Client Transitions in Adventure Therapy

Clients experience many transitions within their treatment process. This section focuses on the primary transitions of intake and discharge from services. Managing both of these transitions well provides organizations, programs, and practitioners improved opportunities to be effective in their work with clients. This section addresses operational guidelines that should be in place to support these processes. Whatever transition a client is experiencing, and due to the nature of AT, it is also important that communication channels are clear, open and being utilized. In addition, documentation of these processes is crucial.

Intake
Admission to services is a key time in the treatment process for clients. It is when clients are informed about what to expect (and probably families or other natural supports as well), are educated about the risks and benefits of services, and explore treatment goals and their presenting problems. Establishing the treatment environment including the development of engagement and rapport begins at intake. Additionally, practitioners assess clients and determine if the services provided will meet the needs of the client. Therefore, it is important that established policies and procedures related to intake account for this and provide maximum opportunities to enhance the long-term treatment process.

It is best practice to have a diagnostic assessment completed by a licensed mental health professional for a client prior to or at intake. This may be completed by the AT organization, program or practitioner, or it may be provided by a different service provider. No matter the way, it is important to have a clear understanding of the client's issues in order to determine that services are an appropriate fit for the client's needs as well as the client requires the service and will likely benefit from it. If the assessment is completed by an outside provider, it will still be important for the AT provider to compare the diagnostic assessment to the AT provider's admissions criteria to ensure that the client is appropriate for services. The depth of the assessment may be determined based on the type of services being offered and will be impacted by things such as length and intensity of services, severity of client needs or behaviors, or environment of service locations.

In addition to the initial clinical assessment, AT providers are also expected to evaluate medical issues at intake. Once again, the depth of this evaluation is largely dependent on the types of services provided and activities utilized. This evaluation should include identification of medical history and issues, current medications, allergies, and contraindicated conditions. Keep in mind that many medications interact with the environment in unique ways. Be sure to consult with medical professionals about medication side effects that may impact a client's ability to participate in activities. Consider the need for access to trained medical personnel as well. For example, organizations, programs, or practitioners may need nurses on staff, doctors on call, or personnel trained and certified in wilderness medical care. The more intensive the program (whether by activity, remoteness, etc.) the more information practitioners are likely to need in order to plan and respond appropriately. Because of the physical nature of AT, some awareness of medical issues is expected.

It is best practice for operational guidelines for intake to AT services to include clear policies and procedures about clinical assessment, medical evaluation, client population, and informed consent. These guidelines should recognize program limits and provide options for referring clients to other services if it is not a good fit.

Other Transitions
Continued assessment throughout any program is integral to best practices. There are many transitions that occur for clients during services that may need to be addressed, including movement through the process of change, crisis intervention, situational family or residential placement changes, etc. Operational guidelines also include clear procedures and policies about continued clinical assessment, medical evaluation, client population, and informed consent. These guidelines should recognize program limits and provide options for referring clients to other services if it is found to no longer be a good fit.

Discharge
The client's transition at the end of a program is an important time. Clients should be prepared for discharge, as well as any family or natural supports who are involved in the client's care. Clients are more likely to be successful if some work has been done in their home environments prior to discharge to reinforce their change process. Additionally, the next steps in the client's care are critical ones and practitioners are responsible for attempting to link clients to whatever services are appropriate for their next steps in treatment. Practitioners are also expected to communicate about discharge with all involved in order to support the client in having a successful transition. Operational standards for managing this transition should involve producing a clinical summary of client progress toward goals, a discharge plan, and recommendations for future services. Best practices for guidelines around discharge also include measuring outcomes, connecting clients with appropriate aftercare services, and communicating about services to appropriate people (families, other providers, client natural supports, etc.)