The Outdoor Behavioral Healthcare Council was founded in 1996 when representatives from a handful of wilderness treatment programs joined to collaborate and to share best practices.

About OBHC

The Outdoor Behavioral Healthcare Council was founded in 1996 when representatives from a handful of wilderness treatment programs joined to collaborate and to share best practices.

The founding programs realized the advantage of uniting to promote program standards and excellence and thus the OBH Council was founded.

Today, the organization and its member programs have been instrumental in raising the bar for outdoor behavioral healthcare, facilitating research on the efficacy of wilderness and other outdoor behavioral treatments for adolescents and adults, and in promoting the field as a whole.

What is Outdoor Behavioral Healthcare ?

Outdoor Behavioral Healthcare is the prescriptive use of adventure experiences provided by mental health professionals (often conducted in natural settings) that engages clients on cognitive, affective, and behavioral levels (Gass, Gillis, & Russell, 2020).

Outdoor Behavioral Healthcare (OBH) includes but is not limited to:

  • Extended backcountry travel and wilderness living experiences that last for an average of 90 days that allow for clinical assessment, establishment of treatment goals, and a reasonable course of treatment not to exceed the productive impact of the experience,
  • Active and direct use of clients’ participation and responsibility in their therapeutic process,
  • Continual group living and regular formal group therapy sessions to foster teamwork and social interactions,
  • Individual therapy sessions, often supported by the inclusion of family therapy,
  • Adventure experiences utilized to appropriately enhance treatment by fostering the development of eustress (i.e., the positive use of stress) as a beneficial element in the therapeutic experience.
  • The use of nature in reality as well as a metaphor within the therapeutic process, and
  • A strong ethic of care and support throughout the therapeutic experience.

Outdoor Behavioral Healthcare is delivered by trained professionals in an outdoor setting​.​

OBH practitioners are trained in therapeutic techniques and interventions as well as adventure and wilderness-context facilitation.

OBH refers to the work done in providing primary care, secondary care and is considered an alternate intermediate care program with regards to public health and for obtaining full insurance reimbursement according to state and federal mental health and substance abuse parity regulations.

Mission

The Outdoor Behavioral Healthcare Council is a community of leading outdoor behavioral healthcare programs working to advance the field through best practices, effective treatment, and evidence-based research.

Philosophical and Ethical Standards

The OBH Council members believe outdoor treatment is a highly effective form of treatment for most adolescent and young adult behavioral healthcare problems.

We commit ourselves to making it effective, safe, and more widely available. We are members of OBH Council not because we are perfect, but because we want to improve our programs through collegial interaction. We commit ourselves individually and collectively to work continuously and sincerely to improve outdoor treatment in our own programs and to share information with our colleagues and to help them with their improvement efforts.

Both in order to ensure the high quality and good reputation of our industry, and to make possible a trusting and open dialogue among ourselves, we commit ourselves to these standards. As members, we shall:

  • Serve children and families with understanding, patience and integrity, promoting personal dignity and self-worth.
  • Offer a journey of self-discovery that models sound values and principles.
  • Not discriminate on the basis of sex, gender, race, color, beliefs, disability, sexual orientation or cultural background and shall acknowledge these individual differences as important in the treatment process.
  • Provide quality experiences that are guided by competent and professional staff.
  • Be adequately staffed to provide the level of service they offer. They ensure that staff are adequately trained.
  • Promote the protection and beneficial uses of our natural resources, with respect and attention to our impact upon them.
  • Practice the effective use of outdoor programming as part of the existing continuum of behavioral healthcare and therapeutic approaches.
  • Acknowledge the risk associated with outdoor programming and take reasonable and responsible steps to manage that risk.
  • Provide services after a process of appropriate screening and informed consent.
  • Have appropriate licensure and permits when required by regulating agencies or bodies.
  • Provide educational and program curricula in accordance with state standards.
  • Accurately represent their programs, including ownership, competence, experience, and scope of activities.
  • Manage their finances to ensure that there are adequate resources to accomplish their mission.
  • Fully disclose to prospective candidates the nature of services, benefits, risks and costs.
  • Provide an appropriate professional referral if they are unable to continue services.
  • Not actively solicit or recruit fellow members’ employees (e.g. jobs can be posted and advertised, but we do not call or aggressively target individuals from other programs).
  • Do their best to maintain objectivity in our recommendations and counsel to the families.
  • Avoid dual relationships with professional referral sources. This includes:
    • Paying for referrals (directly or indirectly),
    • Referring a family to a single specific professional referral source, or
    • Requiring that a family have a professional referral source before admission to the program.
    • Referrals to external referral sources will be based upon that which will best serve the needs of the child and family, not the needs of the program or referral source.

