Qualitative Article Critique Assignment Guidelines 1. Please keep the 10 questions below in your document preceding your answer (i.e., don’t delete the question after you answer it or prepare the paper in a narrative format without the questions embedded). 2. You don’t need to cite the authors in each of your responses, it’s clear what article you are referring to. 3. However, any time you include a short quote from the article in your response (which should be done sparingly), please do provide the page number from the article. 4. Ensure you appropriately paraphrase the material from the article in your response to each question (use no more than 3-4 of the authors’ words in a row when summarizing information from the article). 5. All discussions of the study that follow should be in past tense as the study has already happened (Note the use of was and were above rather than is and are in the sample text in #1 below). 6. If you didn’t cite any other sources in your critique, besides the article you critiqued, you can delete the word References at the bottom of this page as you won’t need a reference list. Critiqued by: Date: Source reference (provide the complete citation of the article here, using correct APA format, which you are critiquing): 1. Introduce the study by providing a brief summary of the focus and the research question(s) or purpose for the study. (“The focus of this study was… There were ___ research questions: …. No research questions were stated, but the authors indicated the purpose of the study was….”) 2. Did the researchers use a theory or conceptual framework in the introduction of the study to guide the study (Note: Manyqualitative studies do not. They begin the article with a brief literature review, use some form of qualitative framework to structure the study, and then let a theory emerge from the data. In such instances, it is appropriate to indicate that this is the case). Provide support for your response. 3. If the authors did describe a theory or framework, what are some of the core ideas or assumptions of that theory or framework? (If they did not, simply reply NA to this question). 4. Describe the methods used in this study. Include which qualitative approach was used (e.g., grounded theory, phenomenology, ethnography, case study, focus groups), what sampling strategy was used, describe the number and demographic characteristics of the participants, and identify the procedures used to collect the data. 5. What kinds of research questions are the methods employed in this study typically used to answer? In other words, in research studies in general (not this study specifically), why might a researcher choose this design/approach (the approach you identified in #4)? 6. Summarize how the authors analyzed their data. 7. Identify the primary results of this study. 8. Describe what (if any) strategies the authors used to establish the trustworthiness of their results (in qualitative studies they ...

1. Qualitative Article Critique
Assignment Guidelines
1. Please keep the 10 questions below in your document
preceding your answer (i.e., don’t delete the question after you
answer it or prepare the paper in a narrative format without the
questions embedded).
2. You don’t need to cite the authors in each of your responses,
it’s clear what article you are referring to.
3. However, any time you include a short quote from the article
in your response (which should be done sparingly), please do
provide the page number from the article.
4. Ensure you appropriately paraphrase the material from the
article in your response to each question (use no more than 3-4
of the authors’ words in a row when summarizing information
from the article).
5. All discussions of the study that follow should be in past
tense as the study has already happened (Note the use of was
and were above rather than is and are in the sample text in #1
below).
6. If you didn’t cite any other sources in your critique, besides
the article you critiqued, you can delete the word References at
the bottom of this page as you won’t need a reference list.
Critiqued by:
Date:
Source reference (provide the complete citation of the article
here, using correct APA format, which you are critiquing):
1. Introduce the study by providing a brief summary of the

2. focus and the research question(s) or purpose for the study.
(“The focus of this study was… There were ___ research
questions: …. No research questions were stated, but the
authors indicated the purpose of the study was….”)
2. Did the researchers use a theory or conceptual framework in
the introduction of the study to guide the study (Note:
Manyqualitative studies do not. They begin the article with a
brief literature review, use some form of qualitative framework
to structure the study, and then let a theory emerge from the
data. In such instances, it is appropriate to indicate that this is
the case). Provide support for your response.
3. If the authors did describe a theory or framework, what are
some of the core ideas or assumptions of that theory or
framework? (If they did not, simply reply NA to this question).
4. Describe the methods used in this study. Include which
qualitative approach was used (e.g., grounded theory,
phenomenology, ethnography, case study, focus groups), what
sampling strategy was used, describe the number and
demographic characteristics of the participants, and identify the
procedures used to collect the data.
5. What kinds of research questions are the methods employed
in this study typically used to answer? In other words, in
research studies in general (not this study specifically), why
might a researcher choose this design/approach (the approach
you identified in #4)?
6. Summarize how the authors analyzed their data.
7. Identify the primary results of this study.
8. Describe what (if any) strategies the authors used to establish
the trustworthiness of their results (in qualitative studies they
tend not to use the terms reliability and validity, so look for
words like rigor, saturation, credibility, transparency, member
checks, triangulation, and so forth).

3. 9. Did the authors provide any explanation of how researcher
bias might affect their interpretations of their results, including
what strategies they employed to manage this? Such comments
will usually be in the Data Analysis section or occasionally in
the Discussion section.
10. What are the real world implications of the study findings?
Are the results meaningful and important for clinical practice?
Remember that the goal of qualitative studies is typically not to
generalize to a larger population. Having said that, however, it
is still appropriate to identify to what persons or groups might
these results apply.
References
Running Head: CONTRACTING
1
2
CONTRACTING
Contracting
Name:
Institution:

4. There are a number of recommendations and advice given
in the article for any new contract. One of them is that advice
about the authorized agents known as contracting officers who
conduct government businesses. This point insists that it is only
the contracting officers who have the authority to bind the
government and that one should strictly adhere to them unless
in cases where one is advised in writing. However, this point
makes it clear that one has to be careful with the authority of
the person you are dealing with since even these contracting
officers have got limits on the authority. This advice is very
important since it helps in both increasing accountability and
reducing fraud. This is because, it might be easy to trace a
certain officer who you conducted business with on behalf of
the government in case o certain mistakes. Also, identifying
these contract officers may help a lot in reducing frauds
especially in cases of imposters who assume to be conducting
business on behalf of the government but whose main aim is to
commit fraud (Contractors, n.d.).
The other advice is that it is wise to comply with the
contract terms. This point tries to discourage contractors from
trying to come up with something either bigger or even better
from what is in the contract. This is because, if done, it might
be either too heavy or even too big for the government to handle
it for example in terms of funding it and therefore end up losing
the contract (Contractors, n.d.).
The contractor also suffers from a number of challenges
due to the government’s right to conduct either audit on
contractors’ books, and even record documents. These
challenges vary depending on the contract’s types which can
lead to vast amounts of audit oversights. This can in turn make
the contractor suffers from challenges such as fines, penalties

5. and even at times disallowed costs (Demarest, 2017).
So as to avoid such challenges in question, the contractor
can try to comprehend the audit objectives and techniques, the
audit’s main areas of emphasis, and also trying to properly
respond and analyze the audit findings (Spring, 2014).
References
Contractors, (n.d.). Your Responsibilities as a Contractor.
SBA.
Bill Demarest, (2017). The Contractor’s Perspective. Husch
Blackwell.
Spring, (2014). Is Your Company SCA Compliant? Figure It Out
Before the United States Department of Labor Figures It Out for
You! Wiley Rein.
Running Head: ACQUIRING A CONTRACT WITH THE NAVY
ACQUIRING A CONTRACT WITH THE NAVY

6. 8
Acquiring a Contract with the Navy
Name
Institution
Acquiring a Contract with the Navy
A contract is a legally binding agreement that exists between
two or more parties. In a contract, on party usually involves a
buyer and the other a seller. Before one agrees to the terms of a
contract, knowledge should be gained on the prerequisites of a
contract. Below is an analysis of the details of the contract
between our business and the navy.
Primary ways in which a Multiyear contract benefits both the
Navy and our Business
A multiyear contract refers to a contract that exceeds one year,
and one that does not exceed five years. Furthermore, a
multiyear contract provides the performance of services of the
supply of goods during the second and the subsequent years of a
contract. A multiyear contract is contingent upon the
appropriate of funds and in some cases provides the cancellation
payment to be made to a contractor is the necessary
appropriations are not made. In a multiyear contract, it is not
necessary to establish the requirements or options for each
year’s contract. There are various mutual benefits of a multiyear
contract for both the Navy and our small business. Providing
floor refinishing services for the Navy might seem to be tasking
for the first one year. However, walking back into the same

7. venue proves to be less stressful. Notably, within the second
year, all the planning and management of challenging tasks have
been handled, therefore, a contract proves sails smoothly after
the after the second year. In the same fashion, networks and
stronger relationships have been created.
For both the Navy and our small business, it would be easier to
interact during the second year of our contract because
understanding of each other’s perspectives has been gained.
According to Arnold & Harmon (2013), there is less stress
associated with a multiyear contract because knowledge has
been gained on the location and the requirements needed by our
clients. As a result, better and more refined services are offered.
Financial commitment is another benefit of a multiyear contract.
On the part of our company, there is the surety and guarantee of
financial returns during a second year. On the part of the navy,
a multiyear contract provides the guarantee of incentives and
added value to the services. Conversely, cost savings is another
advantage associated with multilayer contract because all
inherent uncertainties associated to a project have been
eliminated. In addition to that, there is the reduction of
administrative burdens.
Two reasons why our Company would qualify under the
HUBZone Act (FAR 19.5)
According to the HUBZone program, a business can qualify for
a contract if meets certain criteria. According to Cheav (2013),
the primary purpose of the HUBZone program is to provide
federal assistance to businesses that are located in underutilized
zones. The program aims to increase investment, employment
opportunities, and economic development in the underutilized
areas. With this in mind, there are various reasons that provide
evidence as to why our business is more qualified to the navy
contract compared to our competitors. First and foremost, our
business is located in the HUBZone region. In addition to that,
our business is small business in the aspect of size and on the
basis of the North American Industry Classification System
(NAICS).

