*Article* **Outcomes from a One-Week Adapted Sport and Adapted Adventure Recovery Programme for Military Personnel**

#### **Suzanne M. Peacock 1,\*, Jim McKenna 1, David Carless <sup>1</sup> and Carlton Cooke <sup>2</sup>**


Received: 15 March 2019; Accepted: 23 May 2019; Published: 31 May 2019

**Abstract:** Background: The Battle Back Centre offers a bespoke, Self Determination Theory-oriented adapted sport and adventurous training programme centred on experiential learning and reflection to support the recovery of military personnel. Aim: To identify the short-term impact of participation in the programme on positive mental health and psychological need satisfaction. Method: Participants were 978 wounded, injured and sick (WIS) personnel classified as: Wounded (battle casualties), Injured (non-battle casualties) and Sick (mental/physical illness). Participants completed the Basic Need Satisfaction in General Scale (Gagné, 2003) and Warwick and Edinburgh Mental Well Being Scale (Tennant et al. 2006) on arrival and course completion. Results: All measures of positive mental health and psychological need satisfaction showed statistically significant increases, with a large effect size, from baseline to course completion (mean ± SD change in positive mental health, competence, autonomy and relatedness were 7.19 ± 9.61, 0.46 ± 0.9, 0.27 ± 0.84, 0.26 ± 0.86, respectively, *p* < 0.05). While the average magnitude of the intervention effect for positive mental health (16%) is comparable or greater than other reported interventions, changes were achieved in a shorter time. Conclusion: Findings highlight the positive short-term effect adapted sport and adventurous activities have for WIS personnel. Declaration of interest: Work supported by The Royal British Legion.

**Keywords:** adventure; armed forces; mental health; physical activity; recovery; soldiers

#### **1. Introduction**

Deployment to a war zone places military personnel in highly stressful and dangerous situations, which can have significant consequences. Since 2006, more than 2200 UK Service personnel have been wounded in action in Afghanistan, returning home with severe wounds, illnesses, and/or disabilities [1]. Equally, almost 3000 deployed personnel were assessed as having a mental health disorder in 2014/15 [2], with as many as 13% meeting the criteria for post-traumatic stress disorder (PTSD) [3–5].

Although the experiences of deployed personnel are challenging and unique, there is also a health need among military personnel who are not battle casualties. For instance, more than 5500 UK personnel have sustained non-battle related injuries and diseases in Afghanistan since 2006 [1] the rate of mental health problems among non-deployed personnel has increased by 63% since 2007 [2]. Further, although rates of PTSD and adjustment disorders are higher for deployed personnel, rates of mood disorders are significantly higher in non-deployed personnel [2]. The challenges faced by these individuals are extensive and diverse, with recovery often being associated with a sense of helplessness and loss of self-identity [6,7] less satisfaction with life [8], reduced psychological need satisfaction [9,10], increased aggression [11] and difficulties with post-deployment social functioning and transitioning into civilian living [12,13]. Consequently, the after care of Service personnel is of

great interest and importance to the Armed Forces, Mental Health Services and Service Charities because personnel who leave the Armed Forces symptomatic generally remain symptomatic and are at greater risk of social exclusion and hardship [14]. Further, upon medical discharge, the responsibility for health care is passed to the National Health Service (NHS) and Service Charities. However, NHS treatment compares unfavourably with treatment in the US' and the appropriateness of the treatment for ex-Service personnel has been questioned [15].

Extensive efforts are being made to support the recovery of Service personnel. However, while interventions focus on prevention, identification and management of injury and illness, there remains limited evidence of programme outcomes [16]. Moreover, clinical models of recovery dominate military rehabilitation, focussing on symptom reduction and physical functioning [17,18]. Although this approach is necessary and can be enhanced by technological and medical advancements, this approach alone is questionable for two reasons.

First, clinical approaches often do not offer a holistic approach to recovery. In contrast, patient-centred models of rehabilitation recognise that Service personnel are trying to make sense of, and search for meaning within, their individual circumstances. Frequently, individuals are attempting to establish a new (often non-military) identity within their post-injured/ill body and integrating this into their lives [18]. This is reflected in the complete mental health model [19], which proposes mental illness and well-being are distinct, with recovery being possible amidst on-going symptoms. Second, clinical approaches to recovery can create stigmatisation. Within the UK militaries, fear of being perceived as 'weak' continues to be the most common stigmatising belief across time [20], with personnel preferring to 'handle it on my own' than seek help [21]. Instead, personnel favoured informal support, with the majority seeking help through a spouse, friend, chaplain, or internet search [22]. In light of the dominance of clinical approaches and the associated stigmatisation, Dustin and colleagues [23] (p. 329) highlight the need to explore alternative approaches to recovery outside conventional practice which 'are not associated with hospitals, rehabilitation centres, or other clinical settings'. One area which has attracted recent attention is sport and adventurous physical activity, which is thought to compliment mainstream practices by 'facilitating a faster return to healthy levels of psychological functioning' [24].

There are a number of initiatives which currently use sport and physical activity as a tool for recovery in the USA (Wounded Warriors Programme, Disabled Sports USA), Canada (Soldier On), Australia (Australian Defence Force Paralympic Sport Program) and the UK (Battle Back Programme). However, little evidence has been generated to document programme outcomes and the impact on mental health and recovery. Moreover, existing research has mostly focussed on US populations and primarily considers combat-veterans, with small samples. In the first systematic review of its kind, Caddick and Smith [25] highlighted the therapeutic value of sport and physical activity on the subjective and psychological well-being of combat-veterans. In addition to generating positive emotions, the researchers concluded that sport and/or physical activity has the potential to shape the personal growth of combat veterans following acquisition of a disability or psychological trauma.

