Amer. J . Orthopsychiat. 48(4), October 1978
WILDERNESS CAMPING: An Evaluation of a Residential Treatment Program for Emotionally Disturbed Children Lenore Behar, Ph.D., and David Stephens, M.A. North Carolina Division of Mental Health, Raleigh, N.C.
A follow-up of 46 youthful clients discharged from a therapeutic camp between its inception in 1972 and September 1975 indicates an overall improvement in functioning, especially in the areas of school performance, interpersonal relationships, and household behavior. The one area in which no overall improvement was found was delinquency.
uring the last fifteen years, mental health professionals have witnessed the development of model programs for the residential treatment of emotionally disturbed children. As the need for mental health services has continued to grow beyond the available resources, there has been a demand for innovation in treatment programs, not only to meet the volume demand, but also to meet the demand for services for a population for whom one-to-one clinical treatment based on cognitive and communication skills has not been considered the treatment of choice. Cowen and Zax2 highlighted shortcomings of contemSubmitted to the Journal in July 1977.
644
porary mental health services, by noting that previous techniques have left large subgroups completely untouched and that the effectiveness of psychotherapy as the mainstay of psychological services appears to have been overestimated. One residential treatment model that has been evaluated as effective is the wilderness camping model. Programs in the wilderness camping model currently exist in North Carolina and several other southern states. Over the past two years, there has been considerable interest in expanding the wilderness camping program, based on its apparent attractive-
BEHAR AND STEPHENS
ness to and success with disturbed adolescent males. Thus, a more formal evaluation of that program seems timely and appropriate. The wilderness camping model was begun in 1948 in Texas by Loughmiller.3 Briefly, the program involves five units of ten emotionally disturbed boys, each under the supervision of two counselors (chiefs). Located in a wilderness setting, therapeutic experiences are derived the year round from the following aspects of group living, as summarized by Skipper and McNeil: 1. The constant focus on self in an attempt to encourage the use of new behavioral alternatives results in the following processes: a ) each boy is made aware of his self-destructive response patterns, b ) other coping strategies are proposed, c) opportunities are provided for each to practice these new behaviors in the relatively safe confines of group life. 2. The wilderness experience, apart from its many educational and recreational benefits, is an experience in survival. Real dangers and problems are present, and the boys are given opportunities to try out their own skills in meeting these challenges. By design, the boys are successful in the preponderance of cases, thereby permitting a number of perhaps unprecedented feelings of efficacy in a concentrated time period. Secondarily, the less socially complex wilderness environment serves to reduce the number of stresses that ordinarily inhibit the child’s adequate coping. 3. The centrality of group problemsolving processes results in sharing of power and responsibility, which serves to reduce the dependency patterns of many of the boys. Problem-solving sesions achieve the following: a ) new be-
645
havioral tools are developed; b ) the boys experience the feeling of helping others grapple with their problems; c ) empathy, perhaps unknown to many campers, is heightened as they begin to see a mirror of themselves in other boys, consequently reducing their omnipresent sense of alienation; d ) new social skills are practiced and responded to by others. 4. The counselors, chosen for their leadership and interpersonal skills, serve as competent models for identification. 5 . Natural consequences of a child‘s behavior are felt more sharply in the camp setting. For example, a boy who neglects his dishwashing detail will be faced at the next meal with dirty dinnerware. Because the outcomes are not arbitrarily imposed by an adult authority, these experiences become especially useful for learning about the inappropriateness of certain defensive maneuvers. Peer pressure accentuates this learning process. 6. Throughout the year, the boys are constantly planning and setting goals for the day’s and week’s activities. They are encouraged to be realistic about what they accomplish, and, at the termination of a goal period, they are asked to reflect upon the reasons for their success or failure in reaching stated goals. 7. There is a constant focusing on the positive, on the power and skills a boy has to make a difference in what happens to him in the present. Without such a realization, the chance of the experience transferring to his continuing life experience may be minimal. The original model, the Dallas Salesmanship Club Boys’ Camp, was evaluated by Bower and Hobbs.’ Their report identified five characteristics of the program that contributed to its apparent