8. Secondly, our employees consist of individuals from
economically under disadvantaged areas of the United States.
Almost all our employees and shareholders are U.S citizens
thereby a large percentage of our business is owned by United
States citizens.
In addition to the sentiments raised above, our business has
established itself recently. The navy contract provides a
pathway in which our business can chance expand and create a
firm foundation. Because of the reasons provided above, we
believe that our business wholly qualifies for the Navy contract.
The contract provides a platform in which our business can be
self-sufficient and expand itself further. Other than that, the
contract provides ample opportunity in which our small business
can display our skills and lay the foundation for more contracts
in the future. The acquisition of this contract provides our
company with the opportunity to expand and provide
employment opportunities to citizens that live in the HUBZone
region.
Bid Proposal
Procurement management is an essential tool that is provides
assistance to businesses to understand the procurement
concepts. In respect to our contract with the navy, the cost-
reimbursement is the most conducive for our small businesses.
In the cost-reimbursement contract, a seller is provided with
reimbursement for work completed plus fee that represents the
profits. A cost-reimbursement contract is most commonly used
when there is risk or uncertainty involved in a project.
Furthermore, it is worthy to note that in the cost-reimbursement
contract, the buyer is the one who caters for all the risks
involved in a project since he caters for all the risks. Under the
cost-reimbursement contract are various categories. There is the
cost-reimbursement fee contract that involves the payment of a
seller for all incurred costs plus a fixed fee regardless of the
performance of the contract. Secondly, there is the cost plus
incentive contract that involves the reimbursement of a seller
for all the costs plus an incentive fee based on the achievement

9. of a certain level of performance. Thirdly, there is the cost plus
award fee that involves the payment of a seller for all the
legitimate costs plus an award fee. Lastly, the cost plus
percentage of cost involves the payment of a seller for all the
costs plus an incurred percentage for all the costs (Lewis,
2015).
In regards to the contract with the navy, the cost plus incentive
fee contract is most conducive. In this aspect, our small
business would be reimbursed for all the costs incurred plus an
incentive fee that would be provided upon the achievement of
certain performance objectives as outlined in the contract. The
rationale for the selection of this contract type is based on the
level of our business. Markedly, as mentioned above, our small
business is at the beginning stages. The contract therefore
provides an opportunity for our business to display the level of
our expertise. With this type of contract in place, our small
business would strive to produce a high quality performance in
order to create a receive incentives for work completed as well
as create a good reputation for our business.
Category of Incentives willing to be offered
Because of the magnitude of the project, there are various
incentives that are willing to be offered on the part our
company. The first form of incentive is in the aspect of
performance. In this aspect, an analysis of the small projects
that the company has undertaken in the past would be provided
in order to provide the navy with the certainty of our quality
work. Secondly, incentives in the aspect of costs would be
provided. However, such an incentive would only be provided if
only the navy agrees to provide our company with a multiyear
contract. With this in place, a cost incentive would be provided.
Thirdly, incentives would be provided in the aspect of repairs
after the completion of the project. Notably, repairs would be
provided for free fro any maintenance issue that erupts with the
first year after the completion of the project.
Whether the Bid proposal should be technical, management, or
cost proposal

10. In the aspect of bid proposal, various approaches can be
utilized. First, there is the technical bid proposal that involves
providing the intricate details that encompass a project. In the
technical approach, knowledge must be manifest in the
understanding of the requirements of a project. Secondly, there
is the cost proposal that focuses on providing a detailed
breakdown of the quoted price in the aspect of the cost elements
of project materials. Lastly, there is the management proposal
that involves the demonstration of how the staff that is involved
in a project is qualified to take a contract. In the aspect of the
contract with the navy, the management proposal is the most
conducive. Notably, this is the first time for our small business
to undertake such a huge contract. Because of this, the perfect
opportunity is provided to advertise the level of expertise n our
business. As a new business, the business market, more so the
navy lack knowledge on the level of our expertise. Moreover,
advertising the level of competency of competency of our team
members is a good form of advertising and the promotion of our
company.
Five potential risk factors to be considered
Despite being equipped with the right personnel for the project,
there are various risk factors that need to be considered. First,
there is the risk of loss. As indicated above, our small business
has embarked on the first long-term contract. As outlined in the
terms of the contract our business would be reimbursed for the
costs incurred plus an additional fee for incase the performance
standards have been attained. Notably, even though there is the
certainty on the expertise of our team, there is no guarantee for
the success of the contract. Because of this, a risk is posed on
the financial returns on our company. Another risk posed is the
termination of the contract before the multiyear period is over.
Termination of the contract interferes with the planning in or
company. The third risk that is posed is under performance.
Notably, this is the first time that our company has embarked on
such large contract. Because of this, this contract provides the
framework for the availability of future contracts. Any failure

11. on the part of this contract poses the risk of a bad reputation
and image for our company. The fourth potential risk that is
posed is in the aspect of the inability to procure capital
necessary to support the project to the point of completion. As
indicated in the contract, our company is required to come up
with finances to complete the project. Only after the project has
been completed can the navy make the necessary payments
according to the costs incurred. Lastly, another potential risk to
be considered in the project is failure of timely payment on the
part of the navy. Lack of timely payment inconveniences our
company in the aspect of the payment of the payment of our
suppliers.
References
Arnold, S. A., & Harmon, B. R. (2013). The Relative Costs and
Benefits of Multi-year Procurement Strategies. Institute for
Defense Analyses. Documento NS D-4893.
Cheav, V. (2013). Programs of Parity: Current and Historical
Understandings of the Small Business Act's Section 8 (a) and
HUBZone Programs. DePaul Bus. & Comm. LJ, 12, 477.
Lewis, H. (2015). Bids, tenders and proposals: winning business
through best practice. Kogan Page Publishers.
Running head: CONTRACT NEGOTIATION
1
CONTRACT NEGOTIATION
5
Contract Negotiation
Student’s name

12. University affiliation
Contract Negotiation
Suggest three (3) ways in which the basic concepts of the FAR
Policy would mutually benefit your small business and the
Navy.
Federal Acquisition Regulation, (FAR) refers to the system
that governs the acquisition process through which individuals
acquire certain goods and services through the utilization of
contracts. Unlike the simple buying and selling processes
through which individuals obtain goods and services on stores
and pay for them cash, the contract processes are complex and
might involve services to be rendered for a long time before
payments are made. To ensure that every organization or
individual keeps the terms of the contract, the FAR has
established certain contract terms through which all individuals
must follow completely. The FAR, therefore, provides a
uniform policy through which all contracts must follow. Its
policies will significantly benefit both the Navy and the small
business.
One of the ways through which the FAR policies would
mutually benefit both the business organization and the Navy is
the provision of a contract procedure through which these two
organizations will utilize to formulate and agree upon its terms.
This significantly helps both the small business and the navy
since with the process having already being developed and
determined; there is no need to start developing and formulating
procedures to utilize in the contract. This might even cause
other problems where the organization and the Navy do not
agree upon the process to utilize in formulating the process. The
FAR policy regarding the already determined contract process
that all organizations and individuals joining contract
agreements, therefore, benefits both the small business and the
Navy by helping to reduce the time needed to create the contract
(Manuel, Halchin, Lunder, & Christensen, 2015).

