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A Summary of
Participant Perspectives
Allison Pinto, PhD
A Summary of Participant
Perspectives on Residential Treatment for Youth Provided in States
across the Country and in Montana
Allison Pinto, Ph.D.
Louis de la Parte
Florida Mental Health Institute University of South Florida
Reports continue to emerge
regarding the mistreatment and abuse of American youth in
unregulated “therapeutic” boarding schools and similar “specialty”
residential treatment programs. An online survey was developed and
posted to gather information from young adults who participated in
these types of programs when they were adolescents. Reports from 230
former program participants who attended programs located in 21
states across the country and 5 countries outside the United States
reveal a pattern of communication and privacy rights violations,
misuse of seclusion and restraint, and inhumane treatment, as well
as significant distress and suffering relating to program
participation. An analysis of the reports submitted by 49 young
adults who attended programs in Montana, specifically, also revealed
this pattern. It is hoped that these findings will be informative to
decision-makers as the state of Montana reviews its policies
regarding the oversight of residential programs for youth and
considers legislation that would increase protections for children
and adolescents receiving any and all types of residential care.
INTRODUCTION
Over the past two years, while I
have served as the contact person for A START: Alliance for the
Safe, Therapeutic, and Appropriate use of Residential Treatment, I
have spoken with many parents and professionals who are shocked by
the descriptions of institutional abuse that continue to emerge
relating to the care that American adolescents are receiving in
unregulated “therapeutic” boarding schools and similar “specialty”
residential treatment programs across the country. In disbelief,
people often ask,
“How do you know that these aren’t just a few isolated incidents
that have been blown way out of proportion?” or
“How do you know that these aren’t just the complaints of “troubled
teens” who have already tried to manipulate their families, and the
residential programs, and now are trying to manipulate the public?”
At first, these were rather
difficult questions for those of us trained as social scientists to
answer. While there were dozens of newspaper articles that included
compelling accounts from former program participants and their
parents, there were no “hard data” to reference, and no research
studies to cite. However, as parents and former program participants
continued to contact A START and share their personal accounts and
concerns, it became increasingly clear that as mental health and
other child-serving professionals we needed to trust our intuition
that the concerns expressed by youth and families warranted further
investigation, and to trust that as the broader public became aware
of these problems, a caring, protective response would ultimately
follow. As social scientists, we realized that we could assist in
increasing public awareness by collecting more information on the
issues of concern through research and then sharing the research
findings with the public.
In order to gather reports from
individuals who participated in “specialty” boarding schools and
residential programs when they were adolescents, a survey was
developed and posted online. Within six months there have been over
500 responses to the survey. The detailed descriptions that young
adults have been willing to share through this survey have provided
data that reveals a highly disturbing phenomenon. While there are
youth and families who are satisfied with the care and services they
have received in “specialty” boarding schools and residential
programs, a significant number of adolescents report being
mistreated in programs across the country, in states including
Montana. It appears that there are not yet sufficient protections in
place throughout the country to keep all youth safe and ensure their
well-being when they are receiving residential care.
This report presents a summary of
the survey findings to provide a preliminary description of the
individuals who received services in “specialty” residential
programs and participated in the survey, as well as a description of
the services and care that were provided to these individuals when
they were adolescents in residential facilities. Findings are
presented first in terms of a general group of individuals who
attended programs in states across the country, and then in terms of
the group of individuals who attended programs in Montana,
specifically. Direct quotes from respondents who attended programs
in Montana are included to provide a more qualitative description of
their experiences and perspectives. It is hoped that these findings
will be informative to decision-makers as the state of Montana
reviews its policies regarding the oversight of residential programs
for youth and considers legislation that would increase protections
for children and adolescents receiving any and all types of
residential care.
SURVEY METHODOLOGY
An online survey was posted in July
2006 to gather information from young adults who as adolescents had
gained first-hand experience in residential treatment facilities in
the United States and abroad. In order to find people to participate
in the survey, young adults who attended programs as adolescents
were e-mailed an invitation to participate. Links to the survey were
also posted on various websites. Those individuals who had
previously corresponded with A START to express concerns about
unregulated residential facilities for youth were contacted in this
recruitment process. As such, this survey data does not reflect a
representative sample of youth with residential experience, but does
describe the perspectives of individuals whose concerns may reveal
issues that have not yet been recognized or sufficiently addressed
by formal service systems.