646
success: 1) use of nonprofessional, natural workers; 2) effective deployment of professionally trained staff; 3) the central position of group rather than individual influences; 4) the focus on discovery of self; and 5 ) emphasis upon teaching to learn rather than curing. In 1972, the wilderness camping model was replicated through the development of four camps in Florida, under the management of the Eckerd Foundation, and one camp in North Carolina, under the management of the Learning Institute of North Carolina. The previous evaluation of the Eckerd program * suggests success in that endeavor. The current study represents a iour year follow-up of the children discharged from the Carolina Boys’ Camp, the North Carolina camping program. The general aim of the study was to gain an indication of the characteristics of the clients served by the therapeutic camping program, their environments following discharge, and how well they adjusted within these environments. A second aim was to compare pretreatment and post-treatment functioning of the clients, so that inferences about program impact could be made. METHOD
Sample. The target population consisted of the 46 clients who were discharged from Carolina Boys’ Camp between July 1, 1972, and September 30, 1975. The parents and teachers of 38 of these 46 clients were located and agreed to participate in the follow-up study. Instruments. Data were collected through three types of contacts. Background treatment and demographic information were gathered through available statistical printouts and individual
WILD.ERNESS CAMPING
client records. Information about client satisfaction, living situation, readmissions, and adjustment in various life areas was obtained using a structured interview format by means of face-toface interviews with one or more “significant others” of each client; questions about adjustment were asked for both the client’s current life and, retrospectively, for his life before admission to the wilderness camping program. Information about school performance, for those who were in school at the time of follow-up, was obtained through the use of the Hahnemann High School Behavior Rating Scale,6 which was filled out by the clients’ teachers. In all, information regarding approximately 150 variables was collected. Field eflort. The first field effort involved searching clients’ records to gather background treatment and demographic data for all clients discharged. A second effort involved the gathering of school behavior ratings. These were obtained from teachers of those clients found, at follow-up, to be in school and whose guardians were willing to sign a release form. Ratings were ultimately obtained for 43% of those in school at the time of follow-up. The major field effort involved interviews, using a structured form, with a p propriate respondents throughout the state. In most cases, the appropriate respondent was a parent or guardian; on infrequent occasions, it was a sibling, social worker, or other knowledgeable person. Interviews were conducted with respondents for 38 of the 46 clients discharged from Carolina Boys’ Camp during the stated time period. A statistical comparison of these 38 with the eight for whom interviews were not done shows no differences between the
BEHAR AND STEPHENS
647 Table I
PRETREATMENT CLIENT PROFILE: DEMOGRAPHICS, FAMILY B A C K G R O U N D AND A D M I S S I O N FACTORS
’
IlEM
%
N
ITEM
Prior mental health admissions One-parent household Family member with criminal record Family member with drinking problem Family member with history of mental illness Family member with any of above three Household receiving welfare No one in household employed Inadequate household income
73.7% 22.2
28
26.3
10
23.7
9
36.8
14
51.9 5.3 1.9 0.0
22 2
Nonwhite a 2.2% Referral Source: Correctional or law enforcement channels 41.3 Educational or vocational facilities 23.9 Community (individual families) 17.4 Social service agencies 8.7 Community mental health centen 4.3 Other sources 4.3
8
3
0
Mean age
%
*
(range 9-16)
a Denotes population (N=46) data; all other figures are bared on sample (N=38)
N I I9 II
0 4 2 2
13 y04n date.