13. Another basic concept of the FAR requires that both parties
should ensure that they remain bound and act according to the
terms of the contract without defying them in any way. With
this concept, therefore, both the navy and the small business
will thus attain certainty of each other with regard to satisfying
the terms of the contract. Without proper satisfaction of the
terms of the contract, either the small business would not be
certain that the Navy will uphold its part of the contract, or the
navy would lack certainty that the small business will manage
to provide the services that it describes in the contract. With the
requirement concept of the FAR, however, both organizations
attain this certainty. The third way through which these
organizations will mutually benefit from the FAR concepts is
through the concept of contract pricing. Since contracts are
diverse with many of them being of different values, the
concepts of the FAR policy do not fix a certain value to be the
price of all contract. They, however, provide guidelines through
which the price of a contract should be determined. Since
pricing is among the most problems that individuals acquire
when they are negotiating, the FAR concepts significantly
benefit both the small business and the navy (GSA, 2015).
Determine the method that you will use for solicitation of a bid.
Next, explain why the Navy is likely to choose your company in
the sealed-bidding process.
The process of soliciting for a bid is a significantly important
process that all organizations should be significantly conversant
with. In order to be granted the contract, the navy organization
will require the assurance that the small business organization
has the capability to provide the specific services that are it
requires completed. It also requires attaining the assurance that
the small business is the one offering the best terms among
other competitors for the work that the organization requires
done. To provide the organization with this assurance, I will

14. first explain the abilities of the organization with providing the
services that the Navy requires, by stating the qualifications and
skills of the organizational employees who will provide the
services required. I will then provide the organization with fair
private offers and a short period requirement to complete
providing the services.
The Navy as explained requires the organization offering the
best terms and one that is highly willing to implement the
organizational needs in its service. It is also likely to prefer the
organization with the highest capability of providing the
services professionally. After providing it with the
qualifications of the specific professionals that will provide the
organization with the services needed and offering fair prices,
therefore, the navy organization is likely to choose my company
for the contract (Turner, 2014).
References
GSA, (2015). Federal Acquisition Regulation: GSA. Retrieved
from https://www.gsa.gov/portal/content/101126
Manuel, K., Halchin, E., Lunder, E. & Christensen, M. (2015).
The Federal Acquisition Regulation (FAR): Answers to
Frequently Asked Questions: Congressional Research Service.
Turner, C. (2014). Unlocking contract law. Abingdon, Oxon:
Taylor and Francis.
Running head: ORGANIZATIONAL MANAGEMENT
1
ORGANIZATIONAL MANAGEMENT
5
Organizational Management

15. Student’s name
University affiliation
Organizational Management
Develop your company’s acquisition and planning strategy for
obtaining a contract.
Planning is one of the most important aspects that organizations
utilize in order to ensure that they manage to attain their goals
and targets. Without a plan, it is extremely difficult for any
organization to manage to achieve any goal. It is due to this
reason therefore that organizations plan almost about all actions
that they intend to take with an aim of increasing their
competitiveness. In this scenario, my company, First name Last
name Inc. is an organization that involves in the activities of
floor refinishing. It enjoys the advantage of being the only
business in the region and thus it has no competition. After
receiving patent to carry out business activities, the
organization feels the need to expand, an aspect that would
require funds and promising income sources. It is due to this
reason that the organization is competing for a contract in a
nearby Navy base (Hubbard, 2011).
The planning and acquisition strategy of an organization simply
explain the important aspects that will help the organization
manage to attain goods or contracts. In this case, the acquisition
strategy and planning is aimed at helping the organization
manage to attain contracts and clients. The strategy can simply
be stratified into steps, which will contribute significantly to
ensuring that the organization manages to attain contracts from
the navy base and other organizations or individuals. The first
step is marketing. Marketing the organizational services is
significantly important because it helps all the customers and
clients that would like similar services to those that the
organization offers to understand that the organization exists

16. and is capable and willing to offer them. Marketing also helps
to make the burden of having to make significant explanations
for customers when organizational executives approach them to
obtain contracts. A customer who has heard about the
organization and is well conversant with its services and
products would not need much explanation about the
organization, unlike the case of an individual who has never
heard about the existence of that organization. The next main
step is research. Research should be focused on the market and
targeted customers. In this case, for example, the organization
should conduct research to learn the specific services that the
navy base requires and other organizations that are competing
for the same contract. By obtaining this information, the
organization would simply manage to deliver the needed
services and thus it would be extremely easy to acquire the
contract from the navy and other organization (Engelbeck,
2002).
Analyze the manner in which utilizing SmartPay or a similar
program in electronic contracting will assist your company and
the Navy. Provide a rationale for your response.
Smart Pay is an electronic contracting program that was utilized
to help organizations with the problems and issues that arise
when they operate under contracts. In many cases, organizations
involve in contracts to provide certain services and products to
other organizations or individuals. Unlike for the case of
employees, however, organizations attain difficulties managing
contracts with the many needed activities of protecting the
specific contractor’s rights, processing invoices and processing
payments among other activities. Due to this reason, therefore,
organizations opt to utilize electronic contracting programs like
Smart Pay. This program provides significant assistance to
organizations and individuals that operate in contracts. It
ensures that organizations or individuals who work under
contracts have their rights protected, their invoices and

17. payments are processed in time and the required taxes and other
deductions made when they require being made. These services
would be significantly beneficial to both the organization and
the navy base. To begin with, the navy base would not have
problems processing invoices and making payments when they
are late. This would help them retain the contract and eliminate
any form of problems that may arise with the organization. To
the organization, on the other hand, the program would ensure
that its contract rights are safeguarded, payments are made in
time and all required deductions are made. The Smart Pay or
any other similar electronic program would thus be highly
beneficial to both the organization and the navy base
(SmartPay, 2016).
References
Engelbeck, R. (2002). Acquisition management. Vienna, Va:
Management Concepts.
Hubbard, N. (2011). Acquisition strategy and implementation.
West Lafayette, Ind: Ichor Business Books.
SmartPay, (2016). Smart Pay; Our Umbrella Company for
Contractors: Smart Pay. Retrieved from
http://smartpaylimited.com/contractors/
Discussion
"Contract Termination and Closeout" Please respond to the
following:
Per the text, the government has the right to terminate a
contract whenever it is in their
best interest or convenience. However, the text does not
reference termination of

18. contracts for alleged contractor support of terrorist groups.
From the e-Activity, analyze
the dilemma discussed in the video, and take a position as to
whether you believe the
government should have the right to terminate the contracts
involved due to reasons of
default, breach of contract, or for the convenience of the
government. Provide a
rationale for your response.
Regarding the contract closeout process, make at least one (1)
recommendation for
improvement that would benefit the government and one (1)
recommendation for
improvement that would benefit the contractor. Provide a
rationale for each
recommendation.
Assignment 5: Contract Cost and Documentation for the Navy
Based on the same scenario as in Assignments 1, 2, 3 and 4, you
are now considering
the final factors needed for your proposal based on RFP
#123456789, dated
07/14/2014.
Additional factors to consider are:
The other local competitor has removed their name from
consideration and has
requested to become your company’s sub-contractor due to your
company’s patent on
the specialty coating.
Your existing floor equipment is dated. However, you have

19. learned that the Navy base
has floor equipment which is not currently being used.
Write a six to eight (6-8) page paper in which you:
Determine the payment type (i.e., receiving progress payments,
performance-based
payments, or partial payments) you will use in your bid. Provide
a rationale for your
response.
Determine the approach and the key terms that you would
consider in requesting the
use of the Navy’s floor equipment. Provide a rationale for your
response.
Propose the quality control and inspection procedures that you
believe should be
included in your proposal. Provide a rationale for your
response.
Determine, because of your company’s private patent on the
specialty floor coating,
whether the Navy would or would not have a patent
infringement objection for the use of
the coating. Provide a rationale for your response.
Determine the mechanism for contract closeout your company
would use with the Navy.
Provide a rationale for your response.
Use at least three (3) quality references Note: Wikipedia and
other related websites do
not qualify as academic resources.

