outdoor adventure programming for individuals with …...therapeutic recreation journal vol. 40, no....

THERAPEUTIC RECREATION JOURNAL Vol. 40, No. 3, 182-199, 2006

Outdoor Adventure Programming forIndividuals With Cognitive DisabilitiesWho Present Serious AccommodationChallengesLeo McAvoy, John G. Smith, and John E. Rynders

An outdoor adventure program was offered to 23 individuals with cognitive disabilities whopresented serious accommodation challenges. Participants were accompanied by 23 supportpersonnel, many of whom were group home staff, providing the capability of pair-wise responseagreement. Assessment of outdoor recreation skills was done through a questionnaire on apre-post basis; trip satisfaction was assessed through a post-trip questionnaire; and social/socialization development was assessed with a follow-up interview. Findings revealed thatparticipants' outdoor skills, level of satisfaction and social/socialization abilities generallyincreased as a result of the outdoor experience. A set of programmatic strategies are offered asa means of supporting the participation of persons with cognitive disabilities who present seriousaccommodation challenges in an outdoor adventure program.

KEY WORDS: Outdoor Adventure, Serious Accommodation Challenges, Cognitive Disabilities

Leo McAvoy is a Professor in the Program in Recreation, Park and Leisure Studies at theUniversity of Minnesota. John Smith is a Project Coordinator at the Research and TrainingCenter on Community Living at the University of Minnesota. John Rynders is a ProfessorEmeritus in the Department of Educational Psychology, Special Education Programs, at theUniversity of Minnesota. The development of this paper was supported, in part, by Grant No.H133B980047 from the National Institute on Disability and Rehabilitation Research, U.S.Department of Education. The opinions expressed herein do not necessarily reflect theopinions of the U.S. Department of Education, and no official endorsement should beinferred.

182 Therapeutic Recreation Journal

Outdoor Adventure Programmingfor Individuals With Cognitive

Disabilities Who Present SeriousAccommodation Challenges

Recreation professionals have expandedoutdoor recreation opportunities for personswith many types of disability since passage ofthe Americans with Disabilities Act in 1990(Clark, 2004). However, in spite of makingimpressive progress, when programming is of-fered to individuals who have disabilities in anoutdoor adventure context the obstacles to pro-gram success can sometimes appear insur-mountable.

Obstacles can appear especially dauntingwhen attempts are made to involve individualswith cognitive disabilities who present seriousaccommodation challenges. For example,emotional and behavioral problems, such as anindividual with a cognitive disability usingabusive language or physical aggression on anoutdoor trip, can quickly shut down any sem-blance of team interaction, a basic underpin-ning of a successful group outdoor adventure.Likewise, an unwillingness or inability to re-liably self-monitor a serious diabetic condi-tion, complicated by cognitive difficulties re-lated to brain injury, can lead to an emergencyevacuation with feelings of embarrassment onthe part of the individual with a disability, andfeelings of anger and disappointment on thepart of other participants.

Clearly, social acceptance is a major factorin each of the foregoing situations, and socialacceptance is of great importance in inclusiveprograms (Devine & Dattilo, 2000). In a lei-sure context, it appears that leisure skills, lei-sure satisfaction and social/socialization skillsare important aspects of social acceptance.Devine and Dattilo found that persons withdisabilities who perceived they were sociallyaccepted by their peers without disabilities hada greater frequency of leisure participation anddegree of leisure satisfaction than did thosewho perceived they were not socially ac-cepted. Schleien, Ray and Green (1997)pointed out the importance of social skills for

social acceptance in leisure programs that in-clude persons with cognitive disabilities. But,as Devine (2004) concluded in a recent study,program providers do not yet have a completeunderstanding of how the leisure context canbest be used to foster social acceptance ofpersons with disabilities.

This study focused on the impact of anoutdoor adventure program on persons withcognitive disabilities who present serious ac-commodation challenges. The primary pur-pose of this study was to assess growth inleisure skill functioning of persons with cog-nitive disabilities relative to participation in anoutdoor adventure program. There were twosecondary purposes. These were: (a) to assessparticipants' level of satisfaction with keycomponents of an outdoor adventure trip pro-gram and the overall outdoor experience, and(b) to assess participants' social/socializationskill development in an outdoor adventure tripprogram.

Literature ReviewThe Outdoors and Persons with

DisabilitiesTwo interdependent forces seem to be at

work in programs that offer outdoor adventureopportunities that include persons with disabil-ities. One is the outdoor environment itself.The natural environment offers a multitude ofbenefits to all individuals who visit there,whether or not they have disabilities. Researchby Brown, Kaplan and Quaderer (1999) indi-cated that persons with disabilities are no dif-ferent from anyone else in the kinds of naturalsettings they prefer. They desire the samekinds of natural and wilderness areas, and thesame kinds of outdoor recreation activities, asdo people without disabilities (McCormick,2001). Research by Anderson, Schleien, Mc-Avoy, Lais and Seligman (1997), McAvoy,Schatz, Stutz, Schleien and Lais (1989), andRobb and Ewert (1987) all document thatpeople with disabilities seek the same kind ofchallenge and adventure in the outdoors as dopeople without disabilities. Persons with dis-

Third Quarter 2006 183

abilities have indicated repeatedly that the out-door environment itself is a critical element inrealizing benefits from an outdoor adventureprogram like a canoe/camping trip. The out-door environment intensifies and focusesgroup interaction and development while en-hancing social integration of group memberswithin a group of individuals with diverseability levels (Anderson et al.).