as follows: 1) the client’s demographic characteristics, which are self-explanatory in TABLE 1; 2) their family situations; 3) their adjustment problems; and 4 ) their paths to treatment. In assessing family background, findRESULTS The first set of findings describes the ings confirm the belief that a good many clients’ pretreatment conditions and emotionally disturbed youth come from characteristics; the second deals with troubled family settings. The most tellpost-treatment adjustment and pre-post ing findings in this regard concern the change; the third covers assorted topics frequency of reports of criminal beof special interest. havior, problem drinking, and especially mental illness among the clients’ family Pretreatment : Client Profile members. Nearly 60% lived in houseInformation about the histories and holds with at least one of these indicacharacteristics of the population served tions of pathology; nearly one-third of by the camp are presented in TABLE 1. these households had two or more. These data can provide clues about the Further, 22% of the clients lived in degree of equity achieved in service defamilies headed by only one parent, livery to various subpopulations or, alwhich is somewhat higher than the genternatively, indicate subpopulations eral population figure of 13 % for North whose service needs are apparently greater than others. Further, the data Carolina. Compared with the relatively high specify the kinds of problems that preprevalence of such social problems, incede, and perhaps precipitate, entry into dications of financial problems were the camp program. Four types of prenegligible. Only five percent of the clitreatment data touch upon these matters, two groups on a number of demographic characteristics; thus, the representativeness of the findings can be assumed with considerable confidence.
648
ents lived in households receiving welfare support, for example, and eight percent in households with no one employed. Overall, no household was reported to be without sdiicient income to cover its basic needs. All camp admissions were labeled voluntary, though some clients were offered admission by the courts as the only alternative to a training school commitment. The fact that many admissions were precipitated by trouble with the law is further indicated in the finding that law enforcement or correctional channels constituted the camp’s largest referral source, accounting for 41% of all admissions. The schools were the next largest, with 24% of all referrals, and then individual families, with seventeen percent. An overall assessment of the clients’ adjustment during the months before their admissions indicates that their level of functioning was overwhelmingly poor. In nearly every adjustment area examined, ranging from school performance to use of leisure time, those having problems constituted a majority. The school setting was particularly troublesome. About 70% of the clients were in school before their admissions; among them, problems were frequently manifested in the form of absences, suspensions, dislike of school, and poor academic performance. In their overall school adjustment, 78% of the clients were felt to be doing poorly, eighteen percent fairly well, and only four percent very well. Problems were frequent outside the classsroom also. More than threefourths of the clients had less than satisfactory leisure adjustment, about 60% had behavior problems at home, 60%
WILDERNESS CAMPING
disrupted the functioning of their households, and 5 5 % had trouble with the law. The most common evidence of problems, though, was in the area of interpersonal problems in their daily encounters, with parents, siblings, and teachers. Only in the areas of drinking and drug use did the percentage of those having problems fall below a majority; still, 37% of the clients were using drugs before their admissions, with more than half of these felt to have drug problems, and thirteen percent of the clients had drinking problems. In all, about one-third of all clients were believed to engage in some form of substance abuse. Given the range and frequency of the adjustment problems noted, it is not surprising to find that 75% of the clients had received mental health treatment before their camp admissions. Post-Treatment: Client Adjustment The functioning of clients was measured in various adjustment areas several months following their discharges from the camp, and compared with their functioning before entering treatment, as recollected by respondents. These comparisons stand as evidence of the intervening program’s effectiveness in fulfilling its principal therapeutic goal Additionally, findings about adjustment following discharge can, in themselves, provide insights into the kinds of problems clients face in their passage from residential to community living. The clients’ level of functioning changed, so that, in all adjustment areas examined but one, there were more clients functioning adequately after treatment than before. These summary
