Youth Treatment as Brutal 'Tough Love'

December 5, 2005

Children's advocates are taking aim at privately run programs that treat kids with a range of problems as delinquents who need to be straightened out by force.

If this was therapy, it sure didn't feel like it. From September to January, Claire Kent spent her days digging up tree stumps from a barren field, her mind and body battered by the elements. The work was part of her "treatment" for the drinking and sex that had landed her at a boarding school for "troubled teens."

In the Montana woods, Kent and a couple dozen other adolescent girls had been committed by their families to a disciplinary program that included chopping wood, exercising to the point of physical breakdown, and being regularly bullied and insulted by "counselors" - all in the name of what the private treatment industry calls "emotional growth."

"It was just based on, 'How badly can I scare you?'," said Kent, now in her late twenties and still suffering from anxiety that she attributes to her experience. During her two-year stay, she said, "they gave me the reality that life was just completely unfair and was going to keep being that way."

The facility where Kent was held, the Mission Mountain School, is still in business today. Though staff declined repeated requests for comment, the recent explosion of hundreds of other so-called "private residential treatment facilities" speaks to the growing popularity of the "tough love" approach to "reforming" youth. Behavioral health experts estimate that the industry deals with roughly 10,000 to 14,000 children and teens, charging typical tuition rates of tens of thousands of dollars per year. The patrons are anxious parents hoping for a solution to issues ranging from attention deficit disorder to drug abuse. Worth approximately $1 billion, emotional growth programs thrive on the promise of turning "bad" kids "good."

Government connections enable "teen help" industry to thwart regulation. Though some mental health professionals believe residential treatment could be helpful in extreme circumstances, horrific experiences reported by young people confined to unregulated facilities prompt questions about who is caring for them, and who is held accountable when care becomes abuse?

"It appears that there's a growth industry of very harsh kinds of programs that are using confrontational therapies, incredibly strict discipline, the kind of exhaust-them-until-they-break-down kind of [practices]," said Charles Huffine, an adolescent psychiatrist with the advocacy coalition Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment. "These are practices that are much more akin to certain kinds of harsh prison conditions than they are to anything that would be remotely considered therapy."

Private residential treatment facilities take various forms, from camp lodges in Montana to militaristic disciplinary compounds on foreign territory. The main defining features are physically isolated campuses and in many areas, virtually no formal government oversight.

Growing alongside the teen "help" industry is the political and legal backlash against tactics that some view as cruel and bizarre. In recent years, several facilities have closed following abuse investigations. Activists are also promoting the End Institutionalized Abuse Against Children Act, which would fund state and local monitoring of treatment facilities, along with the Keeping Families Together Act, which would enhance access to community-based behavioral healthcare. Yet youth advocates and former program participants caution that legislative action would merely dent the complex culture surrounding institutions that aim to "fix" youth.

At especially harsh facilities, said Huffine, once adolescents are inside, "as human beings they have no rights. They cannot stand up and say, I have been slimed, I have been harmed, I have been hurt, I want out of this."

Rules and Consequences

One night, a few months before his high school graduation, Charles King was awakened by strangers, handcuffed, and told he was being taken somewhere to get help. When his escorts released him, he found himself in another country, locked in a concrete compound, watching a dismal parade of shaved-headed youngsters marching silently in a line.

King's new home was Tranquility Bay in Jamaica, part of a network of behavior modification facilities tied to the Utah-based corporation World Wide Association Specialty Programs and Schools (WWASPS).

"You weren't allowed to talk, you couldn't call home to your family," recalled King, now in his mid-twenties. "You weren't allowed to do anything, basically, without permission - and if you did, there were consequences."

"Consequences" is the term WWASPS facilities prefer instead of "punishment." Under a point system, participants theoretically earn privileges for following rules and suffer consequences for breaking them: completing intensive chores or sitting obediently through self-help "emotional growth" videos might after a few months earn a kid the prerogative to call home.

But King recalls the consequences more clearly than the rewards: spending days on end in detention, known as "observation placement," lying rigid with his face plastered to the floor, under the surveillance of domineering staff. Seared in his memory, and reported by other former detainees, are the frequent screams of boys and girls who endured special disciplinary sessions in isolation at the hands of staff.

"They thought they were going to die; that's what it sounded like to me," King said.

In California, families of former participants have sued WWASPS and several affiliated schools, claiming abuse and inhumane living conditions. Though children's advocates consider WWASPS schools an extreme example of behavior modification programming, the company's promises of bringing "structure" to kids' lives are common throughout the industry.