In addition to the environment, a secondforce at work in programs is the type andquality of the program. Much of the recentresearch in this area has focused on outdoorprograms where people with and without dis-abilities participate as equal or almost equalparticipants on organized outdoor adventuretrips (McAvoy, 2001). These programs offerall participants an opportunity to participatefully in outdoor trips and activities such ascanoeing, kayaking, camping, horse packing,and dog-sledding. The literature has been en-hanced by recent texts and chapters describinginclusive outdoor adventure program planningand implementation (Brannan, Fullerton,Arick, Robb, & Bender, 2003; McAvoy &Lais, 1999; Schleien, McAvoy, Lais, &Rynders, 1993).

Research and evaluation findings indicatethat there are a number of benefits realizedthrough participation in inclusive outdoor ad-venture programs. For example, research byAnderson et al. (1997), McAvoy (2001),McAvoy et al. (1989), Robb and Ewert (1987),and Stringer and McAvoy (1992) has shownthat persons with disabilities in inclusive pro-grams gain enhanced self-concept and self-esteem, personal growth, increased outdoorrecreation skills, increased social adjustmentand positive behavior changes. Interestingly,both participants with and without disabilitiesshow improved attitude and lifestyle changesin recreation patterns, growth in interpersonalrelationships and social patterns, increasedsensitivity to the needs of others, increasedwillingness to take risks, greater feelings ofself-efficacy, spiritual benefits, and an in-creased respect for nature. Additionally, re-search is finding that inclusive family wilder-

ness programs make a positive difference infamily satisfaction, that is, in family cohesion,in overall family satisfaction, in the family'sability to try new things, in the amount of timethe family spends together, and in the numberof activities the family does together (Scholl,McAvoy, Rynders, & Smith, 2003).

Research has also focused on residentcamp and outdoor education programs thatserve persons with developmental disabilities.McAvoy and Schleien (2001) summarized theresults of six inclusive outdoor education andday interpretation programs that included chil-dren with developmental disabilities, somewith severe disabilities. They found that theoutdoor recreation skill levels of these childrenincreased during the programs, as did the lev-els of social interaction between children withand without disabilities. They also found thateven children with severe cognitive disabilitiescould be active participants. Similarly, Rynders,Schleien and Mustonen (1990) studied a twoweek overnight camp program that emphasizedcooperative learning and included three childrenwith severe disabilities and eight children with-out disabilities. They found it was a positiveexperience for all of the children and that thechildren with disabilities showed substantial in-creases in outdoor skills, while children withoutdisabilities grew significantly in their feelings ofself-confidence and empathy.

A nationwide evaluation study conductedby researchers at Portland State Universityfocused on participant outcomes and effectivepractices of youth camps and outdoor pro-grams that included youth with and withoutdisabilities (Brannan, Arick, & Fullerton,2002; Fullerton, Brannan, & Arick, 2000,2002). Called the National Inclusive CampPractices project, the study included 14 campsand outdoor schools, and 742 youth with andwithout disabilities. The study showed posi-tive gains for both youth with and withoutdisabilities, including outdoor skills and per-sonal/social development (self- reliance, socialinteraction, communication, and self-esteem).However, only a small percentage (6.8%) ofthe study's participants with disabilities were


youth with moderate to severe mental retarda-tion, or other significant cognitive disabilities.

Outdoor Programs and Personswith Cognitive Disabilities

The term "cognitive disability" describes asubstantial intellectual deficit or impairmentfrequently accompanied by one or more im-portant impairments in learning, social or vo-cational ability. (An extended use of the termis described in the "Participant Assessmentand Selection" section of this paper.) Therehas been a paucity of research focused onpersons with cognitive disabilities who typi-cally go on camping excursions into wilder-ness or wilderness-like natural areas ratherthan staying in a developed camp facility.Much of the research has been conducted onprograms that were not inclusive. However,the research available does show that benefitsare realized from outdoor adventure programsthat include persons with cognitive disabilities(Herbert, 1998; Robinson, 1991; Rose & Mas-sey, 1993). Moreover, the research shows thatcognitive limitations need not automaticallyrule out adults with cognitive disabilities inoutdoor adventure programs that take place inmore remote regions.

More specifically, the few studies in thisarea of the literature generally indicate thatincreases occur in areas such as locus of con-trol and self-esteem among individuals withcognitive disabilities from pre-to post-testing,but these positive changes are not often main-tained over time (Herbert, 1998). The studiesin this area also usually have small samplesizes, making application to a broader set ofparticipants difficult. For example, Robinson(1991) found modest gains in self-concept fora small group of four young adults with mildmental retardation in a program based in pro-vincial parks of Ontario. In a very interestingand unusual study, Rose and Massey (1993)assessed a group of seven adults with severecognitive disabilities participating in a moun-taineering expedition on Mount Blanc in theFrench Alps. Assessment data included inter-

views with participants, family and other sup-port persons, staff and volunteers, an analysisof detailed diaries kept by staff on the expe-dition and videotapes of the expedition. Theresults showed that study participants experi-enced an enhanced sense of accomplishment,cooperation, trust, self-esteem, role reversal,and an increase in fitness level and problemsolving abilities.

