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 HarrisonPosted August 12, 2004 at www.askquestions.org
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 isnot the daughter’s real name). Taylor, who lives in Thousand Oaks, California, knew shecouldn’t handle Grace’s needs by herself. She took Grace to a therapist, who recognizedthe overwhelming nature of Taylor’s other responsibilities and suggested that Taylorplace 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 enteredin December, 2003, the school promised therapy mixed with outdoor sports, dances, andother recreational activities.
Less than a month later, says Taylor, Grace came home covered in bruises, gaunt andtraumatized by her experiences. On one of the worst nights, says Taylor, staff forciblyinjected Grace with the antipsychotic drug Haldol for supposed insubordination. Grace’sonly crime, she told Taylor, was telling staff she needed to use the bathroom. Graceawoke to a kick the next morning and found herself lying on a hallway floor, her visionblurred and her facial muscles severely contorted. Worse still, Taylor says that Grace, arape victim and voluntary patient, was forced to submit to strip searches on severaloccasions and was sexually assaulted by Provo Canyon staff—only compoundingGrace’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 centerslike Provo Canyon: there were 43,365 admissions to RTCs in 1997, and 27,642 patientsunder care in RTCs at that time, according to a 2000 report by the United States SurgeonGeneral’s office http://www.mentalhealth.org/publications/allpubs/SMA01-3537/chapter15.asp
Private residential treatment centers can cost as much as a year in college; they’re mostlythe province of well-off parents. However, some insurance companies will covertreatment at schools accredited by Joint Commission for Accreditation of HealthcareOrganizations (JCAHO), an independent, nonprofit organization that inspects andaccredits nearly 16,000 health care facilities in the United States. But JCAHO’s standardsare geared mainly toward monitoring surgical and pharmacological procedures. And soRTCs, which are more like boarding schools than traditional hospitals, can become
accredited under standards that have little to do with the daily programs and activitiespracticed in them. Many RTCs are not accredited at all.
Some residential treatment programs have amassed a disturbing number of complaintsfrom kids and parents who, like the Taylors, allege that the schools physically andmentally abuse their students. Recent articles in the New York Times
and the UKGuardian
document abuses at treatment centers abroad including Tranquility Bay Schoolin Jamaica. Controversy has arisen in Tranquility Bay amid the death of a student, parentcustody battles, and allegations of unlawful incarceration. Lawsuits have been broughtagainst the Worldwide Association of Specialty Programs and Schools (WWASPS), anaffiliated group of private residential treatment centers and schools that managesTranquility Bay. And there are many complaints about other RTCs on websites run bywatchdog 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 phoneprivileges to solitary confinement and physical punishments, according to survivors.
In recent years, government agencies in other countries have begun to crack down onthese American-owned programs; authorities in Costa Rica, Mexico and the CzechRepublic have shut down at least four WWASPS programs thus far. But in the UnitedStates, regulators have been less assertive. In 2003, Congressman George Miller ofCalifornia asked the United States Department of Justice (DOJ) to investigate a growingnumber of allegations against WWASPS, but to date the DOJ has taken no action. InUtah, State Office of Licensing Director Ken Stettler proposed legislation that wouldhave established stricter licensing requirements for teen treatment centers, but it didn’t flywith lawmakers. As Stettler told the Salt Lake Tribune
in April, 2004,http://22.214.171.124/2004/apr/04102004/utah/155803.asp many Utah legislators felt thathis office was “empire building” when it proposed instituting licenses for the paid “escortservices” that private treatment centers use to transport teens to their facilities, eventhough there are many complaints against them.
After her daughter’s ordeal, Helen Taylor mounted a letter-writing campaign to informStettler 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 legislatorsare taking reports of child abuse in their state very lightly and that the police are clearlyacting in league with abusive schools. Local police routinely come out to help ProvoCanyon deal with attempted escapes, for example, but have not investigated thechildren’s charges of abuse. “This is political corruption at its worst,” Taylor said.
Parents like Taylor commonly assume that there is more government oversight thanactually exists within the treatment industry. On the contrary, kids incarcerated in ajuvenile prison may have more protection from abuse than kids voluntarily enrolled inprivate 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 advantageof distressed parents. Some families have experienced problems with the enrollmentcontracts, discovering too late that they signed away too much authority or waived toomany of their legal rights regarding disputes with the schools.
Parent Watchdog Groups
Survivors and parents have formed watchdog groups and mounted education campaignsto warn other families about the risks. Some are listed below. Other parents are pressinglawmakers to step in: Helen Taylor has developed an email list for updates on herattempts to contact legislators, while another person launched Fornits, a web forum withan extensive teen treatment section allowing survivors and parents to air theirfrustrations, tell their stories, and strategize the legal and criminal investigation ofabusive facilities. Many people now in their forties post messages at Fornits documentingthe long-term devastation that results from time they spent in RTCs as teenagers.
And even parents whose children were well served at residential programs are wary ofthe teen treatment industry because of the big money involved. Linnea Soderlund, aparent who sent her teenage son to two different residential programs primarily for whatshe called “out-of-control behavior,” says that parents should proceed with extremecaution when selecting a residential program. “Consultants and programs are happy totake 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 ina treatment program,” because parental vigilance is the best protection against abuse.