Therefore, recognising (i) the need to treat mental health problems during Service; (ii) the stigmatisation associated with professional medical help and preference to seek informal sources of support; (iii) the recommendation to use holistic, non-clinical approaches to recovery; (v) the role of sport and outdoor pyshical activity in recovery; (v) the dominance of US combat veterans in samples and; (vi) the need to rigorously document programme outcomes, the current study explores the role of a five-day adaptive sport and adventurous training (AS & AAT) programme in the recovery of UK wounded, injured and sick (WIS) in-Service personnel.

#### **2. Method**

#### *2.1. Setting: The Battle Back Centre*

Established in 2011, the Battle Back Centre (BBC) aims to assist the recovery of UK wounded (battle casualties), injured (non-battle causalities) and sick (mental/physical illness) (WIS) in-Service personnel. To achieve this, civilian coaches deliver the Multi Activity Course (MAC); a five-day bespoke, Self Determination Theory (SDT)-oriented programme (Ryan & Deci, 2000), using AS & AAT as a vehicle for personal development. Providing 24× MAC per year, the facility operates on a participant:coach ratio of 3:1, with each course offering space to 22 Service personnel across the three Services.

Following an optional morning walk and breakfast, each day opens with a daily brief where personnel are informally introduced to various psychological concepts or strategies (e.g., motivation, attitude, goal setting). Following this, personnel participate in a variety of AAT (e.g., indoor rock climbing, mountain biking, kayaking) and AS (e.g., archery, wheelchair basketball, seated volleyball, indoor bowling) activities. The presence of a full-time Technical Advisor and an extensive array of bespoke adaptive equipment facilitates enables all participants, regardless of individual circumstance, to participate in activities and experience success. Each day concludes with a review that encourages personal reflection and discussion at a group and individual level. This process encourages individuals to extract meaning from their experience and apply their learning to other life domains. Following a communal meal, social activities are held in the evening to promote social interaction and integration, including a cinema trip, quiz night, interest talks and evening walks.

#### *2.2. Participants and Recruitment*

Participants were WIS personnel directed to attend the BBC by their chain of command. Formal inclusion criteria are that participants will be (i) male and female UK Service personnel (British Army, Naval Service, Royal Air Force), including mobilised reserves; (ii) either wounded, injured and/or sick and; (ii) be independently mobile and self-medicating. Due to the nature of the participants and the sensitivities within this population, the researchers were advised to reduce participant burden and increase participant anonymity. To achieve this, we were recommended to avoid the disclosure of personal information that could lead to non-participation. Therefore, specific demographic and background information is not reported. However, in line with the demographic profile of the Armed Forces (Defence Analytical Services and Advice [DASA], 2014), the sample was dominated by white male Army personnel under the age of 25 years. Although attendance at the BBC is mandatory for Army personnel and recommended for the Royal Air Force and Naval Service, participation in the evaluation was voluntary. On arrival at the Centre, personnel were introduced to the aims of the evaluation and invited to participate. Voluntary written consent was then collected.

#### *2.3. Data Collection*

Approved by the Leeds Beckett University Ethics Committee, a formative service evaluation has documented the Centre's development across the 11 Pilots and its progression into full operational capacity. Initial qualitative, open-ended feedback from those attending the pilot courses suggested that the programme generated experiences, reflection and learning that were consistent with mechanisms of change associated with the Self-Determination Theory [26]. Therefore, Pilot 10 marked a change in the evaluation strategy with the initiation of a pre–post assessment using validated questionnaires, which explored possible changes to the elements of self-determination and psychological wellbeing. Specifically, volunteers completed two self-report measures on arrival and completion of the BBC Course. This study focusses on data collected during 69 MACs over a 25-month period between March 2012 and April 2015.

#### *2.4. Measurements*

Psychological Needs Satisfaction. The Basic Psychological Needs Scale is a family of scales which measure need satisfaction in specific domains (i.e., work, interpersonal relations, physical education) and life as a whole. The 21-item Basic Need Satisfaction in General Scale (BNSG-S) [27] was included as a measure of both outcome and of treatment fidelity, and was purposefully selected for this population because it is context-free and addresses WIS personnel's need for autonomy (7 items; e.g., 'I feel like I am free to decide for myself how to live my life'), need for competence (6 items; 'Often, I do not feel very competent' reversed) and need relatedness (8 items; 'I get along with people I come into contact with') within life in general. This approach is thought to provide insight into the general recovery of this military population. Responses were based on a 7-point Likert scale ranging from 1 ('not all true') to 7 ('very true'). After reversing the scores of nine negatively worded items, average scores for the three sub-scales were calculated, with high scores representing greater need satisfaction. The scale has reported Cronbach alpha coefficients of 0.69, 0.71, and 0.86 for the autonomy, competence, and relatedness scores, respectively [27].

Positive Mental Health. The Warwick–Edinburgh Mental Well-Being Scale (WEMWBS) was developed from the Affectometer-2 [28] and covers two dimensions of wellbeing: (i) hedonic perspective and (ii) eudaimonic perspective. The 14-items represent the only valid, positively worded scale to measure positive mental health. Responses are based on a 5-point Likert scale ranging from 1 ('none of the time') to 5 ('all of the time'). Answers are summed to provide an overall score, ranging from 14 (minimum) to 70 (maximum). The scale is a user-friendly and psychometrically sound measure of mental wellbeing, providing high internal consistency (α = 0.89) and good reliability [29]. It provides a normal distribution with no floor or ceiling effects [30] and is responsive to change [31], making it an appropriate tool for monitoring mental wellbeing in population samples. Furthermore, it is suitable for individuals aged 13+ years [30], making it appropriate for the current setting where average reading ages are low [32].