BEHAR AND STEPHENS
649
conclusions are highlighted, as follows: * On specific indicators of school adjustment, the number of clients with favorable outcomes showed generally substantial increases over pretreatment levels, ranging from an increase of 40 percentage points (33% to 73%) in those with no school suspensions to one oi 54 percentage points (33% to 87%) in those doing at least fairly well academically. A high level of improvement was seen in those whose overall school adjustment was judged to be adequate, increasing from 27% to 73% of the population for whom these data were available. While leisure adjustment remained problematic for some clients, the number of those with good adjustment had increased considerably from pretreatment levels. The percentage with overall satisfactory leisure adjustment increased from 22% to 58%. The percentage engaging in specific disapproved leisure activities decreased from 66% to 42%. The number of clients having interpersonal problems with such key figures as parents, siblings, and teachers, which ranged from 56% to 71% during the pretreatment period, dropped in each case to the fifteen percent level or lower. The magnitude of the improvement in this area is indicated by the summary finding that the number of clients for whom there were no indications of interpersonal problems with any category of persons increased from three percent to
a good many clients. The number who had at least one confidant increased from 56% to 94%. The household problems generated with considerable frequency before admission were minimal at the time of follow-up. The number of clients with serious behavior problems at home decreased from 60% to sixteen percent, and the number whose condition disrupted normal household functioning dropped from 60% to eight percent. Because problems in areas of substance abuse were relatively infrequent to begin with, pre-post improvement was less substantial here than in other areas, when measured in terms of raw percentage points. The number using drugs dropped thirteen percentage points, from 2 1% to eight percent. The number who drank remained about at the pretreatment level of 40%, and the number felt to have drinking problems remained at slightly over ten percent. Collapsing data about drug and drinking problems into a single measure indicating the presence of either of these difficulties, findings show that the number of clients with substance abuse declined from 32% to sixteen percent. Delinquency was the single adjustment area in which there was no evidence of improvement. The fact that delinquency was a common problem among admitted clients was illustrated earlier in such findings as the high incidence of referrals from law enforcement or correctional agencies, the frequent 61%. With this apparent easing of troubled mention in the clients’ records of “legal relationships, there was a concurrent problems” as a reason for admission, strengthening of interpersonal bonds for and the number of parents who listed
* The following findings dealing with pretreatment/post-treatmentchanges in client adjustment or with relationships among variables are significant at p
WILDERNESS CAMPING: An Evaluation of a Residential Treatment Program for Emotionally Disturbed Children Lenore Behar, Ph.D., and David Stephens, M.A. North Carolina Division of Mental Health, Raleigh, N.C.
A follow-up of 46 youthful clients discharged from a therapeutic camp between its inception in 1972 and September 1975 indicates an overall improvement in functioning, especially in the areas of school performance, interpersonal relationships, and household behavior. The one area in which no overall improvement was found was delinquency.
uring the last fifteen years, mental health professionals have witnessed the development of model programs for the residential treatment of emotionally disturbed children. As the need for mental health services has continued to grow beyond the available resources, there has been a demand for innovation in treatment programs, not only to meet the volume demand, but also to meet the demand for services for a population for whom one-to-one clinical treatment based on cognitive and communication skills has not been considered the treatment of choice. Cowen and Zax2 highlighted shortcomings of contemSubmitted to the Journal in July 1977.