1.0 – State and Federal Laws

The program shall adhere to all applicable state and federal laws in the administration of their business, their hiring and employee practices, their observance of safety regulations and the procedures / treatment of their program participants.

2.0 – Administrative Practices and Procedures

2.1 – Plan for Governance

Every program shall have a written Plan for Governance and program administration. The written plan is to include a written Program Description, which is to be available upon request. The program description is to include:

    • Introduction and history of the program
    • Description of the population the program serves
    • Mission statement
    • Philosophy of the program
    • Description of the services provided
    • Fee statement with full disclosure of costs, including ancillary charges and refund policy

2.1.1 – The written Plan for Governance shall identify the responsibility and authority over development, implementation, compliance, amendment, and oversight of the policies in order to meet the program mission.

2.1.2 – An organizational chart shall be available identifying the operating units and their inter-relationships; lines of authority and responsibility from ownership to direct care staff. The plan shall ensure the program has general liability insurance, professional liability insurance (as appropriate), vehicle insurance and fire insurance.

2.1.3 – The plan shall ensure the program has general liability insurance, professional liability insurance (as appropriate), vehicle insurance and fire insurance.

2.2 – Code of Ethics

The program shall have a written Code of Ethics that is consistent with the published National Association of Schools and Programs (NATSAP) Code of Ethics.

2.3 – Self-Evaluation

The program shall have an identified process for self-evaluation and program improvement.

2.3.1 –  The program will provide adequate amounts and quality of equipment and vehicles and have policies and procedures for maintaining them in good repair.

2.2 – Confidentiality

Confidentiality policies and procedures shall be in place that covers program participants, staff and the program in general.

2.3 – Accounting

The program will follow generally accepted accounting practices.

2.4 – Incident Reporting

The program will comply with state and/or federal standards on incident reporting, and will report qualified incidents to OBH Council’s collection person.

2.5 – Staffing Policy

Programs will be adequately staffed to provide the level of service they offer.

2.6 – Education

Educational curriculum will be provided in accordance with individual state standards.

3.0 Employee Practices

3.1 – Staffing Practices

The program will meet staffing requirements of its state or professional bodies, and will have staffing levels and levels of staff expertise necessary to ensure the well-being and treatment growth of its clients.

3.2 – Hiring Practices

All applicants to a program will be required to complete an Employment Application. When a decision to hire is made, the following actions must take place for all candidates:

    • A criminal background check will be conducted by a certified agency (FBI, NCIC, etc.)
    • The program will require reference screening, including professional references. Written and verbal references are required.
    • The program will complete a professional credential screening that is in compliance with their accreditation/licensure body, as applicable, and will require proof of credentials.
    • Every candidate will be required to sign a Job Description and a confidentiality agreement
    • The program must obtain a Department of Motor Vehicle check of the driving record of every candidate who may drive company vehicles.

3.3 – On-Going Employee Practices

The program will have written job descriptions for each position that include specific statements of duties and responsibilities; and the minimum level of education, training and work experience required for the position.

