Abstract

Outdoor behavioral healthcare (OBH or wilderness therapy) is an out-of-home adolescent treatment option serving tens of thousands of youths annually for behavioral, substance, and mental health issues in the United States. About half of OBH participants attend involuntarily and are transported by services specialized for “uncooperative” youth. Transportation has been argued by some researchers to have little impact on youth in treatment, and Tucker and colleagues found little difference in outcomes between not transported and transported youth. Ethical and empirical concerns arise from these findings, and we apply a critical perspective to address these concerns. Specifically, we examined the claim in OBH research that being transported has no significant bearing on client treatment outcomes. We propose that the findings of no difference were random, rather than systematic, because they were constructed on a post hoc measure of perceived voluntariness. To demonstrate, we used data from OBH to construct five different measures of voluntary/involuntary, also fabricated post hoc. All five operationalizations resulted in statistically significant differences across a variety of social and psychological outcomes, demonstrating inconsistencies across the findings. Further independent and rigorous research is called for in OBH to understand the use and ethics of forced transportation, coercion, and involuntary treatment.

摘要

户外行为医疗保健（OBH 或荒野疗法）是一种户外青少年治疗选择，每年为美国数以万计的青少年提供行为、物质和心理健康问题的服务。大约一半的 OBH 参与者非自愿参加，并由专门为“不合作”青年提供的服务运送。一些研究人员认为，交通运输对接受治疗的青年影响不大，塔克及其同事发现，未交通运输的青年和交通运输的青年之间的结果几乎没有差异。这些发现引起了伦理和经验方面的担忧，我们运用批判性的观点来解决这些问题。具体来说，我们检查了 OBH 研究中的说法，即运输对客户治疗结果没有显着影响。感知自愿性的事后测量。为了证明，我们使用来自 OBH 的数据构建了五种不同的自愿/非自愿措施，也是事后捏造的。所有五种操作都导致了各种社会和心理结果的统计上的显着差异，证明了调查结果的不一致。OBH 需要进一步独立和严格的研究，以了解强制运输、胁迫和非自愿治疗的使用和伦理。