The Troubled Teen Industry

The Troubled Teen Industry (TTI) is a network of Behavior Modification Programs, Residential Treatment Centers (RTC), Therapeutic Boarding Schools Religious Academies, Wilderness Programs and Drug Rehabilitation Centers. This industry has thrived for decades despite constant allegations of child abuse, neglect, dangerous treatment practices, and negligence resulting in death.

Thousands of youth are held within the Troubled Teen Industry every year. Due to lack of government oversight, these Residential Treatment Centers operate with near impunity. Children, between the ages of 5-18 years old, can be held against their will, with no due process or criminal charges for an undetermined amount of time, sometimes years.

At-risk youth often face many difficulties during their most formative years on top of the typical stresses of growing up. When a parent feels they can no longer control or help their struggling teen, they often seek additional resources and are often referred to long-term residential treatment by way of online sites, school counselors, and educational consultants. Many Residential Treatment Centers claim to rehabilitate defiant teens and instill strict values using militaristic and unproven methods.

Behavior Modification was developed from B.F. Skinner’s theory of operant conditioning. When this theory is taken outside of the clinical boundaries, based heavily on punishment and applied to a population of vulnerable, already traumatized youth, this can quickly become a recipe for abuse, neglect and a climate of fear. Without access to report this abuse, children will endure months if not years of these tactics, and many more cruel and unusual punishments. We also find that wilderness programs have their own brand of harsh conditions that compound these tactics with an environment that is designed to break them down into desperation of survival mode. 

Institutional Child Abuse and Neglect

The term “institutional child abuse” means – child abuse or neglect by a person who is an employee of a public or privately covered program; or
institutional practices, policies, or conditions that are reasonably likely to result in child abuse or neglect.

Methods of Institutional Child Abuse include: 

  • Forbidding communication with parents and peers (including the ability to speak or non-verbal during day to day operations, 24/7 silence).
  • Redacting communication with parents that alludes to mistreatment at the facility.
  • Forcing psychiatric medication, or overmedication.
  • Use of physical, mechanical, and chemical restraint (injectable sedatives).
  • Use of seclusion as punishment.
  • Lack of credentialed staff and clinicians.
  • Conversion therapy
  • Aversion therapy
  • Attack therapy
  • Dangerous “therapeutic” processes (example: rape reenactment).
  • Cruel and unusual punishment (excessive exercise, humiliation, false confessions).
  • Excessive and unnecessary use of strip searches and cavity searches
  • Lack of medical treatment or denial of medical treatment.
  • Lack of access to basic needs (weather appropriate clothing, food, water, bathroom)
  • Human trafficking (threatening to send or the act of sending children to international programs that lack laws to protect children, this is being used as punishment). 
  • Denial of education (Using religious accreditation where academic credits are non-transferrable)
  • Financial incentives to staff and educational consultants for referring and maintaining child enrollment.
  • Lack of appropriate licensing, accreditation, and reporting to oversight bodies.

Enduring this treatment for months and years at a time can cause serious psychological and physiological catastrophe resulting in a fragmented sense of self, PTSD, ongoing flashback and nightmares, and can completely derail a child’s future. In 1974, Congress investigated a program by the name of The Seed that was one of the pioneers of the industry and found their methods to be “similar to the highly refined brainwashing techniques employed by the North Koreans.”

There are easily over 5000 residential treatment centers for youth in the United States. – Breaking Code Silence Research Database

While most programs accept private pay and private insurance for a portion of the tuition, the burden often falls on taxpayers who unknowingly fund these institutions through Medicare, Medicaid, the juvenile justice system or through their local school districts under IEP services.

Evidence shows that the most effective treatments are community-based services that intend to keep the family unit intact. However, often parents find programs located out of state where state law differs and has inadequate regulation and oversight. Many children are pipelined into residential centers from their state’s Foster Care, IEP/School Districts, Juvenile Justice programs, and through custody related court orders.

In 2007, The Government Accountability Office found significant evidence of deceptive marketing techniques, abuse described as “torture” and ineffective management in the programs they investigated. The GAO report cited that a lack of adequate nourishment, untrained staff, and reckless operating practices played a significant role in the deaths of youth. In response to these findings Rep. George Miller, speaker of the house and chairman of the Education and Workforce Committee, proposed the Stop Child Abuse in Residential Treatment Programs for Teens Act. Despite multiple introductions, this bill has yet to be enacted while many programs remain unlicensed and poorly regulated.

