conceptual analysis of wtp websites 1 running header...

Conceptual Analysis of WTP Websites 1

Running Header: CONCEPTUAL ANALYSIS OF WTP WEBSITES

Conceptual Analysis of Evidence-Based Practice Using

Wilderness Therapy Websites

Sarah Canatsey

Georgia College


Introduction I began working for Outward Bound in 2008 in what was called the Discovery program.

The programs ran from four bases and worked with at-risk and adjudicated teenagers. I only

worked there a short time before moving to the Sea Program where I worked predominately with

military veteran populations. Although I only worked a handful of courses directly with at-risk

youth, the experience left me with a strong desire to know more about the psychology and

philosophy wilderness programs employ with these populations.

In 2010 I attended the Association for Experiential Education (AEE) International

Conference in Las Vegas. One workshop dealt with research on therapeutic wilderness and

wilderness therapy programs. During question and answer time a question was asked that struck

a nerve. Someone asked how are programs and researchers supposed to do solid research, more

specifically meta-analysis, of the industry if researchers are not giving enough detail about

programs.

Mulling over that question started to produce a plethora of questions. There are plenty of

people in the outdoor behavioral industry asking similar questions. Having only been exposed to

the inner workings of one therapeutic wilderness program, many questions stem from that

limited experience. Some of the questions were:

- What are wilderness therapy and therapeutic wilderness programs doing in terms of program design?

- Are programs conducting research for funding, continual program improvement, or a mix of both?

- Do programs in the larger Outdoor Behavioral Industry make a clear distinction between therapeutic wilderness and wilderness therapy programs?

- Are programs using resources from near-by universities to help them conduct research? - Is the industry working to create a standard of research that takes into account the many

external variables effecting participants in a wilderness setting? - What does evidence-based programs and practices look like for this industry? - How accountable are these programs to the larger healthcare industry?


The original idea for this study was to study the use of evidence-based research

specifically in wilderness therapy programs. The plan was to use a modified stages of change

model and Kolb’s learning cycle to show where programs were in terms of research. After

several conversations there was a realization that a more foundational issue needed to be

addressed. There was a problem with conceptual definitions.

Continuing with the original plan would have left the research full of gapping holes due

to an apparent inconsistency of definitions with the use of research in wilderness therapy

programs (WTP). There was also a potential weariness of programs to answer questions about

their research. This assumption was made from both antidotal evidence from researcher

comments at the 2010 AEE International conference and the lack of transparency offered by

programs involved in research with Outdoor Behavioral Healthcare Research Consortium

(OBHRC). The decision was made to do a conceptual analysis of WTP websites looking for

indications of research methods, therapy practices used, participant profiles, and outcomes.

SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP)

website was examined because of its status as a national registry and specific requirements

related to evidence-based research. At this time there are no WTP listed on NREPP. In order to

be considered for inclusion on this registry a program needs to submit information concerning

their research and dissemination material. Both are rated on a 4-point scale. Quality of research

material is rated on: reliability of measures, validity of measures, intervention fidelity, missing

data and attrition, potential confounding variables, and appropriateness of analysis. Readiness for

dissemination is rated on: availability of implementation materials, availability of training and

support resources, and availability of quality assurance procedures. Finding no WTPs on this


national registry, the next step was to look at membership with professional organizations

dedicated to enhancing the research and effectiveness of the wilderness therapy industry.

Organizations were chosen because their mission, vision, or accreditation standards

emphasized the need for research in the betterment of the industry. These organizations include:

Association of Experiential Education (AEE), National Association of Therapeutic Wilderness

Camping (NATWC), National Association of Therapeutic Schools and Programs (NATSAP),

Outdoor Behavioral Healthcare Research Consortium (OBHRC), and Outdoor Behavioral

Healthcare Industry Council (OHBIC). Inclusion and exclusion criteria were applied to the

programs listed on these organizations’ membership. In the end, nineteen programs were chosen

for the study.

The majority of programs listed results from outcome studies on their websites. The most

utilized assessment tool mentioned in outcome studies was the Youth-Outcome Questionnaire

(Y-OQ). In all the studies listed, the use of wilderness therapy programs was seen to be effective.

This is relevant when subscales of the Y-OQ are compared to behavioral issues and disorders

these programs list as being typically profiles of students they serve.

