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Safe Choices for Troubled Teens
Residential treatment centers for troubled teens are plagued by allegations of abuse and ineffectiveness. But do anguished parents have an alternative?

By Anthony Meza-Wilson and Christy Harrison

Posted August 12, 2004

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Helen Taylor didn’t feel like she had much choice. A registered nurse and mother of five, Taylor was caring for a sick parent and studying for a law degree when her seventeen-year-old daughter Grace* was raped at a party and fell into a deep depression. (Grace is not the daughter’s real name). Taylor, who lives in Thousand Oaks, California, knew she couldn’t handle Grace’s needs by herself. She took Grace to a therapist, who recognized the overwhelming nature of Taylor’s other responsibilities and suggested that Taylor place her daughter in residential treatment. Mother and daughter both agreed that a full-time care facility was a good idea, and Grace, who had always been a well-adjusted, bright girl, was willing to do whatever the therapist suggested in order to get better. Taylor asked a neighbor for advice, and after a little research and a tour of the facility, decided on a treatment center in Utah called Provo Canyon School. When Grace entered in December, 2003, the school promised therapy mixed with outdoor sports, dances, and other recreational activities.

Less than a month later, says Taylor, Grace came home covered in bruises, gaunt and traumatized by her experiences. On one of the worst nights, says Taylor, [] staff forcibly injected Grace with the antipsychotic drug Haldol for supposed insubordination. Grace’s only crime, she told Taylor, was telling staff she needed to use the bathroom. Grace awoke to a kick the next morning and found herself lying on a hallway floor, her vision blurred and her facial muscles severely contorted. Worse still, Taylor says that Grace, a rape victim and voluntary patient, was forced to submit to strip searches on several occasions and was sexually assaulted by Provo Canyon staff—only compounding Grace’s emotional despair. Provo Canyon did not return phone calls seeking comment.

It's a Big Business

Despite horror stories like this one, there is big business in residential treatment centers like Provo Canyon: there were 43,365 admissions to RTCs in 1997, and 27,642 patients under care in RTCs at that time, according to a 2000 report by the United States Surgeon General's office.

Private residential treatment centers can cost as much as a year in college; they’re mostly the province of well-off parents. However, some insurance companies will cover treatment at schools accredited by Joint Commission for Accreditation of Healthcare Organizations (JCAHO), an independent, nonprofit organization that inspects and accredits nearly 16,000 health care facilities in the United States. But JCAHO’s standards are geared mainly toward monitoring surgical and pharmacological procedures. And so RTCs, which are more like boarding schools than traditional hospitals, can become accredited under standards that have little to do with the daily programs and activities practiced in them. Many RTCs are not accredited at all.

Some residential treatment programs have amassed a disturbing number of complaints from kids and parents who, like the Taylors, allege that the schools physically and mentally abuse their students. Recent articles in the New York Times and the UK Guardian document abuses at treatment centers abroad including Tranquility Bay School in Jamaica. Controversy has arisen in Tranquility Bay amid the death of a student, parent custody battles, and allegations of unlawful incarceration. Lawsuits have been brought against the Worldwide Association of Specialty Programs and Schools (WWASPS), an affiliated group of private residential treatment centers and schools that manages Tranquility Bay. And there are many complaints about other RTCs on websites run by watchdog groups, parents, and survivors.

Most RTCs use a religious "tough love" approach to treatment, doling out points for “appropriate behavior” and imposing consequences—ranging from the loss of phone privileges to solitary confinement and physical punishments, according to survivors.

Lax Regulators

In recent years, government agencies in other countries have begun to crack down on these American-owned programs; authorities in Costa Rica, Mexico and the Czech Republic have shut down at least four WWASPS programs thus far. But in the United States, regulators have been less assertive. In 2003, Congressman George Miller of California asked the United States Department of Justice (DOJ) to investigate a growing number of allegations against WWASPS, but to date the DOJ has taken no action. In Utah, State Office of Licensing Director Ken Stettler proposed legislation that would have established stricter licensing requirements for teen treatment centers, but it didn’t fly with lawmakers. As Stettler told the Salt Lake Tribune in April 2004, many Utah legislators felt that his office was “empire building” when it proposed instituting licenses for the paid “escort services” that private treatment centers use to transport teens to their facilities, even though there are many complaints against them.