Newman (2004) employed two well-known therapeutic recreation assessment in-struments, the Comprehensive Evaluation inRecreation Therapy—Outdoor for Psych/Be-havioral (CERT-O/Psych), and the RecreationParticipation Data Sheet (RPD), to examinesocial and leisure skill achievement of personswith cognitive disabilities, both across outdooradventure trips and the within group homeenvironments where the individuals resided.Results of Newman's study revealed that pre-post differences on the instruments were notsignificant statistically within, between, oracross study phases. However a correlationanalysis, when applied to summaries of thefrequency of activities during which individu-als displayed the highest scores on the twoassessment instruments, showed a statisticallysignificant correlation. Activities associatedwith the four highest leisure functioning scoreson the RPD were: meals, canoeing, free timeactivities, meal prep/cleanup; fifth place wastied between campfire and loading/unloadinggear. The activities that were associated withthe five highest social skill functioning scoreson the CERT-O/Psych were: meals, canoeing,meal prep/cleanup, group talks, and campfire.

Encouraged by Newman's results with in-dividuals who had cognitive disabilities, andrecognizing the need for further work in thisarea, the primary purpose of the study reportedin this paper was to assess the growth inleisure skill functioning of persons with cog-nitive disabilities relative to participation in anoutdoor adventure activity. There were twosecondary research objectives in the study: (a)to assess participants' level of satisfaction withand enjoyment of key components of an out-door adventure trip program and the overall


outdoor experience, and (b) to assess partici-pants' social/socialization skill development inan outdoor adventure trip program.

The study utilized the Peterson and Stumbo(2000) Leisure Ability Model as a conceptualfoundation for service and evaluation. Usingthis model, the service components of func-tional intervention, leisure education and rec-reation participation were used to provide oppor-tunities for normalization, self-determination,social role valorization and to create optimalenvironments conducive to growth and devel-opment (Sylvester, Voelkl, & Ellis, 2001).

MethodsThe present study was conducted in the

context of "Gateway to Adventure," an out-door adventure program devoted to assistingand training persons whose disabilities makeparticipation in an outdoor adventure programdifficult for themselves or for other trip par-ticipants. Gateway to Adventure trips are partof a larger trip schedule offered by WildernessInquiry, Inc. (WI), a non-profit outdoor adven-ture organization located in Minneapolis, MN.The Gateway program facilitates participationin a wilderness adventure trip through: (a)ongoing structured training in routine outdoorskills; (b) the provision of support staff part-ners (many of whom come from a cadre ofvolunteers and group home staff); and (c) ashorter and less demanding trip than WI'stypical fully inclusive ones. According to WI,participants in the program sometimes gain alevel of comfort and proficiency in outdoorsettings that will help them succeed in subse-quent outdoor adventures that are more fullyinclusive. Although some participants take re-peated Gateway trips, the Gateway trips areseen as a potential stepping stone to moreinclusive programs.

Gateway trips in this study were eitherthree or five days in length, and featured camp-ing and canoeing as the primary outdoor ac-tivities. Trips took place at either VoyageursNational Park on the northern border of Min-nesota or the St. Croix National Scenic River-

way in Minnesota and Wisconsin. Trip groupsranged in size from 12-16 persons, includingparticipants, support staff and WI staff. Ap-proximately 40% of participants in each grouphad a disability with the remainder of eachgroup consisting of WI trail staff, support staff(including direct support professionals fromparticipants' homes or group homes and vol-unteers recruited by WI), and a data collector.The trips included traveling as a group viacanoes to each day's destination, completingcamp chores such as setting up tents, preparingand sharing meals, and engaging in planningdiscussions and group games or activities,such as evening campfires. Each day also in-cluded several naturally occurring breaks of15-90 minutes where participants could volun-tarily participate in small group or individualactivities like playing cards, fishing, swim-ming or going for a hike.

A Certified Therapeutic Recreation Spe-cialist (CTRS) was involved in all four parts ofthe Gateway programs that were the focus ofthis study (assessment, planning, implementa-tion and evaluation). The CTRS supervised theassessment of all participants, was heavilyinvolved in the trip planning phase, contrib-uted to the training of WI leaders who wereresponsible for program implementation, ac-companied participants on all the trips, andsupervised all data collection.