Individuals were directed to a
description of the study on surveymonkey.com, a website that hosts a
variety of Internet-based surveys. If they consented online to
participate, they were directed to the survey itself. Participants
were informed that their responses would be anonymous. The survey
was programmed so that it would only accept one completed set of
responses from a given e-mail address. Participants who had attended
more than one residential treatment program were instructed to
choose a single program they had attended, and to focus their
responses on their experiences in this particular program. At the
end of the survey, participants were provided with contact
information for the National Disability Rights Network as an
available resource, and were provided with the principal
investigator’s contact information in case they wanted to follow up
with questions or concerns.
The survey is comprised of 194
questions regarding direct experience in residential mental health
treatment programs. Questions are organized into sections focused
on: 1) basic demographics and program identifying information, 2)
the process leading up to program entry, 3) program participation,
4) and participant satisfaction. Questions have been designed to
gather information regarding the various aspects of residential care
that have been highlighted as problematic in public media accounts,
but efforts were made to ensure that questions were not framed in
ways that would bias responses. The survey includes a combination of
multiple choice and free response questions.
SURVEY FINDINGS
The survey was posted online in
July 2006. Three months later (in October 2006), an in-depth
analysis of the responses that had been submitted thus far revealed
that 230 of the survey respondents were individuals who reported
that they had attended “specialty” residential program (defined as a
program that identified itself as a therapeutic boarding school,
emotional growth academy, or alternative residential treatment
program, rather than a licensed residential treatment center) and
who reported no or unknown access to an advocate while attending the
program. This group of participants represents a group of especially
vulnerable youth, as they were attending the types of programs that
are more likely to have no state oversight, and the youth were not
formally advised about seeking help if they perceived themselves to
be in danger while attending the program. For these reasons, the
multi-state analyses focused on this group of 230 individuals.
A subsequent state-specific
analysis of the data was conducted at the end of 2006 to identify
patterns in the responses of individuals who indicated that they had
previously attended residential facilities in Montana. By that time,
there were 446 young adults who had responded to the survey between
July 17 and December 26, 2006 and provided information about their
direct experience in any type of residential treatment program in
the United States, and 49 were young adults who had previously
attended a program in Montana. The Montana-specific analyses focused
on this group of 49 individuals.
Basic Demographics of Youth
Participants and their Families
Multi-State Analyses The
multi-state analyses revealed that the majority of the 230
respondents who reported their racial / ethnic identity were white
(87% Caucasian, 6% bi-racial/bi-cultural, 3% Latino/Hispanic, less
than 1% Asian or other cultural identities) and female (68.6%). Half
reported that their family income was $100,000 or greater. Half
reported that they had received a psychiatric diagnosis prior to
admission to the program (50.4%). Almost a third reported that they
had also been prescribed psychotropic medications prior to attending
the program (31.3%). Slightly over half (57.6%) reported that they
had tried services and supports in their home community before
attending the residential “specialty” program. At the time when they
were sent away, youth were most commonly living in the states of
California (26.9%), Florida (7.3%), New York (6.9%), Texas (5.2%),
Michigan (4.3%) or Washington (4.3%).
Montana-Specific Analyses The
Montana-specific analyses revealed that of the 49 young adults who
attended programs in Montana, 33 were female and 16 were male. They
ranged from 18 to 30 years of age at the time of their participation
in the survey, and all had attended programs during their
adolescence. The majority identified themselves as White or
Caucasian (82%), while several identified themselves as Hispanic
(4%), Hispanic / White (4%), Asian (4%), Native American (2%) or of
mixed ethnicity (2%). The majority (75%) reported that their family
income was $70,000 or higher.
Of the 37 respondents who answered
questions regarding issues that factored into their parents’
decision to send them to a program in Montana, many identified
issues relating to drug use (70%), family conflict (68%) and
academics (65%). Sexual activity (51%) and legal issues (27%) were
identified as fairly common parental concerns as well. Some youth
reported that although they were acting out, their behavior seemed
relatively age-appropriate; as one respondent commented, “I was kind
of a wild kid, however I wouldn't say anymore so than any teenager.”
Seventeen respondents reported that
they had been diagnosed with psychiatric disorders prior to entering
the residential program; diagnoses included Depression (53%),
Bipolar Disorder (35%), Anxiety Disorder (24%), ADHD (24%), Anorexia
(6%), Schizophrenia (6%), Multiple Personality Disorder (6%) and
Oppositional Defiant Disorder (6%).
