Decompensation And Failure To Thrive In Wilderness Therapy Programs

By: Michael Conner, Psy.D

Comprehensive Information: www.WildernessTherapy.Org
Mentor Research Institute:
E-mail: Conner@OregonCounseling.Org
Revised: May 21, 2014


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 student’s psychological needs are not met, the student is overwhelmed and the length of the program becomes too long.

Prevention

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.

  • Screening. In this case, the program is unable to recognize, understand and address an underlying or pre-existing medical problem. In some programs, students are taken off medications  that they need immediately prior to a program or during a program. In other cases they may be taken off a medication abruptly and inappropriately. Some students enter a program on the wrong medication or medications. Other students have unrecognized medical problems that can look like psychological and behavioral problems. Subtle medical problems can contribute to a student’s behavioral problems. Some of the more common medical problems include endocrine and neurological disorders such are diabetes, hypothyroidism and seizure disorders. A surprising number of students enter programs who were put on antidepressants when they were simultaneously using marijuana and alcohol on a regular basis. Consumer research is demonstrating in medical journals that a consequence of today’s managed for profit health care system is a growing trend in which medical problems that cause psychological and behavioral problems are not properly evaluated and treated. Children with mental health problems are ending up in the criminal justice system.

  • Program Incompatibility. The individual and social demands of a program can overwhelm the resources and abilities of some students. Some programs are emotionally too demanding and a few student problems are beyond the reach of a particular program. Some students will respond to one program and not another. In some cases, programs do not provide an adequate screening or they may accept students that they are not designed to work with. In addition, parents who mean well may not provide the necessary information to adequately screen students. The former can happen when a program is inexperienced, financially desperate, or the program does not have a qualified clinician involved in the screening process. The latter can happen if there is a history of guilt or fear that the family may have caused the current problem. In most cases, parents are not informed by their child’s health care professional and they are not given a good understanding of their child’s needs and problems. Psychological impairments associated with trauma or abuse, developmental delays and psychological impairments are common problems that can be misunderstood and go unrecognized.

Solutions

The optimal program will address a student’s 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.

  • Work with educational consultants and mental health professionals who are knowledgeable and have experience working with wilderness programs.

  • Consult 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.

  • Consult with a clinical psychologist, and when directed, obtain a comprehensive interview, individual and family history, as well as a psychological evaluation that includes personality, intelligence and neuropsychological functions.

  • Look for programs that have screening procedures that include consultations with qualified and licensed professionals who have credible training and experience in diagnosis as well as recognizing 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 the risk is very low if a child is screened and admitted to a well designed and implemented program.

copyright 1999 to 2002, Michael G. Conner