Mapping the Concept, Content, and Outcome of Family-Based Outdoor Therapy for Children and Adolescents with Mental Health Problems: A Scoping Review

Abstract

Outdoor therapy and family-based therapy are suggested to be promising interventions for the treatment of mental health problems. The aim of the present scoping review was to systematically map the concept, content, and outcome of combining family- and outdoor-based therapy for children and adolescents with mental health problems. The Joanna Briggs Institute methodology and PRISMA guidelines were applied. Eligible qualitative and quantitative studies were screened, included, and extracted for data. Seven studies were included. Findings from these studies indicated that family-based outdoor therapy programs have a positive impact on family- and peer relationships, adolescent behavior, mental health, self-perceptions (self-concept), school success, social engagement, and delinquency rates. However, participant characteristics, study design, and content and mode of delivery of the interventions varied substantially, hence preventing detailed comparison of outcomes across studies. In addition, most of the studies included few participants and lacked population diversity and comparable control groups. Although important ethical concerns were raised, such as non-voluntary participation in some of the programs, there was a lack of reporting on safety. This review indicates that a combination of family- and outdoor-based therapy may benefit mental health among children and adolescents, but due to the limited number of studies eligible for inclusion and high levels of heterogeneity, it was difficult to draw firm conclusions. Thus, future theory-based studies using robust designs are warranted.

Addressing ethical issues in outdoor health practice: a scoping review

“…Crucially, it will also need to ensure that OH practices are effective, safe, and secure, and that practitioners are competent and accountable. (Harper & Fernee, 2022;Jeffery & Wilson, 2017;King & McIntyre, 2018;Stea et al, 2022) Egalitarian relationships (Drost, 2019;King et al, 2022;King & McIntyre, 2018;Moriggi et al, 2020;Pearce, 2018;Stålhammar & Thorén, 2019) Ethics of Care and Person-Centred approach (Harper & Fernee, 2022;King et al, 2022;Lokugamage et al, 2020;Moriggi et al, 2020;Stålhammar & Thorén, 2019;Stea et al, 2022;Taranrød et al, 2021) Joy and enjoyment (Kolb & Kolb, 2018;Ljubicic et al, 2021;Moriggi et al, 2020;Pearce, 2018;Taranrød et al, 2021) Nonmaleficence (avoid harm)…”

“…Participant autonomy (Haber & Deaton, 2019;Hall, 2019;Hooley, 2016;King et al, 2022;Taranrød et al, 2021) Safety including emotional, physical, cultural, spiritual, and, practitioner safety (Bradford, 2019;Hall, 2019;Harper & Fernee, 2022;King et al, 2022;Reese, 2018) Transparency, Informed Consent & Coercion (Bradford, 2019;Haber & Deaton, 2019;Harper & Fernee, 2022;Hooley, 2016;King et al, 2022;King & McIntyre, 2018;Reese, 2018;Stea et al, 2022) Confidentiality and privacy (Bradford, 2019;Haber & Deaton, 2019;Harper & Fernee, 2022;Hooley, 2016;King et al, 2022;King & McIntyre, 2018;Reese, 2018) Vulnerability…”

“…Issues of justice were evident in 17 of the 24 studies and include the related principles of rights, dignity, respect, and care for people, place and planet. Power relations were discussed in some papers (Bradford, 2019;Drost, 2019;Haber & Deaton, 2019;King & McIntyre, 2018;Lokugamage et al, 2020) alongside practice related issues of transparency, informed consent, coercion, confidentiality, and participant autonomy which are significant areas of discussion due to the nuanced contextual, cultural, and political landscape of OH practices (Bradford, 2019;Haber & Deaton, 2019;Hall, 2019;Harper & Fernee, 2022;Hooley, 2016;King & McIntyre, 2018;King et al, 2022;Reese, 2018;Stea et al, 2022;Taranrød et al, 2021). The potential impact of conflicting values between practitioners and participants was thought to be more prevalent in the OH context due to often strong pro-environmental values held by practitioners (Bradford, 2019;King & McIntyre, 2018;King et al, 2022;Lokugamage et al, 2020;Moriggi et al, 2020;Pearce, 2018;Reese, 2018).…”

“…These included a range of psychotherapeutic techniques such as: environmental psychology (Benz et al, 2022), ecopsychology (Plesa, 2019), nature-based counselling & EcoWellness (Reese, 2018), psychotherapy outdoors (Hooley, 2016), and ecotherapy (King & McIntyre, 2018;King et al, 2022). Further, a range of outdoor therapies were represented: adventure therapy, bush adventure therapy, forest therapy, surf therapy, nature-therapy, wilderness therapy, friluftsterapi (therapy in the open air), outdoor family therapy, and more (Harper & Fernee, 2022;Jeffery & Wilson, 2017;Stea et al, 2022). Indigenous healing practices featured strongly (Drost, 2019;Lokugamage et al, 2020;Tujague & Ryan, 2021), alongside cultural land-based practices (Ljubicic et al, 2021;Tujague & Ryan, 2021).…”

“…Three groups of ethical issues relating to practitioner skills were articulated. The first was related to planning-assessing need (Hooley, 2016;King & McIntyre, 2018;King et al, 2022;Reese, 2018), long-term planning (Ljubicic et al, 2021;Moriggi et al, 2020;Stea et al, 2022;Tujague & Ryan, 2021), co-design, and tailoring services to individual, group and community needs (Harper & Fernee, 2022;Hooley, 2016;Lokugamage et al, 2020;Moriggi et al, 2020). The second was related to being adaptive to different relational contexts-working with individuals or working with groups (Bradford, 2019;Haber & Deaton, 2019;Jeffery & Wilson, 2017), managing dynamic boundaries (Harper & Fernee, 2022;King et al, 2022;Reese, 2018), managing dual relationships (Bradford, 2019;Haber & Deaton, 2019;King et al, 2022;Moriggi et al, 2020), and managing the complex interplay between individual, group, culture, activity, and environment (Bradford, 2019;Haber & Deaton, 2019;Hooley, 2016;Lokugamage et al, 2020;Pearce, 2018).…”