Participant Assessment andSelection

Over the past 25 years, WI has developedand repeatedly refined an assessment processfor the purpose of trip planning. The processbegins with a participant's (or advocate's) re-quest to join a particular trip and submission ofa registration form containing detailed infor-mation on the applicant's personal character-istics/needs. From this form, a WI assessmentspecialist, a staff member who has had exten-sive trip-leading experience and specific train-ing in addressing accommodation challenges,reviews the registration form and makes apreliminary judgment about the likelihood of


need for a Gateway trip (as opposed to aninclusive trip). This judgment is based on theUniversal Program Participation Model devel-oped by Lais (2002) which considers the en-vironment of a trip, the participant's and othergroup members' characteristics, the resourcesavailable for a trip (e.g., staff, equipment), andthe activities of a trip. The assessment special-ist also notes emotional or behavioral issuesand cognitive, sensory, health and physicaldisability concerns that may require additionalequipment, equipment or other forms of mod-ification, or the support of a personal careattendant while on the trip.

When this assessment process is com-pleted, if it is determined that a Gateway trip isneeded, the leader assigned to a Gateway trip(a trip that approximates the applicant's orig-inal request, if possible) meets with the assess-ment specialist for a briefing about modifica-tions/adaptations or other forms of support thatmight be required in light of the specific ac-commodation challenges presented. Thereaf-ter, the leader of the recommended Gatewaytrip will speak by phone or in person with theindividual and often his/her representative, tofinalize planning.

The majority of WI applicants who havecognitive disabilities, even serious cognitivedisabilities, are enrolled in a regular (fullyinclusive) WI outdoor adventure trip and dowell in it. It is not the cognitive disability perse that leads to Gateway enrollment. Rather,the functional characteristics of applicants arekey factors in determining the need for aGateway trip. To make the determination forthe present study, heavy reliance was placedon the comments of key informants (e.g.,group home staff) who were asked a numberof closed and open ended questions that weredesigned to converge on accommodation is-sues. Occasionally, due to the nature of aparticular accommodation challenge or con-stellation of challenges, WI encourages anapplicant to enroll in a one- day canoe work-shop instead of an overnight experience. WIroutinely offers these workshops across theMinneapolis/St. Paul area.

This study included 23 individuals withcognitive disabilities, most of whom weregroup home residents. Eighteen were male andfive were female, with the average age being38.5 years (range 21-62). Fifteen participantshad a cognitive disability that qualified themfor the classification of mental retardation,with eight having mild to borderline mentalretardation, six having moderate mental retar-dation, and one having severe mental retarda-tion. The other eight participants were classi-fied as having traumatic brain injuries (7) orhaving a mental illness (1). Of these eightindividuals, key informants either used theterm cognitive disability or a near equivalentto describe these participants. For example,they used phrases like "lacks reasoning andjudgment," "borderline IQ," "very slow," and"jumbled thinking ability" to describe theseindividuals. Of the 23 support persons whoaccompanied participants, eight were grouphome staff, 14 were social workers or employ-ment counselors, and one was a parent.

The 23 individuals selected for this study'sGateway trips had the following functionalcharacteristics: Five participants exhibited fre-quent bouts of aggression; five individualswere described as showing a lack of judgmentto the extent that they posed a serious dangerto themselves or others; five persons had ahistory of making highly inappropriate sexualadvances; four individuals were obsessed withfood and food hoarding and became hostilewhen prevented from engaging in this behav-ior; one participant had a history of severalsuicide attempts; another had a habit of per-sistently teasing others with a visible disabil-ity; one exhibited extreme over-attachment toanyone in a leadership position; and one per-son was extremely fearful of unfamiliar sur-roundings. In several instances, these accom-modation challenges could be found inmultiple forms across the group. In otherwords, multiple disabling conditions were therule, not the exception. Moreover, participantsfrequently had additional impairments thatwere complicating factors in functionality de-termination. Several instances of severely


compromised physical stamina, poor balance,seizure disorders, poor communication, incon-tinence, poor memory, and multiple problemswith activities of daily living were alsopresent. Taken together, and focusing particu-larly on functional ability, the challenges toaccommodation of the 23 selected individualswarranted enrollment in a Gateway trip basedon the judgment of a team comprised of WIassessment specialists and trip leaders.

Only participants and support staff fromwhom consent was obtained were invited to bepart of this study, to fill out questionnaires onthe trip, and to be contacted for an interviewfollowing the trip. There were no selected tripparticipants or support staff who declined, orwhose legal representative declined, to takepart in the study.

Data Collection and AnalysisTwo questionnaires were developed, one to

assess participant growth in outdoor recreationskills and one to assess participant satisfactionwith components of the outdoor adventure tripexperience. In addition, an interview instru-ment was developed to assess participant so-cial/socialization skill development and to fur-ther assess participant satisfaction with tripcomponents and the trip overall. Instrumentand protocol development was a cooperativeprocess among the program staff of WI andresearchers in Therapeutic Recreation, Out-door Recreation and Special Education fromthe University of Minnesota. The primary goalwas to create instruments that were under-standable by, and respectful of, participantswith serious disabilities, as well as manage-able in the context of an outdoor adventureprogram. The literature reviewed to developthese tools included published approaches tomeasurement of leisure interests and skills ofpersons with cognitive disabilities (Hoge &Dattilo, 1995; Mactavish, 1997). Additionally,suggestions from experienced WI staff (espe-cially Gateway staff) regarding these con-structs were actively solicited. A parallel ver-sion of the questionnaires and interview

protocol was developed for support persons.This additional perspective offered an oppor-tunity to compare support staff and participantresponses, providing an important measure oftrustworthiness.