#### *2.5. Data Analysis*

Data analysis was conducted using the IBM SPSS Statistics 22 package (Version 22, IBP Corporation, Armonk, NY, USA). All data were cleaned, screened for missing values and assessed for normality. With instances of missing values, the baseline score was brought forward [33,34], thus representing no change to psychological wellbeing. This conservative approach assumed a neutral intervention effect of the BBC.

Descriptive statistics, together with changes in scores and significance values were identified. To assess the impact of participation in the MAC, paired sample *t*-tests were conducted on each of the dependent variables (positive mental health, autonomy, competence and relatedness). The significance level was set at 0.05. However, because statistical significance is likely to be achieved due to the large sample size [35], the effect size will also be presented to establish the magnitude of the intervention effect [36]. This will be reported through Cohen's d, with 0.2 representing a small effect, 0.5 representing a moderate effect and 0.8 representing a large effect [37].

#### **3. Results**

In total, 1020 WIS Service personnel attended 69 MACs across a 25-month period. Of these, 96% (*n* = 978) volunteered to participate in the research. From this group, 971 participants completed the WEMWBS, with 15% of these (*n* = 177) providing WEMWBS data at only one time point. A total of 957 participants completed the BNSG-S, with 21% (*n* = 200) of these participants providing BNSG-S data at only one time point.

#### *Overall Changes to Positive Mental Health and Psychological Need Satisfaction*

Descriptive statistics, together with changes in scores and significance values are presented in Table 1. All measures of positive mental health and psychological need satisfaction showed statistically significant increases from baseline to course completion, each with a large or moderate effect size (Table 1). The largest increase was shown in positive mental health, 16% (7.19 ± 9.61, t (970) = −23.332, *p* < 0.0005, two-tailed, eta = 0.44). Of the psychological needs met during the week, competence increased the most, increasing by 11%, followed by a 6% rise in autonomy and a 5% rise in relatedness.

**Table 1.** Descriptive statistics, reliability coefficients and change in scores of positive mental health and basic psychological need satisfaction.


#### **4. Discussion**

Responding to the need for military recovery interventions to document programme outcomes [16], the present study evaluated the impact of a bespoke five-day AS & AAT programme on the well-being of in-Service UK WIS personnel. Moreover, this study moves beyond research addressing combat veterans with small sample sizes (e.g., Caddick & Smith [25]) and explores the health needs among a very large military sample that includes all categories of in-Service WIS personnel: the full panoply of Service employees. Findings suggest the innovative, SDT-orientated programme produced significant positive changes. Personnel reported significant increases to positive mental health and satisfaction of three core psychological needs.

While the WEMWBS is commonly used as a measurement of positive mental health at the population level [30] and has been used extensively in interventions with the general population that often last 4–12 weeks [38–42], this study marks the introduction of the WEMWBS as viable outcome measures for military interventions. While the scale of the effect of the current programme is comparable to or greater than existing interventions, it was achieved in a much shorter time frame (only five days). With more than a quarter of UK Service personnel experiencing common mental health disorders [3,4], the development of positive mental health within this population is essential because it embraces more than the absence of ill-health. Embracing the idea that positive mental health is 'a state of complete physical, mental and social well-being', suggests that WIS personnel experience mental well-being even alongside mental illness.

Underpinning the facilitation of these positive mental health experiences is the Self-Determination Theory (SDT) [26]. SDT suggests that optimal psychological functioning, growth and integrity are only achieved with the satisfaction of innate psychological needs for (i) autonomy, (ii) competence and (iii) relatedness. Even though performance outcomes are not the primary focus of delivery, perceived competence experienced the largest significant increase (11%). While military life is underpinned by physical activity, recovery is often associated with prolonged periods of (frequently enforced) inactivity following injury/illness [43]. Moreover, this is often accompanied by reduced perceived competence and belief in personal capability [8,44–46]. Therefore, the flexible physicality of the programme seemed to appeal to many participants, perhaps leading to this increased competence outcome. Previously, the MAC was shown to provide personnel the opportunity to 'do things again' and promotes participation

in both familiar and new sporting activities [44–46]. A similar notion of 'discovery' was reported by four injured combat veterans following a nine-day climbing expedition of Mount Kilimanjaro [24].

A further explanation for the rise in competence score may be due to the combined effects of completing a physical challenge during the day, followed by the retelling of the experience during end-of-day reflections and being encouraged to consider how these (re)discoveries could apply to daily life. Experiencing success, in addition to participating alongside other WIS personnel, enabled MAC participants to reappraise and develop an accurate representation of their physical ability following injury [43]. These findings are consistent with previous research, which emphasised both focussing on ability, rather than disability, and providing opportunities for comparison and reappraisal. Both featured during (i) a National Veterans Wheelchair Games (NVWG) and Winter Sports Clinic (WSC) [47]; (ii) a climbing expedition to Mount Kilimanjaro for injured combat veterans [24]; and (iii) three-day U.S. Paralympic Military Sport Camp (USPMSC) [48].

Autonomy also increased significantly, rising by 6%. Within a military context, this development is particularly significant because the Armed Forces have been described as a 'dependency culture' [49]. However, while sport has been suggested to enhance autonomy by assisting combat veterans to cope with the psychological consequence of acquiring a disability [24], or to take control of their behaviour [50], developments to autonomy are only occasionally recorded. For instance, although competence and relatedness were facilitated during a three-day USPMSC, expressions of autonomy were limited [48]. Accounting for this, Hawkins et al. suggested that the limited evidence for autonomy was most likely due to attendance being recommended or required by their chain of command. However, this was also true for MAC participants. Therefore, recognising the importance of an autonomy-supportive environment for predicting psychological need satisfaction [51], it could be argued that course content and delivery facilitated enhanced autonomy. While Hawkins et al., did not detail programme delivery, the MAC operates on the ethos 'challenge-by-choice', which encourages individuals to take charge of their BBC experience. This ownership may be influential in the development of overall autonomy scores.