The program will have written Employee Policies and Procedures that include:

    • Orientation and on-going training, including:
      • Orientation in philosophy, objectives and services
      • Emergency procedures
      • Behavior management
      • Statutory responsibilities, including those covered by state and federal laws
      • Current program policy and procedures
      • Frequency, content and duration of continuing education
      • First aid and CPR
    • An organizational chart which will identify the operating units and their inter-relationships; lines of authority and responsibility from ownership to direct care staff.
    • Rules of conduct
    • Policies on performance appraisals
    • Policies on disciplinary actions and termination procedures.
    • Policies covering sexual and personal harassment.
    • Policies covering abuse reporting laws
    • Policies on volunteers, interns and contract personnel
    • Policies on sick and personal leave, vacations, holidays and extended leaves
    • Policies on confidentiality
    • Policies on transportation of program participants
    • Training on policies on incident reporting

3.4 – Personnel File

The program will maintain a personnel file on each employee, owner, board member, volunteer and intern that is to include:

    • Application and resume
    • I9, W4, drivers’ license, proof of insurance (for contracted professionals), social security card
    • Proof of applicable licensure
    • Proof of credentials
    • References
    • Copy of completion of orientation
    • Signed job description
    • Background clearances (criminal and motor vehicle)
    • Signed copy of confidentiality agreement
    • Documentation of on-going training and continuing education
    • Work related accidents
    • Performance evaluations
    • Emergency contact information
    • Termination papers and related information

4.0 – Program Participant Related Procedures

4.1 – Admissions Policy

The program will have a written Admissions Policy that defines enrollment criteria, including types of client and problems appropriate for the program, and inclusion and exclusion criteria. Admission forms include a form to gather background information and current physical information. The Admissions screening process will examine the physical, emotional, behavioral history, academic history and past assessments, as applicable to above, and establish that admitted clients are appropriate for the program based on admission criteria and program description.

Upon admission, a file will be created for the Program Participant and will contain:

    • Background obtained at enrollment and maintained through the program
      • Medical
      • Family
      • Behavioral
      • Educational
      • Past and current assessments
    • Contracts, releases and consent forms
    • Documentation of pertinent communication with families, referral sources, post-treatment resources, consultants and agencies
    • Emergency contact information
    • Physical description
    • A general plan of treatment for each youth, developed within a week of the youth’s admission to the program, and revised as needed over time. When youth have conditions that may be difficult to manage in an outdoor setting, such as epilepsy, diabetes, significant past musculo-skeletal injuries, severe depression or recent suicide attempts, schizophrenia, borderline personalities, a history of serious assaultive behavior, significant alcohol or drug abuse, or other similar conditions, the treatment plan must address how those issues will be managed by the program.
    • Treatment (Progress) notes which are sufficiently extensive to “tell the story” of each youth’s progress in treatment
    • Discharge Treatment Summary and Discharge Plan which gives post-treatment recommendations
    • Copy of grievance filings and actions taken

4.2 – Behavior Management Plan

The program will have a Behavior Management Plan that will include the following:

    • All behavioral management procedures will respect human dignity and outline participant rights which are in keeping with state regulations
    • A policy identifying acceptable and non-acceptable consequences
    • Crisis intervention policies and documentation, training and review
    • Runaway procedures
  •  

4.3 – Rights and Responsibilities

The program will have written policies and procedures that cover rights and responsibilities and provide for the following:

    • Every individual will have the right to respect of human dignity
    • Privacy and confidentiality of information and privacy for both current and closed records
    • An environment that manages environmental and interpersonal risks
    • Identification and description of program participant responsibilities including tasks, privileges and rules of conduct
    • The procedures for grievances and complaints with statement on freedom from retaliation. All grievances and complaints shall be kept on record including documentation of action taken.
    • Right to freedom from discrimination
    • Defines the policies and the right to communicate with family and others
    • Outline visitation and communication rules while maintaining the rights of the program participants and their families
    • Policies regarding contraband
    • Policies relating to religious practices
    • Participant rights to involvement in treatment planning and to information about the program’s plan
    • Participants shall be provided with a diet that is nutritionally sufficient for age and activity level
    • Rights to appropriate medical treatment

4.4 – Medical Management

The program will have defined procedures for: medical management, access to medical care, evacuation and medications.

