Decompensation And Failure To Thrive In Wilderness Therapy Programs
Wilderness programs for youth at risk are growing across the country. These programs are growing in response to a gap in health care services that have been created by managed health care companies that do not recognize or provide services for youth at risk or children 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 is a real but very infrequent event. Decompensation and a failure to thrive are more severe problems and very different problems 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. Decompensation is an extremely rare problem. Programs must be cautious and not mistakenly attribute such to such things as manipulation, defiant or oppositional behavior.
Failure to thrive can also take many forms. Wilderness programs provide opportunities for students to respond to various opportunities, challenges and ordeals with a rewarding and healthy initiative. Once students are separated from their former environment, they are soon faced with individual, environmental and social realities that are free of unhealthy distractions, drugs and the ability to avoid or escape the consequences of their choices. A failure to thrive occurs when a student is unable or unwilling to take advantage of this environment. They are not persistent, determined or adaptable.
Failure to benefit from a particular program is quite different from a failure to thrive in a program. There are many reasons why a student may not benefit from a particular program. For instance, a student may not benefit because the 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, we increase the length of a program beyond the child's ability to endure, a student may decompensate or fail to thrive. This can happen when the students psychological needs are not met, the student is overwhelmed and the length of the program becomes too long.
Knowing in advance that enrollment in a program may lead to decompensation or a failure to thrive is not impossible and in some cases is not difficult. Screening and monitoring procedures are the key to prevention. Decompensation and failure to thrive are usually the result of one or two of the following factors.
The optimal program will address a students psychological needs as well as provide challenges. The structure and philosophy of programs can be as different as people are different. Parents, programs, educational consultants and mental health professionals each have a role in minimizing the risk that a child may decompensation or fail to thrive in a wilderness program.
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 the risk is very low if a child is screened and admitted to a well designed and implemented program.