Facts and Statistics on Troubled Teen Industry Population
  • In 2014, 415,129 youth were in out-of-home care, with 23,233 (6%) placed in group homes and 32,955 (8%) placed in residential treatment and other institutions.
  • There are over 10,000 residential treatment centers for youth in the United States. 
  • More than 12,000 minors have been sent to Utah for behavioral treatment by state agencies across the country since 2015 — far more than any other state. 
  • National data indicate the majority of youth served in TRC settings are adolescents (69%), while a concerning 31% are under the age of 13 years.
  • Black children are 35% more likely than white youths to be placed in group homes or residential treatment facilities. 

There are over 50,000 children kept in residential treatment centers every year. –Latest findings in Children’s Mental Health, Nearly 66000 children Mental Health Programs, Vol. 2, No. 1

Treatment Data

  • 1 in 4 youth residential care is a first placement, and 40% have no clinical level indicators that suggest this level of care is needed. 
  • In 2015, it was reported that 82% of these residential facilities were still actively using traumatizing tactics such as seclusion and restraints.
  • Youth who are referred to residential care are 3 times more likely to have a DSM IV classification and 6 times more likely to have behavior problems than youth referred to lower levels of care in the community. 
  • 33% of youth have difficulties with their facility’s grievance process—either they do not know how to file a complaint or they fear retaliation if they do so.
  • Poor relations with staff characterize life in custody for more than 2 in 5 youth (43%) and 33% report overuse of force.

At least 145 children have died from preventable causes in residential treatment centers, and at least 62 from asphyxiation or injury caused by restraint. –PROPUBLICA

Support Industries

The Troubled Teen Industry cannot survive without the deceptive marketing techniques used to convince parents to send their kids away. Often when a child is struggling in school, or with behavior issues at home their families reach out for help. The internet is saturated with referral websites and Educational Consultants who charge upwards to $4000 to recommend their affiliated wilderness and residential programs.

Parents are then referred to transport companies that insist that the child must not know that they will be taken or where they will be taken to. They come in the middle of the night, waking the child from their bed and threatening that “Either we can do this the easy way or the hard way, either way, you are coming with us”. They are often taken in handcuffs or zip ties and restrained if they resist. This process can be so traumatic for children that many survivors will describe recurring nightmares well into adulthood. 

Behavior modification programs have utilized deceptive marketing techniques for years, purporting themselves as residential treatment centers or therapeutic boarding schools with majestic settings and fun activities. When the reality is that what happens beyond the gates is something else entirely. Many programs do not employ licensed staff or supervising physicians, psychiatrists or psychologists and a good deal of the staff have been shuffled from program to program as they shut down or are fired for inappropriate (yet unreported) behavior. 

This industry also utilizes misleading accreditation. A seal of approval might make you think that a program is safe and properly regulated. The sad truth is that this is a smoke screen. Trade organizations, spearheaded by the program owners themselves provide their own endorsement and only represent and lobby for the best interest of the industry, not the safety of the children.

At the GAO Hearing on Abuse and Death in Residential Treatment Programs for Teens, the president of NATSAP – National Association of Therapeutic Schools and Programs, admitted that the organization had no system of investigations or enforcement of their proposed standards, membership is solely based on payment of dues. Their code of ethics are not enforceable and despite the fact that most programs within the NATSAP membership have had long histories of abuse, sexual abuse and death, they still operate today with NATSAP’s official seal of approval.

Economic Impact of the Troubled Teen Industry

Currently, these facilities are pocketing funds instead of investing it into the youth in their care. The financial burden for funding residential treatment facilities often falls on taxpayers who unknowingly fund these institutions through Medicare, Medicaid, social services, the juvenile justice system or through their local school districts under IEP services. Data collected from multiple sources indicate that public funds are funnelled into these facilities without oversight from governmental agencies.