After her daughter’s ordeal, Helen Taylor mounted a letter-writing campaign to inform Stettler and other state and federal legislators of Grace’s experiences at Provo Canyon, but to date she has only received a couple of terse replies. She feels that these legislators are taking reports of child abuse in their state very lightly and that the police are clearly acting in league with abusive schools. Local police routinely come out to help Provo Canyon deal with attempted escapes, for example, but have not investigated the children’s charges of abuse. “This is political corruption at its worst,” Taylor said.

Parents like Taylor commonly assume that there is more government oversight than actually exists within the treatment industry. On the contrary, kids incarcerated in a juvenile prison may have more protection from abuse than kids voluntarily enrolled in private treatment centers. The DOJ routinely shuts down juvenile prisons when abuse occurs, but it has yet to investigate the private RTCs. The industry is not well regulated, most facilities operate without accreditation or a license, and some take unfair advantage of distressed parents. Some families have experienced problems with the enrollment contracts, discovering too late that they signed away too much authority or waived too many of their legal rights regarding disputes with the schools.

Parent Watchdog Groups

Survivors and parents have formed watchdog groups and mounted education campaigns to warn other families about the risks. Some are listed below. Other parents are pressing lawmakers to step in: Helen Taylor has developed an email list for updates on her attempts to contact legislators, while another person launched Fornits, a web forum with an extensive teen treatment section allowing survivors and parents to air their frustrations, tell their stories, and strategize the legal and criminal investigation of abusive facilities. Many people now in their forties post messages at Fornits documenting the long-term emotional devastation that results from time they spent in RTCs as teenagers.

Even parents whose children were well served at residential programs are wary of the teen treatment industry because of the big money involved. Linnea Soderlund, a parent who sent her teenage son to two different residential programs primarily for what she called “out-of-control behavior,” says that parents should proceed with extreme caution when selecting a residential program. “Consultants and programs are happy to take thousands of dollars from you in exchange for the hope of saving your kid,” Soderlund wrote me in an email. She says, “Stay in close touch if you place your child in a treatment program,” because parental vigilance is the best protection against abuse.

Soderlund also counsels parents to seek expert diagnosis when determining whether to send a child to residential treatment. “I would urge anyone considering residential treatment to obtain a physical exam and complete psychological evaluation before making any plans for treatment,” she wrote. While she said that the psychological evaluation was a large expense not covered by insurance, she was “immeasurably thankful” that she got one for her daughter. “This is the only way to determine what the issues are and what is at stake,” she wrote.

Karen Stanton, another parent who has enrolled a child in residential treatment and was particularly happy with the results, agrees that it’s crucial to screen both the child and the school. Her son, Peter, was diagnosed with dyslexia at a young age, and she and her husband had tried numerous treatments including therapy, Ritalin, summer programs, and a private school for students with learning disabilities. Nothing worked, she said, until she found an educational consultant who reviewed Peter’s test results, talked to his teachers and therapists, and helped find programs that were tailored to his specific needs. Stanton says that their consultant was “expensive, but totally worth the money.” Stanton added, “We were desperate when we went to her.”

Several parents we spoke with reported using educational consultants with good results, but here again, parents must be careful. Some consultants accept financial rewards for enrolling kids in specific programs, so bias could be a problem. It is important to ask about any commercial ties between your consultant and the schools so that you can evaluate their recommendations accordingly.

Experts are Skeptical

Unfortunately, even if a parent finds a suitable, non-abusive program, the long-lasting results are difficult to predict. Dr. Oscar Bukstein, an associate professor of psychiatry at the University of Pittsburgh School of Medicine who specializes in children’s psychiatric disorders, says that even when kids make progress in these “tough-love” residential programs, they very often have trouble reincorporating the skills they learn into their home lives. “When kids get back to their original situation, they start to slip back,” he said. “If anything, the center is probably a safe holding place until kids mature out of [their behavior problems].”

