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
Alliance for the Safe, Therapeutic, and Appropriate use of Residential Treatment, ASTART
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.
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.
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.
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
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%).
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.
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.
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
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.
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
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.
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
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%).
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
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%).
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
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.
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
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.”
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.”
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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