Every year, thousands of children are placed in behavioral treatment centers and camps where allegations of abuse are rife.
What is the 'troubled teen' industry?
It's a loose network of reform schools, treatment centers, religious academies, and wilderness therapy camps across the U.S. that purport to treat young people struggling with behavioral problems, addiction, or mental health issues. Operated by private companies, nonprofits, and faith groups, the programs charge an average of $6,316 a month — sometimes paid by desperate parents, sometimes by state care systems — and advertise their ability to break kids out of destructive cycles through therapy, tough love, and radical changes in environment. About 100,000 teenagers are estimated to go through such programs annually, and reports of abuse abound. Former patients and ex-employees say many providers are more focused on profit than care, and that therapy often consists of verbal and physical abuse, forced labor, food and sleep deprivation, and humiliation. By one estimate, 86 children died in troubled-teen programs from 2000 to 2015. Hotel heiress Paris Hilton, who says she was abused at a Utah boarding facility in the late 1990s, is now lobbying Congress to clamp down on the multibillion-dollar industry. "They stole my childhood," Hilton said, "and they're continuing to steal the childhood of so many other innocent children."
What happens inside the facilities?
Teens' experiences vary significantly, and many report positive outcomes. But Hilton likens Provo Canyon School, where she was sent at age 17 for rebellious behavior, to "a torture camp." During her 11 months there, she says, she was subjected to repeated late-night cervical exams by nonmedical staff, made to consume sedatives, assaulted, and forced to shower in front of male guards. Provo Canyon was bought in 2000 by Universal Health Services, one of the nation's largest hospital providers, which says it can't comment on what happened under previous ownership. But news investigations have detailed alleged abuse at other youth UHS facilities. Austin Skidmore, a 19-year-old with autism, suffocated on his vomit after being tackled and restrained by staff at a UHS center in Georgia in 2016. A medical examiner labeled his death a homicide. A year later, a 16-year-old girl at the same facility said her arm was broken when a male employee slammed her to the ground; her family said it was the sixth time she had been injured at the facility. UHS said patient privacy regulations bar it from commenting on specific cases, but that it works with law enforcement and takes corrective action when "isolated and rare negative events" occur.
Do the programs work?
UHS reports that about 80 percent of its adolescent inpatients show improvements on clinical outcome measures. But grading such programs is tricky, because children enter facilities for a wide array of problems and because there is a lack of independent research. Heather Mooney spent two years at a therapeutic boarding school in the late '90s after playing truant and running away from home. She thinks the experience helped her complete high school and succeed in college, but notes that many of her boarding-school friends have since died of overdoses and suicide. A former patient named Jaxtyn told The New York Times that he saw both sides of the industry. He said he was held in isolation and sedated at a UHS facility in Utah; UHS said it does not use solitary confinement or drugs as a form of discipline. But at a facility in Texas, he said,he received compassionate treatment that helped him address his mental health issues. "They're there for the patient," Jaxtyn said. "They're there for the child."
Are these programs regulated?
Not at the federal level, where legislation to reform the industry has repeatedly failed. Congress did launch an investigation into the sector in 2007. But it concluded that the scale of the industry's problems was impossible to gauge because of inconsistent state regulations and a lack of data — there is not even a reliable count of how many facilities are operating nationwide. Outrage over abuses has led some states to crack down on behavioral treatment centers. In 2021, Utah passed a law limiting seclusion and restraint and increasing funding for abuse investigations. California requires residential facilities to operate as nonprofits, and has removed foster children sent to out-of-state facilities. Oregon did the same following news reports of a 9-year-old girl sent to a Montana institution run by national provider Acadia Healthcare. When Oregon officials visited the girl six months later, they found her unwashed and wearing a dirty, too-large scrub shirt and paper booties. Acadia subsequently closed the facility because of "overall business and operational considerations," not because of alleged mistreatment.
Will Congress take action?
Hilton's advocacy prompted a bipartisan group of lawmakers to introduce the Stop Institutional Child Abuse Act last year. That bill would authorize a federal study to discover exactly how many kids are being held in residential facilities for behavioral problems and create a working group to develop best practices and prioritize safe and effective outpatient services. But some self-described survivors worry that such legislation will only legitimize the industry, offering a veneer of respectability with little enforcement. "It's like trying to put a Band-Aid on an arterial bleed," said Liz Ianelli, who says she was raped by a cook at a therapeutic boarding school in the 1990s, and then bound in a blanket and left in a boiler room for days as punishment for "lying" about it. "This is a devastating, harmful industry."
Into the wild
Wilderness therapy exploded in popularity in the 1990s with the promise that the healing power of nature — combined with grueling outdoor activities — can help struggling teenagers learn accountability and self-empowerment. Some parents say such programs saved their children from destructive paths, as do a large number of past participants. But many others say they were scarred by their experiences. Rowan Bissette, sent to a Utah camp at 16 for self-harm and suicide attempts, said she often passed out during hikes in the desert heat. To cope with the stress, she began self-harming again — a staff member responded by holding her in a restraint. Ciara Fanlo, who spent 12 weeks in a Colorado program at age 17, said she became sick after drinking water from cow ponds, and was ordered to carry around her vomit in a plastic bag for five days. The illness meant she didn't have a bowel movement for days, so Fanlo was then forced to drink laxatives until she soiled herself. "The intentions of these programs can be well-meaning," said Fanlo. But "what these programs fail to realize is that it is not necessary to break a person's will to redirect it."
