Questions & Answers
When attempting to explain the “Troubled Teen Industry” and the widespread child abuse that occurs within it, I am often met with several common questions and incorrect assumptions. The purpose of this article is to provide a comprehensive overview of this industry, how it operates, and what has been researched and proven in regards to child abuse.
Q. What is the “Troubled Teen Industry”?
A. Across the United States (and in remote countries, operated by US corporations) there is a burgeoning industry of for-profit specialty boarding schools, behavior modification facilities, emotional growth schools, and wilderness education programs that all focus on “rehabilitating” or “treating” struggling youth. A simple internet search for “troubled teen” will reveal 100’s of different facilities, each utilizing different modes of treatment. Unlike jail or juvenile hall, the youth sent to these facilities do not have to commit a crime. There are no specific enrollment requirements for most of these facilities, so youth are admitted solely at their parent’s discretion. The length of stay for the majority of these programs is 12-18 months, with many kids staying for multiple years. The typical age range treated is 12-17, however some facilities accept youth both younger and older.
Q. But how many parents would really send their kids off to a private facility?
A. As many states do not require private specialty schools of this type to register or apply for licensing, there is little statistical data available as to the total number of children enrolled in a private facility at any given time. In a report sponsored by the Alliance for the Safe, Therapeutic and Appropriate Use of Residential Treatment, the Department of Child & Family Studies at the University of South Florida, and the Bazelon Center for Mental Health Law, it is noted that, “The issue is that we don’t even know how many youngsters are living in these programs, or how many have died in them. In fact we don’t have a shred of legitimate data on the overall short-term and long-term effects of these programs on the youth that they serve.” A further study by the Bazelon Center for Mental Health Law, details that, “The number of children placed in residential treatment centers (or RTCs) is growing exponentially. These modern-day orphanages now house more than 50,000 children nationwide.” While official statistics are difficult to assertain, it is clear that this is a widespread issue affecting many families across the United States.
What is Child Abuse?
Any recent act or failure on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or an act or failure to act which presents an imminent risk of serious harm
The Federal legislation above is only the minimum definition. Most states have expanded upon this law to better specify the specifics associated with the different types of abuse that can be inflicted upon children.
Overall, most states recognize the following as forms of child abuse:
Abandonment, wherein the child is found to be abandoned when the parent’s identity or whereabouts are unknown, the child has been left alone in circumstances where the child suffers serious harm, or the parent has failed to maintain contact with the child or provide reasonable support for a specified period of time
Emotional and Psychological Abuse, where the child is subjected to a pattern of behaviors that impair their emotional development or sense of self-worth. This includes constant criticism, threats, rejection, or withholding love, support, or guidance.
Physical Abuse, when non-accidental physical injury is inflicted by a parent, caregiver, or person held responsible for the care of the child. Physical injury is considered abuse regardless of whether the caregiver intended to hurt the child, with the exception of physical discipline, providing it is reasonable and causes no bodily injury to the child.
Neglect, where the child is denied basic needs in regards to physical safety and protection, medical attention, educational access, and emotional care.
For the purposes of this paper, “child abuse” in residential programs and institutions shall be defined using the same guidelines outlined above.
Q. Child abuse is illegal, so it must be illegal to abuse children in these facilities, right?
A. In theory, yes. In practice, no. The majority of programs limit or monitor communication between youth and their families. Most programs will only allow a monitored phone call after the student has been at the facility for a minimum of 30-45 days, or has reached a specific level or number of points within the program. Typically, all mail is monitored and students are provided no access to any communication with the outside world, including law enforcement. Parents are typically warned that their child will likely use “manipulation tactics” to have themselves removed from the facility. This often leads to claims of abuse or mistreatment being ignored by parents and caregivers. Further, as most facilities are exempt from any Federal or State oversight, regular inspections of the facilities or their practices are typically not performed. This loophole allows for a variety of tactics including restraint, isolation, and unique therapy techniques to be utilized by often untrained staff with little to no background in juvenile justice, child care, or psychology. Without proper training, many of these tactics can be abusive in and of themselves as they are often overused or incorrectly implemented. Overall, the environment is condusive to abuse as it places teens in an isolated environment without specific requirements or standards for the care they are provided, leaving them vulnerable to abuse and neglect.
An important point to recognize is that most Federal and State child protection laws primarily refer to cases of harm to a child caused by parents or other caregivers; they do not generally include harm caused by other people, such as acquaintances or strangers.
