Using the Integrated Care Model in Wilderness Therapy

A common question in mental health treatment is, “Where does treatment start?” Should therapists focus first on healing trauma and mental health issues to stop drug use? Should they resolve physical health concerns to alleviate emotional problems or vice versa? In a seamless cycle of coexisting issues, how do professionals know where to start treatment?

According to the Integrated Care Model, the best treatment addresses all risk factors concurrently. This model focuses on viewing dysfunction and treating clients holistically.

Integrated Care Model’s Areas of Focus

Integrated Care addresses addictive behaviors, general health, mental health, relationship problems, and academic well-being that disrupt a teen’s normal development.

Mental Health:

The rates of depression, anxiety, and other emotional disorders in children and adolescents continue to grow. Unlike most other health concerns, emotional disorders are on the rise. Adolescent mental health disorders are concerning as they:

  • interfere with normal development
  • can lead to poor school performance, school avoidance, or dropping out of school
  • strain family and social relationships,
  • increase involvement with the child welfare and juvenile justice system,
  • and can escalate to other disruptive behaviors.

Unresolved mental health concerns in adolescents lead to greater risks of chronic mental illness in adulthood, addiction, and physical health problems. To re-engage adolescents in healthy development, we must empower teens with the skills and insight to appropriately manage their mental health issues.

Physical/General Health:

The connection between physical health and mental health is well established. A healthy lifestyle including a nutritious diet, regular exercise, a physically active daily routine, good self-care and hygiene, and appropriate sleep habits is predictive of good mental health. Unresolved physical and general health concerns lead to increased emotional distress, lower self-esteem, loneliness, and other maladaptive and avoidant behaviors. Disrupting unhealthy patterns needs to include an assessment and treatment of the adolescent’s physical and general health risk factors.

Addiction:

Nearly half of all families who seek treatment for a struggling adolescent include substance use and addiction as a major concern. Substance use by teenagers is a significant developmental concern as it interferes both with physiological development and the ability to perform age-appropriate tasks. Harmful drugs inhibit the ability to cope, impair cognitive functioning, and disrupt familial and social relationships. An integrated treatment approach includes assessment and treatment for addictive behaviors.

Relationship Health:

Family functioning is strongly associated with healthy psychosocial development in children and adolescents. Therefore, truly effective treatment for adolescents includes family relationships. RedCliff Ascent utilizes Narrative Family Therapy that has been adapted to our unique treatment environment. Adolescents and parents write and share personal narratives during the entire treatment process. The narratives are also shared with the therapist, staff, and the group, who all become witnesses to the evolving family narrative.

Academic Health:

Academics are a major part of a teen’s life. Often, academic struggles are induced in part by a teenager’s distress and directly contribute to dysfunction. Due to the importance of academics in the adolescent phase of life, assessment and treatment need to include academic risk factors.

Evolution of Clinical Sophistication in Wilderness Programs

Wilderness therapy programs have grown over the past 30 years. Major innovations like the therapist-centric groups helped increase programs’ clinical sophistication. As a community, we evolved from wilderness experience programs with therapeutic support to robust evidence-based wilderness therapy programs.

So many wilderness programs across the country adopted these developments that they’ve become the standard approach to wilderness therapy.

Standard Wilderness Therapy Approach

Most therapeutic wilderness programs have some form of the following:

  • Milan groups - Every week guides coming on shift join students and outgoing field staff for an exchange group called “Milan.” During Milan, students and outgoing staff update the group on the student’s progress, wins, and struggles during the previous week. This allows for maximum transparency and trust among staff and students. It also provides a framework of accountability while also limiting “triangulation” and students' feelings of being talked about behind their backs.
  • Clinical meetings - these weekly or biweekly meetings provide therapists with time:
    • for coordination & logistics
    • for therapeutic training & development
    • to give clinical support on challenging cases
  • Field Guide training - all field staff in wilderness therapy programs go through rigorous training. In addition to their initial orientation training, every staff member attends hours of training each week before joining students in the field. This develops a clinical sophistication not only in therapists but in the field guides who spend every day with the students.

At RedCliff we celebrate these widely adopted practices and want to build on this progress.

Using the Integrated Care Model in Wilderness Therapy

Assessment and treatment at RedCliff Ascent are based on the Integrated Care Model. This model focuses on viewing dysfunction and treating clients holistically. SAMHSA states, “integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs.”

SAMHSA’s recommended best practice for implementing an Integrated Care Model in treatment is through a weekly treatment team meeting. Though it is standard for residential and other treatment programs to use treatment teams, it isn't standard practice in wilderness therapy.

Weekly Treatment Team Collaboration

In addition to having weekly Milan groups, clinical meetings, and staff training sessions, RedCliff also has a weekly treatment team meeting with members from the:

  • clinical team
  • academic team
  • nursing & medical team
  • & field guide team

This treatment team approach allows us to holistically review each and every student’s progress and regularly adjust their treatment goals and interventions. This collective & single moment of collaboration provides therapists with:

  • clearer communication between teams
  • a more comprehensive view of a student’s struggles and progress
  • better insight to the root causes of a student’s struggle
  • greater insight to group dynamics so they can provide a better experience for all the students in the program.

Viewing teens holistically means viewing them as complex and integrated individuals whose current struggles are influenced by their mental health, physical health, relationship health, addictive behaviors, and academic well-being. By adopting an Integrative Care Approach and collaborating as a treatment team, wilderness therapy is better aligned with the rest of the treatment world. More importantly, it’s better for the families we help.

Read Our Research on the Integrated Care Model

To learn more about research outcomes on our integrated treatment click here to access our research article. 

Read the Research Article