Deciding to examine websites had a couple advantages to this study. Websites are used

for marketing and information. They are some of the most public faces of these programs. The

image they convey about the effectiveness of programming and their dedication to research is

easily accessible to a large range of clients and researchers. This study set out to develop themes

around the concept of research on WTP websites. In doing so, a wide-range of terms were

referenced when discussing research techniques and practices. Following are four concepts

integral to this study: conceptual analysis, evidence-based research, wilderness therapy

programs, and Youth-Outcome Questionnaire.


Literature Review

Conceptual Analysis. “Words are meant to serve human purposes and desires, and must be used

in such a way as to serve them efficiently” (Wilson, 1985, pg. 6). Conceptual analysis used to

bring greater understanding to words used and create a larger concept around them. It has been

used in many different disciplines, but its roots are in philosophy. It allows a text, or set of text,

to be analyzed for themes or concepts present. This type of analysis allows researchers in

developing concepts and themes, which may be used to later develop theories. Techniques used

in conceptual analysis select a word to examine and then record and analyze the frequency of the

term within a text or set of texts. Themes are developed to aid in explaining the selected term in

greater depth.

Evidence-Based Practice. Evidence-based practice (EBP) is one way to gain valuable feedback

about how an organization is performing and how to improve practice. Northwestern University

maintains a website dedicated to resources and training in EBP. The definition offered is clear

and inclusive:

Evidence-based behavioral practice entails making decisions about how to promote healthful behaviors by integrating the best available evidence with practitioner expertise and other resources, and with the characteristics, state, needs, values and preferences of those who will be affected. This is done in a manner that is compatible with the environmental and organizational context. (www.ebbp.org, 2011)

According to the Evidence-Based Behavioral-Practice project, one benefit of

implementing EBP into healthcare programming is a common language between disciplines that


will help to enhance the overall research and help “facilitate collaboration in transdisciplinary

research and practice” (www.ebbp.org, 2011).

The 2009 Symposium on Experiential Education Research (SEER) presented three

research papers related to evidence-based practices. Shooter (2009) introduced them by

reminding the industry that, “evidence-based research requires more than documenting

outcomes” (pg. 291). The purpose of EBP is not only to produce solid research on outcomes, but

to find out how programs are creating these outcomes (Shooter, 2009). These two pieces come

together so that we can, “design programs in a well-informed, intentional, and purposeful way”

(pg. 291). EBP creates a way for programs to conduct feedback that can be based in solid

research. It allows programs to assess their effectiveness and apply that feedback into future

programming. Wilderness therapy programs would benefit from a thorough examination of

practice that goes beyond data crunching for funding. This type of honest assessment is asked of

many clients in these programs, but how many programs apply the same criteria to themselves?

Research in areas of wilderness therapy and therapeutic wilderness need stronger, more

valid research conducted (Becker, 2010). The use of wilderness for treatment is lacking in solid

research and is misunderstood by other healthcare industries (Becker, 2010). Thomas, Potter, and

Allison (2009) noted that “previous criticisms have suggested that the literature in the fields of

outdoor education, experiential learning and adventure education is fragmented, disparate, weak,

easily criticized and in need of alternate approaches” (pg. 24). Becker (2010) concluded, “the

dearth of empirical research, the absence of research undertaken by professionals from varied

perspectives, and the relatively few programs which have participated in published research all

contribute to the criticisms placed on the field of wilderness therapy by other mental health


professionals” (pg 53). Both these critiques only add to the argument for implementation of EBP

into the outdoor behavioral healthcare industry.

There are obstacles in the way of wilderness programs truly dissecting their programs to

see how it works. Ewert and Sibthorp (2009) mention three major areas where confounding

variables may influence results. Within each area (pre-course, course, and post-course) there are

numerous confounding variables. Unlike other healthcare programming and treatment options,

wilderness programs have to account for more uncontrollable variables. Elements such as the

weather have yet to be controlled by researchers. Ewert and Sibthorp (2009) offer ways that

researchers might overcome this confounding variables and each has its own issues. One of the

issues that arise is the use of control groups. For example, in order to see how influential a

follow-up component is to maintenance of treatment gains, it would be beneficial to have a

control group of participants who do not have a follow-up. This would require an organization to

have some students not participant in a central part of a program’s treatment. The organization

may be unwilling to compromise their program for the research.