  • Monthly charges for congregate care facilities can be as high as $40,000.
  • According to 2020 data released by the Justice Policy Institute, the average state cost for the secure confinement of a young person is now $588 per day, or $214,620 per year.
  • States pay Sequel Youth & Family Services $275 to more than $800 a day per child to provide residential and therapeutic services. For children who qualify, Medicaid reimburses Sequel for medical and mental health treatment.
    • In Alabama alone, Sequel received nearly $25 million in Medicaid payments from 2018 to this August despite reports of troubling conditions to state agencies for years.
    • California entities paid Sequel $17 million to house Californian youth in 2017.
  • The 2015 economic impact of 59 behavioral programs in Utah resulted in $269 Million in Earnings, $423 Million in State Gross Domestic Product (Utah GDP), and $22 Million in State and Local Tax Revenue. Almost 90% of this revenue comes from out of state placements, predominantly from California.
  • Universal Health Services netted $11.37 billion in annual revenue in 2019.
    • Behavioral health care brought in 45.8% of FY19 revenue
    • Approximately one-third of UHS’s Behavioral Division’s revenues are derived from taxpayer dollars, such as Medicare, TRICARE, and Medicaid, with the remaining two-thirds from commercial payers.

The financial strain on the states whose agencies place youth within these facilities is staggering, even more so is the price individual families pay for services out of pocket. Without federal oversight over the funneling of children both within and out of state into residential facilities we will continue to see public funds misappropriated for financial gain, only to the detriment of the children they purport to provide care for.

The Urgent Need for Reform

Currently, there are no federal laws or national standards of regulation and oversight of this multi-billion dollar industry, only a patchwork of inconsistent and ineffective state to state statutes exist. In many states, there are absolutely no laws and absolutely no jurisdiction to protect children from institutional abuse. Without federal laws, many programs will continue to operate poorly regulated or completely unlicensed.

After the California Department of Social Services announced that they are bringing all youth in out-of-state placements home by 2021 due to rampant abuse at the facilities, they began scrambling to find appropriate placement for their returning youth. Like California, other states such as Utah, Oregon, Montana and Missouri have been forced to look at the limitations of services within their state and insufficient oversight that has led to ongoing systemic abuse in residential settings. With these issues being brought to the forefront of state’s agendas in recent months, it is the right time to develop new standards and systems.

There is little to no oversight over treatment programs for troubled youth in the United States. – Position Statement 44

The urgent need for reform is now more imperative than ever before. It is critical that vulnerable youth and their families are protected. Institutional child abuse significantly contributes to long term trauma, which in turn, negatively impacts youth, families, and communities. 

Breaking Code Silence has uncovered disturbing trends that reveal evidence of abuse and civil rights violations occurring within residential treatment facilities across the US.

  • Children are often sent to facilities far from their homes and communities. California alone has sent nearly 4,000 youth into Utah’s Troubled Teen Industry from 2015-2019
  • U.S. children are spending an average of eight to nine months in group placements. More than a third of children remain in such settings even longer.
  • For 1 in 4 youth, residential treatment is a first placement, and 40% have no clinical level indicators that suggest this level of care is needed
  • In 2015, it was reported that 82% of residential facilities were still actively using traumatizing tactics such as seclusion and restraints
  • At least 145 children have died from preventable causes in residential treatment centers, and at least 62 from asphyxiation or injury caused by restraint
  • 33% of youth have difficulties with their facility’s grievance process—either they do not know how to file a complaint or they fear retaliation if they do so
  • Poor relations with staff characterize life in custody for more than 2 in 5 youth (43%) and 33% report overuse of force
Forward Momentum

Breaking Code Silence recently worked with lawmakers In Utah, to pass Senate Bill 127. With overwhelming support from the committee’s, house and senate, as well as a call for an ongoing commission to address these issues in Utah we believe change is possible. We’re extremely proud to have collaborated on SB 127, Utah’s 1st bill in 15 years to address and regulate the troubled teen industry, providing youth with the protections they were long overdue.

We’re seeing progressive movements in states like California, Utah, Oregon, Missouri, and Montana who’re investigating these systemic failures and are working with Breaking Code Silence on solution-based approaches. After hosting a rally in Provo, UT, in 2020 the outpour of support has quickly spawned a momentum for this movement, and change is already happening!

Everyday more survivors are finding their voice and standing up to call for change. We are ready for action. With the passage of our legislation, approximately 200,000 youth annually will be safer in treatment, with fewer incidents, increased access to advocacy and protection, and increased positive health outcomes across the nation.

As we raise our voices, we will end institutional child abuse.

We are Breaking Code Silence

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