[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
CASES OF CHILD NEGLECT AND ABUSE AT PRIVATE RESIDENTIAL TREATMENT
FACILITIES
=======================================================================
HEARING
before the
COMMITTEE ON
EDUCATION AND LABOR
U.S. House of Representatives
ONE HUNDRED TENTH CONGRESS
FIRST SESSION
__________
HEARING HELD IN WASHINGTON, DC, OCTOBER 10, 2007
__________
Serial No. 110-68
__________
Printed for the use of the Committee on Education and Labor
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COMMITTEE ON EDUCATION AND LABOR
GEORGE MILLER, California, Chairman
Dale E. Kildee, Michigan, Vice Howard P. ``Buck'' McKeon,
Chairman California,
Donald M. Payne, New Jersey Ranking Minority Member
Robert E. Andrews, New Jersey Thomas E. Petri, Wisconsin
Robert C. ``Bobby'' Scott, Virginia Peter Hoekstra, Michigan
Lynn C. Woolsey, California Michael N. Castle, Delaware
Ruben Hinojosa, Texas Mark E. Souder, Indiana
Carolyn McCarthy, New York Vernon J. Ehlers, Michigan
John F. Tierney, Massachusetts Judy Biggert, Illinois
Dennis J. Kucinich, Ohio Todd Russell Platts, Pennsylvania
David Wu, Oregon Ric Keller, Florida
Rush D. Holt, New Jersey Joe Wilson, South Carolina
Susan A. Davis, California John Kline, Minnesota
Danny K. Davis, Illinois Cathy McMorris Rodgers, Washington
Raul M. Grijalva, Arizona Kenny Marchant, Texas
Timothy H. Bishop, New York Tom Price, Georgia
Linda T. Sanchez, California Luis G. Fortuno, Puerto Rico
John P. Sarbanes, Maryland Charles W. Boustany, Jr.,
Joe Sestak, Pennsylvania Louisiana
David Loebsack, Iowa Virginia Foxx, North Carolina
Mazie Hirono, Hawaii John R. ``Randy'' Kuhl, Jr., New
Jason Altmire, Pennsylvania York
John A. Yarmuth, Kentucky Rob Bishop, Utah
Phil Hare, Illinois David Davis, Tennessee
Yvette D. Clarke, New York Timothy Walberg, Michigan
Joe Courtney, Connecticut Dean Heller, Nevada
Carol Shea-Porter, New Hampshire
Mark Zuckerman, Staff Director
Vic Klatt, Minority Staff Director
C O N T E N T S
----------
Page
Hearing held on October 10, 2007................................. 1
Statement of Members:
Altmire, Hon. Jason, a Representative in Congress from the
State of Pennsylvania, prepared statement of............... 132
McKeon, Hon. Howard P. ``Buck,'' Senior Republican Member,
Committee on Education and Labor........................... 5
Prepared statement of.................................... 6
Miller, Hon. George, Chairman, Committee on Education and
Labor...................................................... 1
Prepared statement of.................................... 3
American Bar Association recommendations................. 7
Alliance for the Safe, Therapeutic, and Appropriate Use
of Residential Treatment (ASTART), statement of........ 132
Letters submitted for the record......................... 11
Questions for the record submitted to Dr. Pinto.......... 26
Questions for the record submitted to Mr. Kutz........... 27
Questions for the record submitted to Ms. Moss........... 27
Statement of Witnesses:
Bacon, Bob, father of Aaron Bacon............................ 41
Prepared statement of.................................... 43
Harvey, Cynthia Clark, mother of Erica Clark Harvey.......... 38
Prepared statement of.................................... 40
Kutz, Greg, Managing Director, Forensic Audits and Special
Investigations Unit, Government Accountability Office...... 30
Prepared statement and the GAO report, ``Residential
Treatment Programs: Concerns Regarding Abuse and Death
in Certain Programs for Troubled Youth,'' Internet
address................................................ 32
Responses to questions for the record.................... 32
Lewis, Paul, father of Ryan Lewis............................ 34
Prepared statement of.................................... 36
Moss, Jan, executive director, National Association of
Therapeutic Schools and Programs........................... 44
Prepared statement of.................................... 46
Additional materials submitted........................... 50
Responses to questions for the record.................... 64
Pinto, Ph.D., Allison, research psychologist and assistant
research professor, Louis de la Parte Florida Medical
Health Institute, University of South Florida.............. 75
Prepared statement of.................................... 77
Additional materials submitted........................... 81
Responses to questions for the record.................... 79
CASES OF CHILD NEGLECT AND
ABUSE AT PRIVATE RESIDENTIAL
TREATMENT FACILITIES
----------
Wednesday, October 10, 2007
U.S. House of Representatives
Committee on Education and Labor
Washington, DC
----------
The committee met, pursuant to call, at 10:33 a.m., in room
2175, Rayburn House Office Building, Hon. George Miller
[chairman of the committee] presiding.