Therapeutic Wilderness versus Therapy Wilderness Programs. In previous studies therapeutic

and therapy have been used interchangeably (Russell, 2001). Therapy denotes not only use of

therapeutic methods, but includes use of professionals in the counseling industry (Itin, 2001).

Russell (2001) outlined four definitions offered for therapy programs by other studies and none

of them indicated direct contact with the participants to a licensed counselor. In fact, the

definitions offered by Kimball and Bacon (1993) and Powch (1994) require no licensed staff (as

cited in Russell, 2001). Itin (2001) gave a clear distinction between therapy and therapeutic by

defining desired outcomes. Therapeutic programs are not concerned with previous history of


participant as much as correcting exhibited behaviors and helping create plans to improve

behaviors in the future. Therapy programs are not only concerned with behaviors, but also with

reasons behind actions (Itin, 2001).

According to the Council on Accreditation the following standard should be followed for

wilderness and adventure-based therapeutic outdoor services in regards to clinical oversight: “it

is provided by a professional with an advanced degree in a mental health field, therapeutic or

experiential education, or another human service field; appropriate licensure; and experience in

the field of therapeutic, adventure programming” (Council on Accreditation, 2008). While many

people have attempted to construct a working definition for wilderness, or adventure therapy

(Hill, 2007; Itin, 2001; Russell, 2001) the most distinct difference in recent definitions is direct

use of licensed therapist in wilderness therapy (Davis-Berman & Berman, 1994).

Youth-Outcome Questionnaire (YOQ). As mentioned above, the Y-OQ was the most widely

reported assessment tool in outcome studies mentioned on WTP websites. The Y-OQ has two

versions, one is a student self-report and the other is completed by the parent/guardian. The self-

report is available to adolescents ages 12-18. The questionnaire measures six sub-scales:

interpersonal distress (anxiety, depression, fearfulness), somatic (headache, stomach, bowel,

dizziness), interpersonal relationships (attitude, communication and interaction with parents,

adults, and peers), critical items (paranoid ideation, suicide, hallucinatory, delusions), social

problems (delinquent or aggressive behavior, breaking social mores), and behavioral dysfunction

(organize and complete tasks, handle frustration, impulsivity, inattention) (OQ Measures, 2012).

Methods


Participants

Wilderness Therapy Programs having affiliation or membership with one or more of the

following professional organizations: Association for Experiential Education (AEE), National

Association of Therapeutic Wilderness Camping (NATWC), National Association of

Therapeutic Schools and Programs (NATSAP), Outdoor Behavioral Healthcare Research

Consortium (OBHRC), and Outdoor Behavioral Healthcare Industry Council (OHBIC).

Inclusion criteria included serving youth within the age-range of 12-18, the predominant venue is

wilderness, and expeditions last at least 5 consecutive days. Exclusion criteria included serving

adjudicated youth and being a government agency.

Design

This study used a conceptual analysis design. Deductive inquiry was used to create the

first codebook. Inductive inquiry was used during research to create the final codebook. Website

text from nineteen wilderness therapy programs were copied and pasted into a Microsoft Word

document and printed for coding. Major behavioral issues and disorders listed on websites were

turned into a word cloud using Wordle.net. A word cloud was used to give a better visual

understanding of relationship frequency different behavioral issues and disorders were

mentioned on program websites. Multiple uses on the same website were not counted again.

Procedure

The first step in this program was to identify professional organizations in which WTP

are members since no WTPs were listed on NREPP. Professional organizations emphasized use

of research in their standards or mission. Programs chosen were: AEE, NATWC, NATSAP,


OBHRC, and OBHIC. Of these five programs, NATSAP was the only one that offered thorough

bios on individual programs. Prior to going through the NATSAP membership directory to find

wilderness therapy programs, an initial list of categories were created. This list was created using

a deductive process based on previous experience and education.

Document analysis was done in four stages. The first stage used deduction to create an

initial set of categories for the codebook used in this study. Deduction relies on outside

knowledge or information to produce categories or parameters. The second stage used an

inductive process. Induction produced categories from items such as text, terms, and phrases

from primary documents used in the study. In this case, wilderness therapy program websites. In

the final two stages the researcher narrowed done the themes created from both the inductive and

deductive process to focus in depth on two categories in the codebook and one additional theme

analyzed for its indirect relevance to research.