Finally, relatedness also increased significantly, rising by 5%. Three explanations might account for this rise. First, is the occurrence of a positive reappraisal of existing relationships that occurred during the course. Previous research has documented how some personnel came to value relationships with their families and/or partners as a result of reflection that took place during the course [45]. Second, is the shared experience of military culture. Military culture is distinctly different from civilian organisations or institutions, with its own language, humour, rituals and beliefs [52]. Personnel often believe civilians do not and cannot understand their military experiences [3,53]. However, the MAC has previously demonstrated its ability to enable personnel to unite through a shared military experience and rekindle elements of the military culture which were often lost as a result of the isolation associated with injury and/or illness [43].

Third, is the shared experience of injury, illness and/or recovery. Recognising that personnel can often feel unique, embarrassed and/or isolated with their injury/illness [44], the MAC may offer a normalising and reassuring experience. Previous research conducted at the Centre suggests personnel can easily interact with and observe other WIS participants at varying stages of their recovery process and compare themselves and offer support [43]. This process enables participants to share similar authentic and first-hand experiences, and offer support, insight and suggestions to other group members, while also providing perspective, hope and inspiration [54]. Of 11 studies which were included in a systematic review, eight acknowledged the role of sport and physical activity in the facilitation of social well-being [25]. For instance, consistent with outcomes from the MAC, participation in a three-day military sport camp also enhanced relatedness through the shared experience of the military and traumatic injury [48].

Moving beyond the single programme, the findings also have wider implications. Clinical models of rehabilitation dominate military health care, with levels of physical functioning or symptomology often acting as markers of recovery. However, with the appropriateness of current NHS recovery programmes for veterans being questioned [17,49], alongside the tendency for clinical approaches to predominantly help the minority [55], there is a need to explore alternative avenues for enhancing the recovery of WIS Service personnel. Considering the holistic definition of recovery [56–59] and patient models of rehabilitation [18], an alternative approach could be through sport and/or physical activity. These are perceived as 'normal', 'healthy' behaviours and not accompanied by the stigma or side effects associated with counselling and medication [58]. Furthermore, recognising the ideology of a soldier and the emotional inexpressiveness of some men, it is suggested that these men need assistive activities to stimulate personal exploration and emotional expression [59]. While these findings provide promising evidence to support the role of AS & AAT in the recovery of in-Service UK WIS personnel, further studies are necessary to explore several areas. First, it remains unclear whether attendance at the MAC creates a halo effect, with participants potentially experiencing positive improvement that declines after the course. Changes to positive mental health and psychological need satisfaction require exploration in the weeks, months and years following participation in the programme. Second, it may be useful for future research to collect demographic information (i.e., gender, rank, age) and differentiate between categories of wounded, injured and sick to determine effects across sub-populations. Third, while the magnitude of change is greater than many existing non-military interventions, further studies are needed to determine how the outcomes compare to other existing five-day military residential programmes. Finally, incorporating in-depth qualitative research will add depth to the research, providing detailed insight to 'the Battle Back experience' and the underlying mechanisms which generate the documented changes in wellbeing.

#### **5. Conclusions**

This study marks a progression in the recovery literature, documenting the role of a five-day AS & AAT programme in the promotion of well-being in UK in-Service WIS personnel. Findings suggest attendance of the MAC generates statistically significant improvements to positive mental health and satisfaction of psychological needs. Moreover, while the scale of the effect is comparable to, and often greater than, existing interventions, it is achieved in a much shorter time frame. Future research should explore the longer term implications of attending the MAC.

**Author Contributions:** Conceptualization, S.M.P., J.M., D.C. & C.C.; Methodology, S.M.P., J.M., D.C.; Validation, S.M.P., J.M., D.C. & C.C. Formal Analysis, Peacock, McKenna & C.C.; Investigation, S.M.P.; Resources, S.M.P.; Data Curation, S.M.P.; Writing-Original Draft Preparation, S.M.P.; Writing-Review & Editing, J.M. & D.C.; Visualization, S.M.P.; Supervision, J.M., D.C. & C.C.; Project Administration, S.M.P.; Funding Acquisition, J.M.

**Funding:** This research was funded by The Royal British Legion.

**Acknowledgments:** The Royal British Legion and participants for taking the time to engage in the research.

**Conflicts of Interest:** The authors declare no conflict of interest

#### **References**


© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

## *Article* **Purposeful Outdoor Learning Empowers Children to Deal with School Transitions**

#### **Vikki Slee \* and John F. Allan \***

Carnegie School of Sport, Leeds Beckett University, Leeds LS6 3QS, UK

**\*** Correspondence: slikkiv@hotmail.co.uk (V.S.); j.allan@leedsbeckett.ac.uk (J.F.A.); Tel.: +44-7852302124

Received: 17 April 2019; Accepted: 30 May 2019; Published: 31 May 2019

**Abstract:** UK schoolchildren are vulnerable to transitional stress between primary and secondary school, which may impact negatively upon their psychological health and academic achievement. This is experienced most acutely by children from ethnic minorities and lower socio-economic status (SES) households. Outdoor Adventure (OA) residential programmes are purported to develop behavioural adaptations which enable positive educational transitions of children. Personal, social and academic skills (self-reliance, getting along with others, curriculum alignment) may be best acquired through bespoke nature-based residential OA programmes. A mixed methods study evaluated the efficacy of a bespoke OA programme for developing school children's psychological well-being and self-determination during their transition into secondary school. Participants were representantives of ethnic minorities and lower SES groups. A bespoke OA residential programme achieved the strongest scale of change in children's psychological well-being (F (30,69) = 1.97 < 0.05) and self-determination (effect size 0.25) compared to a generic OA residential and a non-OA school-based induction programme. Qualitative testimonies illuminated personal experiences and processes underpinning the perceived changes in the self-determination domains of *Autonomy* (the capacity to self-direct learning), *Competence* (the ability to complete tasks) and *Relatedness* (developing connections with others). Providing early opportunities for children to take control for their own learning through nature-based tailored OA programming improves their psychological well-being and adaptability to combat transitional stress.