Present: Representatives Miller, Kildee, Payne, Woolsey,
Hinojosa, McCarthy, Tierney, Kuchinich, Wu, Bishop of New York,
Sarbanes, Sestak, Loebsack, Hirono, Altmire, Clarke, McKeon,
Petri, Castle, Platts, Kline, Boustany, and Kuhl.
Staff present: Tylease Alli, Hearing Clerk; Jeff Appel, GAO
Detailee; Sarah Dyson, Investigative Associate, Oversight;
Patrick Findlay, Investigative Counsel; Denise Forte, Director
of Education Policy; Ruth Friedman, Senior Education Policy
Advisor (Early Childhood); Ryan Holden, Senior Investigator,
Oversight; Lamont Ivey, Staff Assistant, Education; Thomas
Kiley, Communications Director; Ann-Frances Lambert,
Administrative Assistant to Director of Education Policy;
Danielle Lee, Press/Outreach Assistant; Alex Nock, Deputy Staff
Director; Joe Novotny, Chief Clerk; Rachel Racusen, Deputy
Communications Director; Dray Thorne, Senior Systems
Administrator; Margaret Young, Staff Assistant, Education;
Michael Zola, Chief Investigative Counsel, Oversight; Mark
Zuckerman, Staff Director; James Bergeron, Minority Deputy
Director of Education and Human Services Policy; Robert Borden,
Minority General Counsel; Cameron Coursen, Minority Assistant
Communications Director; Kirsten Duncan, Minority Professional
Staff Member; Taylor Hansen, Minority Legislative Assistant;
Victor Klatt, Minority Staff Director; Alexa Marrero, Minority
Communications Director; Susan Ross, Minority Director of
Education and Human Services Policy; and Linda Stevens,
Minority Chief Clerk/Assistant to the General Counsel.
Chairman Miller [presiding]. A quorum being present, the
investigative hearing of the Committee on Education and Labor
titled ``Cases of Child Neglect and Abuse in Private
Residential Treatment Facilities'' will come to order.
Pursuant to Committee Rule 12(a), any member may submit an
opening statement in writing which will be made part of the
permanent record, and I will recognize myself, followed by the
senior Republican member, Mr. McKeon, for an opening statement.
I want to welcome everybody to today's hearing on cases of
child neglect and abuse at private residential treatment
facilities. For a number of years now, I have been deeply
concerned about the allegations of child abuse in private
residential treatment programs, which are often referred to as
boot camps or wilderness programs or behavior modification
facilities. These allegations range from neglect to torture, a
word I do not use lightly.
Today, we will hear about neglect and abuse cases where the
outcome was the worst one imaginable, the death of a child. We
will hear testimony from parents of children who died, and I
thank them for joining us today and for having the courage to
speak publicly about their ordeals.
It is estimated that hundreds of private residential
treatment programs operate nationwide. The programs are
governed for the most part by a weak patchwork of state
regulations. In many states, these programs operate without
regulation, licensing or accreditation of any kind, despite
often exorbitant prices of tuition.
Parents often send their children to these programs when
they feel they have exhausted their alternatives. Their
children may be abusing drugs or alcohol, attempting to run
away or physically harm themselves, or otherwise acting out.
They send their children to these programs because the promises
of staff members to be able to help children straighten out
their lives.
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 the trust in some of the more horrific
ways imaginable. We are aware of stories where program staff
members have forced children to remain in seclusion for days at
a time, to remain in so-called stress positions for hours at a
time, to undergo extreme physical exertion without sufficient
food or water.
And, today, we will hear evidence of even more horrifying
stories of the children denied access to bathrooms, forced to
defecate on themselves, or children forced to eat dirt or their
own vomit, of children paired with older children, their so-
called buddies, whose job it essentially was to abuse them.