Twenty-one respondents reported
that they had tried services in their home communities prior to
attending the residential program in Montana; these community-based
efforts most often included counseling, psychotherapy, and/or
psychiatric medications. They reported that the most common way
their families found out about residential programs in Montana was
through the internet (32%); the next most common sources of
information were educational consultants (22%) and recommendations
provided by other families (19%).
Youth came to programs in Montana
from 19 states. The most common states of residence prior to
attending a program in Montana were California (31%), Illinois (10%)
and Washington (8%). Other states included Arizona, Colorado,
Florida, Georgia, Idaho, Maryland, Minnesota, Montana, Nebraska, New
Hampshire, New Jersey, Oregon, Tennessee, Texas, Virginia and
Wisconsin. Note that only two of the survey respondents attending a
residential facility in Montana reported that they had lived in that
state before they were admitted to the program.
Program Specifics
Multi-State Analyses The
multi-state analyses conducted in October 2006 revealed that
respondents identified 58 programs in 21 states. Survey participants
most frequently reported that they had attended a program in Utah
(15.7%), Montana (13%), New York (10.8%), California (7%), or
Georgia (5.7%). There were also a number of individuals who reported
that they attended a program outside the U.S. in Jamaica (12.2%),
Mexico (7%), and 4% reported the attending programs in the Dominican
Republic, Western Samoa, or Costa Rica. Lengths of stay in both the
US-based and foreign-based programs were extended; slightly over
two-thirds (69.1%) reported that they attended the program for a
year or longer.
Montana-Specific Analyses The
Montana-specific analyses revealed that 34 respondents attended
Spring Creek Lodge Academy, 10 attended Mission Mountain School, one
attended Summit Preparatory School, and four preferred not to share
the name of the program they attended.
Concerns that Emerged in the
Reports from Young Adults
Use of Escort / Transport
Services
Multi-State Analyses The
multi-state analyses revealed that almost half the respondents
reported that they were transported to the program by an “escort”
service (48%). When parents pay for an escort service, this means
that they hire one or more adults to travel with their child to the
residential programs where he or she will be admitted.
Montana-Specific Analyses In the
Montana-specific analyses, 19 survey participants (39%) reported
that their families hired escort companies to transport them to the
program in Montana; of these, 79% reported that this was a very
negative experience and they felt very upset about it. While one
comment expressed acceptance of the process (“I needed some kind of
intervention, for SURE. I would have ended up in a lot more trouble
if I hadn't gotten away from the situation I was in”), all other
comments reflected distress. Comments included: o “I felt horrible
being a 16 year old being lead through the airport in hand cuffs.” o
“I will forever have anxiety about locked doors and privacy, due to
the fact that escorts ripped me out of bed at 3 a.m. I feel that
experience was truly traumatizing. I didn't understand what was
going on and really believed I was in a dream. I was pinching myself
on the plane to Montana to see if I would wake up.” o “When
strangers come into your home in the middle of the night to take you
away from your family no matter what the situation it is an awful,
awful experience.”
Communication and Privacy Rights
Violations
Multi-State Analyses The
multi-state analyses revealed that many participants reported
experiencing communication and privacy rights violations: The
majority reported that their mail was monitored (93%) and their
calls were monitored (96%). Furthermore, the majority also reported
that their letters or conversations were filtered, restricted or
interrupted (86%). As was reported earlier, none of these
individuals reported that they were provided with access to the
contact information of advocates.
Montana-Specific Analyses Of the 36
individuals who described their experience upon arrival at the
residential program in Montana, 86% reported that the program staff
did not fully describe their rights to them. One respondent
commented, “This is the first time I'm hearing about me having
rights;” another said, “It was pretty terrifying. I was very
compliant so I just went along with everything and questioned
nothing. I never thought about what my ‘rights’ were or would be, I
wish I had.” Several respondents explained that they were required
to shower and then jump naked in front of program staff in order to
demonstrate that they were not hiding items in body cavities.
