Wilderness therapy is becoming a more widely used intervention for adolescents, but there have not been any meta-analyses focused solely on its clinical effectiveness for private pay clients. This study's objective was to conduct outcome-based meta-analyses of private-pay wilderness therapy programs, benchmark primary features of this approach, and educate the clinical community as to its effectiveness. The authors conducted a review of all available databases, as well as manual searches. Searches resulted in a meta-analysis based on 36 studies, totaling 2399 participants receiving wilderness therapy. Our metaanalyses found medium effect sizes for all six constructs assessed: self-esteem (g = 0.49), locus of control (g = 0.55), behavioral observations (g = 0.75), personal effectiveness (g = 0.46), clinical measures (g = 0.50) and interpersonal measures (g = 0.54). Subgroup analyses included age of participants, duration of program, open or closed model, presence of a mental health practitioner, and publication year.

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Adopted children are disproportionately represented in residential treatment programs in the United States. Adopted children in the United States constitute only 2% to 3% of the U.S population. Nevertheless, they comprise approximately 16.5% of the population in residential care. This descriptive study evaluated a sample of 473 psychological evaluations of adolescents in wilderness and residential treatment centers. Results indicated that, compared with nonadopted youth, adopted youth had greater histories of recent trauma, higher rates of suicidal tendency and biological parents' mental illness, and poorer academic achievement. However, there were no significant differences between adopted and nonadopted youths in terms of defiant behaviors, IQ, substance use/abuse, reasons for referral, impulsivity, anxiety, or depression. Study results suggest that wilderness and residential programs may need to target programmatic elements specifically to meet the special needs of adopted adolescents who comprise a significant percentage of their client population.

This study explored the impact of moral injury (MI) and posttraumatic stress disorder (PTSD) on health care utilization, mental health complexity, and suicidality in rural and urban veterans. Analyses combined data from the Salt Lake City PTSD Clinic Intake Database and the Department of Veterans Affairs Corporate Data Warehouse. Participants (N = 1,545; M age = 45.9 years) were predominately male (88.3%) and White (87.8%). Adjusted analyses indicated associations between a 1-unit increase in Moral Injury Events Scale (MIES) score and increased mental health complexity, RR = 1.