There is only one word for this behavior, and that is inhumane.
This nightmare has remained an open secret for years.
Sporadic news accounts of specific incidents have built a
record that should never have been ignored, but shamefully it
was and the federal government has completely failed to grasp
the urgency of this situation.
In 2003, I urged then Attorney General John Ashcroft to
begin an immediate investigation into reports of child abuse at
private residential treatment programs. The attorney general
refused, as did his successor, Alberto Gonzales.
I also then wrote Secretary of State Colin Powell asking
him to investigate the treatment of children in facilities
located overseas but serving American children and operated by
U.S. companies. Secretary Powell's response was insufficient.
We will learn today that a number of these programs
actually operate on federal land, yet no federal agency, not
the Bureau of Land Management nor the Department of Interior,
no one, has thought to review problems associated with these
federal tenants, despite repeated incidents of injury or death
of a child.
No federal agency keeps official data about the number of
children enrolled in private residential treatment programs,
despite the fact that children are typically transported across
state lines, sometimes even by force, in order to be enrolled
in the programs, and I believe that that is an outrage.
In late 2005, I asked the Government Accountability Office
to launch an investigation of private residential treatment
programs. The GAO agreed, and I am pleased that the GAO has
devoted its significant resources to this important issue.
Today, the GAO will present case studies of programs where
death has occurred. Next year, GAO expects to release an
industrywide review, thus providing us with a comprehensive
look at the industry.
In the past, it has been estimated that anywhere from
10,000 to 20,000 children are enrolled in these programs at any
one time. I am sure that there are programs staffed by caring
professional and competent staff members who do help to improve
children's lives, yet there are clearly a number of programs
staffed by untrained, unlicensed, poorly paid staff members who
simply cannot be entrusted with the child's welfare.
As a result, without regulation, the industry as a whole
will continue to present unacceptable risks to children it
serves. That is why in 2005 I proposed legislation to provide
resources to states to help them create licensing standards for
private residential treatment programs. The legislation would
also boost the oversight of facilities overseas operated by
U.S. companies.
This hearing, as well as the ongoing work by GAO and by the
committee's investigative staff, will help determine if it is
the appropriate legislative response or if the situation
demands something else.
One thing is clear, however, that in light of the findings
we will hear today, Congress must act and it must act swiftly
to ensure the wellbeing of children participating in these
programs. We can all agree we have no mandate more urgent than
keeping children safe.
I would like to thank all of our witnesses for joining us
today. We will look forward to your testimony and working with
you to put a stop to these abuses.
And now I would like to yield to Congressman McKeon for his
opening statement.
[The statement of Mr. Miller follows:]
Prepared Statement of Hon. George Miller, Chairman, Committee on
Education and Labor
Good morning.
Welcome to today's hearing on ``Cases of Child Neglect and Abuse at
Private Residential Treatment Facilities.''
For a number of years now, I have been deeply concerned about
allegations of child abuse in private residential treatment programs,
which are often referred to as ``boot camps,'' ``wilderness programs,''
or ``behavior modification facilities.''
These allegations range from neglect to torture--a word that I
don't use lightly.
Today, we will hear about neglect and abuse cases where the outcome
was the worst one imaginable: the death of a child. We will hear
testimony from the parents of children who died. I thank them for
joining us today and for having the courage to speak publicly about
their ordeals.
It is estimated that hundreds of private residential treatment
programs operate nationwide. The programs are governed by a weak
patchwork of state regulations. In many states, these programs operate
without regulations, licensing, or accreditation of any kind, despite
the often exorbitant price of tuition.
Parents often send their children to these programs when they feel
they have exhausted their alternatives. Their children may be abusing
drugs or alcohol, attempting to run away or physically harm themselves,
or otherwise acting out. They send their children to these programs
because of the promise that staff members will be able to help children
straighten their lives out.
In far too many cases, however, the very people entrusted with the
safety, health, and welfare of these children are the ones who violate
that trust in some of the most horrific ways imaginable.
We have heard stories where program staff members forced children
to remain in seclusion for days at a time; to remain in so-called
``stress'' positions for hours at a time; or to undergo extreme
physical exertion without sufficient food and water.
Today, we will hear even more horrifying stories, of children
denied access to bathrooms and forced to defecate on themselves. Of
children forced to eat dirt or their own vomit. Of children paired with
older children--so-called ``buddies''--whose job it is, essentially, to
abuse them.