As described in testimony and documentation from the United States Government Accountability Office, “States are primarily responsibly for ensuring the well-being of youth in facilities and other settings, and do so by setting their own standards of care certain facilities must meet to obtain and maintain an operating license.” While Federal laws do exist to protect the civil rights of students residing in programs primarily funded by state or local governments, “Federal oversight authority does not extend to private facilities that serve only youth placed and funded by parents or by private entities. In some states, safeguarding youth in these facilities is the primary responsibility of the parents and facility staff.”
This report goes on further to explain that, “All states have processes in place to license and monitor certain residential facilities, but states reported oversight gaps that may place youth in some facilities at higher risk for maltreatment and death. Most notably, state agencies exempted some types of government and private facilities from licensing requirements altogether, primarily juvenile justice facilities and private schools and academies. In addition, licensing standards do not always address suicide and other common risks to youth well-being. Although monitoring is key to ensuring facility compliance with standards, agencies in states we visited reported an inability to conduct yearly on-site reviews of conditions at each facility, because of fluctuating levels of staff resources committed by the state. Similarly, although information sharing can strengthen oversight for facilities shared by multiple agencies, many state agencies reported that they did not routinely share information with other state agencies about negative findings or when facility licenses were suspended or revoked. HHS, DOJ, and Education all have processes to hold states accountable for the well-being of youth, but federal efforts are hindered by the scope of the agencies’ oversight authority and monitoring practices. Most notably, these agencies do not have the authority to hold states accountable for youth well-being in private residential facilities unless they serve youth in state programs that receive federal funds. For facilities under federal purview, federal requirements did not always address the primary risks to youth well-being, such as suicide, and requirements were inconsistent among programs. In monitoring state compliance, federal agencies did not always include residential facilities in their oversight reviews.”
This creates an enormous loophole within the child abuse laws, essentially allowing parents (and in some cases state and federal authorities) to place children in unlicensed, non-regulated facilities, placing them at risk for abuse, neglect, and death.
Q. How Big of an Issue Is This?
A. According to the GAO report referenced above, investigators found that “Survey respondents from 49 states reported investigating complaints of youth maltreatment in residential facilities in 2006, including physical abuse, neglect, and sexual abuse, and 28 states reported deaths.”
The GAO report also stated that “State-reported data collected by HHS in 2005 showed 1,503 incidents of maltreatment by facility staff in 34 states, including physical abuse, neglect or deprivation of necessities, and sexual abuse. Moreover, 28 states responding to our survey reported at least one death in residential facilities in 2006, with accidents and suicides among the most common types of fatalities. These reported data, however, did not captureinformation from all facilities. Many states lack authority under state law to collect data on exclusively private facilities, and data that states did report were often incomplete. As a result, the number of adverse incidents was likely more numerous and widespread than reported.”
Teen Advocates USA, an advocacy group for survivors of institutionalized child abuse, offers a memorial page on their website that pays tribute to some of the youth who have died within a residential treatment facility, listing their cause of death and the facility at which they were held. This site reports a total of 115 deaths ranging in cause from suicide, accidental death, restraint related death, drowning, neglect, suicide, and cases still under investigation. While this is not a comprehensive number of all children who have ever died as a result of abuse within an institutionalized treatment center, is still represents an alarmingly high number of preventable deaths of youth.
A second GAO report, titled “SECLUSIONSANDRESTRAINTS: Selected Cases of Death and Abuse at Public and Private Schools and Treatment Centers” released in 2009 goes into greater detail on the types of abuse and causes of death they found during their investigation of the troubled teen industry. Seclusion and Restraint are two forms of punishment that are widely used within troubled teen facilities. As released in the report, “GAO found no federal laws restricting the use of seclusion and restraints in public and private schools and widely divergent laws at the state level. Although GAO could not determine whether allegations were widespread, GAO did find hundreds of cases of alleged abuse and death related to the use of these methods on school children during the past two decades.” Noting that there is little to no oversight on the use of these methods in both public and private facilities, it is not surprising that these tactics have been abused and in some cases, have led to severe abuse, neglect, and death.