Soderlund also counsels parents to seek expert diagnosis when determining whether tosend a child to residential treatment. “I would urge anyone considering residentialtreatment to obtain a physical exam and complete psychological evaluation beforemaking any plans for treatment,” she wrote. While she said that the psychologicalevaluation was a large expense not covered by insurance, she was “immeasurablythankful” that she got one for her daughter. “This is the only way to determine what theissues are and what is at stake,” she wrote.
Karen Stanton, another parent who has enrolled a child in residential treatment and wasparticularly happy with the results, agrees that it’s crucial to screen both the child and theschool. Her son, Peter, was diagnosed with dyslexia at a young age, and she and herhusband had tried numerous treatments including therapy, Ritalin, summer programs, anda private school for students with learning disabilities. Nothing worked, she said, untilshe found an educational consultant who reviewed Peter’s test results, talked to histeachers 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.” Stantonadded, “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 askabout any commercial ties between your consultant and the schools so that you canevaluate their recommendations accordingly.
Experts are Skeptical
Unfortunately, even if a parent finds a suitable, non-abusive program, there is noguarantee that the program will provide long-lasting results. Dr. Oscar Bukstein, anassociate professor of psychiatry at the University of Pittsburgh School of Medicine whospecializes in children’s psychiatric disorders, says that even when kids make progress inthese “tough-love” residential programs, they very often have trouble reincorporating theskills 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 placeuntil 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 andcommunity-based intensive treatment centers that provide more than just an hour a weekof counseling are good options for overwhelmed parents, and that generally kids don’tneed “tough love” to be treated effectively. “You have to model appropriate behavior,”he said, “but intimidation doesn’t model appropriate behavior—being tough andconsistent doesn’t entail being mean and abusive.”
Listening to adults who were sent to RTCs as teenagers, you often hear a much harsherjudgement of these programs. Said one, “These tough love programs are not merelyineffective, but often totally devastating to the children and families taken in by theirmarketing experts.” Many adult survivors wan the programs shut down completely.
The late Dr. Loren Mosher, Clinical Professor of Psychiatry at the University ofCalifornia at San Diego School of Medicine and former Chief of the Center for Studies ofSchizophrenia at the National Institutes of Mental Health, agreed that residential centersaren’t effective at training patients to function in their normal environment. “If thoseprograms are not continued after they get back,” he said, “the learning they received isgone within three weeks to six months.” Mosher, who is best known as the founder ofSoteria, a revolutionary treatment center for schizophrenics that eschewed medicationand placed patients in a shared living situation with non-medical-professionals, said thatany effective treatment should involve the whole family. “Anything that doesn’t,” hesaid, “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 thanresidential programs.
“I don’t think there’s much out there to tell parents about where you draw the linebetween normal teenage acting-out and serious behavior problems,” said Barbara Huff,Executive Director of the Federation of Families for Children’s Mental Health. While shesays there are no easy answers to this question, guidance counselors at the local schools,
private therapists, and other professionals can help identify children with behaviorproblems 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 despairthat keeps them from seeking appropriate help close to home. “We all fear the stigma thatis attached to ‘troubled teens,’” said Dawn Martin-Rugo, a parent who enrolled herdaughter in a wilderness program and a therapeutic boarding school. “We want to protectour teen and ourselves from the judgments of others, but it is important to get over thisfear as quickly as possible—everyone knows someone who has a child who has “fallenapart.’” Common sense and community support are your best protections against the falsepromises offered by unscrupulous people who stand to profit from selling you anexpensive residential program.
If your children or your friends’ children run into trouble, consider these tips from otherparents 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
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
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 inEducation. The site provides a good collection of documents and news articles from arange of sources. http://www.nospank.net/boot.htm
The International Survivors Action Committee</a> is a nonprofit, independent watchdogorganization. Their site includes a list of warning signs to help parents avoid abusiveprograms, 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 beencampaigning for reform of residential treatment programs since 1989 when his son wasabused in one. His site includes his book and information about other books on thesubject. http://www.thestraights.com
Personal testimonials from survivors and their families can be found at Fornits.com/wwfhttp://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 aconsultant. http://www.educationalconsulting.org/
Here are well researched, recent news articles: f
rom the NY Times, January 2003,
“Parents Divided Over Jamaica Disciplinary Academy” http://nospank.net/n-k52.htm and
from the British paper, Guardian an article published last summer also looks at the
Tranquility Bay program in Jamaica.
http://observer.guardian.co.uk/magazine/story/0,11913,987172,00.html 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.
Powerless to Tackle Piracy? The naval forces face a thankless task. Theiral community needs to involve the littoral coun-course of action is rather limited by three self-tries in the fight against piracy. A “Cooperativeimposed restrictions. The safe havens of the pi-Mechanism at the Horn of Africa” needs to berates are not to be attacked despite the fact thatestablished copying the
Robert P. Wills, M.D. Brannon R. Frank, M.D. John W. Wages, M.D. Christine M. Anderson, M.D. Paul H. Le, M.D. Alan D. Silberberg, M.D. Laura K. Prewitt-Buchanan, M.D. Austin, TX 78758 Phone: 512-416-7246 Fax: 512-416-6791 www.austinpainassociates.com APA In-Office Procedure Room Guidelines PRE-PROCEDURE INSTRUCTIONS PATIENT INFORMATION: For your safe