There is only one word for these behaviors: Inhuman.
This nightmare has remained an open secret for years. Sporadic news
accounts of specific incidents have built a record that should never
have been ignored, but shamefully was.
The federal government has completely failed to grasp the urgency
of this situation.
In 2003, I urged then-Attorney General John Ashcroft to begin an
immediate investigation into reports of child abuse at private
residential treatment programs. The Attorney General refused, as did
his successor, Alberto Gonzales.
I also wrote to then-Secretary of State Colin Powell asking him to
investigate the treatment of children in facilities located overseas
but serving American children and operated by U.S. companies. Secretary
Powell's response was insufficient.
We will learn today that a number of these programs actually
operate on federal land. Yet no federal agency--not the Bureau of Land
Management, not the Department of the Interior, no one--has thought to
review problems associated with these federal tenants, despite repeated
incidents ending in the injury or death of a child.
No federal agency keeps official data about the number of children
enrolled in private residential treatment programs, despite that fact
that children are typically transported across state lines--sometimes
even by force--in order to be enrolled in the programs.
This is an outrage.
In late 2005, I asked the Government Accountability Office to
launch an investigation of private residential treatment programs. The
GAO agreed, and I am pleased that GAO has devoted significant resources
to this important issue. Today, the GAO will present case studies of
programs where deaths occurred. Next year, GAO expects to release an
industry-wide review, thus providing us with a comprehensive look at
the industry.
In the past, it has been estimated that anywhere from 10,000 to
20,000 children have been enrolled in these programs at any one time.
I am sure that there are programs staffed by caring, professional,
competent staff members, who do help to improve children's lives. Yet
there are clearly a number of programs staffed by untrained,
unlicensed, poorly paid staff members who simply cannot be entrusted
with children's welfare. As a result, without regulations, the industry
as a whole will continue to present unacceptable risks to the children
it serves.
That is why, in 2005, I proposed legislation to provide resources
to states to help them create licensing standards for private
residential treatment programs. The legislation would also boost
oversight of facilities overseas operated by U.S. companies.
This hearing, as well as the ongoing work by GAO and by the
Committee's investigative staff, will help determine if that is the
appropriate legislative response or if the situation demands something
else.
One thing is clear, however: In light of the findings we will hear
today, Congress must act, and it must act swiftly, to ensure the well-
being of children participating in these programs. We can all agree
that we have no mandate more urgent than keeping children safe.
I'd like to thank all of our witnesses for joining us today. We
look forward to your testimony and to working with you to put a stop to
these abuses.
Thank you.
______
Mr. McKeon. I thank the chairman for yielding.
Today's hearing will explore a difficult topic. The
facilities we will be looking at receive no federal funding
and, therefore, are not regulated by the federal juvenile
justice legislation under this committee's jurisdiction.
Nonetheless, the allegations of mistreatment raise a number of
serious questions.
I want to recognize the families who are here today and
thank them for their willingness to share their personal
stories. The loss of a child is something no parent should have
to endure.
I also want to take the opportunity to recognize the
Government Accountability Office for its work in this area.
Often on issues like these where our jurisdiction as federal
lawmakers may be uncertain, the GAO's work can help provide
clarity. This includes an analysis of how these programs are
funded and regulated and what efforts are in place currently at
the state level, but also perhaps at the federal level to
ensure the safety and effectiveness of the programs.
We will also hear today from a researcher in this field
and, on behalf of practitioners, the National Association of
Therapeutic Schools and Programs, who can offer perspectives on
the regulatory framework in place as well as steps that can be
taken to improve upon current requirements to protect the youth
in these facilities.
As I understand it, the work of the GAO has focused on the
question of whether allegations of abuse and death at these
residential treatment facilities are widespread and on
providing a review of the case studies. The GAO was unable to
differentiate between public and private programs in
determining how prevalent these allegations are, which
demonstrates how difficult it may be to address this issue at
the federal level.
It seems to me that the question of how widespread these
alleged incidents of mistreatment are is critical. Of course,
even one incident of abuse or, worse, the loss of life is
unacceptable.
But before we consider federal intervention, we need to
better understand the breadth of the problem so we can
determine the best way to protect the youth in these programs.
We need to take a step back to evaluate what an appropriate
federal role would be, if any, in regulating these programs.
