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Live Licensed or Die: The Why and the How. UNH- TAPG Conference June 23, 2007 Will White LCSW, LADAC. Outline of the Talk. Welcome to New Hampshire- State Motto- Live Free or Die- Background Warm up activity Learning Style Whys HB 1738 Concerns

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Live licensed or die the why and the how

Live Licensed or Die: The Why and the How

UNH- TAPG Conference

June 23, 2007

Will White LCSW, LADAC


Outline of the talk
Outline of the Talk

  • Welcome to New Hampshire- State Motto- Live Free or Die-

  • Background

  • Warm up activity

  • Learning Style

  • Whys

  • HB 1738

  • Concerns

  • Avenues for Licensure- individual & program

  • Questions


Live licensed or die the why and the how
Why

  • Early history-

  • Growth of programs

  • Media exposure

  • Accidents and deaths in programs

  • Increase in licensed programs

  • Increase in licensed providers

  • Lack of research

  • The blurring of lines due to definitions of programs- Wilderness, Boot Camp, Emotional Growth, Outdoor Behavioral,…

  • Checks and balances


Early history
Early History

  • The bad old days where, in some programs, punitive tactics where used.

  • Chronicled in “Loving them to Death” article in Outside Magazine, October 1995 by John Kauker.

  • Although these programs were the exception and not the rule. Programs need to be transparent, self-critical, licensed


Growth of programs
Growth of Programs

  • Adventure/wilderness/OBH programs have been around for fifty years.

  • There are over 116 OBH in existence. (Russell, 2007)

  • The majority of programs are less than twenty years old.

  • Models are various- Base Camp, expedition, residential, integrated expedition.

  • Of Outdoor Behavioral Programs identified by Russell 33.8% are owned by for profits.


Media exposure
Media Exposure

  • When adventure therapy is shown on television or in magazines it is about what went wrong or what is funny. Some exceptions

  • Brat Camp- The good, the bad and the ugly

  • Books- :” Help at Any Cost” Maia Szalavitz, “Shouting at the Sky” Gary Ferguson.


Incidents accidents and fatalities in programs
Incidents, accidents and fatalities in programs

  • From the years 2001-2004 the rate of therapeutic holds, runaways, injuries, and illness steadily declined. (Russell, 2007)

  • OBHIC related programs that 3.0 fatalities for every 1 million user days in the field. (Russell, 2007).

  • Yet fatalities happen. (As they do in RTC, boarding schools, high schools, etc..)

  • Wilderness is not safe

  • Population is a challenging one.


Increase in licensed programs
Increase in licensed programs

  • More states have licenses for Adventure Therapy (Utah, Oregon)

  • Some states are developing them (Colorado, Montana)

  • New England programs tend to work under different license such as RTC or Inpatient.

  • National License available- JCOH, CARF

  • Of NATSAP members of the Adventure Therapy programs 87% are licensed by their state.

  • Study or 63 OBH programs 53 said they were licensed in the state they


Why are some programs unlicensed
Why are some programs unlicensed?

  • Good question! Some Responses:

  • “Unavailable”- Solve it through being CARF, JCOH

  • “Do not want someone telling them how to do things.”

  • “Psychotherapist are “ruining” what we used to do”.


Lack of research
Lack of research

  • “paucity of research” Russell, 2007

  • Difficulty of research due to various models

  • Evidenced Based….

  • Yet often the therapy used in conjunction with the outdoor experience is often researched including cognitive behavioral, Mutisystemic therapy, dialectical behavioral therapy.


Blurring of lines
Blurring of lines

  • General public (and even people in the field) has a challenge in defining the difference between boot camp, wilderness, adventure therapy, outdoor behavioral, etc..

  • General public may view us all as “like Outward Bound” or “boot camps”

  • There is consolidation of programs and many are owned by larger corporations who have varied levels of care.


Checks and balances
Checks and Balances

  • Having a license welcomes oversight

  • Having a licensed professionals working for your organization encourages dialogue when ineffective or questionable interventions are used.

  • Licenses for individuals and programs gives a clear line of responsibility for treatment methods.


Hb 1738
HB 1738

  • Proposed by Congressman George Miller from California-

  • This bill is still in committee and is currently being investigated by the GAO.

  • Review of the bill.


Concerns
Concerns

  • Name of bill.

  • Needing to follow license regulations of program state and student state. This is very difficult in New England. Creates more bureaucracy.


Avenues for licensure
Avenues for licensure

  • Individuals- should be licensed by your state to the highest level possible. If you specialize than get the specialty license (for example substance abuse-Licensed Alcohol and Drug Abuse Counselor).

  • Programs should be licensed by the state the program is in. Should consider federal licensure by Joint Commission on Accreditation for Healthcare (JCOAH) or Commission of Accreditation of Rehabilitation facilities

  • AEE is a good accreditation but is not (at present) therapeutically focused.