Residential treatment programs for troubled teenagers have been the subject of thousands of allegations of abuse over the past 17 years, including a number of documented deaths, but much about such facilities remains unknown, the Government Accountability Office reports.
Although it is estimated that hundreds of public and private residential treatment programs exist across the country, there’s no standard definition for such programs, and no way to know precisely how many are operating, the GAO says. The programs serve teenagers with a range of problems, including drug abuse, alcohol abuse, and mental illness. They can include boarding schools; wilderness-therapy programs, which aim to help troubled youths connect with nature; and so-called boot camps, which emphasize strict, military-style discipline.
The GAO examined thousands of cases of alleged abuse, from 1990 to 2007, as reported by state agencies, the federal Department of Health and Human Services, pending and closed criminal and civil cases, and allegations posted on the Internet. In 2005, 33 states reported that 1,619 staff members of residential programs had been involved in alleged abuse at such programs, according to the report.
GAO officials also conducted detailed examinations of 10 closed civil or criminal cases of teenagers who died while enrolled in private residential programs. They concluded that many of those deaths occurred at facilities where staff members weren’t properly trained to cope with mentally ill adolescents or to handle medical emergencies.
Gregory Kutz, a managing director at the GAO, testified before the House Education and Labor Committee on Oct. 10 that in some of the cases the GAO examined in depth, program staff members thought students suffering from conditions such as dehydration were faking their symptoms.
“It seems the only way staff could be convinced that these kids weren’t faking it was when they stopped breathing or had no pulse,” Mr. Kutz said.
Mr. Kutz said many of the private facilities are expensive for parents, costing an average of $300 a day.
Cynthia Clark Harvey, whose 15-year-old daughter, Erica, died of heatstroke and dehydration while on a hike with the Catherine Freer Wilderness Therapy Program, told the education committee that she had chosen the facility in part because it was one of the founding members of the National Association of Therapeutic Schools and Programs. NATSAP, based in Prescott, Ariz., is a professional association of residential treatment programs that lists some 180 members on its Web site.
“We chose [Catherine Freer] because they claimed to be fully licensed, … because they claimed experience with teens being treated with psychiatric medication,” Ms. Harvey said, a picture of her daughter on the witness table in front of her.
The Nevada facility her daughter attended is now closed, but the program continues to operate in Oregon and is still a member of NATSAP, according to the GAO. Some of the other facilities investigated by the GAO also remain NATSAP members.
Jan Moss, NATSAP’s executive director, testified that the organization was established in 1999 to “raise the bar” for private therapeutic programs. The organization does not certify programs or conduct investigations of its members, she said.
There are programs that help troubled adolescents get their lives moving in a positive direction, she said.
“We are committed to ensuring that these programs remain available to families in dire need of help,” Ms. Moss told the panel.
Rep. George Miller, D-Calif., the chairman of the House education committee, who had asked the GAO to examine the programs in 2005, plans to introduce legislation to regulate such facilities. Right now, he said, the programs are subject to a hodgepodge of state regulations, and some states don’t have specific guidelines for private programs.
“Parents often send their children to these programs when they feel they have exhausted their alternatives,” Rep. Miller said. “In far too many cases, however, the very people entrusted with the safety, the health, and the welfare of these children are the ones who violate that trust in some of the more horrific ways imaginable.”
The GAO said it is planning to release a more comprehensive report next year that will provide more detail on the scope of programs and the incidents of alleged abuse.
A version of this article appeared in the October 17, 2007 edition of Education Week