**Keywords:** school children; transitions; primary and secondary school; nature; tailored outdoor education programming; individuality; adaptable productive functioning; green spaces; health and psychological well-being; self-determination

#### **1. Introduction**

#### *1.1. Transitions into Secondary School*

The transition between primary and secondary school represents a significant adjustment for young people both socially and academically. Periods of transition typically necessitate life change which may cause vulnerability to psychological adjustment difficulties [1,2]. Challenges include moving from a small school where lessons take place in a single room with one teacher, to navigating a complex timetable with multiple subjects, locations and teachers. Although many children make successful transitions, this process can impact a significant minority of individuals to such an extent that their level of motivation, psycho-social well-being and subsequent academic attainment is impaired [3–10]. Moreover, the potential harm initiated by school-based educational transitions may be experienced most acutely by children already considered vulnerable to life changes—namely, those from lower socio-economic status (SES) households and ethnic minority groups [11,12].

Given the extent of challenges presented during educational transitions, several studies have aimed to understand factors associated with transitional stress and the successful assimilation of school children (e.g., [1,13]). Risk factors associated with transition vulnerability include the loss of old friendships, feelings of isolation, and lack of curriculum continuation. Schools that report successful transitions help children to develop new friendships, become more self-reliant, and promote curriculum interest and continuity [14,15]. These practical findings fit well with the strongest contemporary theories about the adaptive capabilities of young people in overcoming problems [16–18]. For example, the Self-Determination Theory (SDT) proposes that conditions which support high levels of autonomy (feelings of independence and control), competence (a sense of accomplishment) and relatedness (ability to get along with others) will help to nurture high-quality forms of motivation, which underpins wellness in that setting [19–21].

To further develop an understanding of school children's prerequisites for successful educational transitions, there have been calls for longitudinal research which reveals the processes which underpin their behavioural adjustment. Longitudinal studies offer opportunities to investigate risk and protective factors that co-occur and affect transition success over time [8]. Such developed insight may help to inform practices which provide young people with a broad set of assets and resources as a focus for positive change alongside skills built for risk avoidance or amelioration.

#### *1.2. Outdoor Adventure (OA) Programming*

There has been extensive research implicating OA residential programming for promoting positive behavioural adaptations pertinent for educational transitions. These include short-term and lasting improvements in self-efficacy, social connectedness, problem solving, resilience and academic performance [22–27]. It is claimed outdoor learning generates 'social capital' by boosting self-confidence and creativity [28], fostering pride and a sense of belonging [29,30], and improving cooperation, honesty, trust and compassion [31,32].

OA relies upon the process of experiential learning within a dynamic, natural setting to generate adaptive skill sets for young people. Experiential learning represents a progressively staged mechanism whereby participants learn through direct immersion and reflection of experiences [33,34]. An array of unfamiliar experiences is purported to compel individuals to engage with risk and uncertainty [35]. This helps to create an authentic sense of capability initiated through a supported, controlled disruption of everyday behaviours [21,36].

Additionally, a growing number of studies suggest just being in close proximity to green spaces significantly contributes to improvements in children's mental health and wellbeing [37–40]. Indeed, even short-term doses of nature can make a marked impact upon their mental health in natural settings. Just five minutes of exercise undertaken in an urban green space may be sufficient to boost physical and mental well-being of young people through 'biophilia' [41], described as an innate connection to nature [42,43]. This has particular significance given a growing number of children, particularly from poorer households and ethnic minority groups, have less opportunities to experience natural environments [44,45]. Further, the most recent meta-analysis advocating the health-giving benefits of greenspace exposure recommend policymakers and practitioners create, maintain and improve greenspaces specifically in deprived areas [46].

Because of the perceived benefits associated with OA and young people, schools have deployed a range of OA providers to deliver residential programmes which aim to boost children's capacity to avoid any transition-related problems [47–49]. It is proffered personal and social skills which contribute to the effective transition of school children may be best optimised through carefully constructed residential experiences, incorporating challenges which are shaped to accommodate the specific abilities of participants. This includes purposeful exposure of children to nature-based OA, whereby teachers collaborate with experienced OA providers to shape programming which meets the aims of schools [50].

Irrespective of the apparent success of different forms of OA programming, there is little empirical research to show how OA empowers schoolchildren to cope with educational transitions. It is argued beneficial outcomes emanating from OA may be largely based on intuitive belief systems, situation-specific novelty or even coercion, rather than an informed understanding of the dynamic nature of processes and outcomes. Therefore, any benefits will remain context-specific [51] and may not readily transfer into everyday behaviours in schools [52–54]. Without evidence of the transitional experiences of schoolchildren, coupled with the processes within OA programming which influence changes in young people (i.e., facilitation techniques, group dynamics), OA practitioners and schools are unlikely to make judgements about the validity of OA programmes to meet school aims. Addressing this shortcoming may ensure that provision meets the needs of particular groups, such as pupils newly transiting into secondary school.

#### *1.3. Research Aim and Objectives*

The aim of this study was to investigate the efficacy of three contrasting induction programmes for facilitating improvements in children's psychological well-being and self-determination during their transition into secondary school.

Objectives:


#### **2. Methods**

#### *2.1. Study Overview*

Partnerships between educational providers and outdoor practitioners are deemed critical for educating children through OA [55]. Therefore, this study was a collaborative project between three UK secondary schools, a university and an Adventure Development Unit within a Metropolitan District Council.