The first stage involved examining the NATSAP member bios. These were chosen

because they were thought to be the most succinct versions of an organization’s professional

face. A program’s website can be seen as their storefront. These bios acted as their business card.

Bios were limited to one page in length and appeared to be written for potential clients and

consulting agencies (i.e. Social worker). This produced an initial codebook with nine categories:

components of program, outcomes, distinctive characteristics listed, wilderness benefits,

emotional and behavioral issues of participants, clinical practices, parent involvement,

credentials of therapists, admission, program length, and group make-up.

After applying inclusion/exclusion criteria to programs associated with one of five

professional organizations listed above, nineteen programs were selected. All pages from

program websites were printed. The second stage of document analysis was applied to these


WTP websites. This round of document analysis produced another eight categories that were

added to the codebook: methods, milieu therapy, therapy focus, research, skills taught, outcome

assessment, exclusion criteria, and follow-up.

The seventeen categories were divided into primary and secondary categories based on

relevance to the major topic of evidence-based practice. This process produced six primary

categories. A third document analysis was conducted on the websites using six primary

categories. The last document analysis focused on two primary categories, research terms and

behavioral issues and disorders, to look at them in greater depth. Research terms were examined

because of apparent lack of consistency across program. This fourth round also looked at one of

the secondary categories, distinguishing characteristics. This category was examined because it

was thought the organization’s way of communicating their distinctiveness might be insightful.

There were several steps occurring congruently during the fourth document analysis. A

list of terms used for type of research conducted was pulled out. Distinctive characteristics were

listed out and compared across programs. Finally, the list of emotional and behavioral issues was

created. Items in this list were transformed to create consistency among terms. An example was

changing “poor grades” to “academic performance.” This allowed the researcher to put all the

terms in Wordle.net to create a word cloud.

Results

This study involved a conceptual analysis of wilderness therapy program websites. The

results focused on the use of terms for research being done by programs and the types of

behavioral issues and disorders the programs’ designs are effective in improving. This project

also looked at themes across the websites in reference to research.


Not all of the websites mentioned research. Six of the nineteen programs made no

mention about research or outcome results from the program. Of those program websites that

mentioned research the following terms were used to describe the research being done: outcome

research, time-tested approach, “silver standard” research, qualitative research, evidence-based

therapeutic approach, independent research, outcome studies, evidence-based model, university-

led empirical research, peer reviewed research, outcome study, and time-proven. There was a

lack of consistency between WTPs on how to describe the research being done. Several of the

organizations were included in the same study by the OBHRC and still used different phrasing to

describe the study.

Table 1 lists themes most relevant to the purpose of this study. They are followed by

examples and/or explanations. The term “evidence-based” was used on only 2 program websites

to refer to research being conducted at a program. It was used more often in reference to therapy

being employed.

Table 1. Concepts Relevant to Research Theme

Explanation/Examples

Research Terms

There was inconsistency among websites for the terms used to describe research being done within their programs. Six of the programs did not mention research on their programs at all on their website.

Outcome Assessment

Outcome assessments included the following types of questionnaires. The most prominent one referred to was the Youth-Outcome Questionnaire. Most common: Youth-Outcome Questionnaire Others listed: Life Effectiveness Questionnaire, Treatment Expectancies Questionnaire, Hope Scale, Therapeutic Alliance Scale, Brief Family Assessment Measure

Treatment methods

There was consistency across programs for treatment methods such as individual and group therapy. Non-traditional methods were listed on a couple


of websites such as yoga, equine, and therapeutic drumming. Most common: Individual therapy, group therapy, substance-abuse intervention, journaling, family therapy

Clinical Practices

Not all the programs specifically listed their clinical practices. CBT was the most common clinical practice listed. Examples: Reality Therapy, Cognitive Behavioral Therapy (CBT), experiential therapy, play therapy, Dialectical Behavioral Therapy (DBT), Motivational Enhancement Therapy (MET)

Outcomes

Outcomes listed on program websites were a mix of assessable and not easily assessable. Examples: Improvement in family relationships, sobriety, improved communication skills, healthy behaviors, self-reliance, self-respect, self-efficacy, awareness for the environment, moderation, balance.