This requires that we first understand current federal
involvement, an area I hope we will explore today.
Many of these facilities have been established to serve
children who are deeply troubled, whether they are suffering
from drug addiction or severe emotional or behavioral problems.
Many of the youth who enter these facilities are placed there
by their parents as a last resort.
This committee has held a series of hearings this year to
examine how we can improve our juvenile justice system. Our
efforts have focused on identifying effective strategies that
prevent juvenile delinquency and encourage healthy child
development. Although these privately funded programs are not
currently governed by the juvenile justice statute under our
jurisdiction, I hope we can examine this issue through the
broader context of juvenile delinquency prevention in order to
understand how existing programs can meet the needs of troubled
youth.
Once again, let me thank the witnesses for being here to
help shed light on these facilities, the role they play in
serving troubled youth and the efforts at the state and local
level to ensure safety.
I yield back the balance of my time.
[The statement of Mr. McKeon follows:]
Prepared Statement of Hon. Howard P. ``Buck'' McKeon, Senior Republican
Member, Committee on Education and Labor
I thank the gentleman for yielding.
Today's hearing will explore a difficult topic. The facilities we
will be looking at receive no federal funding, and therefore are not
regulated by the federal juvenile justice legislation under this
Committee's jurisdiction. Nonetheless, the allegations of mistreatment
raise a number of serious questions.
I want to recognize the families who are here today and thank them
for their willingness to share their personal stories. The loss of a
child is something no parent should have to endure.
I also want to take the opportunity to recognize the Government
Accountability Office for its work in this area. Often on issues like
these, where our jurisdiction as federal lawmakers may be uncertain,
the GAO's work can help provide clarity. This includes an analysis of
how these programs are funded and regulated, and what efforts are in
place currently--at the state level, but also perhaps at the federal
level--to ensure the safety and effectiveness of the programs.
We will also hear today from a researcher in this field and, on
behalf of practitioners, the National Association of Therapeutic
Schools and Programs, who can offer perspectives on the regulatory
framework in place, as well as steps that can be taken to improve upon
current requirements to protect the youth in these facilities.
As I understand it, the work of the GAO has focused on the question
of whether allegations of abuse and death at these residential
treatment facilities are widespread, and on providing a review of case
studies. The GAO was unable to differentiate between public and private
programs in determining how prevalent these allegations are, which
demonstrates how difficult it may be to address this issue at the
federal level.
It seems to me that the question of how widespread these alleged
incidents of mistreatment are is critical. Of course even one incident
of abuse or worse, the loss of life, is unacceptable. But before we
even consider federal intervention, we need to better understand the
breadth of the problem so we can determine the best way to protect the
youth in these programs. We need to take a step back to evaluate what
an appropriate federal role would be, if any, in regulating these
programs. This requires that we first understand current federal
involvement, an area I hope we will explore today.
Many of these facilities have been established to serve children
who are deeply troubled. Whether they are suffering from drug addiction
or severe emotional or behavioral problems, many of the youth who enter
these facilities are placed there by their parents as a last resort.
This Committee has held a series of hearings this year to examine
how we can improve our juvenile justice system. Our efforts have
focused on identifying effective strategies that prevent juvenile
delinquency and encourage healthy child development. Although these
privately-funded programs are not currently governed by the juvenile
justice statute under our jurisdiction, I hope we can examine this
issue through the broader context of juvenile delinquency prevention in
order to understand how existing programs can meet the needs of
troubled youth.
Once again, let me thank the witnesses for being here to help shed
light on these facilities, the role they play in serving troubled
youth, and the efforts at the state and local level to ensure safety. I
yield back the balance of my time.
______
Chairman Miller. I thank the gentleman for his statement.
Without objection, all members will have 14 days to submit
additional materials and questions for the hearing record.
[The American Bar Association Recommendations, submitted by
Mr. Miller, follow:]
American Bar Association Recommendations
February 12, 2007
RESOLVED, That the American Bar Association urges state,
territorial, and tribal legislatures to enact laws that require the
licensing, regulating, and monitoring of residential treatment
facilities that are not funded by public or government systems, but are
privately-operated overnight facilities that offer treatment to at-risk
children and youth under age 18 for emotional, behavioral, educational,
substance abuse, and social issues and problems, including strenuous
athletic, mental health, and tough love programs. This legislation
should:
1. Require licensure of, or otherwise regulate, private residential
treatment facilities by defining clearly which programs must comply
with the statute and impose minimum legal requirements to operate and
maintain them, including standards regarding staff qualifications and
residents' physical and emotional safety, educational, mental health,
and other treatment needs.