20. O R I G I N A L P A P E R
Enhancing Family Communication: Examining the Impact
of a Therapeutic Wilderness Program for Struggling Teens
and Parents
Katie Liermann1 • Christine Lynn Norton2
Published online: 19 January 2016
� Springer Science+Business Media New York 2016
Abstract Every year approximately 130 families partic-
ipate in Intercept, a program for struggling teens and their
families at the Voyageur Outward Bound School, because
they are concerned about the loss of trust, poor commu-
nication, and/or other high-risk behaviors they are experi-
encing with their children. Though families hope for
improvements in family functioning, little research has

21. been done on the impact of this type of program on the
parent/child relationship or how families function once
they leave the program. This phenomenological study
collected qualitative data from nine families to determine
what positive relationship outcomes emerged between
parent(s) and their adolescent child post-program, as well
as what aspects of the program curriculum were helpful in
improving the parent/child relationship. Results showed
that communication among family members improved as a
result of participation in the Outward Bound program, and
families reported utilizing new skills they had learned,
including the use of time-outs, improved listening, and
other assertive communication tools. Families reported that
the parent/child conference at the end of the program was
the most helpful aspect of the Intercept curriculum for
improving the parent/child relationship. Implications for
family therapy include support for therapeutic wilderness
programs as a viable intervention for families of high-risk

22. teens struggling with communication.
Keywords Therapeutic wilderness program � Family
functioning � Communication � Family therapy
Introduction
The family system is an integral part of adolescents’
‘‘social, emotional and behavioral well-being’’ (Harper
and Cooley 2007, p. 393). The health and functioning of
the family system can play an important role in an ado-
lescent’s development into adulthood (Coady and Leh-
mann 2008). According to a seminal study by Resnick
et al. (1997), strong family connectedness can be a pro-
tective factor that promotes youth functioning. However,
when youth experience negative family dynamics, such as
poor communication, anger, and distrust, they can expe-
rience problems in family functioning (Steinberg 2001).
When this occurs, families may require intervention
through family therapy.
Though a wide range of systemic family therapy inter-

23. ventions exist (Cottrell and Boston 2002), research has
shown that therapeutic wilderness programs can improve
both youth and family functioning (Harper and Cooley
2007; Harper and Russell 2008). According to Norton
(2007), there is a continuum of therapeutic wilderness
interventions, from experience-based wilderness programs,
which include non-clinical staff, to Outdoor Behavioral
Healthcare, which involves clinical staff administering
therapeutic interventions, specifically targeting a client’s
treatment plan. Regardless of the level of clinical services
provided, most therapeutic wilderness programs utilize
adventure-based activities in the outdoors to implement
therapeutic interventions for adolescents who are strug-
gling with behavior issues, as seen by parents, schools and/
or the courts (Berman and Davis-Berman 2008).
& Christine Lynn Norton
[email protected]
Katie Liermann
[email protected]
1

24. San Jose State University, 1 Washington Square, San Jose,
CA 95192, USA
2
Texas State University San Marcos, San Marcos, TX, USA
123
Contemp Fam Ther (2016) 38:14–22
DOI 10.1007/s10591-015-9371-5
http://crossmark.crossref.org/dialog/?doi=10.1007/s10591-015-
9371-5&domain=pdf
http://crossmark.crossref.org/dialog/?doi=10.1007/s10591-015-
9371-5&domain=pdf
Traditionally, it is has been thought that these programs
only treat the adolescent who attends the wilderness pro-
gram (Harper and Cooley 2007). In fact, it was not until the
late 1980’s that wilderness programs saw the opportunity to
involve the family in the adolescent’s recovery (Bandoroff
and Scherer 1994). However, research on therapeutic
wilderness programs has begun to show the need for ‘‘more
intentional and direct involvement of families in the change
process…to help families address issues preventing effec-

25. tive family functioning’’ (Harper et al. 2007, p.126).
Therefore, more wilderness programs are involving the
entire family system, such as Outward Bound’s Intercept
program for struggling teens, which incorporates the family
into the adolescent’s experience (Outward Bound 2013a).
Every year approximately 130 families participate in the
Intercept program at the Voyageur Outward Bound School
in Ely, Minnesota. Intercept is a 28-day therapeutic
wilderness program for struggling teens and their families.
Pre-program data collected show that families participate in
this program because they are concerned about the loss of
trust, poor communication, and/or other high-risk behaviors
they are experiencing with their children. Though significant
research demonstrates the positive impact of therapeutic
wilderness interventions on youth functioning (Clark et al.
2004; Norton et al. 2014), more research is needed on the
impact on the parent/child relationship and how families are
functioning once they leave a program. The purpose of this

26. study is to determine what positive relationship outcomes
emerged between parent(s) and their adolescent child after
participation in the Outward Bound Intercept program.
Though this program is not a traditional Outdoor Behav-
ioral Healthcare program, the risk factors of youth in this
program are similar to those in OBH programs (Norton
2010); therefore, this research is deemed applicable and
relevant to the larger category of OBH research. Further-
more, therapeutic wilderness programs are on the same
continuum of care as OBH, and may play a key role in
addressing the mental health needs of adolescents before they
need OBH (Berman and Davis-Berman 2015). On one side of
the continuum there are [therapeutic wilderness] programs
like Outward Bound that provide adolescents with thera-
peutic adventure experiences for personal growth and
development, but do not require staff to be licensed mental
health professionals. Rather, staff administering Outward
Bound programming are trained outdoor instructors who may

27. also provide paraprofessional counseling and support. On the
other side of the continuum are wilderness therapy programs,
also known as Outdoor Behavioral Healthcare, a modality of
mental health treatment, in which clinical staff provide
therapy in a wilderness context. Overall programming, field
staff training, and the type of youth served is often similar,
and both types of programs play a key role in serving youth
and families, but key differences should be noted.
Therapeutic Wilderness Programs as a Family
Systems Intervention
When an adolescent is struggling, the family plays an
important role in the teen’s growth and development
(Harper et al. 2007). Family systems theory reaffirms this,
by viewing the adolescent as a part of a system that focuses
not only on the individual but the relationships within the
family system (Becvar and Becvar 1999). When adoles-
cents struggle to make healthy decisions, it can affect the
entire family system, often creating conflict between par-
ents and the adolescent child. When this occurs, families

28. sometimes seek community-based counseling services.
Though wilderness programs historically have been used as
a last resort for families struggling with high-risk adoles-
cents, families seek out wilderness programs when they
perceive traditional therapy as ineffective (Russell 2000).
When a family makes the decision to change the family
dynamic by sending the adolescent child to Outward Bound,
the Intercept program staff first work with the adolescent to
create goals for the expedition that are transferable to home
life, gain insight as to why they were sent to this program,
and what they and their parents can change to create a more
positive home life (Norton 2007). Though it is the adoles-
cent that participates in the wilderness expedition, the parent
plays an important role in the program outcomes as well.
While the adolescent is engaged in the wilderness program,
it is the parents’ responsibility to evaluate their parenting
style and relationship with their child, by completing weekly
homework assignments, writing a letter to their child and

29. participating in a Parent/Guardian Seminar at the end of the
wilderness phase of the program. The letter is guided by
restorative, strengths-based questions to help the parent
reflect on what they love about their child and what they
hope for in their relationship with them upon their return
home. It is given to the youth the night before youth are
reunited with their families.
During the parent/guardian seminar, the parents and
child have a conference to determine what positive changes
they would like to sustain in the home environment. The
Intercept instructors work with the family to transfer
learning that has occurred over the past month for both the
parents and the child. This conversation includes setting
goals and expectations upon their arrival home (Norton
2007). Intercept instructors who are trained in family sys-
tems theory facilitate this therapeutic conversation, but are
not licensed family therapists. The conversation is intended
to help families connect, to provide appropriate space for

30. autonomy, and to help families work on regulating their
emotions by applying new skills. It is also a time to coach
the family in how to use the new skills they learned in the
program upon their return home. This model of family
intervention is similar to Doherty’s (1995) family life
Contemp Fam Ther (2016) 38:14–22 15
123
education approach, which ‘‘provides family members with
information, skills, experiences, or resources intended to
strengthen, improve or enrich their family experience’’
(NCFR 2014). Often, these conversations lead families to
be more open to the idea of participating in formal family
therapy upon their return home.
Prior Research on Family Involvement
in Therapeutic Wilderness Programs
In addition to youth functioning, research on therapeutic
wilderness programs has also looked at the impact and role of

31. the family in treatment, as well as impact on attachment. Many
wilderness programs have a requirement of family involve-
ment in the treatment process and research has shown mixed
results on the impact of wilderness therapy on family func-
tioning (Harper and Cooley 2007; Harper and Russell 2008).
The evaluation of a 1 day pretreatment and 1 day post treat-
ment multifamily program, in addition to wilderness therapy,
showed significant impacts on youth’s behaviors post dis-
charge; however, had limited impact on family functioning
(Harper and Cooley 2007). A mixed methods study looking at
the involvement of family and impact of wilderness on family
functioning found only one out of four areas impacted in terms
of functioning, yet qualitative interviews revealed families felt
a stabilizing effect from wilderness therapy involvement
(Harper and Russell 2008). These findings point to the com-
plexity of family relationships, further highlighted by research
showing the mixed impacts of wilderness treatment on
attachment in youth participants.