#### *2.2. Participants*

Following institutional ethical approval, 100 school children, mean (M) age of 11 years (female N = 55/55%), were recruited as a purposive sample of pupils transiting into three inner-city secondary schools in the North of UK. The majority of pupils were representatives of lower SES households (classes 5 and 6) and ethnic minorities.

The sample comprised:


Three school teachers, mean (M) age of 26.4 (± SD1.56) of white ethnicity, (female, N = 2, 67%) were sampled to ascertain their perceptions associated with pupils' immersion within the 'Tailored OA' group.

#### *2.3. Procedures and Programme Design*

#### 2.3.1. Tailored OA Programme

The Tailored OA group of transiting children participated in a three-day, two-night residential in a local authority OA centre. Emphasis was continually placed on the school's ideology to develop self-determined learners and promote the core values of honesty, integrity, compassion and excellence. These principles equate with recognised qualities needed for transition and are associated with the three underpinning components of the SDT [20]. These components include Competence (the ability to complete tasks), Autonomy (the capacity to self-direct learning) and Relatedness (how well a person can connect with others).

Pupils were empowered to be responsible for planning, organising, executing and reviewing naturally emerging experiences beyond primary-level learning, even when things did not go to plan. For example, this included pupils moving from describing movement and applying basic problem-solving to selecting and appraising different components of physical education across activity areas. While these activities were novel for many pupils, they were not so far removed from every-day school life to make them seem irrelevant and non-transferable. Therefore, within the limits of safety, pupils perceived being directly responsible for shaping their learning outcomes and for the nature and direction of the activities undertaken. This included pupils working collaboratively and in negotiation with facilitators, whether building rafts, organising equipment for journeys or ensuring personal and collective safety.

Further, to bridge to the secondary school curriculum, protocols for OA activities were infused with learning tasks from physical education, numeracy, literacy and information technology Although qualified OA practitioners delivered the technical elements of the programme, 10 undergraduate student volunteers facilitated all other collaborative activities such as a group-planned nature-based journey, housekeeping duties and meal preparation. Most importantly, these university students acted as an interface between school teachers and the children. Throughout, photographic images from previous days' events, written reflections and pictures associated with a range of emotions were displayed; group presentations allowed pupils to present evidence of their learning through role play, songs, poetry, narratives and poster work. Themes emanating from this work included (i) dealing with fear of the unknown, (ii) inclusion, (iii) empathy for others, (iv) sharing, and (v) future desires to go to university.

#### 2.3.2. Comparison Programmes

Intervention studies within education should establish realistic comparisons [56]. To provide suitable comparisons for this programme, two induction programmes aimed at supporting children in their transition were evaluated. The first comparison group experienced an active one-week induction programme delivered in school. Activities focussed on integrating pupils into their new environment, familiarising them with subject areas, and helping them to form friendships. A second comparison group involved children who attended a five-day commercial OA residential programme. This comprised team building challenges, land- and water-based pursuits. There was no attempt to align this programme to the school's educational objectives or aspects of self-determination and general well-being. All activities were delivered by experienced qualified personnel. The characteristics of all programmes are featured in Table 1


#### **Table 1.** Programme Characteristics

#### *2.4. Measures and Data Analyses*

#### 2.4.1. Quantitative

Two validated age-appropriate self-report questionnaires were completed by children immediately before and on completion of their respective programme. The 14-item Warwick–Edinburgh Mental Well-being Scale (WEMWBS) [57] provides a single graduated score reflecting pupils' positive thoughts and feelings. The 21-item Basic Psychological Needs Satisfaction in Life Scale (BPNS) [20] depicts pupils' self-determination through three separate subscale scores of autonomy (freedom to express ideas), competence (ability to learn interesting new skills) and relatedness (amount of care received from others). Both the WEMWBS and the BPNS have established age-appropriate validity and reliability, possess positive links to increased psychosocial and academic functioning of pupils in schools [58,59] and relate closely to behaviours needed for successful transition.

#### 2.4.2. Qualitative

This approach enabled qualitative data to strengthen inferences contained in quantitative findings of the Tailored OA programme. Semi-structured interviews and informal discussion took place in groups of five/six children during and following the residential programme (immediately and four months later in school). Children were encouraged to express their thoughts and opinions through open questioning and discussion which allowed clarification and exploration of ideas [60]. Questions were guided by elements which underpin psychological well-being and components of self-determination (Table 2). Teachers took part in the open interviews to share their perceptions of the value of the intervention programme for the schoolchildren's general well-being and their ability to respond to the expectations of the school.

#### 2.4.3. Data Analyses

Quantitative data analyses investigated the magnitude and direction of change to measures of psychological well-being and self-determination immediately following all three induction programmes. Similarities and differences within and between group (mean) scores for WEMWEBS and BPNS were identified using descriptive and parametric statistical analyses (percentage differences, independent t tests, effect sizes, one-way between-participants analysis of variance). Analyses were conducted using Statistics Package for the Social Sciences (SPSS) Version 24 [61]. In-programme and follow-up qualitative data analyses involved transcription and thematic analysis (a coding technique allowing information to be sorted into distinct frameworks which related to the research aims and objectives).


**Table 2.** Sample of themed discussion questions

Key: Psychological well-being\* & Self-Determination Theory (SDT) subscales of Autonomy\*\* Competence\*\*\* & Relatedness\*\*\*\*.

#### **3. Results**

#### *3.1. Quantitative Data*

#### 3.1.1. Psychological Well-Being

A significant difference was observed between the three programmes (Tailored OA, School Induction, Generic OA) on pre- and post-programme differences in psychological well-being F (30,69) = 1.97 < 0.05 (Figure 1). The Tailored OA programme achieved the greatest improvement in psychological well-being ('medium' effect size 0.43) compared to the school-based induction, which reported a reduction, and the generic programme, which registered a small improvement.