Of the 35 individuals who answered
questions regarding communication policies and practices, 94%
reported that there were restrictions in terms of whom they could
telephone or write letters to outside the program, 97% had their
calls monitored, and 86% had their letters or conversations filtered
or interrupted. Furthermore, 97% reported that the program never
provided them with the name and phone number of an advocacy group
that they could contact. Comments included: o “I got a phone call
only after I reached level 3 (6 months). This was a 10 minute call
during which I was forced to sit next to my ‘family rep.’ The rep
listened to my end of the conversation and was close enough to most
likely hear what my parents were saying as well. I was warned ahead
of time not to complain- about anything, including being hungry or
cold- that the conversation would abruptly end. My letters home were
checked by my ‘family mother’ who sealed and initialed them; they
could then not be reopened.” o “I think it’s dumb that some kids if
they choose to sit there only can write their parents and never hear
their voice. I mean there were some kids in there that it had almost
been a year since they had heard a word come out of there parents’
mouth.” o “When we finally got to talk to our parents our phone
calls were monitored, and if we said something the program didn’t
like, they would take the phone and end our conversations!” o “We
were supposed to be mending our relationships with our parents. Not
shutting them off almost entirely.”
Misuse of Seclusion and
Restraint
Multi-State Analyses The
multi-state analyses revealed that many respondents reported
firsthand experience of the residential program using seclusion
(57%) or physical restraint (34%) as a form of intervention. A
number of participants witnessed their peers being placed in
seclusion (45%) or restrained (60%). The most commonly reported
trigger for seclusion or restraint was aggressive behavior,
especially aggression toward staff (87%); however, a number of
behaviors that would never warrant seclusion or restraint in a
licensed or accredited residential treatment center were also
endorsed as triggers. Respondents reported that triggers for
seclusion or restraint in the programs they attended included
breaking a program rule (67%), saying something disrespectful (52%),
cursing (48%) or making a face (30%).
Montana-Specific Analyses In the
Montana-specific analyses, of the 35 individuals who responded to
questions regarding seclusion and restraint, 85% reported that the
program they attended used restraints and 94% reported the program
used isolation or seclusion. Furthermore, most respondents indicated
that seclusion or restraint would be used not only when a youth was
a danger to self or others, but also when a youth was breaking a
program rule. Comments included: o “Within my first few minutes at
the program I was restrained and taken to a little room and left
there for hours. I didn't know what the hell was happening to me.
They wouldn't let me see my parents.” o “Physically held down for
hours on end put into isolation for 3-8 days at a time” o “Carrying
40lbs rocks on my back” o “I often saw kids violently being
restrained. They often would be tackled to the floor for very minor
infractions.” o “There are two forms of isolation- worksheets and
‘the hobbit’/special needs/intervention. The former is isolation
while in a small group of 8; the latter is solitary confinement.
Both can last hours, days, weeks...” o “A small room called the
‘hobbit’ or another one called ‘worksheets.’ No windows and a small
confined white room to sit in. No talking was allowed or sleep for
up to 48 hrs depending on your ‘crime.’” o “I spent many days in a
building called worksheets where I was isolated for the entire day
and required to listen to motivational tapes and take notes on
them.” o “They would put people ‘off talk’ where they wouldn't be
able to talk at all to anyone. One girl was ‘off talk’ for 3
months.” o “Girls would be put ‘off talk’ and couldn't talk to
anyone. Girls would be given tasks to do completely alone and
couldn't participate in group activities.” o “When a student would
run away they would send the higher level boys out to look for them,
whoever found the runaway got a STEAK DINNER, and those boys were
allowed to tackle the runaways, if they wanted.” o “I was on 'no
talk' for a month. My letters and calls were cut off for months at a
time. I was left secluded more than once in a cabin in the woods.” o
“If you were 'jumpy' you were restrained! I had 2 heavy staff sit on
me when I was in there.” o “What is there to describe it happened it
was completely horrible it hurt like hell and I never want to
experience it again.”
Reports of Inhumane Treatment
Multi-State Analyses The
multi-state analyses revealed that beyond seclusion and restraint,
there were multiple reports of various forms of inhumane treatment
and abuse in the name of intervention. Many participants reported
that they had had been required to participate in forced labor
(71%), restricted access to the bathroom (68%), scare tactics (63%),
and exposure to harsh elements like extreme heat, snow or rain
(60%). In addition, participants described experiences of excessive
exercise (58%), food/nutritional deprivation (43%), sleep
deprivation (41%), and physical punishment (31%). When asked whether
they were ever emotionally, physically or sexually abused by staff,
a number of individuals reported that this was often or sometimes
true (45%).