32. Bettmann (2005) explored the impact of wilderness
treatment on youth and parent attachment and found ado-
lescents improved attachment relationships in terms of
decreased anger and increased emotional connection; yet
increases in problems of trust or communication with
parents at discharge. In a similar study, Bettmann and
Tucker (2011) found mixed results in terms of increases in
connection, but decreases in trust and communication, as
well as both positive and negative growth in attachment
with peers. These trends may be reflective of the nature of
out of home treatment, which makes family involvement
versus family engagement difficult due to distance and
expense; as well as the adolescent versus the family being
the main focus of the treatment. Attachment may also be
negatively affected by the high rate of youth who go on to
some form of aftercare after participating in OBH. Dif-
ferent than most OBH programs, in which 60 % of clients
go on to some form of aftercare (Russell and Hendee

33. 1999), most youth attending Outward Bound’s Intercept
program return home; therefore, the program presents an
ideal climate in which to research the impact on family
functioning post-program because youth are back in the
home environment and the family has more opportunity to
use the tools that they gained in the program.
Methods
A phenomenological, qualitative approach was used in this
study in order to gain in depth, descriptive information
regarding the lived experiences of families who participate in
the Intercept program. This study queried nine families through
open-ended pre-post course questionnaires administered to
parents one-month prior and 6 months after the program, as
well as in-depth phone interviews with parents conducted
3 months post-program. Both the questionnaires and the
interviews sought to answer the following research questions:
(1) How has the parent/child relationship been impacted
since participating in the Intercept course?

34. (2) What, if any, aspects of the Outward Bound
Intercept curriculum made a positive impact on the
parent/child relationship?
The open-ended questions utilized in the questionnaire
and in the qualitative interviews focused on how the par-
ent-adolescent relationship has changed since the Intercept
course in particular, especially in regards to communica-
tion, trust and connectedness. Questions asked also exam-
ined what aspects of the Intercept course were beneficial in
improving the parent-adolescent relationship, with a focus
on the specific skills the family has used since participating
in the program. The following are a sample of the interview
questions asked to the parents who participated in the
Outward Bound Intercept course.
(1) What can you tell me about the improvement in your
relationship with your son/daughter in regards to
connectedness, trust and communication?
(2) What can you tell me about the frustrations that exist

35. in your relationship with your son/daughter in regards
to connectedness, trust and communication?
(3) What parts of the Intercept curriculum did you find
useful?
(4) What components of the parent/guardian seminar
have been helpful in improving the relationship with
your son/daughter?
Participants
Twenty families were invited to participate in this study by
an Outward Bound staff member, over the phone or via
email. A convenience sample of nine families agreed to be
in the study; however, given the depth of the phe-
nomenological approach, the sample size was deemed to be
appropriate for this level of inquiry (Groenewald 2004).
16 Contemp Fam Ther (2016) 38:14–22
123
The sample included families of primarily Caucasian

36. background, middle to upper class socioeconomic status,
and mixed family structures (i.e. adopted children, married,
divorced, raised by grandparents). Because one of the
researchers in this study was involved in working directly
with families in the Outward Bound Intercept program, a
different Outward Bound staff member informed the fam-
ilies of the consent process via phone. The IRB at San Jose
State University approved this study, and informed consent
was gained in writing from families who agreed to be in the
study. Consent forms explained the research topic, what
was expected of them through their participation (i.e. sur-
vey, interviews, time commitment, etc.). Information about
the identity of the families participating in the study has
been kept highly confidential and for this reason, family
demographics are not provided.
Program
This study conducted research with families who partici-
pated in Outward Bound’s Intercept program to better

37. understand the impact of the program on family relationships
and communication. Outward Bound is an adventure-based
organization that operates in 33 countries around the world,
with nine wilderness programs alone in the United States.
Every year approximately a quarter of a million youth and
adults participate in an Outward Bound course worldwide,
with almost 33,000 of those participants attending expedi-
tions in the United States (Outward Bound International
2012). Significant to all Outward Bound courses are
wilderness expeditions in which participants move through
three phases: training, main, and final expedition. At each
phase the group gains more autonomy such as they would in
life (infancy, adolescence, adulthood). All students also
participate in a solo experience where they spend a prede-
termined amount of time away from the group, supervised by
an instructor, in which to reflect on their lives and connect
with the natural world. In particular, Outward Bound’s
Intercept courses for struggling teens believe in the ability of

38. the wilderness to impart confidence and strength to the
adolescent, which can become the building blocks for a
healthy adulthood experience (Outward Bound 2013a). An
Outward Bound Intercept course also includes parent
involvement in a 3 day Parent/Guardian Seminar at the end
of the 28-day wilderness expedition. At the Voyageur Out-
ward Bound School the seminar is divided into four com-
ponents: facilitated multi-family group discussions on
course curriculum and adolescent development; a parent
conference with the Intercept instructor that provides parents
with information on how their teen performed on the
wilderness expedition; group presentations by the students to
the parents in which youth show a slide show with photos
from their trip, discuss highs and lows, share tools they
learned to take home and try to help parents experience what
they experienced; and the parent/child conference, a facili-
tated, therapeutic conversation between parents and their
teen. Through these components the parents learn the skills

39. their teen learned and utilized on their wilderness expedition.
These skills are related to communication, trust, and other
needs specific to each family.
Analysis of Data
All of the parent qualitative survey questions were
administered as part of the online questionnaire using SJSU
Qualtrics survey software. The survey data was coded and
analyzed thematically using a constant comparative
method of sequential coding (Strauss and Corbin 1990).
The interview responses were recorded (with consent),
transcribed, coded and thematic analyzed using the same
data analysis methods. Consistent with qualitative phe-
nomenological data analysis procedures as described by
Creswell (2013), data in the form of participant statements
from the questionnaires and interview transcripts were
coded and categorized using open, axial and then selective
coding methods. Throughout this process, the researcher
became immersed in the data in order to effectively

40. interpret and understand the meaning of participants’
experiences. To minimize bias, the second researcher, who
had no contact with the families, also examined the data to
assure consistent interpretations across analysts.
According to Auerbach and Silverstein (2003), it is
important to exercise reflexivity when conducting qualita-
tive research through the active self-examination of the
researcher’s biases and participation in the research process.
In this study, the researcher and the second author have also
worked as instructors for Outward Bound and value the
therapeutic adventure approach. Therefore, it was particu-
larly important for us as the researchers to recognize and own
our personal views, values, and biases throughout the
research process. We instituted efforts to maximize our plan
to elicit parents’ views of the therapeutic adventure approach
and not impose our values on them. These reflexivity efforts
included discussions with other clinical, research, and
teaching professionals, keeping notes throughout the

41. research process, and prioritizing an awareness of parents’
feedback about the program. Furthermore, a phenomeno-
logical explorative research design was selected in order to
prevent or restrict the researchers’ bias (Groenewald 2004).
Findings
This study used open-ended questions on all surveys (pre-
program, one-week and six-month post-program) and par-
ent interviews at three-month post intervention.
Contemp Fam Ther (2016) 38:14–22 17
123
Throughout the multiple sources of qualitative data col-
lected, communication stood out as a positive theme from
pre-program to six-month post-program data, which sup-
ports its significance in this research.
Pre-Program Survey Themes
Communication and Trust
The pre-program survey highlighted themes of improved

42. communication and trust as desired outcomes of the
Intercept course, as evidenced by this parent quote: ‘‘I
would like to see trust in the relationship. I have lost trust
in my son after repeated and compulsive lies to the point I
am skeptical about anything that he says’’. And this father
expresses comparable frustrations with truthful communi-
cation at the root of the problem:
‘‘I would like to see improved communication. I
would like for my son to be truthful with us and with
everyone so that when we speak to each other it is
based on substance rather than something made
up…to leave him alone.’’
The need for open and honest communication was a
common theme among parents sending their youth to
Outward Bound. Families reported feeling stuck in avoi-
dant or confrontational patterns of communication, which
negatively affected levels of trust.
One-Week Post-program Survey Themes