644
porary mental health services, by noting that previous techniques have left large subgroups completely untouched and that the effectiveness of psychotherapy as the mainstay of psychological services appears to have been overestimated. One residential treatment model that has been evaluated as effective is the wilderness camping model. Programs in the wilderness camping model currently exist in North Carolina and several other southern states. Over the past two years, there has been considerable interest in expanding the wilderness camping program, based on its apparent attractive-
BEHAR AND STEPHENS
ness to and success with disturbed adolescent males. Thus, a more formal evaluation of that program seems timely and appropriate. The wilderness camping model was begun in 1948 in Texas by Loughmiller.3 Briefly, the program involves five units of ten emotionally disturbed boys, each under the supervision of two counselors (chiefs). Located in a wilderness setting, therapeutic experiences are derived the year round from the following aspects of group living, as summarized by Skipper and McNeil: 1. The constant focus on self in an attempt to encourage the use of new behavioral alternatives results in the following processes: a ) each boy is made aware of his self-destructive response patterns, b ) other coping strategies are proposed, c) opportunities are provided for each to practice these new behaviors in the relatively safe confines of group life. 2. The wilderness experience, apart from its many educational and recreational benefits, is an experience in survival. Real dangers and problems are present, and the boys are given opportunities to try out their own skills in meeting these challenges. By design, the boys are successful in the preponderance of cases, thereby permitting a number of perhaps unprecedented feelings of efficacy in a concentrated time period. Secondarily, the less socially complex wilderness environment serves to reduce the number of stresses that ordinarily inhibit the child’s adequate coping. 3. The centrality of group problemsolving processes results in sharing of power and responsibility, which serves to reduce the dependency patterns of many of the boys. Problem-solving sesions achieve the following: a ) new be-
645
havioral tools are developed; b ) the boys experience the feeling of helping others grapple with their problems; c ) empathy, perhaps unknown to many campers, is heightened as they begin to see a mirror of themselves in other boys, consequently reducing their omnipresent sense of alienation; d ) new social skills are practiced and responded to by others. 4. The counselors, chosen for their leadership and interpersonal skills, serve as competent models for identification. 5 . Natural consequences of a child‘s behavior are felt more sharply in the camp setting. For example, a boy who neglects his dishwashing detail will be faced at the next meal with dirty dinnerware. Because the outcomes are not arbitrarily imposed by an adult authority, these experiences become especially useful for learning about the inappropriateness of certain defensive maneuvers. Peer pressure accentuates this learning process. 6. Throughout the year, the boys are constantly planning and setting goals for the day’s and week’s activities. They are encouraged to be realistic about what they accomplish, and, at the termination of a goal period, they are asked to reflect upon the reasons for their success or failure in reaching stated goals. 7. There is a constant focusing on the positive, on the power and skills a boy has to make a difference in what happens to him in the present. Without such a realization, the chance of the experience transferring to his continuing life experience may be minimal. The original model, the Dallas Salesmanship Club Boys’ Camp, was evaluated by Bower and Hobbs.’ Their report identified five characteristics of the program that contributed to its apparent
646
success: 1) use of nonprofessional, natural workers; 2) effective deployment of professionally trained staff; 3) the central position of group rather than individual influences; 4) the focus on discovery of self; and 5 ) emphasis upon teaching to learn rather than curing. In 1972, the wilderness camping model was replicated through the development of four camps in Florida, under the management of the Eckerd Foundation, and one camp in North Carolina, under the management of the Learning Institute of North Carolina. The previous evaluation of the Eckerd program * suggests success in that endeavor. The current study represents a iour year follow-up of the children discharged from the Carolina Boys’ Camp, the North Carolina camping program. The general aim of the study was to gain an indication of the characteristics of the clients served by the therapeutic camping program, their environments following discharge, and how well they adjusted within these environments. A second aim was to compare pretreatment and post-treatment functioning of the clients, so that inferences about program impact could be made. METHOD