5.0 – Risk Management

Each facility shall follow all related state and federal laws pertaining to safety and shall document the following:

5.1 – Illness & Injury Prevention Plan

The program will have an Illness and Injury Prevention Plan that will be covered in the Employee Orientation and provided to employees in on-going training sessions, which addresses the following:

    • Emergency procedures
      • Fire
      • Natural disasters
      • Medical emergency
      • Evacuation
      • Drills
    • A hazard communication procedure will be documented
    • A safety committee will be in place and meet on a scheduled basis
    • Occupational health reporting will be maintained
    • Personal protective equipment will be provided
    • Safety related roles will be defined
    • Safety policies will be documented
    • Education and awareness of blood born pathogens/infectious diseases
    • Safety training
      • First Aid
      • CP
      • WSI (as applicable)
      • WFR (as applicable)

5.2 – Incident Reporting

The program will document and follow Incident Reporting Procedures. Each program must keep a list of all incidents, including injuries, illnesses, or behavioral incidents which either require evacuation of a youth from the field, involve a therapeutic hold procedure, or interrupt regular programming for the youth for a period of 12 hours or more (the WRM standard.) Incidents should be briefly described, including how they were resolved by the program. It is the expectation that this list will remain confidential, for reviewers’ use only.

6.0 – OUTDOOR PROGRAM POLICIES AND PROCEDURES

Programs will have reasonable policy and procedure related to the nature of their outdoor program activities (e.g., hiking, climbing, solo.)

6.1 – Local Registration

    • Programs will use only lands and facilities for which they have appropriate approval for the type of use involved. Such approvals would include Special Use/Recreation Permits from the BLM or USFS, agreements with private landowners, state agencies or, of established base camp facilities, any group home or educational facility permits required by existing regulations. Such approvals must be documented.
    • A program must register its presence and activities with the appropriate law enforcement offices in the areas of its operations
    • In the event of a runaway, a program will notify local law enforcement and land management agencies at such point in time as its own search efforts have proven non-productive and the youth involved or the public may be endangered by conditions of weather or the actions of the youth. In such cases the program will support any needed search and rescue operations by law enforcement officials, and they in turn will proceed in close consultation with the program as to the appropriate amount and type of search effort needed.

6.2 – Personnel

    • A program’s regular field staff must be 21 years of age or older. Younger staff are acceptable as interns, but do not count as staff in maintaining required staff: client ratios.
    • Programs must have a sufficient number of staff with any outdoor group not in a constructed (wooden buildings or platform tents) base camp so that the ratio of staff to clients does not drop below one: four. While a staff member may be detached to drive one or two clients to a doctor’s visit, etc., the remaining group must maintain at least the one to four ratio. Exceptions for emergency evacuations or searches, when well documented, could be acceptable provided they are infrequent and irregular.
    • Each program will have present with each youth group whenever the group is not in base camp a staff person who is medically trained and certified as either a Wilderness First Responder (WFR) or an Wilderness Emergency Medical Technician (WEMT.)

Officers
Karen Scrafford, Chair – karen@elementswilderness.com
Katelyn BeVard, Vice Chair – katelyn@evoketherapy.com
Misty Blakesley, Treasurer – misty@themountaincenter.org
Andrew Taylor, Secretary – ataylor@purelifeadventure.com
Tara Feeney-Stireman, Board Member – tara@elementswilderness.com
Ryan Bromberek, Ambassador – ryan@obhcouncil.com

Research Committee
Lindsay Myrick, Chair – lmyrick@bluefirewilderness.com
Dr. Michael Gass, OBHRC Director  – michael.gass@unh.edu

Diversity, Equity, and Inclusion Committee
Margaret Kelso, Chair – margaretk@blueridgewilderness.com

Community-Based Committee
Tony Dixon, Chair – tony@themountaincenter.org

Marketing Committee
Emily Fritz, Chair – emily.fritz@nvwild.com

Membership Committee
Anson McNulty, Chair – ansonm@summitachievement.com

Best Practices Committee
Daniel Kikkert, Chair – daniel.kikkert@dwtbend.com

Insurance & Accessibility / Government Relations Committee
Andrew Scott, Chair – ascott@dwtbend.com

Wilderness Therapy Symposium Committee
Darcy Holt, Chair – darcyh@redcliffascent.com

The OBH Council members believe outdoor treatment is a highly effective form of treatment for most adolescent and young adult behavioral healthcare problems.