Relying heavily on self-report informationsupplied by persons with cognitive disabilitiesrequired the design of a protocol that wasshort, asked questions that placed a low cog-nitive demand on respondents, and had a lim-ited number of easy to understand items. Thequestionnaires (for participants and supportstaff) were field-tested on two pilot studyGateway trips and were found to be toolengthy and complex for many of the partici-pants with cognitive disabilities. As a result,the number of outdoor recreation skill items onboth the support staff and participant versionsof the questionnaire was decreased. Further-more, the number of choice points on therating scales within the questionnaires wasalso reduced because participants with disabil-ities were generally having great difficultydistinguishing differences between ratingchoices. Finally, the interview instrument waspilot tested with participants and support staffof two Gateway trips, requiring only minorwording changes.

Quantitative measuresOn the first day of each trip, and again on

the final day, all participants were asked tocomplete a questionnaire using a three pointLikert scale procedure, rating their perceivedability to complete 10 basic camping and ca-noeing skills (see Table 1 for list of skills). Asan example, participants were asked to indi-cate their skill level in paddling a canoe bymarking an "X" in one of three boxes. Thethree choices were "I don't know how" (Box1), "This is hard" (Box 2), or "This is easy"(Box 3). At the same time that participantscompleted their questionnaires, participantsupport staff completed their version of thequestionnaire. They were asked to rate the skilllevel of the participant they were accompany-ing. As an example, support staff were asked


Table 1.

Outdoor Recreation Skills as Perceived by Participants with Disabilities andSupport Staff

Outdoor Recreation Skill

1. Rolls up or "stuffs" a sleeping bag.StaffParticipant

2. Selects clothes to bring on a 3-day camping trip.StaffParticipant

3. Assists to set-up a tent.StaffParticipant

4. Knows three safety rules to follow when on a camping trip.StaffParticipant

5. Knows where to find small dry sticks to start a campfire.StaffParticipant

6. Knows how to put on a life jacket so it will work best.StaffParticipant

7. Knows how to hold a canoe paddle properly.StaffParticipant

8. Knows how to get in and out of a canoe safely so it doesn'ttip over.

StaffParticipant

9. Knows how to paddle a canoe.StaffParticipant

10. Knows the rules to follow to be safe while in a canoe.StaffParticipant

Pre-TripMeanRating

1.962.65

1.962.52

1.481.95

1.872.55

2.222.87

1.962.65

1.722.09

1.482.45

1.612.22

1.702.43

Post-TripMeanRating

2.392.91

1.912.70

2.142.48

2.552.91

2.502.87

2.592.91

2.732.91

2.433.00

2.762.87

2.672.96

Participants n = 23, support staff n = 23.

to indicate the participant's skills in paddling a and knows how to do it well" (Box 3). Partic-canoe by marking an "X" in one of three ipants who had difficulty reading items orboxes, "Has not done this skill and does not marking their answers on the form were pro-know how" (Box 1), "Has tried this skill but is vided assistance by a research assistant orstill learning" (Box 2), or "Has done this skill member of the WI staff in order to minimize


Table 2.

Level of Satisfaction about the Trip as Expressed by Participants with Disabilities(N = 18)

NumberResponding with

HighestSatisfaction

17161713171715111713

Percent!

94%89%94%72%94%94%83%61%94%77%

1. The leaders on the trip were friendly to me2. The leaders on the trip knew what they were doing3. I felt safe all the time4. I got to do things I wanted on the trip5. I made some new friends on the trip6. I learned new things about camping and canoeing7. The food was good8. I didn't have to work too hard on my trip9. The tents and other equipment were in good shape*10. I would go on another trip like this**

*Two respondents indicated "low satisfaction" on this item.**One respondent indicated "low satisfaction" on this item.

the possibility of support staff bias. Thesescales must be considered ordinal since, whilethe options clearly indicate differing levels ofthe attribute being measured, the scale pointscannot be quantified in such a way as to beable to judge their weights or values in relationto each other.

On the last day of each trip, all participantswith disabilities were asked to respond to asatisfaction questionnaire. Ten items (see Ta-ble 2 for satisfaction items) were read to themabout key aspects of the trip and they ex-pressed their level of satisfaction using ratingsof high satisfaction, medium satisfaction, andlow satisfaction.

Qualitative measuresA qualitative approach was emphasized in

this study because relatively little is known, orclearly defined, about programming success-fully for individuals who present cognitivedisabilities as well as serious accommodationchallenges. This is especially true in the arenaof outdoor adventure programs. Thus, the use

of open-ended and probe questions during thefollow-up interviews surfaced highly usefulinsights about satisfaction and social/socializa-tion skills, and themes to promote them, thatwould not have been possible to capture in astrictly quantitative oriented approach.