**Figure 1.** Baseline and follow-up Warwick–Edinburgh Mental Well-being Scale (WEMWBS) score by programme. One way Anova F(30,69) = 1.97 < 0.05 (Tailored OA v School induction and Generic OA) T bar lines on each block depicts the standard deviation of mean scores for each programme.

3.1.2. Self-Determination

Figure 2 highlights the degree of differences in the mean BPNS subscale scores of autonomy, competence and relatedness for each programme. Beneficial increases in each subscale were evident for the Tailored OA residential programme. These subscale increases represented an overall effect size increase of 0.25 for self-determination. In contrast, the school-induction and generic OA programmes recorded decreases in Autonomy and Competence and smaller increases in Relatedness.

**Figure 2.** Baseline and follow-up mean difference scores on Basic Needs Satisfaction in Life Scale (BPNS) for Autonomy, Competence and Relatedness by programme. BPNS 0-7 (low-high) standardised scale for each subscale mean score; Independent t tests \* Tailored OA v School induction t(78) = 3.04, p = 0.05; ~Tailored OA v Generic OA t(78) = 3.42, p = 0.05; \*\* Tailored OA v Generic OA t (78) = 2.84, p = 0.05; Lines depict standard deviation.

The tailored OA programme recorded statistically significant differences in Autonomy (effect size increase of 0.25) compared to the school induction programme, t (78) = 3.04, p = 0.05, and the generic OA programme t (78) = 3.42, p = 0.05. The tailored OA programme also increased the Competence of school children (effect size 0.18.) There was a statistically significant difference in Relatedness between the Tailored OA programme (effect size increase of 0.33) and the generic OA programme t (78) = 2.84, p = 0.05.

#### *3.2. Qualitative Data*

#### 3.2.1. Psychological Well-Being

Qualitative responses of children attending the tailored OA programme confirmed findings from the WEMWBS measure. Children portrayed confidence in their abilities, contentment and appreciation for others during a programme which emphasised active immersion within nature.

*"I was proud of raft building, I kept falling o*ff *but learnt how to climb back on"*

*"I didn't think I was a good leader, leading orienteering"*

*"I learned that you can show compassion without even realizing it! I know that I can show it my friends now. I feel happier"*

*"I couldn't believe I was outside so late. I love being outside"*

*"I enjoyed learning outside because I didn't even think I was learning* ... *it's boring in the classroom."*

#### 3.2.2. Self-Determination

Children attending the tailored OA programme reflected upon their enhanced self- determination depicted through the three subscales of autonomy, competence and relatedness.

In respect to the development of the subscale of Autonomy, children recognised opportunities for self-reliance through authentic challenges.

*"In map reading we found our way back from the river without help from the grown-ups!"*

*"I felt independent when we had to clean our rooms and make our own sandwiches"*

*"It didn't matter that we got wet when our raft collapsed, we just re-built it"*

Children considered their improvements in the subscale of Competence following successful negotiation of the tasks presented through their perseverance and effort.

*"In archery I came first but I didn't think I would, and made me more confident in my ability"*

*"Having done the residential I think I can cope with this [secondary school] responsibility because I know*

*I am capable of it"*

*"My favourite thing was doing a presentation, this made me feel excited to do it again at school and be not*

*so scared"*

*"Sky-walking was really scary but I did it with help from my new friends"*

The subscale of Relatedness increased across all groups. However, the sharpest increase was reported within the tailored OA programme where the importance of collaborative effort and support for others was continuously reinforced. This equated to future challenges children would face in school.

*"I found working together meant it were easier—If I was on my own, I wouldn't have done it"*.

*"I think that I have lots of people to talk to now and I can go to my teachers"*

*"We have more friends because we slept in the same room and did activities together so we helped and supported all the time"*

3.2.3. Teachers Perspectives on Tailored OA Programme

Teachers' perspectives helped to illuminate processes associated with learning within the tailored OA programme. The characteristics of the tailored OA programme placed emphasis on allowing the children the freedom to plan and explore, undertake supported risk-taking and review naturally emerging experiences.

*"There are no right or wrong answers, just a process, with multiple solutions. In working through these,*

*children are able develop creativity, collaborative learning and decision-making skills so early in coming to school"*

*"If the trust and relationship is not there, the pupils do not have much confidence in the classroom (or in*

*you) which links into lower academic attainment"*

*"Usually we see pupils only twice a week for an hour and so it takes longer to form relationships...gaining trust and understanding of how they learn may take till Christmas—this is a way to get them on track before then"*

*"Unfamiliar activities act as a leveller, whereby some children who traditionally are more dominant in school may be stretched out of their comfort zones outside, those quiet kids get a chance to shine"*

3.2.4. Tailored OA Programme Sustainability of Impact

Four months following the programme, children and teachers were able to self-reflect on the importance of these behaviours which showed a degree of resonance.

*"When I started this school, I was really shy but now my confidence has grown because I got to know people better than if we didn't go on residential"*

*"Yeah, I remember the time we had at the Outdoor Centre, and when I start to feel nervous, I remember how well I got on and how you have to try something even if it is scary"*

*"Practice makes perfect as I learn in archery that's because I saw improvements in me, so I practice much more now with other things"*

Behaviours regarded as important for transition were observed by teachers during school time.