2. Require government monitoring and enforcement of the operational
standards outlined in the statute.
3. Promote the preferred use of appropriate in-home and community-
based prevention and intervention programs for at-risk children and
youth by requiring enhanced governmental support that provides families
with better access to these programs.
FURTHER RESOLVED, That the American Bar Association urges the
Congress to enact legislation that would assure the safety of American
children and youth placed in U.S-owned, but foreign-based unregulated
private residential treatment facilities by requiring U.S. federal
agencies to work with foreign governments to monitor such facilities
regularly.
Report: The ABA Youth at Risk Initiative and Relevant ABA Policy
In August 2006, American Bar Association (ABA) President Karen
Mathis launched the ABA Youth at Risk Initiative geared towards youth
ages 13 to 19 who are at risk of entering juvenile and criminal justice
systems. Many of these youth and families face problems that elevate
this risk, including serious unmet mental health needs, serious
emotional or behavioral problems, bad peer choices, and gang
involvement.
They require the use of proven, ``evidence-based'' services
including appropriate in-home services that resolve these problems with
the youth's family and in the community.\1\ Also in August 2006, the
ABA House of Delegates approved a recommendation urging state,
territorial, and tribal governments to ensure that ``community mental
health systems serving youth are reinvigorated and significantly
expanded to provide greater access to troubled youth and their
caretakers.''
The ABA has long supported appropriate government regulation and
oversight of residential facilities serving children and youth. In
1979, the House of Delegates approved the Institute of Judicial
Administration/American Bar Association Juvenile Justice Standards, in
which the ABA called for ``the provision of a safe, humane, caring
environment, and access to required services for juveniles'' with the
``least possible restriction of liberty'' necessary and a ``careful
adherence to legal rights'' (Standard 1.2, Standards Relating to
Correctional Administration). The standards also encouraged governments
and independent agencies to assure the protection of juveniles'
substantive and procedural rights and pertinent laws and regulations
were ``continuously complied with'' (Standards 1.2, 1.3, Standards
Relating to Monitoring).
More recent ABA resolutions have addressed similar and related
issues. In 2004, an ABA resolution encouraged the use of law to ensure
foster care children have ``uninterrupted education access'' (August
2004). The ABA has also called for an increase in funding and financing
``for public mental health services so that * * * juveniles with mental
health or emotional illness or disorders can obtain the support
necessary to enable them to live independently in the community, and to
avoid contact with the criminal and juvenile justice systems.''
(February 2004). In 1990, the ABA passed a resolution supporting
juveniles' right to physical safety ``to be protected from abuse,
physical violence, and sexual assault while in foster custody'' (August
1990).
In August 2004, the ABA approved Standards for the Custody,
Placement and Care; Legal Representation; and Adjudication of
Unaccompanied Alien Children in the United States. The standards state
that unaccompanied alien children in residential facilities must always
``be treated with dignity, respect and special concern for [their]
particular vulnerability as a child'' (III.B). They are ``entitled to a
reasonable right of privacy'' including ``the ability to talk privately
on the phone without automatic monitoring; to receive and send
uncensored mail; and to meet privately with attorneys and other
visitors'' (III.K). The standards also state that unaccompanied alien
children must be protected ``from all forms of physical, sexual or
mental violence, injury or abuse, as well as neglect, abandonment,
maltreatment and exploitation'' while in residential care (III.L).
United States citizen children and youth placed by their parents or
others in purportedly ``therapeutic'' unregulated private residential
facilities require and deserve no less protection.
This is by no means the first time the ABA has called for the
protection of American children from harm in the international context.
Indeed, the safety of American youth who might be placed in foreign-
based facilities is also related to earlier concerns for children
addressed by the House of Delegates. In August 1997, the Association
endorsed U.S. ratification and full implementation of the Hague
Convention on Jurisdiction, Applicable Law, Recognition, Enforcement
and Co-operation in Respect of Parental Responsibility and Measures for
the Protection of Children, which calls for protection of children who
cross national borders. In February 1991, the ABA urged U.S.
ratification of the Convention on the Rights of the Child (now ratified
by over 190 nations but not the U.S.) which contains several provisions
focused on the protection of children who cross national borders. Much
earlier, the ABA's call for the U.S. ratification of the Hague
Convention on Civil Aspects of International Child Abduction (of which
the U.S. is a party) demonstrates another instance of the ABA's concern
for children's welfare when they are victims of international care and
custody disputes.
