The schools/programs in the Parent Empowerment Handbook™ were pre-screened to include the most respected programs and schools across the country. The data does not include every program in the country, but rather only those who reached a high level of recognition and excellence. The demand for quality programs continues to fuel the industry at a rapid pace. A full 60 percent of the programs listed in the latest edition of the handbook came into existence in the past 15 years.

Two strong trends have emerged indicating that the development of regional or national assessment centers may not be too far away. These trends suggest a steady movement toward a higher level of clinical infusion into programs in both wilderness and long-term programming.

The growth of wilderness programs demonstrates a dramatic change in attitudes and practices. Fifteen years ago, the public at large and specifically mental health professionals were not supportive of wilderness programs. Today, wilderness programs have largely replaced the acute hospital stays that were so common in the 80's. They are often a required prerequisite to enrollment into many long-term schools and programs.

In addition, their clinical oversight has increased and they now provide traditional group and individual therapies in the field. With the clinical additions, wilderness programs now conduct psychological testing in the field. Though wilderness programs serve a valuable purpose, they are not set up to provide the more traditional and complex assessments needed to fully understand a clinically complicated youth, especially in regard to a diagnostic and long-term treatment point of view. This does not mean that wilderness programs are not a potentially powerful diagnostic tool. A consultant and family working closely with an astute therapist, to identify and interpret a youth's patterns and ways of responding to various situations is an invaluable tool.

Years ago, the primary purpose of a wilderness program was to provide a short-term high impact experience that placed a youth in a rigorous environment that enabled them to gain great insight into his or her life. Most returned to their community and family after the experience. Today, with the increased knowledge of the benefits of wilderness programs, parents and consultants use these programs more frequently for assessment and to prepare a youth for a successful enrollment into a long-term program.

Another trend has emerged that has changed the face of residential schools and programs. This trend is the nearly universal return to enhanced clinical programming. Beginning with the development of Island View, the trend towards clinically based programs has been remarkable. In total, since the development of Island View, 20 programs listed in the Parent Empowerment Handbook™ have a strong clinical base. At the time Island View was developed, there were only seven programs listed in the handbook that were considered residential treatment with a strong clinical basis. This trend indicates an approximate 300 percent increase in clinically based programs over the past 10 years.

Additionally, established, non-clinically based programs have chosen to integrate clinicians into their programming. The California and Idaho CEDU schools are the most notable in having a full integration of standard clinical practices. Notably, Provo Canyon has also made strides towards enhancing their clinical based programming. In a sense, this long-standing icon of residential programming moved away from relying exclusively on behavioral and educational programming and into expanding their clinical based programming. It would be hard to overlook the Menninger Clinic's presence in the Parent Empowerment Handbook™. The founder of Menninger Clinic, known as the "father of psychiatry," earned this well deserved title. Thus, perhaps the most respected psychiatric entity in the country and perhaps the world is now included in the handbook as an acknowledged resource for the parent choice network.

This clear trend toward clinically based programming in a large number of programs indicates a definitive shift in the parent choice world; a shift that is increasing the clinical sophistication of programs. In this writer's point of view, the trend toward clinical programming may logically lead to regional or nationally based assessment and placement centers. The development of assessment centers may allow comprehensive assessments in a few weeks with the potential to improve the predictability of long-term treatment decisions. These assessments would include developmental and school history, parent interviews, educational and psychological testing, psychiatric evaluations, neuro-psychiatric evaluations and student observations. If needed, more advanced assessment tools for a very complex youth may also be available.

It would be a mistake if this potential evolution reverted to a strictly clinical perspective with all youth exhibiting behavioral or emotional problems referred to an assessment center. Wilderness and other programs have been highly innovative, and they contributed enormously to the creative care of youth over the years. They learned to blend clinically-based approaches with experiential/ adventure and educational therapies that I believe surpass the treatment received by youth in the past. They do an excellent job of assessing those students that do not have serious clinical problems.

The interest in developing assessment centers may be emerging because of the increased clinical programming in the industry. That would suggest an assessment center may be heavily clinically based and possibly overkill for many of the children with more common behaviorally based problems. The wilderness programs probably best serve those youth with primarily behavioral problems, both for assessments and treatment. In a wilderness program, the child's experience is observed 24/7 in a natural environment instead of the relatively artificial environment of a clinically based assessment center.

Unless there is clear knowledge of a complicated clinical problem, the industry is best served if the first line of assessment remains in a wilderness program. In the event the youth does not respond normally in the wilderness program, it may indicate a serious clinical problem, and the next step would be to refer the youth to an assessment center for a full clinical review. Additionally, assessment centers could be used for youth who are not functioning well in a long-term program when it is indicated that the problem may be clinically based.

Assessment centers may require a close alignment with already established wilderness programs and various decision-making entities. This combination would help point to the most logical and appropriate intervention to best serve the youth and families. Under these circumstances, the plan could also be pre-arranged to allow a youth to go from wilderness to the assessment center, or the assessment center to the wilderness depending on the appropriateness determined by the parents, consultant and program staff.

The real question is, 'Will assessment centers provide an important addition to our industry?' If assessment centers are designed to supplement existing resources, rather then trying to replace them, I think they will.