*"Pupils were drafting and re-drafting and they weren't happy or content with it being*

*mediocre......sometimes it took six or seven attempts.......not by the teacher saying it isn't good enough, it was the students taking responsibility over their work and being proud of what they had done and achieved"*

*"They don't [pupils from the intervention group] seem to have the [academic] dip as much, they are more*

*confident. They ask for help much more and seem a lot happier around school—and attendance is better"*

#### **4. Discussion**

This study investigated the efficacy of a tailored OA programme for facilitating benefits in children's psychological well-being and self-determination during and following their transition into secondary school. Investigations suggested a tailored OA programme compared to a non-OA school-based induction programme and generic OA intervention achieved the strongest scale of change in psychological well-being and in all three SDT subscales of autonomy, competence and relatedness. Increases in the perceived ability of school-children to connect with others during transition were reported across all three induction programmes. Qualitative testimonies corroborated the quantitative findings of the tailored OA programme, highlighting personal experiences and processes underpinning these changes.

Although limited to a modest population sample, these findings shed light onto the benefits of developing focused strength-based functioning within an OA residential programme for school children. More importantly, the nature of this change suggests that interventions can be devised that, potentially, support an effective transition for children from inner-city areas who may not be able to access effective learning in green spaces. OA residential programme exposure which helps pupils to (i) feel proud and content (well-being) (ii) become independent (autonomy), (iii) be good at something (competence) and (iv) feel valued as a group member (relatedness) can produce a range of adaptive capabilities that help transition to secondary school. To discuss the implications of these major findings, each of the study's objectives are considered separately.

#### *4.1. The Psychological Well-Being of Schoolchildren across Programme Conditions*

Both OA programmes delivered short-term increases in the children's psychological well-being compared to induction practices undertaken in a school setting. Items contained on the WEMWBS scale include the extent to which children 'feel optimistic', are 'interested in others and new things', can 'deal with problems', and 'feel loved'. In this regard, these findings confirm the value of the exposure of young people to novel, shared activities in a natural residential OA for providing immediate psychosocial benefits ('social capital', creativity, a sense of belonging) (e.g. [28,29,35,37]) that may transmit into school life and beyond [40]. Findings also suggest that natural settings advocating shared expectations, freedom of expression and promotion of teacher–pupil relationships may be preferable for embedding new pupils in transition than more uniform environments [50].

#### *4.2. The Self-Determination of School-Children across Programmes*

Intense challenges in OA which emphasise the need for self-reliance may create real senses of capability through individual's overcoming dissonance [21]. The tailored OA programme was foremost in enabling changes to more schoolchildren's self-determination. This aligns with findings from a recent similar study of children transiting into secondary school [50]. The predominance of change across all subscales reported by children exposed to this programme provides justification for deploying focused, collaborative approaches in OA for addressing schoolchildren's transitional needs. Appropriately planned and executed programming involving schools and wider partners may help to inform teachers and create confidence in formulating OA. This practice may take the form of distinctive residential programming or curriculum-based outdoor learning which is delivered in and around school premises.

#### *4.3. Processes Associated with Learning within the Tailored OA Programme*

To prepare incoming schoolchildren for the reality of secondary education, schools have been encouraged to develop approaches for pupils to become more self-determined [16]. The SDT subscale of Relatedness increased across all groups. This could represent the overarching emphases placed upon social skills needed for transition within each of these programmes. Nevertheless, the characteristics of the tailored OA programme placed most emphasis on allowing the children the freedom to plan and explore, undertake supported risk-taking and review naturally emerging experiences. To consolidate learning, children were encouraged to move from describing outcomes and applying basic problem-solving (primary learning) to selecting, appraising and presenting an understanding of skills needed to achieve in school. Although these skills aligned with the school's philosophy (i.e., honesty, integrity), they were more practically understood as making friends, knowing staff, asking for help and being responsible for oneself and others.

#### *4.4. The Sustainability of the Tailored OA Programme*

It is contested that exposure to OA experiences does not implicitly build positive characteristics in young people which transfer across contexts but provide situations whereby individuals experience novelty and/or feel compelled to conform [52]. Although the transferability of OA continues to be questioned, there continues to be a dearth of evidence which advocates the use of OA for the holistic development of young people (e.g. [26]). In the present study, personal attributes akin to personality traits were not targeted for change through enforced participation. Rather, self-directed habitual behaviours in children were introduced and encouraged throughout all aspects of programming which could be replicated in local green spaces and school settings.

#### *4.5. Limitations and Future Considerations*

This study provides valuable insights into the comparability of programme effectiveness for enacting changes to well-being and self-determination of children during and beyond school transition. However, there are caveats to these findings. A limited number of pupils were recruited from similar schools, and therefore the findings do not generalise across the sector. Neither do the data reflect the on-going demands of a full academic cycle. Furthermore, the data can only confirm the programme content and follow-up measurement for the tailored OA programme. However, the measures of well-being and self-determination were responsive in determining differences in pupils' functioning and could be used to evaluate further impacts of targeted OA interventions upon school children in transition.

Evidence from the current study suggests that empowering children to taking responsibility for their own comfort, safety and learning through tailored OA programming provides authentic consequences which may lead to improvements in their well-being and personal adaptability. The children's self-determination was ensured by channelling workable ratios of pupils towards self-directed tasks, allowing them the freedom to succeed and fail in a neutral testing ground for challenges akin to those faced in secondary school. These findings provide encouragement for schools delivering active programmes aiming to smooth the transition of school children, particularly those targeted at more vulnerable groups. These experiences are optimised when teachers collaborate with experienced OA providers to shape programming to meet the specific aims of schools.

**Author Contributions:** Writing-Original Draft Preparation, V.S. Writing—Review & Editing, J.F.A.

**Funding:** This research received local authority funding

**Acknowledgments:** Carnegie Great Outdoors for access to inductees attending a three-day OA residential programming. Permission was granted by the authors of WEMWBS for its use in this study.

**Conflicts of Interest:** The authors declare no conflict of interest

#### **References**


© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

*Article*
