Does Wilderness Therapy Work?

We Deliver Proven Results & Positive Change

How We Gather Data: Thoughtful, Research-Based Wilderness Therapy

Trails Carolina continually analyzes the outcome data and feedback from our students and their parents who have participated in our wilderness therapy programs to allow us to better understand the efficacy of our wilderness therapy program.

This ongoing evidence-based research study is done in coordination with the Center for Research, Assessment, and Treatment Efficacy (CReATE; Asheville, NC) and the University of Arkansas. The results are collected independently from Trails Carolina’s involvement.

One of the more impactful portions of the outcome study is reviewing the way we do family work and what the impact of our wilderness therapy program looks like up to a year after a family has graduated from Trails Carolina.

The independence of the research study along with the transitional model used by Trails Carolina helps to legitimize the work we do in our wilderness program and provide evidence-based results for our methods.

View the latest outcomes datasheet.

98% of students continued to report significantly improved mental health 12 months after graduation
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Suicidal Thoughts

79% of students reported experiencing an improvement in the severity of suicidal thoughts, 12 months after graduation.

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Depression & Anxiety

91% of students reported experiencing continued improvement in depression and anxiety, 12 months after graduation.

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ADHD Symptoms

83% of students reported an improvement in managing symptoms associated with ADHD, 12 months after graduation.

Full Transparency: Research-Based Wilderness Therapy


An Ongoing Third-Party Research Initiative with CReATE and the University of Arkansas

At Trails Carolina, we have embarked on an evidence-based research initiative in collaboration with the esteemed Center for Research, Assessment, and Treatment Efficacy (CReATE) and the distinguished University of Arkansas.

This ongoing endeavor, which commenced in 2014, is dedicated to assessing the efficacy and long-term impact of our wilderness therapy programs on youth, adolescents, and families with transparency, accountability, and a focus on highlighting areas of concern and where we can work to improve our program.


Wilderness Therapy Program Participant Profiles

With over 1,000 Trails Carolina wilderness therapy students and their families participating in the study, our research initiative casts a wide net, encompassing a diverse spectrum of youth and adolescents who have attended our wilderness therapy program.

Here is an overview of the outcome study participant demographics:

  • Average Age: 14.9 years old with a significant portion falling within the pre-adolescent range of 9 to 12 years.

  • Gender Distribution: A balanced gender distribution is reflected in the cohort, with females constituting over half.

  • Ethnic and Racial Diversity: Ethnic and racial diversity mirrors that of all Trails Carolina students and families, with predominant identification as White, along with representation from Hispanic/Latinx, Asian American, Black/African American, Native American, and multi-racial/other groups.

  • Mental and Behavioral Health Status: Upon admission to Trails Carolina’s wilderness therapy program, all student participants reported significant problems associated with mental health issues, including the symptoms of depression, ADHD, disruptive behavior, substance abuse, suicide ideation, academic struggles, and aggressive behavior.

  • Adopted Children: Adoptees make up 1-in-5 participants.


Methodology, Data Collection Methods, and Assessment Tools

This research initiative assesses the frequency and severity of problem behaviors and mental health symptoms including anxiety, depression, ADHD, disruptive behavior, substance abuse, suicidal thinking, academic struggles, aggressive behavior, defiant behavior, peer and family conflict, as well as the quality and amount of sleep experienced by students before the program, during the program, immediately after graduation, 3 months after graduation, and 12 months after graduation.

Standardized instruments are employed to measure child, adolescent, parental, and family functioning. This encompassing evaluation includes factors such as mental health symptoms, traumatic stress, skill acquisition, family cohesion, and treatment satisfaction.

Phase One of Wilderness Therapy Outcomes Study

  • Pre-treatment assessment upon enrollment

  • Post-treatment assessment upon graduation from Trails Carolina

Phase Two of Wilderness Therapy Outcomes Study

  • Follow-up surveys at 3 and 12 months post-graduation

  • Evaluation of participants' transitions into additional residential treatment programs, therapeutic schools, and reintegration into home communities and educational environments.

Data Collection Methods and Assessment Tools

Data collection methods utilized in the research study include the Treatment Outcome Package (TOP), a comprehensive assessment tool that is widely considered the gold standard for measuring the response to therapeutic intervention in wilderness therapy, adventure therapy, other outdoor behavioral healthcare settings, and residential treatment programs, and the Achenbach System of Empirically Based Assessments, another comprehensive and trusted assessment tool by mental health professionals and public health agencies.


We Value Accountability and Prioritize Efforts to Improve Our Wilderness Therapy Program for the Students and Families We Serve

Through our partnership with CReATE and the University of Arkansas, we showcase our commitment to evidence-based excellence.

By rigorously analyzing outcome data and engaging in thorough third-party assessments, we gain insights into the efficacy of our wilderness program and evolve it in line with the evolving needs of our students and families.

This ongoing research initiative stands as a testament to our dedication to innovation and growth in wilderness therapy techniques, and the holistic well-being of the youth and families we are privileged to serve.

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96% of students reported experiencing a decrease in externalizing behaviors, 12 months after graduation.

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Rule Breaking

93% of students reported experiencing a decrease in rule breaking behaviors, 12 months after graduation.

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Disruptive Behavior

Only 1% of students showed signs of disruptive behaviors, 12 months after graduation.

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98% of students reported experiencing a decrease in aggressive behaviors, 12 months after graduation.

