Wilderness Therapy Industry’s Decline Accelerated by Embark Behavioral Health’s Exit

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The behavioral health industry continues its shift away from adolescent wilderness therapy programs as payers opt for other care models and the segment grapples with strong public backlash.

Chandler, Arizona-based Embark Behavioral Health becomes the latest in this trend as it shutters its wilderness therapy division. This comes as providers continue to move away from destination treatment offerings toward more accessible services.

Several powerful forces have motivated this shift. Not the least of which include parity allowing more local behavioral health offerings to come to market, payers focusing on less intensive treatments, and bad news about wilderness therapy programs becoming more prominent in mainstream discourse.

For example, a 12-year-old boy died at a wilderness therapy camp not affiliated with Embark Behavioral Health called Trails Carolina, earlier this month. Sources tell Behavioral Health Business that Trails Carolina, a part of Salem, Oregon-based Family Help & Wellness, has been rocked by the development.

Inside Embark’s closures

Two of Embark Behavioral Health’s three wilderness therapy entities — Deschutes Wilderness Therapy in Bend, Oregon, and New Vision Wilderness in Medford, Wisconsin — will close outright. The other, First Light Wilderness in Dahlonega, Georgia, is attempting to transition its licensure to a residential treatment center.

Embark Behavioral Health already operates a residential treatment center in Bend. That facility will support Deschutes Wilderness Therapy in the transition. The Deschutes facility will end the outdoor program on April 30, according to a letter to its community penned by Executive Director Andrew Scott.

It’s not clear when the other two wilderness programs will shutter services. Representatives of Embark Behavioral Health did not answer specific questions sent by Behavioral Health Business.

Instead, Embark Behavioral Health pointed to a decade-long evolution in intensive youth mental health services — driven by patient demand, parity and payors that pushed the organization — toward mainstream facility-based care and outpatient services.

“Ten years ago, youth private pay programs were the only quality options available for families in need,” the company’s representative said in a statement. “This is natural for a maturing healthcare system.”

Embark Behavioral Health specializes in youth behavioral health and has been a fixture in the at-risk youth, sometimes called the troubled teen, industry for years. Today, the company is focused on growing more accessible outpatient, telehealth, intensive outpatient programs (IOP) and residential treatment centers. It operates 32 locations in 16 states and virtual IOP services in 11. It treated a company-record 2,750 patients.

The youth rights nonprofit Unsilenced, which catalogs deaths and other failings of the broader at-risk youth industry, does not have documents detailing a death at any Embark Behavioral Health facilities. It does, however, warehouse several documents from state regulators detailing occasional compliance missteps and many stories from former program participants.

The evolution of Embark Behavioral Health

Embark Behavioral Health’s assessment aligns with analysis from several industry experts. Several tell BHB that wilderness programming has long relied on big-dollar private payments, unstable state funding and limited funding from health plans.

Ned Carlson, CEO in Residence at the private equity firm Varsity Healthcare Partners, told BHB that some health plans may have covered some wilderness therapy services but still likely presented “a significant financial burden for families.Further, demand for IOP programming has increased. This is a phenomenon also recently seen in the eating disorder treatment space.

These issues are well-known in and outside of the wilderness therapy industry.

“As the behavioral health market grows and evolves, new and more accessible programs have become families’ choice for treatment,” Kaci Sapinski, executive director for New Vision Wilderness, wrote in a letter to the program’s community announcing the closure. “It has become increasingly difficult to operate going forward. As responsible stewards of mental health treatment, challenging decisions needed to be made.”

Embark Behavioral Health’s evolution has been in motion for years but accelerated about a year ago. Consonance Capital Partners, the private equity division of New York City-based Consonance Capital, acquired a majority stake in the company. That deal was one of the few big-dollar deals in the behavioral health space in 2023.

Alex Stavros, CEO of Embark Behavioral Health, has previously described his vision of a company that can provide a wide acuity spectrum of care that uses clinical outcome-based decision-making to determine whether to step patients up or down in care intensity.

“We can start to use that data to understand how to treat transitions — when to step up, when to step down — how to improve the family system, how to fine-tune the treatment plans,” Stavros told BHB in January 2024.

