Research on Medication Changes in Wilderness Therapy

Posted by Katie Massey MSW, MSPH, Research Director on March 02, 2015

What about medications in wilderness therapy? Let’s bring data to the conversation!

Questions about medications often arise in conversations with families and educational consultants. There are valid concerns about changes and increases in medications, and also about how effective the meds their child is currently taking. In response to these concerns, we generally talk about how our goal is to get the best baseline assessment possible; so we are not going to suggest new medications or make big changes, unless it is really warranted. We talk about our fantastic team and the fact that we can do any kind of med management.

This response is accurate and satisfactory to parents and educational consultants; however, these questions made us ask ourselves: How many clients enter with meds? What meds are clients taking? How do medications change, or not change, during our wilderness program? From our anecdotal perspective, it seemed that clients generally decreased or stopped their medications. But these conclusions were based on our anecdotes; we couldn’t answer definitively - and we wanted to.

These questions came to the research team, and I was thrilled. I knew our nurse at Entrada had been taking meticulous notes on medications, and that the answers were there. All we needed to do was code the notes, and Wa-Lah – definitive answers! This is the stuff I LOVE.

Below are the questions and the answers from a year of medication records for clients at Evoke at Entrada - The new name for Second Nature Entrada. I have found that answers to questions often spur more and even better questions. We have rich data that is just waiting for a good question, so let us know if you have any!

(NOTE: When I refer to “meds” here, I am only talking about psychotropic medications, or medications for a mental health purpose. This doesn’t include medications for allergies, acne, joint pain, etc.)

How many clients are taking meds? And how many are they taking?

• 62% of clients entered with one or more psychotropic medications.
• On average, clients on meds took two kinds of psychotropic meds.

What kind of meds are clients taking?

• 41% of clients enter with an anti-depressant and almost one-quarter with anti-psychotics.

Do clients have changes in their medications while they are in the program?

• 59% of clients entering with meds, had no med changes during the program, and 41% of clients who entered with meds had med changes (increase, decrease, or stop).
• Less than 5% of clients who entered without meds began meds.

How do medications change?

• When looking at all of the medications prescribed to clients from intake to discharge:
  • 71% of meds remained the same from intake to discharge
  • 23% of meds decreased or stopped from intake to discharge (14.7% stop, 8% decrease)
  • 5% of meds started or increased (3.5% start, 2% increase)

Psychotropic Medication Changes for Entrada Clients

 Are there types of medications that see decreases or increases more frequently?

• The increases appear evenly distributed over the types of meds, but thedecreases and stops in meds appear more associated with anti-psychotics and nicotine.
  • 30% of anti-psychotic meds decreased or stopped
  • 80% of nicotine meds were decreased or stopped