Sample. The target population consisted of the 46 clients who were discharged from Carolina Boys’ Camp between July 1, 1972, and September 30, 1975. The parents and teachers of 38 of these 46 clients were located and agreed to participate in the follow-up study. Instruments. Data were collected through three types of contacts. Background treatment and demographic information were gathered through available statistical printouts and individual
WILD.ERNESS CAMPING
client records. Information about client satisfaction, living situation, readmissions, and adjustment in various life areas was obtained using a structured interview format by means of face-toface interviews with one or more “significant others” of each client; questions about adjustment were asked for both the client’s current life and, retrospectively, for his life before admission to the wilderness camping program. Information about school performance, for those who were in school at the time of follow-up, was obtained through the use of the Hahnemann High School Behavior Rating Scale,6 which was filled out by the clients’ teachers. In all, information regarding approximately 150 variables was collected. Field eflort. The first field effort involved searching clients’ records to gather background treatment and demographic data for all clients discharged. A second effort involved the gathering of school behavior ratings. These were obtained from teachers of those clients found, at follow-up, to be in school and whose guardians were willing to sign a release form. Ratings were ultimately obtained for 43% of those in school at the time of follow-up. The major field effort involved interviews, using a structured form, with a p propriate respondents throughout the state. In most cases, the appropriate respondent was a parent or guardian; on infrequent occasions, it was a sibling, social worker, or other knowledgeable person. Interviews were conducted with respondents for 38 of the 46 clients discharged from Carolina Boys’ Camp during the stated time period. A statistical comparison of these 38 with the eight for whom interviews were not done shows no differences between the
BEHAR AND STEPHENS
647 Table I
PRETREATMENT CLIENT PROFILE: DEMOGRAPHICS, FAMILY B A C K G R O U N D AND A D M I S S I O N FACTORS
’
IlEM
%
N
ITEM
Prior mental health admissions One-parent household Family member with criminal record Family member with drinking problem Family member with history of mental illness Family member with any of above three Household receiving welfare No one in household employed Inadequate household income
73.7% 22.2
28
26.3
10
23.7
9
36.8
14
51.9 5.3 1.9 0.0
22 2
Nonwhite a 2.2% Referral Source: Correctional or law enforcement channels 41.3 Educational or vocational facilities 23.9 Community (individual families) 17.4 Social service agencies 8.7 Community mental health centen 4.3 Other sources 4.3
8
3
0
Mean age
%
*
(range 9-16)
a Denotes population (N=46) data; all other figures are bared on sample (N=38)
N I I9 II
0 4 2 2
13 y04n date.
as follows: 1) the client’s demographic characteristics, which are self-explanatory in TABLE 1; 2) their family situations; 3) their adjustment problems; and 4 ) their paths to treatment. In assessing family background, findRESULTS The first set of findings describes the ings confirm the belief that a good many clients’ pretreatment conditions and emotionally disturbed youth come from characteristics; the second deals with troubled family settings. The most tellpost-treatment adjustment and pre-post ing findings in this regard concern the change; the third covers assorted topics frequency of reports of criminal beof special interest. havior, problem drinking, and especially mental illness among the clients’ family Pretreatment : Client Profile members. Nearly 60% lived in houseInformation about the histories and holds with at least one of these indicacharacteristics of the population served tions of pathology; nearly one-third of by the camp are presented in TABLE 1. these households had two or more. These data can provide clues about the Further, 22% of the clients lived in degree of equity achieved in service defamilies headed by only one parent, livery to various subpopulations or, alwhich is somewhat higher than the genternatively, indicate subpopulations eral population figure of 13 % for North whose service needs are apparently greater than others. Further, the data Carolina. Compared with the relatively high specify the kinds of problems that preprevalence of such social problems, incede, and perhaps precipitate, entry into dications of financial problems were the camp program. Four types of prenegligible. Only five percent of the clitreatment data touch upon these matters, two groups on a number of demographic characteristics; thus, the representativeness of the findings can be assumed with considerable confidence.