Montana-Specific Analyses In the
Montana-specific analyses, a total of 34 individuals responded to
questions regarding the following program practices, reporting that
these practices, which violate internationally agreed upon standards
regarding the treatment of prisoners of war, are being used in
residential programs in Montana: exposure to the elements such as
extreme heat, cold, rain or snow (79%), restrictions on using the
bathroom (79%), scare tactics (68%), excessive exercise (65%),
forced labor (59%), sleep deprivation (47%), and nutritional
deprivation (35%). Comments included:
o “During seminars we would be
forced to wait outside in the snow in the early morning for several
hours and would have to use a very cold port-a-potty that was not
cleaned.”
o “In one instance, we were walking
through a foot of snow. Once during a summer month, [name removed]
dragged us out and hosed us all down in our pajamas.”
o “Lower levels were only allowed
to wear a certain amount of layers in the wintertime…and wintertime
in Montana is just vicious and it really was not right to not let us
be warm.”
o “We went outside no matter what
the weather was like even if we did not have the appropriate shoes
or clothing.”
o “We were made to shovel snow and
chop wood for the staff's personal use at their homes in the
freezing Montana winters.”
o “We were often not allowed to use
the bathroom for hours sometimes days at a time.”
o “I often heard black students
being threatened with being dropped off in a nearby Ku Klux Klan
settlement.”
o “They blindfold you and make you
walk through the woods, make you follow their voices, and walk down
A PUBLIC ROAD with no one to guide you they said ‘if you hear a car,
move to the side of the road without taking off your blindfold.’
There were cars honking at us.”
o “We were always threatened with
impending punishment or things being taken away like chances to
speak to or see our families.”
o “You were put into O.P.
(observation placement) where you were in a room 10x10 with at least
8 other students. You were required to do a minimum of 150 jumping
jacks, 100 push ups and 300 sit ups in unison. If some one fell out
of count you all started over again until you all do it in unison.”
o “We were forced to do excessive
amounts of exercise which is difficult when you don't get any food
or sleep.”
o “Upper level boys could tackle
girls....girls! And I witnessed one 14 year old in my ‘family’ being
hit by these boys with no one doing a thing but watching including
staff.”
o “I was routinely jumped on by
several staff and dragged face first down stairs.”
o “I remember trying to walk out a
door during group and him picking me up by my shorts and basically
pulling them off to get me back in the room, which for me, was a
terrifying experience.”
o “As a junior staff I was told (by
staff) that, when chasing a runner, ‘What goes on in the woods stays
in the woods.’”
o “They held seminars and we would
not get to sleep. My theory is that they deprived us of sleep
because it is easier to brain wash a tired delirious person.”
o “The meals were never quite
enough. I always left meals still feeling hungry, and longing for
the next meal.”
Education and Mental Health
Treatment
Multi-State Analyses The
multi-state analyses revealed that of the 223 individuals who
answered questions regarding educational and treatment planning in
programs they attended, 60% of the respondents reported that they
did not receive an individualized plan tailored to their needs and
87% reported that they were not satisfied with the training
background of the staff members who were providing education,
therapy, support and/or care.
Montana-Specific Analyses: Of the
34 individuals who answered questions regarding educational and
treatment planning in programs they attended in Montana, 50% of
respondents reported that they had not received an educational plan
individualized to their needs and 53% reported that they did not
receive a mental health treatment plan individualized to their
needs. The majority (88%) reported that they were not satisfied with
the training background of the staff members who were providing
education, therapy, support and/or care. Comments included:
o “I was almost 3 years behind in high school when I got home.”
o “The curriculum only involved
memorization of books and subjects, and never involved a true
understanding of the subjects.”
o “My ‘teacher,’ although very
sweet, was not qualified to be a teacher, had no teaching
certificate, and for all I know, never went to college.”
o “If you failed a test you could
take it again and again until you got a B or higher so everyone was
guaranteed a good grade point average.”
o “School was only three hours a
day, if at all that day, sometimes not for weeks. My therapy was
completely taken away.”
o “There is absolutely no
confidentiality with the individual therapists- what you tell them
makes its way to other staff sooner or later. Group ‘therapy’
consists of bashing the hell out of everybody else just to get kudos
from the family rep.”
o “Therapy, if you could call it
that, was a joke. I only had girls from the ages of 11 to 17 tell me
what was wrong with me. No trained professional.”