The study notes that, “Of the hundreds of allegations we identified, at least 20 involved restraints that resulted in death. Of the 10 closed cases we examined, 4 involved children who died as a result of being restrained. In all 4 cases, staff members used restraint techniques that restricted the flow of air to the child’s lungs. In one of these cases, an aide sat on top of a child to prevent him from being disruptive and ultimately smothered him. The other cases related to the use of different types of prone restraints, a technique that typically involves one or more staff members holding a child face down on the floor. Currently, eight states specifically prohibit the use of prone restraints or restraints that impede a child’s ability to breathe.”
Three specific cases are noted in the study that directly relate to the death of teens in private institutions for troubled youth.
“Case 1: The victim was a 15-year-old male who died while being restrained by two counselors. According to the victim’s mother, in 2000 she enrolled her son in a wilderness program in Oregon to build his confidence and develop self-esteem in the wake of a childhood car accident. The accident had resulted in her son sustaining a severe head injury, among other injuries. According to her lawsuit, her son left the program headquarters on a group hike with three counselors and three other students. Several days into the multiday hike, the victim refused to return to the campsite after being escorted by a counselor about 200 yards to relieve himself. Two counselors then attempted to lead him back to the campsite. According to an account of the incident, when he continued to refuse, they tried to force him to return and they all fell to the ground together. The two counselors subsequently held the victim face down in the dirt until he stopped struggling; by one account a counselor sat on the victim for almost 45 minutes. When the counselors realized the victim was no longer breathing, they telephoned for help and requested a 911 operator’s advice on administering CPR. While the mother was driving to the hospital, her son’s doctor called, advised her to pull to the side of the road, and informed her that her son had died. The victim’s mother told us that she was informed, after the autopsy, that the main artery in her son’s neck had been torn. The cause of death was listed as a homicide. In September 2000, after the boy’s death, one of the counselors was charged with criminally negligent homicide. A grand jury subsequently declined to indict him. In early 2001, the mother of the victim filed a $1.5 million wrongful death lawsuit against the program, its parent company, and its president. The lawsuit was settled in 2002 for an undisclosed amount”
“Case 2: The victim, who died in 2005, was a 12-year-old male. Documents obtained from the Texas Department of Family and Protective Services indicate that the victim had a troubled family background. He was taken into state care along with his siblings at the age of 6. As a ward of the state, the victim spent several years in various foster placements and youth programs before being placed in a private residential treatment center in August 2005. The program advertised itself as a “unique facility” that specialized in services for boys with learning disabilities and behavioral or emotional issues. The victim’s caretakers chose to place him in this program because he was emotionally disturbed. Records indicate that he was covered by Medicaid. On the evening of his death, the victim refused to take a shower and was ordered to sit on an outside porch. According to police reports, the victim began to bang his head repeatedly against the concrete floor of the porch, leading a staff member to drag him away from the porch and place him in a “lying basket restraint” for his own protection. During this restraint, the 4 feet 9½ inch tall, 87-pound boy was forced to lie on his stomach with his arms crossed under him as the staff member, a muscular male 5 feet 10 inches tall, held him still. Some of the children who witnessed the restraint said they saw the staff member lying across the victim’s back. During the restraint, the victim fought against the staff member and yelled at him to stop. The staff member told police that the victim complained that he could not breathe, but added that children “always say that they cannot breathe during a restraint.” According to police reports, after about 10 minutes of forced restraint, the staff member observed that the victim had calmed down and was no longer fighting back. The staff member slowly released the restraint and asked the victim if he wanted a jacket. The victim did not respond. The staff member told police he interpreted the victim’s silence as an unwillingness to talk because of anger about the restraint. He said he waited for a minute while the victim lay silently on the ground. When the victim did not respond to his question a second time, he tapped the victim on the shoulder and rolled him over. The staff member observed that the victim was pale and could not detect a pulse. All efforts to revive the victim failed, and he was declared dead at a nearby hospital. Although the Texas Department of Family and Protective Services alleged that the victim’s death was because of physical abuse, the official certificate of death stated that it was an accident and a grand jury declined to press charges against the staff member performing the restraint. However, the victim’s siblings obtained a civil settlement against the program and the staff member for an undisclosed amount.”