Our Wilderness Therapy Outcome Data

Percent of Trails Carolina Students Experiencing Mental Health Challenges and Stress Before, During, and After the Wilderness Therapy Program

Bar graph showing Percent of Trails Carolina Students Experiencing Mental Health Challenges and Stress Before, During, and After the Wilderness Therapy Program

Children and adolescents at Trails Carolina experience notable mental health and stress improvements during treatment (Fig. 1), persisting up to a year post-program. ADHD symptoms show a temporary increase, attributed to changing environmental support during transitions.

Upon admission, around 80% exhibit elevated anxiety and depression, followed by 75% with significant ADHD symptoms, and 63% experiencing suicidality.

Over 50% struggle with disruptive behavior and 1/3 face sleep disruptions.

One year post-graduation, sustained improvements and symptom reduction are evident in the data.

Percent of Children and Adolescents with Normal Moods

Bar graph depicting Percent of Children and Adolescents with Normal Moods

Most kids and teens at Trails Carolina see a positive shift in their moods (Fig. 2).

When they start, only 20% exhibit normal moods (i.e., without significant symptoms of depression and anxiety).

After Trails Carolina, about 60% show typical moods with a decrease in depression and anxiety.

This percentage increases with each check as they build skills and progress.

Percent of Children and Adolescents with Typical Emotional Functioning and Well-Regulated Behavior

Bar graph depicting the Percent of Children and Adolescents with Typical Emotional Functioning and Well-Regulated Behavior overtime at Trails Carolina

Results show kids and teens in the study improved their emotions and behavior (Fig. 3).

At the start, very few had typical emotional functioning and well-regulated behavior (i.e. the absence
of internalizing symptoms of mental health disorders).

After completing the program, most showed significant improvement, indicating Trails Carolina's focus on building skills and resilience enhances self-regulation for better emotional and behavioral management.

Does Wilderness Therapy Work? Our Students and Families Say Yes.

Both students and parents reported significant changes in behavior and symptoms–in both the youth and the family–from enrollment at Trails to one full year after graduation.

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12 months after graduation, 93% of students showed a decrease in rule-breaking behaviors

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12 months after graduation, 96% of students showed a decrease in externalizing behaviors

Academic Outcomes

School Functioning

12 months after graduation, only 17% of students showed school functioning issues.


Felt Excited

12 months after graduation, 87% of students felt excited about school.


School Refusal

12 months after graduation, only 4% of students showed signs of school refusal.


Adopted Student Outcomes



12 months after graduation, 93% of adopted students showed a decrease in anxious symptoms



12 months after graduation, 97% of adopted students showed a decrease in depressed symptoms



12 months after graduation, 98% of adopted students showed a decrease in aggressive behaviors


Rule Breaking

12 months after graduation, 97% of adopted students showed a decrease in rule-breaking behaviors

State Licensure, CARF Accreditation, and Outdoor Behavioral Healthcare Council Designation

State Licensure: Trails Carolina operates with the highest level of legitimacy and professional standards. Our program holds a license from the State of North Carolina, ensuring that we meet stringent regulatory requirements. But our commitment to excellence goes beyond state licensure.

CARF Accreditation: CARF, the Commission on Accreditation of Rehabilitation Facilities, is a global leader in evaluating and accrediting health and human services, setting rigorous standards that measure program quality, risk management, and positive outcomes.

Our CARF accreditation demonstrates our dedication to providing exceptional care and upholding the highest industry standards.

OBH Designation: We proudly hold the Association of Experiential Education’s Outdoor Behavioral Healthcare designation. This designation signifies our alignment with the Outdoor Behavioral Healthcare Council (OBH), a pioneering institution dedicated to advancing the wilderness therapy field.

OBH promotes ethical practices, proper risk management, and therapeutic interventions in wilderness therapeutic treatment and adventure therapy programs.

As a member of OBH, we contribute to and benefit from cutting-edge research and best practices, ensuring that our wilderness therapy program remains at the forefront of effective and compassionate care.

does wilderness therapy work

Undergoing the Rigorous Accreditation Process

Achieving these accreditations involves a rigorous process. It entails an in-depth evaluation conducted by CARF and the state of North Carolina of our program's structure, treatment process, risk management protocols, and treatment effectiveness ensuring that our version of wilderness therapy works.

Our licenses and accreditations signify our dedication to not only meeting regulatory requirements but also going above and beyond to provide a transformative and safe experience for our students. We continuously strive to improve and innovate, guided by the principles set forth by CARF and the Outdoor Behavioral Healthcare Council, to ensure that our program delivers life-changing outcomes for the young individuals and families entrusted to our care.

Trails Carolina will continue to regularly evaluate and update its approach to providing therapeutic wilderness programs to children and adolescents based on the latest research and clinical best practices in the field.

By constantly striving for excellence and a genuine desire to help those in need, Trails Carolina has established itself as a leader in the wilderness therapy industry, and a trusted resource for families seeking help for their struggling children.

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Trails saved my daughter’s life. Amanda is an amazing human and a brilliant therapist. I am so grateful to her, Science Steve, and the other wonderful people who could reach my daughter at a time when I could not.

Margot Lowman August 2022

Great life changing experience for our son. After becoming addicted to gaming during covid he was very depressed. At Trails he experienced the wilderness, Science Steve, learning survival skills and top notch therapy and support etc… I highly recommend! This gave our son and our family a renewed family bond full of love and excitement about his bright future.

Winnifred Wilson July 2022


Outstanding clinical work and superb staff! There’s a great culture at this company and it shows with how they engage with families/clients.

Kristin Brace June 2022