Dismissing the allegations of mistreatment as groundless, Director Jay Kay told The NewStandard that Tranquility Bay "has assisted kids and families in ways hard to put into words." He continued, "We are about character-building, emotional growth, therapy and family values."

WWASPS President Ken Kay, Jay's father, argued that compared to psychiatric treatment or the prison system, the WWASPS approach is in fact a more humane way to modify destructive behavior in young people.

"It's extremely necessary in society," he told TNS, "to have something between running rampant with negative behavior and juvenile detention or mental lockdown."

On the issue of human rights, the elder Kay remarked, "Children have the right to expect that when they're getting so far out of line, someone is going to rein them in a little bit."

A Tight Leash

According to critics in the mental health community, even programs that are not outright physically abusive can still be degrading and traumatic, especially for vulnerable adolescents already struggling with emotional issues.

Intensive "wilderness" activities, for instance, are billed as a method of building maturity, but some former program participants say that they serve mainly to break spirits.

"It was really about establishing authority and control," said Kathryn Whitehead, who entered Mission Mountain after a suicide attempt at age 13. The work and exercise programs, she said, aim to exhaust girls until they "can't hold anything in. So, you purge yourself of whatever demons you're carrying."

Claire Kent said her stump-digging assignment was the penalty for not giving the staff a detailed enough account of her sexual history - a requirement for all participants.

Between labor sessions in the woods, Kent described navigating a constrained social system in which girls were forced to "disclose" all secrets. Staff routinely rebutted confessions with accusations of lying or withholding information, she said, so girls wound up spinning made-up stories of abuse or family dysfunction just to gain a counselor's approval.

The pressure to confess, Kent said, was compounded by the stress of obeying seemingly arbitrary rules. When the staff deemed excessive toilet use a punishable offense, for example, she recalled that girls resorted to soiling themselves to avoid going to the bathroom.

"They used fear to change us," she said. "We were not changing for positive reasons."

But Larry Stednitz, an educational consultant who refers parents to youth facilities and has visited Mission Mountain, defended work regimens as a useful way of keeping kids occupied. "If you don't structure things pretty tightly," he said, "you're going to have problems."

Indeed, some former participants feel that this structure benefited them in the long run. In an essay featured on the strugglingteens.com website, which is run by educational consultants, former Mission Mountain participant Kristie Vollar used language similar to Whitehead's to argue that the intense stress helps girls by making them "physically, mentally and emotionally worn out until there isn't enough energy left to hide 'what's really going on'."

Such positive perceptions do not surprise Kent; she takes them as evidence that the program succeeds in inducing total, self-obliterating submission. "The other 30 girls there, you know, were believing in the program," she recalled. "You eventually believed in it, too: that you were this rotten, filthy, horrible kid, and that Mission Mountain saved your life." Credibility Gap

An undercurrent of distrust runs through the controversy over these authoritarian adolescent management facilities. Program administrators suggest that troubled youth cannot be trusted to act in their personal best interest and insist that complaints of mistreatment should be viewed with similar skepticism.

Ken Kay countered abuse allegations by pointing to the results of parent questionnaires administered by WWASPS. According to parents, kids have what he calls "a huge history of manipulation and misrepresenting the truth." These youth, he concluded, "have a bad habit of lying to their parents, their school people, to their friends... And so I don't expect that, you know, they are going to stop lying."

For 18-year-old Sean Hellinger, who languished for about two years in residential treatment - first at a Montana-based WWASPS institution called Spring Creek Lodge and later a similar program in Utah- advocating for himself led to a catch-22. Each complaint about severe and humiliating treatment by the Spring Creek staff, he recalled, would run up against the presumption of "manipulation." It was futile to protest to his parents, he said, because staff would inevitably convince them he was lying to get out of the facility.

"You can't talk to the outside world, and when you can, it's all censored," he said. "And your parents don't believe you.... I was ignored, betrayed."

Parental Misguidance

Advocates calling for tighter regulation of residential facilities say that some programs bank on desperation and lure parents with deceptive advertising. Critics of the industry say consultants and recruiters market programs to families by rapidly "diagnosing" serious emotional problems in children and sometimes offering help in securing a fast tuition loan. Meanwhile, parents are left unaware that the program is not clinically licensed, or lacks an adequate trained staff.

Nicki Bush, a psychology graduate student who interned at a rural residential treatment facility, said administrators convinced parents to sink their savings into behavioral treatment that their children supposedly needed. While many children did have serious psychological disorders, she observed it was not uncommon for kids to end up at the facility "because they were having sex with some 20-year-old guy, and [the parents] found a joint, or something like that."