“Case 3: The victim was 16 years old when he died, in February 2006, at a private psychiatric residential treatment facility in Pennsylvania for boys with behavioral or emotional problems. He was a large boy—6 feet 1 inch in height and weighing about 250 pounds—and suffered from bipolar disorder and asthma. The cost for placement in this facility was primarily paid for by Medicaid. According to state investigative documents we obtained, the victim was placed in intensive observation after he attempted to run away. As part of the intensive observation, he was forced to sit in a chair in the hallway of the facility and was restricted from participating in some activities with other residents. On the day of his death, staff allowed the victim to participate in arts, crafts, and games with the other youth, but would not let him leave the living area to attend other recreational activities. Instead, staff told the victim that he would have to return to his chair in the hallway. In addition, staff told him that he would have to move his chair so that he could not see the television in another room. The victim complied, moving his chair out of view of the television, but put up the hood of his sweatshirt and turned his back toward the staff. The staff ordered him to take down his hood, but he refused. When one of the staff walked up to him and pulled his hood down, the victim jumped out of his chair and made a threatening posture with his fists, saying he did not want to be touched. The staff member and two coworkers then brought the victim to another room and held him facedown on the floor with his arms pulled up behind his back. The victim struggled against the restraint, yelling and trying to kick the three staff members holding him down. After about 10 minutes, the victim became limp and started breathing heavily. He complained that he was having difficulties breathing. One staff member unzipped his sweatshirt and loosened the collar of his shirt, but rather than improve, the victim became unresponsive. The staff called emergency services and began CPR. The victim was taken by ambulance to a hospital, where he died a little more than 3 hours later. In the victim’s autopsy report his death was ruled accidental, as caused by asphyxia and an abnormal heartbeat (cardiac dysrhythmia). No criminal charges were filed in regard to the victim’s death. The victim’s mother filed a civil suit over her son’s death against the facility. The suit was pending at the time we completed our investigation.”
Currently, there is no comprehensive data available on the specific licensing requirements by state. It is important to note, however, that most programs operate without any state or federal oversight whatsoever and there are no specific requirements as to the types of therapy and curriculum they provide, nor are staff and facilitators required to meet any specific training or education requirements. In the same report provided by A Start, a letter to Congress notes, “The Child Welfare League of America (CWLA) and our 900 member child-caring, public and private agencies nationwidehave serious concerns about the growing number of unlicensed residential programs and camps for troubled children and youth, often referred to as therapeutic boarding schools or boot camps….These programs are often unregulated by an appropriate state agency or held accountable to any recognized accrediting organization. Allegations of neglect and abuse at many of these programs include the inappropriate use of medications, the employment of vigorous physical means of restraint, or individual seclusion or isolation. Questions are often raised about the credentials of the employees who staff these programs.”
Q. Why isn’t Everyone Involved?
A. Due to lack of comprehensive statistical data and the avoidance of elected officials to get involved in regulating this industry, the issue remains largely at the grassroots level. Some legislation has been previously introduced, such as H.R. 911, however it did not pass through the Senate. Although there is yet to be any formal legislation passed, several advocacy groups have formed and are becoming stronger and louder voices. Abuse in institutions and residential treatment center will only be stopped through education, awareness, and advocacy. We must all work hard to spread as much news as possible, form united lobbying groups to work towards political change, and help to engage the public with our stories and calls to action.
To get involved, the following are excellent resources:
In addition to the links above, several excellent articles and television news pieces are available online:
Montana PBS Aired “Who’s Watching the Kids” in 2007
Maia Szalavitz published “The Trouble with Troubled Teen Programs” in the January ’07 issue of Reason.com
Joanne Green published “Rough Love” in the Miami New Times in 2006
Lou Kilzer released highly regarded “Desperate Measures” in the Rocky Mountain News in 1999
Tim Weiner released “Parents Divided Over Jamaica Disciplinary Academy” in the New York Times on June 17, 2003
Mark Levine released two three-hour segments on the “Abuse of Teenagers in Drug Programs” on September 15th and 16th 2011 and his radio show.
In 2006, a French documentary titled “Tranquility Bay: Les Enfants Perdus De Tranquility Bay” was released that focuses specifically on WWASP (World Wide Association of Specialty Schools) facility Tranquility Bay in rural Jamaica
The BBC released “Teen Rendition” in 2009
In summary, it is important to note that you – as a reader – are an important asset in bringing attention to this issue. Share this blog & the referenced links with as many people as possible. Contact your state and Federal representatives and demand action. Research what programs are currently operating in your state and share any news articles found about allegations of abuse, neglect, or fraud. If you or someone you know have been a victim of institutionalized child abuse, are a former staff member of one of these facilities with stories to tell, or have your own blog or website that you would like referenced on WWASPDiaries, please e-mail firstname.lastname@example.org.