43. Communication
At one-week post-program, the parent survey data specified
less argumentative communication, having a common
language, and listening to their teen more. One parent
commented: ‘‘The communication is more open. We have
a common language now that helps us understand each
other. I think he appreciates what I do for him more and
shows it. He says how he feels more often.’’ Another parent
reported:
‘‘We are communicating better on both sides. I am
more patient as is he. He smiles more. I think we both
can see the other’s perspective better. We have been
using rules for fair-fighting and have been taking time
outs (breaks) like we did at Outward Bound.’’
One area of frustration for several of the parents was
comprised of mothers’ desire for their sons to be more
emotionally expressive. This was revealed several times in
the following comments:

44. ‘‘I wish he would express himself more; let us know
what he is feeling and thinking.’’
‘‘He still seems to not want to talk to me and is easily
frustrated with much of the communication with
me.’’
‘‘I don’t know how he really is feeling, but it is not as
bad as it was in the past.’’
Course Components
When asked what the most important components of the
Intercept course were, a prevalent theme emerged for
parents. They reported that the parent/child conference and
workbook were most beneficial for improving their rela-
tionship with their teens because it got them involved in
their child’s treatment process. Parent’s thorough attention
on the workbook over the course of the month their teen
was in the program helped them be more reflective, as
evidenced by this parent quote: ‘‘The workbook questions
forced me to think through things in advance that I would

45. not have done’’.
The parent/child conference was significant to parents
because of the staff that lead the conference. One parent
said, ‘‘The leadership is so professional and compassionate.
Even though [instructor] was not a counselor, we got so
much out of the meeting because she really knew our son.’’
Another parent commented: ‘‘Hearing how staff approa-
ched issues with [my son], how they helped him develop
skills, was beneficial in improving this relationship.’’ This
parent similarly reported:
‘‘The parent/child conference was very beneficial. In
particular, there was a un-biased third party facili-
tating the conversation who was the same individual,
the field instructor, that spent the past 4 weeks with
my child; this was someone that my child trusted to
be the one facilitating the conversation.’’
Three-month Post-program Interview Themes
At 3 months post-program, parents were interviewed

46. over the phone. The interviews were transcribed and
coded for themes in parent/child relationship and com-
ponents of the Intercept course that were reported as
being beneficial. Again, the main theme that emerged
was improved communication, which triangulates the
findings from the survey data. Course components that
parents found helpful were related to the Parent Seminar
weekend, specifically, information on the adolescent
brain and the group presentations presented by the teens
to the parents.
18 Contemp Fam Ther (2016) 38:14–22
123
Communication
Qualitative data collected showed three aspects that con-
tribute to improved communication between the parents
and their teen: improved listening, taking ‘‘time-outs,’’ and
using specific communication skills taught at Outward

47. Bound. A father stated: ‘‘One of the things that is good is
that we are both listening, I mean not just [wife] and I but
[son] is listening to each other’’. Another parent reflected
on how improved listening creates more understanding in
his relationship with his teen:
‘‘I do think it’s been [a] helpful thing with our rela-
tionship too that I see his side a little bit more than,
gosh darn why is he doing this and I think it makes
these moments not quite as bad…knowing and
understanding on both sides.’’
Taking ‘‘time-outs’’ added to improved communication
because when family members noticed the conversation
spiraling into an argument or that they were not listening to
each other, then a ‘‘time-out’’ was suggested, with the
stipulation to come back in a certain timeframe and finish
the conversation. Several parents identified this as an
important element:
‘‘It is the idea if you are frustrated or something is
bothering [you], step away for a moment and go

48. collect yourself. He [son] use to just storm off
sometimes, I mean like slamming doors and all that.
Now when he gets upset, he does walk away, but he
does it in a much more cool collected way and then
able to come back and move forward.’’
‘‘The time outs have helped out a lot, if one of us
feels like the discussion is going in a really negative
direction, then one of us will say ‘okay, we need to
take a break,’ and we will come back to this at
another time, you know like 15 or 20 min later and
that has been really beneficial as well, instead of
being angry and saying the same thing over and over
again.’’
Finally, communication skills such as using assertive
communication strategies enabled families to work toge-
ther in solving problems, as per this example:
‘‘We communicate a little bit better; I think there is a
little less heat in our conversations. I think because of

49. the skills we all learned at the Intercept course on
communication have come in handy for us, I think we
all fall back on them quite a lot which is awesome,
but remembering what we learned, this isn’t [the]
way we should be digressing into an argument, we
should be talking about this conservatively and
appropriately, so I think that has been a really great
thing. I think that [my son] feels more comfort-
able speaking his mind… and we are all communi-
cating better. We are more assertive in our
communication.’’
Course Components
Parents reported specific aspects of the Parent Seminar as
helpful to their relationships with their teens. These
included information they received about the teenage brain
and the teen’s group presentation to their parents. Learning
about adolescent brain development was useful informa-
tion to parents as they were able to recognize why their

50. teen may be making the choices they make. These two
comments speak to the impact of this information on par-
ents’ ability to better understand their teens:
‘‘His [son] brain isn’t working like ours is, but that
conversation with [facilitator] to kind of reset us to
expectation was very useful.’’
‘‘When the [facilitator] talked about the teenage
brain, I learned how stunningly wonderful it is, even
though it is big into risk taking.’’
The parents were equally impressed with the group
presentation and their teens’ part in it. One parent said:
‘‘Coming from them and seeing the interaction
between them, I don’t know it was just really, really
moving and it gave me a feeling of unusual cama-
raderie that…I was sort of unaware that it could exist
with teenagers because you hear so much about all
the social stuff that goes on with bullying and caddy
remarks and heartbreak and people being mean.’’
Another mother was impressed with her son’s role in the

51. group presentation:
‘‘When I sit here and reflect on it when the kids were
all presenting together…listening to [my son] stand
up in front of that room and talk, I was in tears
because he has never been that confident and that
assured speaking in front of people and feeling
comfortable in his own skin, that was huge I was on
the verge of tears multiple times throughout that
whole thing…to see that transition in my child.’’
Six-month Post-Program Survey Themes
Communication
At 6 months post-program, parents reported that the com-
munication skills they gained were still useful. They
reported continued relationship improvements, such as,
increased trust and a better understanding of each other,
Contemp Fam Ther (2016) 38:14–22 19
123

52. often supported by the use of time-outs. One parent stated:
‘‘We take step backs when emotions run too high. We
forgive and try to start anew. We have learned to commu-
nicate better, take time outs, and regroup.’’ Another said:
‘‘We have a greater level of honesty and trust. He
[son] has taken on more responsibility and I have
tried harder to listen and understand his point of
view.’’
However, despite these positive results, there remain
frustrations of continued lying and a struggle to get
schoolwork completed. One mother said about her son:
‘‘He continues to lie to get out of doing something or to get
out of trouble.’’ Another parent recognizes that her son is
trying, but knows that he can do better in his schoolwork:
‘‘Still schoolwork, while improved, he still does not put
forth his best effort. At least he is now doing enough to get
by, but just that.’’
Course Components

53. At 6-months post-program, parents continue to report that
the Intercept course was beneficial because of the parent/
child conference. This was once again evidenced by the
following comments:
‘‘The parent/child conference was helpful, because it
forced [my son] to open up to not only his own
feelings, but also to see how he affects his family.’’
‘‘The [parent] seminar was helpful, because we were
able to share ideas among the parents’’.
Overall, parents observed the positive impact the expe-
rience had on their child, even 6 months later, as measured
by the six-month post program survey. One parent reflected
on this by stating: ‘‘What stays with me at this point in time
is my respect for what my daughter accomplished on her
OB journey, which was so much more than I knew she was
capable of.’’
Parents also commented on witnessing an increase in
their teens’ confidence and the positive impact the wilder-

54. ness expedition had on their teen. According to parents,
youth gained a sense of pride from the physical and emo-
tional rigors of the wilderness expedition, as indicated by
this quote: ‘‘Looking back, its a marker for how good he can
feel about himself. He gained self confidence’’.
Discussion
This study collected multiple sources of qualitative data
from parents in order to explore positive relationship out-
comes between parent(s) and their adolescent child after a
therapeutic wilderness course. Across all of the qualitative
data collected, improved family communication emerged
as a theme for parents. This remained true immediately
after the therapeutic wilderness intervention and was sus-
tained three and 6 months later. This is especially positive,
as this was a main point of concern for families going into
the program. The communication skills the parents found
to be beneficial in improving the relationship were having a
‘‘common language’’ and listening to their teen. By