Unregulated Private Residential Treatment Facilities
Since the early-1990s, parents have been placing their children and
youth in unregulated private residential treatment facilities at an
increasing rate. Hundreds of U.S. and foreign-based facilities have
opened in the last ten years. It is estimated that these facilities
serve between 10,000 and 14,000 American youth per year.\2\ Despite
research on the efficacy of community-based and family-centered
intervention and prevention programs and treatment, thousands of
parents bypass available public systems and send, at their own expense,
their ``troubled'' children and youth to unregulated private
residential treatment facilities.
As relayed in numerous newspaper articles and exposes, many
children and youth enrolled in these programs are not afforded basic
and fundamental rights and protections. Public media accounts share
disturbing reports by youth and parents describing inferior treatments,
educational access violations, and instances of mental, physical, and
sexual maltreatment, neglect, and abuse.\3\ The Bazelon Center for
Mental Health Law collected the following documented accounts (through
media and Bazelon Center investigations and interviews) that represent
only a fraction of the abuses children and youth have experienced: \4\
Limitations on the ability to contact parents for extended
periods of time;
Overuse of medication to control behaviors. In some cases
children and youth were permanently disfigured because of over-
medication;
Confiscation of children's and youths' shoes to prevent
them from running away;
Use of physical restraint techniques that last for hours
at a time. The overuse of restraints has led to the death of some
children and youth; and
Sexual abuse by facility staff members, in some instances
having young girls exchange sexual favors for food.
Despite egregious abuses, these facilities continue to grow in
number and size. The industry is booming and reportedly worth over a
billion dollars.\5\ A parent may pay between $3,000 and $5,000 dollars
a month to send their child or youth to an unregulated private
residential treatment facility and not be able to monitor his or her
progress because of rules limiting family contact.\6\ The industry
prospers on promises to modify troublesome behaviors and to make
``bad'' kids good. Its financial sustainability is assured by frequent
deceptive advertising on the internet that market facilities as
offering an array of mental health and educational services that are
often not available or provided by unqualified staff.\7\
In 2005, Representative George Miller (D-CA) asked the U.S.
Government Accountability Office (GAO) to conduct a comprehensive
investigation of unregulated private residential treatment facilities
in light of repeated reports and allegations of child abuse and fraud.
In August of 2005, the Children's Welfare League of America also called
upon the GAO to conduct such an investigation, but it has not yet done
so.
Regulation, Oversight, and Monitoring of U.S.-Based Unregulated Private
Residential Treatment Facilities
The first part of this recommendation calls for state legislatures
to pass laws that require states to license, regulate, and monitor
unregulated private residential treatment facilities for children and
youth. First, the recommendation encourages state legislators to define
clearly which programs must comply with the law. Many unregulated
private facilities have easily avoided state licensure and monitoring
by claiming exemption in vague exceptions to state licensure
requirements. For example, one facility skirted state oversight by
designating itself as a ``boarding school'' rather than a residential
treatment facility, despite its lack of educational services.\8\ Many
state laws include broad provisions regarding oversight of residential
treatment facilities that are easily avoided by programs that chose to
designate themselves as something else, e.g., a ``boot camp'' or
``boarding school.''
The first part of the recommendation also encourages states to
establish and enforce standards for licensure that assure the safety,
health, and well-being of children and youth placed in these
facilities. This standards requirement intends to combat the human
rights violations and abuses that have occurred at so many facilities
that remain unregulated by state law. Only a handful of states have
proposed or passed comprehensive legislation that establish standards
to monitor and regulate private residential treatment facilities for
children and youth.
For example, in 2005, the Utah legislature passed a law that
expands state licensing requirements to all residential treatment
programs, including ``therapeutic schools.'' \9\ The Utah law requires
the Utah Department of Human Services, Office of Licensing to establish
health and safety standards for residential treatment licensees that
address client safety and protection, staff qualifications and
training, and the administration of medical procedures and standards.