648
ents lived in households receiving welfare support, for example, and eight percent in households with no one employed. Overall, no household was reported to be without sdiicient income to cover its basic needs. All camp admissions were labeled voluntary, though some clients were offered admission by the courts as the only alternative to a training school commitment. The fact that many admissions were precipitated by trouble with the law is further indicated in the finding that law enforcement or correctional channels constituted the camp’s largest referral source, accounting for 41% of all admissions. The schools were the next largest, with 24% of all referrals, and then individual families, with seventeen percent. An overall assessment of the clients’ adjustment during the months before their admissions indicates that their level of functioning was overwhelmingly poor. In nearly every adjustment area examined, ranging from school performance to use of leisure time, those having problems constituted a majority. The school setting was particularly troublesome. About 70% of the clients were in school before their admissions; among them, problems were frequently manifested in the form of absences, suspensions, dislike of school, and poor academic performance. In their overall school adjustment, 78% of the clients were felt to be doing poorly, eighteen percent fairly well, and only four percent very well. Problems were frequent outside the classsroom also. More than threefourths of the clients had less than satisfactory leisure adjustment, about 60% had behavior problems at home, 60%
WILDERNESS CAMPING
disrupted the functioning of their households, and 5 5 % had trouble with the law. The most common evidence of problems, though, was in the area of interpersonal problems in their daily encounters, with parents, siblings, and teachers. Only in the areas of drinking and drug use did the percentage of those having problems fall below a majority; still, 37% of the clients were using drugs before their admissions, with more than half of these felt to have drug problems, and thirteen percent of the clients had drinking problems. In all, about one-third of all clients were believed to engage in some form of substance abuse. Given the range and frequency of the adjustment problems noted, it is not surprising to find that 75% of the clients had received mental health treatment before their camp admissions. Post-Treatment: Client Adjustment The functioning of clients was measured in various adjustment areas several months following their discharges from the camp, and compared with their functioning before entering treatment, as recollected by respondents. These comparisons stand as evidence of the intervening program’s effectiveness in fulfilling its principal therapeutic goal Additionally, findings about adjustment following discharge can, in themselves, provide insights into the kinds of problems clients face in their passage from residential to community living. The clients’ level of functioning changed, so that, in all adjustment areas examined but one, there were more clients functioning adequately after treatment than before. These summary
BEHAR AND STEPHENS
649
conclusions are highlighted, as follows: * On specific indicators of school adjustment, the number of clients with favorable outcomes showed generally substantial increases over pretreatment levels, ranging from an increase of 40 percentage points (33% to 73%) in those with no school suspensions to one oi 54 percentage points (33% to 87%) in those doing at least fairly well academically. A high level of improvement was seen in those whose overall school adjustment was judged to be adequate, increasing from 27% to 73% of the population for whom these data were available. While leisure adjustment remained problematic for some clients, the number of those with good adjustment had increased considerably from pretreatment levels. The percentage with overall satisfactory leisure adjustment increased from 22% to 58%. The percentage engaging in specific disapproved leisure activities decreased from 66% to 42%. The number of clients having interpersonal problems with such key figures as parents, siblings, and teachers, which ranged from 56% to 71% during the pretreatment period, dropped in each case to the fifteen percent level or lower. The magnitude of the improvement in this area is indicated by the summary finding that the number of clients for whom there were no indications of interpersonal problems with any category of persons increased from three percent to
a good many clients. The number who had at least one confidant increased from 56% to 94%. The household problems generated with considerable frequency before admission were minimal at the time of follow-up. The number of clients with serious behavior problems at home decreased from 60% to sixteen percent, and the number whose condition disrupted normal household functioning dropped from 60% to eight percent. Because problems in areas of substance abuse were relatively infrequent to begin with, pre-post improvement was less substantial here than in other areas, when measured in terms of raw percentage points. The number using drugs dropped thirteen percentage points, from 2 1% to eight percent. The number who drank remained about at the pretreatment level of 40%, and the number felt to have drinking problems remained at slightly over ten percent. Collapsing data about drug and drinking problems into a single measure indicating the presence of either of these difficulties, findings show that the number of clients with substance abuse declined from 32% to sixteen percent. Delinquency was the single adjustment area in which there was no evidence of improvement. The fact that delinquency was a common problem among admitted clients was illustrated earlier in such findings as the high incidence of referrals from law enforcement or correctional agencies, the frequent 61%. With this apparent easing of troubled mention in the clients’ records of “legal relationships, there was a concurrent problems” as a reason for admission, strengthening of interpersonal bonds for and the number of parents who listed
* The following findings dealing with pretreatment/post-treatmentchanges in client adjustment or with relationships among variables are significant at p
