There is growing evidence for the effectiveness of out-of-home treatment programs such as Wilderness Therapy (WT), Residential Treatment Centers (RTC), and Therapeutic Boarding Schools (TBS). Much remains unknown, however, about factors that influence treatment outcomes. To understand the trajectories, or change from program admission to discharge, of six indicators of health assessed by the Youth Outcomes Questionnaire Self-Report (Y-OQ SR; Burlingame et al., 2005) for clients at WT, RTC, and TBS and to explore how health trajectories were impacted by gender, age, adoption status, household income, length of stay, client feeling of belonging, and family functioning. Multilevel regression models assessed the impact of six predictors on each domain of health for 5285 adolescent clients who completed Y-OQ SR surveys at program admission and discharge. Bias from program differences and missing data were accommodated using nested modeling and full-information maximum likelihood. Overall findings on health change from admission to discharge suggest that attendance at WT, RTC, and TBS is beneficial to client health. Family functioning was a significant predictor of change across all program types and most health domains. Client gender identity, adoption status, family functioning, and clients’ feeling that they belong also influenced the magnitude of this change. The impact of these factors varies by program type and is nuanced by client acuity at intake. The findings indicate that attendance at WT, RTC, and TBS programs is beneficial to client health. Programs should endeavor to adopt approaches that optimize outcomes by incorporating family work as a standard of practice. Furthermore, programs should endeavor to ensure prospective clients are informed of and agree to attending treatment.