Qualitative data were gathered throughsemi-structured interviews 7-14 days follow-ing the trip, and included both participantswith disabilities and those who went on a tripas a support staff partner. A total of 15 post-trip interviews were completed, with nine ofthe interviews being completed with personswho had disabilities, and six with supportstaff. This subset of 15 participants and sup-port staff had indicated a willingness to beinterviewed. There were a range of reasons fornon-response. As examples, some group homestaff said that they had scheduling conflicts orthat they were too busy to be interviewed or tofacilitate a follow-up phone interview with aparticipant. One parent of a person refused toallow his daughter with a disability to beinterviewed, even after he had given permis-


sion for her to participate in the questionnairepart of the study. Of the nine persons withdisabilities who completed post-trip inter-views, six had mild intellectual disabilities,one had borderline intelligence and a historyof mental illness, and two were persons whohad experienced a traumatic brain injury andhad some degree of cognitive impairment. Themajority of these interviews were completedvia telephone, but five of the nine interviewsconducted with persons with disabilities werecompleted face-to-face to facilitate interaction.

Interview questions focused on what waslearned on the trips (both recreation skills andsocial skills) and on satisfaction with the tripcomponents and the trip overall. Examples ofquestions asked of participants with cognitivedisabilities included: "What camping and ca-noeing things did you learn on the trip?""What other new things did you learn on thetrip?" "What did you learn on the trip that youcan use back home?" Examples of questionsasked of support staff included: "What skillsother than camping and canoeing did yourparticipant learn on the trip?" "What otherskills did your participant learn on the trip?""What general or social skills did your partic-ipant learn on the trip?" "What about the triphelped the participant learn these skills?""How might these skills be useful for theparticipant back home?" All interviews weretape recorded and transcribed, and loaded intoNVIVO qualitative data analysis software.The themes reported were generated using themethod of constant comparative analysis (Gla-ser & Strauss, 1967) in which similar ideaswere identified across interviews and com-pared/contrasted to identify central conceptsthat described the experiences of most partic-ipants or support persons. A rule was followedthat in order for a theme to be reported as aresult it needed to be represented in at least51% of the interview transcripts.

ResultsThe results of this study are presented in

three sections: (a) outdoor recreation skill de-

velopment, (b) satisfaction levels, and (c) so-cial/socialization skill development. Bothquantitative and qualitative results are pre-sented in each section.

Outdoor Recreation SkillsAs shown in Table 1, the 23 participants, as

a group, on a pre-post basis, rated themselvesas having increased their skill levels in nineout of ten outdoor camping and canoeingskills. Examples of these skills included assist-ing to set up a tent, finding small sticks to starta campfire, and properly putting on a lifejacket. Similarly, the 23 support staff partnersreported, as a group, that they saw participantshaving greater skills in nine of the ten areaspost-trip as opposed to pre-trip. In one area,however, selecting clothing for trip activities,support staff rated their participant partners ashaving less skill.

A close look at individual participantscores indicates some important trends. Whenconsidering the scores for all camping andcanoeing skills, substantial gains occurred inthe self-ratings of eight participants whoseinitial self-ratings were low (a 2 or less on a3-point scale) with nearly all showing largegains in their perception of their own skilllevels. Another group of five participants ratedthemselves pre-trip as having the highest levelof proficiency in all or nearly all skills. Sincethey were already at the top of the scale for thepre-test, it was not possible for them to indi-cate a gain on the post- test. Nonetheless, mostretained a very high perception of their camp-ing and canoeing skills for the post-test, withonly one participant showing a decrease.

The assessments completed by supportstaff regarding their perceptions of participantoutdoor recreation skill levels showed verysimilar trends. Support staff rated nine partic-ipants as having very limited skills pre-trip,with each being rated as having much greaterskills by the same support staff after a trip.Another group of 10 participants that supportstaff rated as having moderate skills on thepre-test showed increases in skills over the


time of the trip, as indicated on the supportstaff post-test.

A strong theme that emerged from thequalitative data, for both participants and sup-port staff, was that the Gateway trips provideda venue in which participants learned outdoorrecreation skills in camping and canoeing. Re-sponses from participants included, "I learnedhow to paddle, and not make a big splash." "Ilearned how to handle a canoe and how to setup camp." "I learned how to set up a tent." Asupport person commenting on the outdoorskills learned on the trip said: "I think thatbeing in a new environment and finding outthat they had abilities they didn't know theyhad, and maybe pushing their abilities." Othersupport staff responses included, "Each timeDon does a trip like this he builds his skills sohe can do more." Another said, "They willforget most of the gains they made on the tripand will have to relearn it again the next time.But, each time they go, they learn and retain alittle more."

Participant SatisfactionOn the last day of each trip, all participants

with disabilities were asked to respond to aquestionnaire where they expressed their levelof satisfaction about key aspects of the tripusing ratings of high satisfaction, medium sat-isfaction, and low satisfaction. This question-naire was completed by 18 of the 23 partici-pants (five were required to leave immediatelyafter the trip due to support personnel sched-uling conflicts and hence could not completethis post-assessment at the canoe take-outpoint as was required). Levels of satisfactionwere highly positive (see Table 2). This wasespecially true in areas reflective of friendship(e.g., new friend, friendly leaders), safety, andnew learning (e.g., canoeing, camping). In aroughly parallel manner, when asked on thesatisfaction questionnaire about their favoritepart of the trip, a majority of participants(>50%) named specific outdoor recreation ac-tivities (e.g., canoeing, swimming) and socialaspects of the trip (e.g., playing games, meet-

ing new friends). When asked to name theleast favorite part of their trip, most cited anelement of the natural environment (rain,bugs), rather than any particular aspect of theprogram.