Distress and Suffering
Multi-State Analyses The
multi-state analyses revealed that survey participants reported
significant distress and suffering in relation to their experiences
in residential treatment programs. When participants were asked to
rate how much they experienced a variety of feelings while attending
the program (where responses included “not at all,” “a little bit,”
“some,” “a lot,” “don’t know”), the majority endorsed “a lot” of
feeling sad, stressed, angry, confused, hopeless and scared; most
participants reported feeling happy, loved, hopeful and proud only
“a little bit” or “not at all.” In response to the question, “Would
you recommend the program to others?” participants’ responses
included, “I still have bad dreams about it. I wake up shaking and
nervous that I am there again. It has scarred me emotionally and I
don't know if I will ever get over it.” “I would hope NO ONE would
ever have to go to a place like that. It's worse than jail.” “I
don't ever want another child to be so abjectly hopeless or so
horribly abused. I don't ever want another family to be torn up when
there is the possibility of being reunited and healed.” “There are
better ways to deal with a troubled teen than send them to a school
that abuses kids.”
Montana-Specific Analyses The
Montana-specific analyses revealed that of the 35 respondents who
rated their level of satisfaction/dissatisfaction with various
aspects of the program they attended, there were high levels of
dissatisfaction across a variety of domains: Program participants
were dissatisfied or concerned about the treatment they had received
in terms of respect for privacy (97%), discipline policies and
procedures (92%), contact between participants and their family
members (92%), respect for individual rights (89%), mail policies
(85%), general medical care (83%), behavior modification practices
(83%), and the process for filing grievances (83%). Comments
included, o “Medical care was awful.” o “I suffered a head injury
and never received medical attention for it.” o “I was pulled after
I had been complaining about a bladder infection for over a month
without any treatment.” o “When the director was unhappy with us he
would deny us food.” o “Excessive force was used on a daily basis.”
o “The physical activity was endless. It was meant to break us.” o
“In short, we were tried and convicted for actions that we may or
may not have committed. We were living in a place where, if we were
accused of something by a staff member, there was no arguing or
questioning for fear of further punishment.”
Of the 28 individuals who responded
to the questions regarding final reflections, 93% said they would
not attend the program again. Their reasons included: o “It was the
most stressful 2 years of my life. I wouldn't put myself through
that again. I have enough nightmares about it to know this.” o “I
would rather commit suicide than go back.” o “I never want to go to
Montana again.” o “Oh god that would be hell.” o “No one would
deserve that”
When asked, “What were the best
things about the program?” the majority of the respondents
identified the friends they made in the program. When asked, “What
were the worst things about the program?” respondents reported: o
Not being able to talk to parents o Humiliation in public and
physical painful restraint o The staff o Poor education o The
therapy / “brain washing seminars” o Lack of medical care o Lack of
after-care o Lack of contact with friends after leaving the program
Of these respondents, 82% said they
would not recommend the program to others. Their reasons included: o
“I have seen horrors that I would not wish on my worst enemies.” o
“They were not qualified to deal with girls with the types of
problems that they had. o “For people with mentally and
psychologically impaired children, THIS PROGRAM IS NOT DESIGNED OR
SAFE ENOUGH FOR THOSE CHILDREN.” o “I think that some people go into
the program and end up coming out learning more bad stuff than good,
like how to roll a blunt or how to get drugs or how to join gangs,
etc., etc. I think the program is somewhat traumatizing, and can
cause many more problems than helping.” o “It was horrible. The
emotional scars are never able to be reversed.”
CONCLUSIONS
Recognizing that the reports
provided are retrospective and are not necessarily from a
representative sample of all individuals who attended residential
“specialty” programs as youth, these survey findings nonetheless
provide compelling information indicating that there are far more
than a few isolated cases of youth who are being mistreated and are
suffering in programs across the country. With regard to Montana,
specifically, reports were received about only a few programs.
However, these reports describe treatment that appears to be
significantly below commonly accepted standards of care in the
fields of education, mental health, child welfare, and human rights.
The findings suggest that increased protections are needed so that
youth will not continue to experience the deplorable conditions and
treatment described by many survey respondents, but instead will be
ensured quality care in all residential programs located in the
state of Montana.
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