Behavioral Issues and Disorders

There was consistency across programs in regards to issues listed that their program was effective in treating. These line up well to the sub-scales of the Y-OQ. Most common: Substance abuse, family conflict, depression, anxiety, defiance, and low self-esteem

Research terms were collected as unique uses of the term by a program. Multiple uses of

the same term on a website was not measured. Only terms used to describe a program’s research

were used. For example, if a program stated they used evidence-based therapies in their

programs, this was not included in this category. Terms needed to speak specifically to the

research done on the TWP’s program and effectiveness. Research terms used were divided into

the following categories: type of research (empirical, qualitative, outcome, evidence-based, and

independent), recognition of research (silver standard, Dr. Phil), and quality of research (time-

tested, peer-reviewed, therapeutic). The most common term used on WTP websites was

outcome. Of the nineteen program websites used in this study, six of the programs did not

mention research results from research conducted on their program. This does not mean these

program do not conduct such research, only that they did not mention anything on their website.


One use of websites is the promotion of a company. This promotion and marketing lends

itself to making declarative statements that may, or may not, have data to confirm the statement.

The following are examples of distinguishing characteristics listed on these websites that could

be backed by empirical research, but no evidence was referenced.

Table 2. Distinguishing Characteristics The most experienced, dedicated, and well-trained professionals in the field of wilderness therapy. The only one that is supported by continuous outcome-based research. Different from any other kind of wilderness therapy. Our treatment model makes us a superior therapeutic wilderness program. Unlike most programs in the wilderness therapy industry, we can back up our claims with hard data. “Simply the gold standard in wilderness therapy.” Setting a new standard in wilderness therapy. Highest-level training and one of the most sophisticated models in the field of wilderness therapy. Unparalleled ability to gain the trust and respect of troubled teens. One of the best researched adolescent therapy programs in the U.S. Widely considered to be pioneers of the field. The only wilderness therapy program that conducts outcome research on each and every student.

The central focus for this study was whether WTP were engaging in evidence-based

research and using that information to inform practice. The following results look at findings

specific to this topic. Two of the websites specifically listed research that was beyond participant

assessment such as the Y-OQ. One mentioned their studies on health and wellness and the other


referred to studies on therapeutic alliance. The second WTP did not indicate if their program was

involved in that study. One WTP stated that their research helped guide future programming.

Figure 1 is a word cloud made from behavioral issues and disorders listed on program

websites. The larger words appear, the higher frequency across all the websites. The original list

of words was edited to create consistency across phrasing. For example, “failing in school” and

“poor academic” were changed to “academic-performance.” Only one program website

categorized these characteristics into mental health, addictions, behavior, and family. See

Appendix A for the original list of behavioral issues and disorders.

Figure 1. Prevalence of behaviors and disorders TWP indicate will find their program effective.


Discussion

It should be noted the great strides taken by the such organizations as Outdoor Behavioral

Healthcare Research Consortium and AEE’s Council on Research and Evaluation. Many of the

program websites were a part of, and listed, the research done through the OBHRC. Those

studies show the effectiveness of wilderness therapy programs in bringing students into normal

social ranges for the 6 sub-scales. The purpose of this project was to do a conceptual analysis of

evidence-based practice using a select group of wilderness therapy programs. Websites are easily

accessed by potential clients and are used for informational and marketing reasons. If a program

was proud of, and felt passionate about the use of evidence-based practice to help better inform

their own programming, there is a chance this would be mentioned on their website.

Evidence-based practice (EBP) is not merely number crunching. It allows a program to

take into account the environment and mission of the organization. On a larger scale, the use of

EVP across programs allows for greater knowledge on both what outcomes are being assessed

and how outcomes are being created by programs. There is both a need for the benefit of

individual programs and for the larger outdoor behavioral healthcare industry. Six of the nineteen

programs used in this project did not mention outcome studies at all on their websites.

There is a need for a common vernacular across programs. This not only helps clients

trying to decipher through websites, it also helps the industry speak to each other. Phrases such

as university-led research empirical research, independent research, or outcome studies could be

more uniform across the industry. Decrease use of language that does not validate the type of

research needed for WTPs. One of the websites referred to their research as “silver standard.”