55. demonstrating listening skills, parents began modeling the
behavior they want to see in their teen. Parents and teens
also learned to communicate more assertively, and take
time outs to manage themselves and better resolve conflict.
All of these improvements in communication brought
about increased trust and better relationships. Though this
study focuses on improvements in family communication
and relationships, parents also noticed positive behavioral
changes in their teens, similar to findings from other studies
showing improvements in youth functioning post-wilder-
ness program (Norton 2008, 2010; Russell 2000). In Rus-
sell’s study, adolescents articulated finding success in
improving their family relationships, increasing abstinence
from drugs and alcohol, and improving performance in
school. Likewise, in Norton’s research, similar positive
results were found in school improvement, improved
family relationships and increased self-confidence in the
teens. This study validated this prior research; however,

56. more research needs to be conducted on youth functioning
following a therapeutic wilderness experience.
This study also examined which aspects of the program
helped improve positive relationship outcomes within the
family. In this study the families found the skills taught
during the expedition and the Parent Seminar to contribute
to improvements in family relationships. The parallel pro-
cess of parents and teens learning the same skills and tools
was highly beneficial for creating lasting change in the
family system. The group presentations at the end, also gave
youth an opportunity to teach some of these skills to their
parents, taking a leadership role in improving family
functioning. Furthermore, though the wilderness interven-
tion targeted the teen as the main participant, the program
found ways for parents to be fully engaged in the process as
well. The parents spent the first 25 days of the program
writing in the workbook in order to reflect on their rela-
tionship with their teens and addressing their parenting

57. style. Then, they attended the Parent Seminar to experien-
tially learn and practice the interpersonal skills their teens
were taught. In many cases, this learning came directly from
their teen and the Outward Bound staff, which was very
empowering. The final parent/child conference provided an
opportunity to bring these skills together to have a con-
versation with other families about how to use what was
learned in the program at home. The outcomes of this study
reflect the continued use of these skills at home.
20 Contemp Fam Ther (2016) 38:14–22
123
Limitations
The families in this study reported improved family com-
munication and enhanced quality of their relationships with
each other. This qualitative study offers descriptions of the
ways in which these families were impacted by their par-
ticipation in the therapeutic wilderness program. The study

58. gained parent perspectives on changes in the family sys-
tem, and found that these changes were sustained six-
months post-program. However, consistent with qualitative
findings, especially with such a small sample size, we
cannot provide causal connections regarding the findings,
and we cannot generalize the findings to other populations
or even to other families who participate in OB Intercept
courses. Additional studies of this nature are needed to
clarify and extend our findings, and studies of a quantita-
tive nature will provide the causality and generalizability
so important for a complete picture of the efficacy and
importance of therapeutic wilderness programs for youth-
at-risk and their families. Furthermore, future studies
should also include the adolescent participants’ perspec-
tives on changes in family functioning post-program.
Implications for Family Therapy
Despite these limitations, several implications for family
therapy have emerged as this study unfolded. First, we know

59. that a therapeutic wilderness program that engages both youth
and parents can be a positive intervention for families strug-
gling with communication. This is in contrast to earlier
research, which found that communication among family
members diminished somewhat after wilderness treatment
(Bettmann and Tucker 2011). Understanding the reason for
this discrepancy was beyond the scope of this study; however,
it may be related to the aforementioned fact that many youth
in wilderness treatment (vs. Outward Bound) often go on to
some form of residential aftercare instead of going home to
live with their families, which may impact communication.
Truancy, anger, defiance, low motivation, and risky
behaviors such as drug and/or alcohol use are also reasons
families may send their adolescent children to a therapeutic
wilderness program (Outward Bound 2013b). Findings
from this study show that this type of program may also
have a positive impact on these issues. Based on these
findings, as well as prior research showing the documented

60. benefits of family participation in an adolescent’s treatment
(Harper et al. 2007), family therapists who work with
families struggling with similar challenges may refer them
to this type of program.
Having parent involvement in this type of program
increases positive outcomes, as parents have the opportu-
nity to reflect on their parenting and family relationships,
and then practice the skills and reflect on their parenting.
Likewise, the psychoeducational information provided to
parents during the Parent Seminar at the end of the Out-
ward Bound course helped build a sense of parental effi-
cacy by giving them tools to help better cope with their
child’s struggles. Based on earlier research showing that
family-based psychoeducation effectively reduces relapse
rates (Fristad et al. 1998), this may allow for the thera-
peutic wilderness experiences to have more lasting effects.
Both parental involvement and family-based psychoedu-
cation are especially important components of family

61. therapy in residential treatment settings. Although youth
are often the primary client of residential programs, the
findings from this study reinforce earlier research findings
which all for a family-centered approach to residential care
(Walter and Petr 2008).
Given that this type of program has such a positive
impact on family communication and relationships, it may
also be an effective tool for family therapists to utilize in
order to promote treatment engagement. Research on
treatment engagement has examined the relationship
between family dynamics and treatment participation. For
example, negative parent interactions with youth have been
shown to predict treatment disengagement (Fernandez and
Eyberg 2009). Recent research also indicates that families
are most at risk of dropout due to family difficulties (Burns
et al. 2008). Similarly, problems with family dynamics are
related to the highest proportion of families who drop out
of treatment (Johnson et al. 2008). If a therapeutic

62. wilderness programs can help a family improve commu-
nication and family relationships, then perhaps families
will experience more cohesion, and be better equipped to
resolve potential conflicts between parents and youth by
finding common treatment goals. According to Gopalan
et al. (2010), these variables are important for promoting
engagement, which may mean that therapeutic wilderness
programs have utility in increasing treatment retention.
In order to further assess this assertion, as well as to support
families who have participated in therapeutic wilderness
programs, follow-up is needed. This could include individual
and/or family therapy to help maintain the communication
skills that families learned in the program. In the interviews,
parents who participated in this study commented on the need
for follow up after the Intercept course. Family therapists
could play an integral role in helping implement follow-up
programming in the community. Even early studies of Out-
ward Bound programming stated the importance of providing

63. community-based programs that have adventure challenges,
community service, alternative education and counseling
(Kaplan 1979). Norton (2007, 2008) also supports the need
for follow up in her prior research on the Intercept program.
After all, the most important aspect of family therapy is cre-
ating lasting change in the family system, long after treatment
has ended.
Contemp Fam Ther (2016) 38:14–22 21
123
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Enhancing Family Communication: Examining the Impact of a
Therapeutic Wilderness Program for Struggling Teens and

73. ParentsAbstractIntroductionTherapeutic Wilderness Programs as
a Family Systems InterventionPrior Research on Family
Involvement in Therapeutic Wilderness
ProgramsMethodsParticipantsProgramAnalysis of
DataFindingsPre-Program Survey ThemesCommunication and
TrustOne-Week Post-program Survey
ThemesCommunicationCourse ComponentsThree-month Post-
program Interview ThemesCommunicationCourse
ComponentsSix-month Post-Program Survey
ThemesCommunicationCourse
ComponentsDiscussionLimitationsImplications for Family
TherapyReferences
Sample Measure Critique
Critiqued by: KL
Date: January 25, 2016
Name of measure: PHQ9
Developer(s): Kurt Kroenke, Robert L. Spitzer, & Janet B.W.
Williams
Source
reference:https://www.communitycarenc.org/media/related-
downloads/depression-toolkit.pdf
Construct(s) assessed: Criteria-based diagnosis of depression in
individuals seen in primary care and other medical and mental
health facilities
Method of administration: Nine symptom checklist that can be
professionally or self-administered (paper and pencil,
electronically, or over the phone).
Summary of reliability evidence:
· Internal reliability was excellent, with a Cronbach’s alpha of
0.89 in a Primary Care Study and 0.86 in an OB-Gyn Study
(Kroenke, Spitzer, & Williams, 2001).