An overarching theme revealed in the qual-itative data was that most participants trulyenjoyed their wilderness trip and their satisfac-tion levels following the trip were high. Whenasked about the trip overall, the most prevalentresponse was "It was fun." One trip participantwith a disability said: "I am feeling prettygood- • T thought it was a good trip. Actually,it was a great trip and I hope to do it againsometime." Other responses from participantsincluded, "Yah, I did really have a good timeand everything. Just being around everybody.""It was fun, I had a great time." "I want tocome again next year." "I think that being in arelaxed, somewhat, setting I sort of forgotabout everything. I had a good time."

As was true on the post-trip satisfactionquestionnaires, most participants in the inter-views discussed the outdoor recreation activi-ties of canoeing and camping as highpoints oftheir trip. One participant, when asked abouthis favorite part of the trip said, "Well, I guessreacquainting myself with the canoe becausethe last time I did anything like that was whenI was seven or eight years old when I canoedwith my dad." Other exemplar quotes fromparticipants were, "I just enjoy being in thecanoes." "It was nice to get in the water and doa little swimming, and such." "I liked being inthe sun, and feeling the breeze." "I liked see-ing the stars with no lights." "Hiking andseeing the animals." "I see lots of birds." Oneparticipant summed up his canoeing experi-ence by saying, "Canoeing, it was my favorite.The paddling was hard though. You know, andit hurts. But once you get used to it, it isn't thatbad, you know."

A support staff person on the trip recountedhow John, a participant with cognitive disabil-ities, felt about the trip: "He still talks aboutit- • -He got to, you know, hang out with dif-ferent kinds of people. And the camping, hestill talks about it." Another support person


commented on the person he was with: "Beingin the canoe and paddling was definitely ahighlight for some of the people because it isso different from what they are used to- • -andjust the event of camping was another high-light."

A major theme in the interview data, re-lated to satisfaction level, was the atmosphereof trust and safety created in the groups by thetrip leaders during the Gateway trips. Partici-pants and support staff remarked on a sense ofphysical and emotional safety that they feltduring the trip, and also the sense that as newchallenges emerged they were part of a teamthat collectively would be successful. A sup-port person summarized this by stating: "Theleaders accepted everyone as they were andhelped each person enjoy the experience. Theywere calm, patient and extremely safety ori-ented. The leaders paid attention to everyoneand made sure that all were included." Anothersupport staff person commented, "The tripleaders from WI were outstanding. They wereexcellent at teaching all levels of ability, verypatient." A support staff person who was alsoa parent of a participant said, "I think every-body was watching out for everybody else. Idon't think it was just myself. I think he got allthe help he needed." A participant with dis-abilities said, "I was happy with the guides. Ifwe go again I'd have the same guides."

Social/Socialization SkillsA major theme evident in the interview

data was that participants learned and prac-ticed appropriate social skills during the Gate-way trips. These skills focused on interactingwith different people and being better able tobe a contributing member of a group. Al-though most of this data came from the sup-port staff, some participants indicated that theylearned social skills. Examples include, "Ilearned how to handle myself around a crowdof people," and "I learned good behavior."Comments from support staff on improvedsocial skills related to interacting with differ-ent people included, "The trip helped his abil-

ity to tolerate others." "This trip helped withphysical stamina and endurance, also his abil-ity to tolerate others." "He is more able tohandle social situations." A support staff per-son of a group home said, "Just learning tomeet different people was good. At the grouphome there's not much social interaction be-cause it is always the same people. On the triphe learned to meet different people, andlearned how to get to know them a bit."

Support staff responses that related to par-ticipants developing their ability to be a con-tributing member of a group included, "Helearned how to participate in group activities,help with and prepare food." "He learnedteamwork." "I think he learned to wait histurn, I mean that's a daily living thing helearned." "Pam's ability to be patient withherself in physically challenging situationsseems to have improved and be less of abarrier." One support staff individual com-mented on the benefit of more than one personfrom a group home attending the same trip, "Ithas done a lot to kind of improve the relation-ship between people here."