They were trying to validate why they do not conduct “gold standard” research. This meant that

they did not have a control group for their study. Programs are not likely to discard parts of their


programs (i.e. family involvement) in order to test whether there is a difference in the outcomes.

The need is not to categorize the research practices used in WTP as “silver standard,” but to

create a gold standard of research for outdoor behavior healthcare. WTPs do not operate in

traditional clinical settings, so why should they be expected to operate their research in the same

fashion in order for it to be the gold standard?

There is a need for more evidence-based practice within the larger outdoor behavioral

healthcare industry. Only those programs viewed as most reputable should not do this alone.

There are certainly obstacles to many programs conducting research; among these are funding

and staffing. More EVB will help create legitimacy in research practices for WTP in view of the

greater behavioral healthcare industry. It would also help to create best practice models for the

larger WTP and outdoor behavioral healthcare industry.

This study found a substantial lack of evidence on program websites suggesting

evidence-based practice is being used to inform and improve programming. Future studies would

have to go beyond the websites to validate the findings from this research. This study does have

limitations in generalizing to the whole wilderness therapy industry. Not all of the websites

available were analyzed. No WTP associated with the selected professional organizations were

excluded except by the inclusion/exclusion criteria. Including the remainder WTP websites

available may produce different results. It is the opinion of the researcher that inclusion of those

remaining websites would only further emphasize the lack of consistency in research terms and

may show a more glaring lack of research reported.

This study did a conceptual analysis on evidence-based practice in wilderness therapy

programs using information available from websites. This first step has created a clearer

understanding of inconsistencies across program websites when referring to research. It also


found few programs mentioning use of research to inform future practices at the organization.

Promising for the industry is voluntary involvement in organizations such as Outdoor Behavior

Healthcare Research Consortium. Transparency in research and more involvement in research

promotion will only improve the reputation and effectiveness of wilderness therapy programs.

One possible obstacle is the cost of research, not only in terms of money, but also staffing

required. Creating more ways to connect researchers to programs would be one way to increase

the use of evidence-based research. This would require more emphasis in undergraduate and

graduate studies on conducting solid research. As mentioned earlier, many of the studies

produced across the outdoor behavioral healthcare industry have been viewed by other

disciplines as “fragmented, disparate, weak, easily criticized” (Thomas, Potter, and Allison,

2009, pg. 29). It is not enough to produce leaders in facilitating outdoor education and wilderness

therapy; the industry must also invest in producing solid researchers for these programs.

There is ample potential for evidence-based research to inform and affirm the

effectiveness of wilderness therapy programs. The lack of substantial research currently being

conducted should be viewed as a challenge to be taken head-on. Many of the programs used in

this study spoke of growth in character for their participants. Evidence-based practice is one

important way programs can apply that outcome to themselves.


References

Becker, S. (2010). Wilderness therapy; Ethical considerations for mental health professionals. Child Youth Care Forum, 39, 47-61. Davis-Berman, J., Dene, S. B., & Capone, L. (1994). Therapeutic Wilderness Programs: A

National Survey. The Journal of Experiential Education, 17(2), 5. Ewert, A. and Sibthorp, J. (2009). Creating outcomes through experiential education: The challenge of confounding variables. Journal of Experiential Education, 31(3), 376-389. Hill, N. R. (2007). Wilderness therapy as a treatment modality for at-risk youth: A Primer for

Mental Health Counselors. Journal of Mental Health Counseling, 29(4), 11. Itin, C. M. (2001). Adventure therapy--critical questions. The Journal of Experiential Education,

24(2), 80. Kimball, R. O. & Bacon, S. B. (1993). The wilderness challenge model. In M. Gass (Ed.).

Adenture therapy; Therapeutic applications of adventure programming. Dubuque, IA: Kendall-Hunt.

MacKenzie, D. (2000). Evidence-based corrections: identifying what works. Crime & Delinquency, 46(4), 457-471. Powch, I. G. (1994). Wilderness therapy: What makes it empowering for women?. Women &

Therapy, 15(3/4), 11-27. Russell, K. C. (2001). What is wilderness therapy? [Information Analyses]. Journal of

Experiential Education, 24(2), 70-79. Shooter, W. (2009). A closer look at the “inner workings” of adventure education: Building evidence-based practices. Journal of Experiential Education, 32(3), 290-294. Spring, B. (2007). Evidence-Based Behavioral-Practice. Retrieved from http://www.ebbp.org/ebbp.html Thomas, G., Potter, T., and Allison, P. (2009). A tale of three journals: A study of papers published in AJOE, JAEOL and JEE between 1998 and 2007. Australian Journal of Outdoor Education, 13(1), 16-29. Wilderness and adventure-based therapeutic outdoor services. (2008). Council on Accreditation.

