Using Outdoor Behavioral Healthcare to Support Hope and Well-Being Among Shelter Residents

Background and Purpose

Women experiencing homelessness often have complex and underserved mental health needs due to trauma and the psychosocial distresses that accompany homelessness.  This population often has a higher level of mistrust with mental health professionals and experiences higher barriers to obtaining mental health treatment.  Outdoor behavioral healthcare (OBH) offers action-centered therapy in a small group setting including adventure and experiential challenges that focus on client strengths to build a climate for change. Replicated research has shown OBH to improve client functioning post treatment with changes that remain up to 12 months later. The HOPE Adventure Therapy program was a pilot program developed and implemented at the Austin Shelter for Women and Children (ASWC) which used OBH to support hope and well-being among women residents.  The aim of this study was to evaluate the impact of this program. Specifically, it sought to understand if there was a difference between participants who participated in HOPE compared to those who received treatment as usual in terms of their sense of hope for the future and their psychological functioning.

Methods

This study used a quasi-experimental, nonequivalent groups design measuring outcomes using the Hope Scale and Outcome Rating Scale (ORS), two standardized measures with strong psychometric properties. Participants included 83 women, some with children and 32 (38.6%) of whom received the OBH intervention. Participants were given the measures at intake and once per month for two months. To address the research questions, repeated measures ANOVAs were performed comparing mean changes over time for OBH versus non-OBH participants (between subjects).

Results

Results showed significant interaction effects for Time x OBH participation for the Interpersonal and Social Role subscales of the ORS, with higher rates of change over time for OBH participants. No differences were found however between groups as measured by the Hope Scale and its subscales.

Conclusions and Implications

This is the first study of its kinds on the impact of OBH and experiential interventions with individuals experiencing homelessness. Due to the nature of the women’s situations, attrition was an issue, hence sample size was limited, especially across three points of time. Results showed there were no differences between groups on the Hope Scale, and it is unclear why. For both groups, their levels of hope remained low both in terms of their ability to set goals (Agency subscale) as well as plans to accomplish goals (Pathways subscale). Considering how complicated homelessness can be, especially when often accompanied by mental health issues, two months may not be long enough to see the true results of any intervention on hope for the future. However, the findings did show more improvements for OBH participants than non-participants in terms of their interpersonal skills and their ability to interact socially. Considering the group context of OBH and the inherent social interaction and engagement required of adventure and experiential interventions, these findings support previous research showing significant improvements in social functioning of participants. Still, more research is needed to further explore these preliminary positive results.