74. · Test-retest reliability was very high at a 0.96 in a longitudinal
study (Draper et al., 2008).
Summary of validity evidence:
In a study done by Kroenke et al. (2001), both criterion and
construct validity were established as well as external validity.
Construct validity was demonstrated in a sample of 580 primary
care patients who underwent an independent re-interview.
Criterion validity was shown by the strong association between
PHQ-9 scores and functional status disability days and
symptoms related difficulty. External validity was achieved by
replicating the findings from 3,000 primary care patients in a
second sample of 3,000 Ob-gyn patients.
· The PHQ-9 had a sensitivity of 88% and a specificity of 88%
for major depression. PHQ-9 sores of 5, 10, 15, 20 fully
represented mild, moderate, moderately severe, and severe
depression respectively (Kroenke et al., 2001).
Summary of clinical use:
The PHQ-9 was founded and used in primary care settings
where a nurse, physician or mental health provider has
administered the questionnaire. In recent years, it has also been
administered in many different types of medical settings and in
mental health offices. Administration by telephone and touch-
screen has been validated (Fann et al., 2009; Kroenke et al.,
2001). Often times it is self administered and the mental health
provider or medical health provider can score and determine
possible depression and severity at the time administered. It has
also been shown to notify mental health providers if
therapy/treatment is going well.
Recommendations for clinical use:

75. The PHQ-9 is a tool that can be used for diagnosing depression,
depression severity, and gauging response to depression
treatment in clinical research (Lowe, Unutzer, Callahan &
Kroenke, 2004; Lowe, Unutzer, Callahan, Perkins, & Kroenke,
2004). The PHQ-9 will be of great help in therapy to determine
if the patient is responding to therapy/treatment. This particular
measure is designed to be used in conjunction with the DSM-5
to provide correct diagnosis and severity level. Since this
assessment tool has been used widely throughout different
settings and with a diverse population, it will be important to
research your population/setting to best reach a correct
diagnosis and severity level, especially during therapy.
Summary of research use:
· Clinical Interviewing for depression (Fann et al., 2005)
· Determining depression in primary care settings (DeJesus,
Vickers, Melin, Williams, 2007; Kroenke et al., 2001)
· Comparisons to other mental health assessments (Draper et al.,
2008; Kroenke et al., 2001)
· Determining if the assessment works for other cultures and
countries (Huang, Chung, Kroenke, Delucchi & Spitzer, 2006;
Yeung et al., 2008 )
· Longitudinal research of depression after traumatic events
(Draper et al., 2008)
· Diagnosis and assessment of depression with comorbid disease
or medical conditions (Lamers et al., 2008; Fann et al., 2005)
· Ability to predict depression severity and accomplishment of
therapy/treatments (Lowe, Unutzer, Callahan, et al., 2004a;
Lowe, Unutzer, Callahan, Perkins, et al., 2004b).

76. Populations utilized with:
The population has been utilized and validated with individuals
of various cultural backgrounds, countries, languages, medical
conditions, marital status, gender, age, regions of the U.S.,
post-disaster, education status, and economical status. Some
examples to name a few are as follows:
· Oncology, using touch screens (Fann et al., 2009)
· Individuals following traumatic brain injury (Fann et al.,
2005)
· Primary care patients (DeJesus et al., 2007)
· Those affected by child abuse or gender-based violence
(Anastario, Larrance & Lawry, 2008; Draper et al., 2008)
· Used in different countries and in different language versions
(Han et al., 2008; Yeung et al., 2008)
· Racially and ethnically diverse population at primary care
facilities (African American, Chinese American, Latino, and
non-Hispanic white patient groups) (Huang et al., 2006)
· Chronically ill elder patients (Lamers et al., 2008)
Example of use in research: (Lamers et al., 2008)
Objective: to assess the psychometric properties of the PHQ-9
as a screening tool for depression in elderly patients with
diabetes and chronic obstructive pulmonary disease (COPD)
without previously known depression.
Method/Design: Diabetes and COPD patients older than 59

77. years were given PHQ-9. 105 participants were given a test-
retest assessment. Participants were also given the Mini
International Neuropsychiatric Interview psychiatric interview
to diagnose major depressive disorder (MDD) and established
Criterion validity. Correlations with quality of life and severity
of illness were calculated to assess construct validity.
Results: PHQ-9 is a valid and reliable screening instrument for
depression in elderly primary care patients with diabetes and
COPD
Future research needed:
Future research is needed to determine if the PHQ-9 would be
used instead of longer, more costly, interviewer-administered
outcome measures such as the Hamilton Depression Rating
Scale.
Overall impression of measure:
The PHQ-9 has well established reliability and validity and can
be used with a variety of populations in both medical and non-
medical settings. I think it can be a wonderful tool for clinicians
with depressed clients to determine if therapy is working.
References
Anastario, M. P., Larrance, R., & Lawry, L. (2008). Using
Mental Health Indicators to Identify
Postdisaster Gender-Based Violence among Women Displaced
by Hurricane Katrina.
Journal of Women's Health, 17(9), 1437-1444.
DeJesus, R. S., Vickers, K. S., Melin, G. J., & Williams, M. D.
(2007). A System-Based

78. Approach to Depression Management in Primary Care Using the
Patient Health
Questionnaire-9. Mayo Clinic Proceedings, 82(11), 1395-1402.
Draper, B., Pfaff, J. J., Pirkis, J., Snowdon, J., Lautenschlager,
N. T., Wilson, I., et al. (2008).
Long-Term Effects of Childhood Abuse on the Quality of Life
and Health of Older
People: Results from the Depression and Early Prevention of
Suicide in General Practice
Project. Journal of the American Geriatrics Society, 56(2), 262-
271.
Fann, J. R., Berry, D. L., Wolpin, S., Austin-Seymour, M.,
Bush, N., Halpenny, B., et al. (2009).
Depression screening using the Patient Health Questionnaire-9
administered on a touch
screen computer. Psycho-Oncology, 18(1), 14-22.
Fann, J. R., Bombardier, C. H., Dikmen, S., Esselman, P.,
Warms, C. A., Pelzer, E., et al. (2005).
Validity of the Patient Health Questionnaire-9 in Assessing
Depression Following
Traumatic Brain Injury. Journal of Head Trauma Rehabilitation,
20(6), 501-511.
Han, C., Jo, S. A., Kwak, J. H., Pae, C. U., Steffens, D., Jo, I.,
et al. (2008). Validation of the
Patient Health Questionnaire-9 Korean version in the elderly
population: the Ansan
Geriatric study. Comprehensive Psychiatry, 49(2), 218-223.
Huang, F., Chung, H., Kroenke, K., Delucchi, K., & Spitzer, R.
L. (2006). Using the Patient
Health Questionnaire-9 to Measure Depression among Racially

79. and Ethnically Diverse
Primary Care Patients. Journal of General Internal Medicine,
21(6), 547-552.
Huang, F. Y., Chung, H., Kroenke, K., Delucchi, K. L., &
Spitzer, R. L. (2006). Using the
Patient Health Questionnaire-9 to measure depression among
racially and ethnically
diverse primary care patients. Journal of General Internal
Medicine, 21(6), 547-552.
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The
PHQ-9. JGIM: Journal of General
Internal Medicine, 16(9), 606-613.
Laowe, B., Kroenke, K., Herzog, W., & Grafe, K. (2004).
Measuring depression outcome with a
brief self-report instrument: sensitivity to change of the Patient
Health Questionnaire
(PHQ-9). Journal of Affective Disorders, 81(1), 61-66.
Laowe, B., Unutzer, J., Callahan, C. M., Perkins, A. J., &
Kroenke, K. (2004). Monitoring
depression treatment outcomes with the patient health
questionnaire-9. Medical Care,
42(12), 1194-1201.
Lamers, F., Jonkers, C. C., Bosma, H., Penninx, B. W.,
Knottnerus, J. A., & van Eijk, J. T.
(2008). Summed score of the Patient Health Questionnaire-9
was a reliable and valid
method for depression screening in chronically ill elderly
patients. Journal Of Clinical
Epidemiology, 61(7), 679-687.
Yeung, A., Fung, F., Yu, S. C., Vorono, S., Ly, M., Wu, S., et

80. al. (2008). Validation of the
Patient Health Questionnaire-9 for depression screening among
Chinese Americans.
Comprehensive Psychiatry, 49(2), 211-217.
Measure Critique
Critiqued by:
Date:
Name of measure: FAD- Family Assessment Devise
Developer(s):
Source reference (provide the complete citation, using correct
APA format, of the article, book or website that contains the
key information on the measure you are critiquing here):
Construct(s) assessed (e.g., relationship satisfaction- Family
Assessment Devise):
Method of administration:
Summary of reliability evidence (this includes internal
consistency reliability, usually Cronbach’s alpha and often test-
retest reliability as well):
Summary of validity evidence (this may include discussions of
content, criterion-related [concurrent and/or predictive], and
construct [convergent and/or divergent] validity):
Describe the number of participants used to develop the
measure and their demographic characteristics (e.g., age,
gender, race/ethnicity):
Provide a brief summary of how clinicians have used this
measure in therapy:
Recommendations for effective clinical use:

81. With what populations has this measure been used with (either
clinically or in research) (e.g., age, gender, race/ethnicity,
setting)
Find and briefly mention the purpose of 2-3 few research
studies that have used the measure:
Provide a summary of the findings from one study that used this
measure using this template:
Objective:
Method/Design:
Results:
What future research is needed on this measure?
Overall impression of measure:
References