More recently, Stavros told the Behavioral Health Business Perspectives podcast that the company wanted to “move to a place where we can be in-network with payers” and that he saw greater use of outcomes data as key to managing payer relationships, especially when it came to “utilization management.”

Further, Embark Behavioral Health is expanding. In 2024, the company says it will add:

—Residential treatment center in Colorado, Virginia and Georgia (potentially replacing the wilderness program)

— A second stabilization center in Utah

— A new outpatient clinic in each area: Walnut Creek, California, Livingston, New Jersey, Atlanta and the Washington, D.C. metro

— Virtua IOP eight more states

Leaving a troubled industry

Over the years, repeated controversies at several wilderness programs have injected skeptical rhetoric about wilderness therapy programs into the mainstream. In sum, wilderness programs are now a tough sell as the industry has “no strong evidence” supporting its model and often appeals to parents of children with genuine needs in a moment of crisis.

These social pressures and health plan regulations around reimbursement parity collide, making the wilderness therapy industry a manifestation of a larger parity issue in behavioral health. It illustrates payers’ concern that heightened parity standards would enable wasteful health care spending.

“There is a balance there that we need to pay close attention to as a country,” Dr. Caroline Carney, president of behavioral health and chief medical officer of Magellan Health, previously told BHB. “I would give an example: If I am a parent and my child is having all sorts of troubles, and I respond to an ad that says, ‘Take them to wilderness care, we’ll fix everything,’ and I’m feeling desperate and [think], ‘I’ve got to do that’ — that’s not evidence-based care and, in fact, can be harmful. There is a predatory kind of arrangement targeting this if parity requires [plans] to pay for that. ​​What’s happening is that it’s care that’s not evidence-based and can actually be unsafe.”

An increasing number of exposés in mainstream media find that alumni from these programs see themselves as survivors. Socialite and media personality Paris Hilton is one of the industry’s toughest and most visible critics. She has testified before Congress and state houses several times, seeking greater industry regulation.

Tragic news stories have also surfaced regarding wilderness programs. Recently, a 12-year-old boy from New York died within hours of arriving at Lake Toxaway, North Carolina-based Trails Carolina on, Feb. 2. Local investigators consider the death to be unusual. An autopsy’s initial findings suggest the death “appeared to not be natural.” A cause of death has not been determined, according to the Transylvania County Sheriff’s Office.

This was not the first child to die at the camp. A 17-year-old boy died at Trails Carolina in 2014. His body was found 12 days after running away from the camp.

A representative of Trails Carolina tells BHB that it is still “continuing to evaluate all possible options for the future of the program.” It employs about 75 people.

Sources close to the company tell BHB that the recent death and the fallout from state and local officials have pushed Trails Carolina close to shutting down. On Monday, Trails leaders told staff that they were exploring options, including an outright closure as well as employee furloughs.

Altogether, the ramping up of what some in the industry call “headline risk” has driven down investment and M&A activity in the space.

“I talk to private equity investors every day, and one of their main concerns is headline risk,” Kevin Taggart, managing partner of the health care M&A firm Mertz Taggart, told BHB. “Nobody wants to be in the newspaper for any reason, but especially if it involves a child that was taken advantage of or passed away.”

This headline risk is widely applicable to behavioral health, especially for investors unfamiliar with health care. PitchBook’s latest health care report says the wider political environment and public sentiment will tamp down investment in behavioral health. However, firms already familiar with the behavioral health industry won’t likely be deterred. But the behemoths of the investing and financial industries might stay out of the industry.

There is some potential for investment to pick up in the broader at-risk youth market. Interest in meeting the increasing demand for — as well as going after increased funding for — youth-specific mental health services may drive increased activity in the small and somewhat sleepy industry, Nancy Weisling, a managing director at the M&A firm The Braff Group, told BHB.

Still, the interest would likely be in care models that have strong ties to payer reimbursement, like IOPs or residential treatment centers, she said.

“Buyers are starting to become interested in that targeted population,” Weisling said. “A lot of what drives buyer’s interest is driven by what we see in the news and what’s happening in the world every day. So much of that is about the mental health needs of teens and adolescents. And we’re starting to hear that now from buyers and investors.”