Another major theme from the qualitativedata, related to social/socialization skills, fo-cused on the group culture and teamwork thatdeveloped during the Gateway trips, an atmo-sphere that encouraged group rather than indi-vidual challenges. Exemplar quotes from par-ticipants included, "I thought the other people[on the trip] were great." "Everybody becamefriends, and helped everybody." "My favoritepart of the trip was the group games." "Iremember the games we played together. Itwas fun to do with all the other people." Asupport staff commented on the group cultureon the trip, "He still talks about it. He missesthe people. He loves to be around people andI think for him that was really neat. He got to,you know, hang out with different kinds ofpeople. He still talks about some of the peoplehe met there." Another support staff remarkedon the impact of the trip teamwork culture,"She likes to be part of a group, and I think thefact that she was helping, it was a successthing for her." A mother who accompanied her


modation problems to inclusive programs. (Asnoted earlier in this paper, six of the original23 participants did go on a fully inclusive WItrip after the study ended.) A follow-up studywith participants similar to those in the presentstudy might identify programmatic elementsthat are especially rich pathways to greaterinclusion. Another fruitful avenue for futureresearch would be to analyze inclusive outdooradventure programs to better understand thedemands that these programs will place onpersons with cognitive disabilities who havebehavior challenges. What is it about the de-mands of an inclusive outdoor adventure tripprogram that could be adapted to make partic-ipation possible by persons with cognitive dis-abilities who present serious accommodationchallenges?

To partially address the foregoing question,we offer a beginning set of programmaticstrategies that are recommended based on theresults of this study, experience of WI staff,and on literature describing the provision ofsupports to people with cognitive disabilitieswho present serious accommodation chal-lenges (e.g., Bos & Vaughn, 1997; Kauffman,1985; Lais, 2002). These strategies were usedin this study and may have led to the percep-tions of skill development and growth. It isrecommended that research be conducted tostudy the effectiveness of each of these strat-egies. The two areas we have included in thelist revolve around the issues of skill learningand social/socialization learning because oftheir centrality to Gateway programming andto the possibility of greater inclusion after-wards.

1. Provide assistance to learn outdoorskills such as paddling a canoe, tent set-up, etc.

• Provide structured outdoor task training;make training times important.

• Make the skills being taught duringtraining sessions concrete through dem-onstration, and include time for "hands-on" practice.

• Develop skills incrementally. Begin by

practicing easy tasks and then move tomore difficult tasks that include one ormore of the more basic skills that partic-ipants have already learned, but stretchtheir abilities slightly.

• Train and retrain consistently throughoutthe trip, weaving learning opportunitiesinto many program components. Work1:1 with participants who have difficultyremembering skills from day to day.

• Establish group participation routines bycreating activities or structures that occureach day and which incorporate or leadnaturally into necessary camp chores.

2. Provide assistance with social/social-ization growth, especially self management:

• Create a cooperative culture that empha-sizes teamwork, honors partial participa-tion and leads to group accomplish-ments.

• Provide a positive environment in whichtrail staff and others continuously dem-onstrate respectful and open communica-tion and also encourage everyone tocommunicate their needs and desires soas to try to prevent problems that maylead to inappropriate behavior.

• Offer, whenever possible, opportunitiesfor participants to make choices. Frustra-tion with not feeling heard and respectedor with being treated as a child (whenyou are an adult) are common causes ofaggressive acts by persons with cogni-tive disabilities. Offering opportunitiesfor participants to make choices (who topaddle with, when to take a break, whatto have for lunch, etc.) helps them to feel"in control" and respected, and may gofar in heading off incidents of aggressivebehavior. Opportunities for choice shouldinclude making allowances for group inputon group-based decisions as feasible, andbuilding in time where individuals canmake choices about what they want to doindependent of the group.


• Encourage communication. People withcognitive disabilities frequently use dis-ruptive behavior to communicate unful-filled needs and desires. Hence, after anysafety issues are allayed, trail staff needto consider why the person is becomingangry (or anxious, upset, etc.), and en-courage the person to find some otherway to communicate his/her feelings.

• Persons should not be reinforced whenusing socially inappropriate behavior(which means, for example, that aggres-sive behavior is ignored, not punished, inso far as possible). Moreover, personsshould be reinforced when solving prob-lems in a socially appropriate manner.

• Use appropriate punishment and thenonly as a last resort; never resort to harshphysical means of punishment. Takingthings away from a participant or pre-venting a person from participating in anactivity that everyone else is allowed todo (time-out), should only be used as alast resort and with the goal of assuringthe safety of the participant and/or otherparticipants. Furthermore, when used,any punishment should end when thebehavior is under control.

• Assure respect. Punitive measures, suchas restraint of someone with a cognitivedisability, are highly regulated by stateand federal laws due to these individu-als' high degree of vulnerability. A per-son who has any recent history of ag-gression or other behavior that mayrequire the use of any form of punish-ment or restraint will usually have a tripassistant who knows the participant welland also knows exactly when and how touse such techniques with the specificperson. Trail staff should take their leadfrom a support person.

For a more extensive description of sup-ports in the form of strategies, adaptive proce-dures and devices used by Wilderness Inquiryreaders can refer to Lais (2002), McAvoy,

Roehl, and Rynders (2002), McAvoy et al.(2003), and Schleien et al. (1993) in the list ofreferences.

ConclusionFindings of this study support the capabil-

ity of a Gateway trip to promote participants'outdoor recreation skills, foster satisfactionwith the trip experience, and enhance social/socialization skill growth. Thus, programssimilar to Gateway are a viable possibility forthis "hard to serve" population and for someindividuals may lead to more inclusive out-door recreation opportunities in the future.But, even if it does not, participants withcognitive disabilities who present accommo-dation challenges can have a positive outdoorleisure experience that adds greatly to thequality of their lives.

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