Bukstein also says that some parents send their kids to residential treatment too early, without first considering other and potentially better options. He says therapy and community-based intensive treatment centers that provide more than just an hour a week of counseling are good options for overwhelmed parents, and that generally kids don’t need “tough love” to be treated effectively. “You have to model appropriate behavior,” he said, “but intimidation doesn’t model appropriate behavior—being tough and consistent doesn’t entail being mean and abusive.”

Listening to adults who were sent to RTCs as teenagers, you often hear a much harsher judgement of these programs. Said one, "these toughlove programs are not merely ineffective, but often totally devastating to the children and families taken in by their marketing experts." Many adult survivors want the programs shut down completely.

The late Dr. Loren Mosher, Clinical Professor of Psychiatry at the University of California at San Diego School of Medicine and former Chief of the Center for Studies of Schizophrenia at the National Institutes of Mental Health, agreed that residential centers aren’t effective at training patients to function in their normal environment. “If those programs are not continued after they get back,” he said, “the learning they received is gone within three weeks to six months.” Mosher, who is best known as the founder of Soteria, a revolutionary treatment center for schizophrenics that eschewed medication and placed patients in a shared living situation with non-medical-professionals, said that any effective treatment should involve the whole family. “Anything that doesn’t,” he said, “is probably a waste of time.” He advocated straightforward family counseling, which is widely available and which, he said, usually costs a whole lot less than residential programs.

“I don’t think there’s much out there to tell parents about where you draw the line between normal teenage acting-out and serious behavior problems,” said Barbara Huff, Executive Director of the Federation of Families for Children’s Mental Health. While she says there are no easy answers to this question, guidance counselors at the local schools, private therapists, and other professionals can help identify children with behavior problems early on and can also work with families to find appropriate solutions.

And above all, experts agree, parents should avoid giving in to embarrassment or despair that keeps them from seeking appropriate help close to home. “We all fear the stigma that is attached to ‘troubled teens,’” said Dawn Martin-Rugo, a parent who enrolled her daughter in a wilderness program and a therapeutic boarding school. “We want to protect our teen and ourselves from the judgments of others, but it is important to get over this fear as quickly as possible—everyone knows someone who has a child who has “fallen apart.’” Common sense and community support are your best protections against the false promises offered by unscrupulous people who stand to profit from selling you an expensive residential program.

Practical Suggestions

IIf your children or your friends’ children run into trouble, consider these tips from other parents and mental health experts:

  • Get a ‘reality check’ from school officials, teachers, family, and friends to help assess the seriousness of the child’s behavior problems.
  • Explore local options first, and look for a therapy program that works with the whole family, not just the teen.
  • Invest in physical and psychological assessments that will define the child’s problem and point to appropriate remedies.
  • Hire an educational consultant who works only for the family (and does not receive a commission from schools).
  • Investigate the schools in person, and also check with the parent watchdog groups (listed below) to avoid the worst offenders.
  • Ask a lawyer to review enrollment contracts before signing them.
  • And finally, stay in contact with the child throughout their stay in a residential facility so that you can move them out quickly at the first sign of trouble.
Resources for Parents

NoSpank.net is the work of a group called Parents and Teachers Against Violence in Education. The site provides a good collection of documents and news articles from a range of sources.

The International Survivors Action Committee is a nonprofit, independent watchdog organization. Their site includes a list of warning signs to help parents avoid abusive programs, as well as a list of schools with the most damaging track records.

The Straights is a website created by a father named Wesley Fager, who has been campaigning for reform of residential treatment programs since 1989 when his son was abused in one. His site includes his book and information about other books on the subject.

Personal testimonials from survivors and their families can be found at Fornits.com/wwf

The Independent Educational Consultants Association (IECA) has a "find a consultant" feature on their web site, as well as some general information about working with a consultant.

Here are well researched, recent news articles: from the NY Times, January 2003 " Parents Divided Over Jamaica Disciplinary Academy". and from the British paper, The Guardian an article published last summer also looks at the Tranquility Bay program in Jamaica. And "Drug Mistreatment" from Mother Jones Magazine documents how courts and schools often force parent to put kids into treatment who may not actually need it.

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