Bills Target Abuses In Residential Facilities

A partially hidden industry offering a controversial approach to teens with psychological or behavioral problems needs better oversight.

Residential treatment programs for young people with behavioral or emotional problems need increased state and federal oversight to eliminate abusive and unproven treatment practices, said mental health advocates at a meeting last month at the U.S. Capitol.

While many beneficial programs exist, many others are not accredited or licensed, according to psychologist Robert Friedman, Ph.D., a professor of child and family studies at the University of South Florida in Tampa. "Some of these programs are exploiting the desperation of parents and mistreating the youth they serve."

At a meeting for Capitol Hill staffers, Friedman and others supported one bill (HR 1738) to allocate funds to help states license and regulate these facilities and a second (HR 823, S 380) to end custody relinquishment as a requirement for coverage by public insurance programs.

Few data exist on the number of children sent to such programs or their effectiveness, said Friedman. Regulatory policies vary, with some states requiring licensing and others having no oversight at all. Fewer than 12 states regulate these programs.

At issue are unregulated facilities using methods with no grounding in research or conventional practice, said Charles Huffine, M.D., of Seattle, a past president of the American Association of Community Psychiatrists. These programs offer only cursory assessment of new residents, followed by issuing diagnoses that frighten parents into committing their children to the facility. Young people are isolated from their families and then get unproven, confrontational therapies. Several deaths have been reported, as well.

"Abuse is sold as treatment," said Huffine. "It's advertised as `behavioral therapy' but as a researcher, I can tell you it has nothing to do with behavioral therapy."

Parents often are so desperate for help that they fail to check the credentials of program staff and are easy prey for fear-mongering sales tactics. They end up paying thousands of dollars a month in the hope that something will help their children.

Because these are private entities and not public institutions, they function as parental surrogates.

"Kids have no rights and no diagnosis and can be sent away to age 18," said Huffine.

The offending residential treatment programs inhabit a nebulous world where data are not easy to find. Many are set up to avoid regulation by mental health, drug abuse, education, or child welfare authorities, said Maia Szalavitz, a freelance journalist and the author of the forthcoming Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids (Riverhead Books, 2006), in an interview.

"We have more regulations for chickens then we do for these kids," said Szalavitz.

Even the numbers are hazy. There may be 100 programs of concern, housing 10,000 to 20,000 children, and bringing in $1 billion a year in fees, Szalavitz estimated. Many are based on outdated, abusive "attack therapies" popularized in the 1970s by organizations like Synanon. The programs often promote harsh discipline, deprivation, betrayal of peers, and isolation from family. Some set up branches outside the United States, both to escape regulation and to distance children from parents.

At present, any regulation is up to state attorneys general. In August, the New York attorney general ordered one such boarding school, Ivy Ridge, near the Canadian border, to refund $1 million to parents for "grossly misrepresenting academic credentials." Despite its claims, the school was not accredited and had no authority to issue the 113 high school diplomas it handed out to students. The school is affiliated with the World Wide Association of Specialty Schools, a group of seven schools in the United States and abroad that have been investigated for allegations of child abuse, according to the Salt Lake City Deseret News.

Passage of HR 1738, the End Institutional Abuse of Children Act, sponsored by Rep. George Miller (D-Calif.), would provide $50 million to the states to license and monitor programs, establish penalties for child abuse within them, and require the State Department to report any abuse of American children overseas, said Tammi Seltzer, senior staff attorney at the Bazelon Center for Mental Health Law in Washington, D.C. The Government Accountability Office should also investigate treatment practices and credentialing in the industry, said Seltzer.

"For the first time, mental health stood up and opposed these programs," said Szalavitz. "They need to be delegitimized by the psychological and psychiatric establishments."

I found this to be true of Provo Canyon School:

Young people are isolated from their families and then get unproven, confrontational therapies. Several deaths have been reported, as well.

"Abuse is sold as treatment," said Huffine. "It's advertised as `behavioral therapy' but as a researcher, I can tell you it has nothing to do with behavioral therapy."

Parents often are so desperate for help that they fail to check the credentials of program staff and are easy prey for fear-mongering sales tactics. They end up paying thousands of dollars a month in the hope that something will help their children.

Abuse in the forms of prolonged isolation, sleep deprivation, humiliation, forced exercise and forced drugging and brutal takedowns are all to common at Provo Canyon School.