Research at Second Nature

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For the last several years Second Nature has been conducting research to assess treatment outcome for adolescent and young adult clients. The study was also designed to assess other factors that may contribute to the overall symptom improvement found among many people attending a wilderness program. This summary provides some preliminary findings with regard to outcome at Second Nature.

Adolescent and adult clients completed a series of measures upon entering the program, after three and five weeks in the program, at discharge, and again at 6 months after leaving the program. The measures completed at each of these time points are as follows.

For adolescent clients: Youth Outcome Questionnaire (parent and self report), Life Effectiveness Questionnaire (LEQ), Treatment Expectancies Questionnaire (TEQ), Hope Scale (HS), and Therapeutic Alliance Scale (TAS).

For adult clients: Outcome Questionnaire (OQ -45.2), Motivation for Therapy Scale (MOTS), Helping Alliance Questionnaire-II (HAq-II), Life Effectiveness Questionnaire (LEQ), and Dysfunctional Attitudes Scale (DAS).

Outcome with Adolescents

The Youth-Outcome Questionnaire assesses behavioral difficulties, depression, anxiety, interpersonal relations, and other psychological difficulties. The Y-OQ 2.01 is rated by a parent, while the Y-OQ Self Report (SR) is rated by the adolescent client. According to these measures, adolescents at Second Nature presented with problems consistent with inpatient facilities and other wilderness programs (Hoag & Burlingame, 2000; Russell, 2003) with regard to the level of dysfunction at intake.

Parents assessed their adolescent children as experiencing clinically significant change while in the program. Clinically significant change is a change that is statistically different as well as meaningful and noticeable. The Y-OQ 2.01 defines clinically significant change as a drop of 13 points on the total score. In this study, parent scores on the Y-OQ dropped by 72 points over the course of the program. In other words, behavioral concerns, substance use, depressive symptoms, and a variety of other issues improved considerably over the course of the program. Interestingly, these teens would be considered as in the "normal" or "community" range of functioning at discharge (scores below 46 are considered in the community range). Six months following discharge these participants had regressed some, though were still in the range of "normal" and had made significant change compared to intake functioning.

Adolescents also rated themselves as changing significantly over the course of the program, as measured by the Y-OQ Self Report. They acknowledged clinically significant changes in behavioral and emotional issues, with a drop in total score of 39 points over the course of the program (from 60 points at intake to 21 points at discharge). The Y-OQ-SR defines clinically significant change as a drop of 18 points and the normal/community range of functioning as scores below 47. While there was some regression at the 6-month follow up, students remained in the community population range.

These two preliminary findings demonstrate that adolescents changed considerably while in the program. While the response rate from parents and students at 6 months post discharge was low compared to the other time points, the data present suggests that participants regressed some, but were still in the range of normal.

Additionally, this study assessed other aspects of the change process. Changes on each of the measures, depicted graphically below, were statistically significant. Adolescents demonstrated improvement on the LEQ which assesses areas of time management, social competency, achievement motivation, and intellectual flexibility. This suggests that these adolescents will be more effective at achieving their desires in school and in their personal life as they have more self-confidence, emotional control, and initiative.

Increased hope and motivation to succeed in life was also demonstrated with adolescents in this study as measured by the HS. Young men and women in the program improved with regard to their hopefulness for the future, their increased ability to initiate and sustain the steps towards their goals, and to find pathways to succeed in their goals. People who improve in this manner generally have increased optimism, are better with problem solving skills, and feel better about themselves.

Aolescents also demonstrated improvement over the course of treatment in motivation for change, hope for their treatment, and alliance with their therapist (as measured by the TAS and TEQ). Adolescents in the study reported an increased belief that the treatment they were receiving would be helpful to them.

Outcome with Young Adults

Like the Y-OQ, the Outcome Questionnaire (OQ 45.2) is a brief self-report instrument designed for repeated measurement of progress through the course of therapy and following termination. Similar findings were obtained with adult clients, with clinically significant levels of change occurring, though the overall "numerical value" of change was not as dramatic. This is not surprising, given that self-report test results tend to be less dramatic than parental measures of change. Young adult scores dropped a total of 26 points, from 66 at admission to 40 at discharge. This is noteworthy considering that a change of 14 points on the OQ 45.2 is clinically significant. Though the response rate for the 6 month follow up was lower than that for other data collection points, the average scores remained the same as the average at discharge. This may indicate that improvements in overall well-being were maintained and remained in the normal range of functioning.

Further, other aspects of the change process improved over the course of treatment. Changes on each of the measures, depicted graphically below, were statistically significant. Young adults were found to have significantly less dysfunctional attitudes that typically correlate with depression. The graph below represents change as measured by the DAS, which showed a decrease of 32 points from intake to discharge. Over the course of treatment, clients appear to be letting go of a number of their negative attitudes and improving in their views of the outside world, themselves, and their future.

Adults also demonstrated improved life effectiveness in the areas of time management, social competency, achievement motivation, and intellectual flexibility. The graph below demonstrates that young adults improved by 24 points on the LEQ while in the program. Overall, this suggests that these adults will be more effective at fulfilling their desires and hopes in their personal and social life.

Another area that shifted during the program was the adult client's motivation for therapy and alliance with their therapist. Young adults in this study reported increases in their commitment to therapy and connection with their therapist, as measured by the MOTS and HAq-II. This enhanced motivation suggests that they will be more likely to engage in therapy with a positive attitude following the program.

Conclusion

In conclusion, preliminary results from this study suggest that Second Nature had a positive effect on behavioral concerns, substance use, depressive symptoms, and a variety of other issues over the course of the program. From Admit to graduation, adolescent and adult clients went from a clinical or abonormal range of functioning to a healthy or community-level range of functioning. Participants also demonstrated significant improvement in overall motivation, life skills, interpersonal relationships, hopefulness, self confidence and emotion control.  These preliminary results are an exciting validation to the overwhelming positive anecdotal testimonials we have received over the years from parents and their children.