Retrieved on Feburary 20, 2011 from http://www.coastandards.org/ Wilson, J. (1985). Thinking with Concepts. New York, NY: Cambridge University Press.


Appendix A. Behavioral Issues and Disorders Listed on WTP Websites

- Disrespectful - Making dangerous

choices - Battle zone - Defying parental

authority - Staying out late - Poor choice of

friends - Relational

problems with family

- Substance abuse - Early sexual abuse - Hyperactivity in

school - Impulsiveness - Depression - Personality

problems - Suspended - Expelled - Attachment

disorders - Mood disorder - Drug abuse - Struggling with

grief - Internet addiction - Low self-esteem - Promiscuity - Angry - Defiant - Anxiety - Depression - Anxiety - Bipolar disorder - Oppositional

behaviors - Substance abuse

- Learning difficulties

- Victims of trauma/abuse

- Low self-esteem - Poor social skills - Immaturity - Internet addiction - Entitlement

orientations - Lack of motivation - Relational

problems with family

- School struggles - Law enforcement

conflict - Peer conflict - Entitlement - Manipulation - Family conflict - Isolation - Low self-esteem - Substance abuse - Defiant behavior - Attention deficit - Learning

differences - School failure - Peer conflict - Defiant - Out-of-control

anger - Experimenting with

drugs or alcohol - Depression - Causing chaos or

stress at home - Manipulative - Impulsive - Breaking rules

- Poor academic performance

- Skipping school - Depression - Anxiety - Substance abuse - Attention deficit - Oppositional

behavior - ADHD or ADD - Depression - Bipolar disorder - Anxiety - PTSD - Panic disorder - Conduct disorder - Oppositional

defiant disorder - Learning

disabilities - Substance abuse - Internet addiction - Pornography - Sexual abuse - Bereavement issues - Anger - Apathy - Irresponsibility - Lazy - Entitlement - School conflict - Law conflict - Family conflict - Negative attitudes - Apathetic

impulsive - Ungovernable - Irresponsible - Low self-esteem - Lack accountability - School failure


- Impulsive - Defiant - Family trauma - Minor criminal

activity - Low self-esteem - Mild eating

disorders - Oppositional

defiance - Entitlement - Drug abuse - Alcohol abuse - Anxiety - Depression - Bi-polar - Anger management - ADD - ADHD - Learning

differences - Social skills

deficits - Identity issues - Self harm - Chemical

dependency - Relationship issues - School problems - Grief and loss - Family conflict - Promiscuity - Attachment issues - Negative life

patterns - Gaming addiction - Adjustment issues - ADD - ADHD - Opposition

defiance disorder

- Depression - Substance abuse - Attachment

disorder - Adjustment

disorder - Impulse control - Learning disorder - Bi-polar disorder - Anger - Defiance - Family conflict - Low motivation - Low self-esteem - Grief or loss issues - Negative peers - Anxiety - Addictions - Substance abuse - Gaming addiction - Internet addiction - Attachment - Family Conflict - Low self-esteem - Depression - Anxiety - Defiant behavior - Adoption - Substance abuse - Manipulative - Poor academic - Learning

differences - ADHD - Trauma - Defiant - School issues - Low self-esteem - Depression - Anxiety

- Negative peer relationships

- ADHD - Learning

differences - Experimenting with

drugs and alcohol - Manipulative - ADHD - Identity issues - Anxiety - Depression - Substance abuse - Oppositional

defiant disorder - Grief and loss - Addictions - Run-aways - Choosing wrong

friends - ADHD - FASD/FAE - Impulsive - Hyperactive - Attachment

disorders - Sexual abuse - Anxiety - Abusing drugs or

alcohol - Beyond parental

control - Rebellious - Angry - Defiant - Low self-esteem - Depressed - Failing in school - Suspended - Expelled

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