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At Some Youth ‘Treatment’
Facilities, ‘Tough Love’ Takes Brutal Forms
by Michelle Chen
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.
Nov. 21, 2005
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."
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.
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.
The pressure to confess, Kent said,
was compounded by the stress of obeying
seemingly arbitrary rules.
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."
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