Cristine Gomez, one of the plaintiffs in the WWASPS lawsuit, said aggressive marketing persuaded her to send her son, who was having trouble in school and suffering from attention deficit disorder, first to Spring Creek Lodge and eventually to Tranquility Bay. She told TNS, "I took for granted that they were licensed and regulated... I assumed that somebody was keeping track of basic indications of the safety of the children."

In the end, troubling letters describing the conditions in the Jamaica facility compelled her to bring her son home. Four years later, she said he suffers from deep psychological trauma and refuses to speak openly about the experience. Calling the decision to send her son away "the biggest mistake I ever made in my life," Gomez said, "It's just the opposite of what our intent was, what we were sold."

The Cost of Reform

Although several months of residential treatment might at least temporarily stem problematic behavior, experts warn that short-term "success" could mask long-term scars. Some survivors of the treatment experiences report recurring nightmares, anxiety attacks and depression.

In King's case, the cost of survival at Tranquility Bay was emotional desensitization. "After the first month, it broke me," he said, "and after that, I was numb to, you know, anything that was happening." The experience also stoked an angry desire to return to the lifestyle that his family had previously disapproved of. "It almost made me dream about doing those things again," he said, "instead of what it's supposed to do."

Some mental health advocates say oppressive rule systems, in which youth are subjected to constant punishment and accusations of dishonesty and immorality, could crumple an adolescent's social development.

Hellinger characterized the rules imposed on him as "totalitarian. You say what you're allowed to say, which is, you know, that you agree with everything they say." The staff members, he said, "wanted me to be their little programmed machine."

Yet proponents of residential treatment argue that while "tough love" might not feel good, it is necessary to reform a self-destructive teen.

Bob Carter is convinced that a residential program in rural Utah transformed his son from an unruly teen into a responsible adult. He believes the program's key feature is "a positive, conformist sort of element," which becomes "indoctrinated by the kids themselves." Soon, he explained, "they create an environment where the kids more monitor each other than anything else."

But in Huffine's view, "turning kids into narcs is not a good thing, in terms of how you want to help kids... establish some sense of their own social ethics."

Bush said that while a young person could eventually learn to adhere reflexively to rules in a confined environment, conformity itself is not a healthy goal. "You might condition... a rat or a monkey to do something if you punish them enough," she commented. "But it doesn't mean there's been some insight or great growth."

Curbing "Emotional Growth"

Mental health advocacy groups say that in order to prevent mistreatment, the government must hold private treatment facilities to some clinically based standard of care. As an initial step, they are pushing the End Institutionalized Abuse Against Children bill, which would provide seed money to develop state-level regulations.

While some service providers, including WWASPS, have publicly supported moderate state-based regulation, the industry group National Association of Therapeutic Schools and Programs has contended that bureaucratic monitoring could hinder innovation, and that the government should defer to the industry's own internally developed guidelines.

But Robert Friedman, chair of the Department of Child and Family Studies at the University of South Florida, warned that given the evidence of mistreatment, "there's a danger that if left to self-regulate... there may be the illusion that there's adequate accountability. And that, in some cases, could be worse than at least not having any illusion."

Nonetheless, youth advocates say legal restraints will accomplish little unless the government strengthens and expands the youth behavioral health system.

Mental health experts note that the parents who enroll children in private facilities typically lack insurance coverage for complex therapies. Meanwhile, openings in local mental health programs are so limited that thousands of families struggling to address their children's problems have felt forced to turn them over to the child-welfare or juvenile-justice systems so the state can provide appropriate treatment.

Amid these resource gaps, Friedman said, the growth of the residential treatment industry indicates the need to "develop services and supports close to home, so that families can get the help that they need."

Last year, research by the National Institutes of Health found that while coercive, fear-inducing treatment programs have not proven effective and could aggravate delinquent behavior, more holistic, family-centered approaches have demonstrated positive results in at-risk youth. One federal legislative proposal, the Keeping Families Together Act, would lift restrictions on a special Medicaid waiver to help families use public funds to access community-based treatment.

But enhancing treatment options is only part of the picture, according to Shelby Earnshaw, who underwent a behavior modification program as a teen and now directs the advocacy association International Survivors Action Committee. What fuels the private treatment industry, she argued, is a societal willingness to stigmatize youth with behavioral problems.

Parents who are desperate to "correct" their children, she said, tend to believe that a misbehaving teen is "not worthy of being treated as well... as a kid who didn't do drugs [or] who didn't get involved in crime. I have a big problem with that. Those kids need more help. They need to be treated better."

Michelle Chen is a staff reporter at The NewStandard.