The new law also empowers the licensing office to revoke licenses if
covered residential programs fail to meet the law's standards or engage
in conduct that poses a substantial risk of harm to any person. Any
facility that continues to operate in violation of the law is guilty of
a misdemeanor, if the violation endangers the welfare of clients. The
law also requires the licensing office to designate local government
officials as residential treatment facility inspectors who are charged
with conducting compliance assessments.
Finally, the first part of this recommendation encourages state
legislatures to assure families access to in-home and community-based
prevention services that have proven effective instead of unregulated
private residential treatment facilities that have not shown their
efficacy.\10\ Studies show that community mental health programs for
children and youth with significant mental health and behavioral
problems are more effective and less costly.\11\ In 1999, the U.S.
Surgeon General, in his report on mental health, found that admissions
to residential treatment facilities had been justified on the basis of
community and child protection. These justifications, however, do not
stand up to research scrutiny. Seriously violent and aggressive
children and youth do not improve in these settings and community
interventions that target change in peer associations are highly
effective at reducing aggressive behaviors. Moreover, children and
youth who need protection from themselves (i.e., who attempt suicide,
persistently run away, or abuse drugs) may require a brief
hospitalization for an acute crisis, but subsequent intensive
community-based services may be more appropriate than a residential
treatment facility.\12\
In 2003, the U.S. President's New Freedom Commission on Mental
Health called for better systems of care to detect early childhood
emotional disturbances and provide prevention and intervention services
to prevent these problems from worsening.\13\ A year later, the
National Institutes of Health, State of the Science Conference--
Preventing Violence and Related Health Risking Social Behaviors in
Adolescents issued a statement affirming that ``scare tactics'' used at
``get tough'' programs and boot camps don't work and in fact may make
children's and youths' behavioral problems worse.\14\ Finally,
communities all over the country have begun to implement evidence-based
community programs for at-risk children and youth, such as treatment
foster care, wraparound services, multisystemic therapy, and functional
family therapy.
Regulation, Oversight, and Monitoring of Foreign-Based Unregulated
Private Residential Treatment Facilities
The second part of this recommendation calls upon the federal
government to oversee the operations of U.S.-owned unregulated private
residential treatment facilities that are located abroad. To avoid
state regulation and monitoring, many U.S. companies have opened
private residential treatment facilities in the Caribbean or overseas.
Some of the most egregious human rights violations against American
children and youth have occurred in foreign-based unregulated
facilities where they are restricted from communicating with
family.\15\
To respond to these abuses, in 2004, the U.S. Department of State
issued a fact sheet on privately-owned overseas behavior modification
facilities stating that some facilities ask parents to sign contracts
giving staff broad authority to take any action deemed necessary to
assure children's and youths' progress in the program.\16\ The fact
sheet also warns that children's and youths' communication privileges
and contact with family and the outside world may be restricted.
Finally, it warns parents that:
The Department of State has no authority to regulate these entities
* * * and does not maintain information about their corporate or legal
structures or their relationships to each other or to organizations in
the United States. The host country where the facility is located is
solely responsible for compliance with any local safety, health,
sanitation, and educational laws and regulations, including all
licensing requirements of the staff in that country. These standards
may not be strictly enforced or meet the standards of similar
facilities in the United States. The Department of State has, at
various times, received complaints about nutrition, housing, education,
health issues, and methods of punishment used at some facilities.
Prior to enrolling their minor children in such overseas ``Behavior
Modification Facilities,'' the Department of State strongly recommends
parents/guardians visit the facility and thoroughly inform themselves
about both the facility and the host country's rules governing it and
its employees.
In the 109th Congress (2005), Representative Miller (D-CA) proposed
the ``End Institutional Abuse Against Children Act,'' \17\ which
requires the U.S. Department of Justice to coordinate with foreign
countries to investigate and inspect foreign-based private residential
treatment facilities, periodically. The proposed legislation also
requires the justice department to issue protection and safety rules
for foreign-based programs and requires the U.S. Department of State to
report any abuses of American children and youth.
Conclusion
In February 2006, then ABA President-Elect Karen Mathis held a
planning conference for her Youth at Risk Initiative. Sixty child
welfare and juvenile justice experts participated in the conference and
recommended that the ABA encourage the passage of legislation that:
Prohibit[s] the operation of unlicensed, unregulated residential
treatment facilities that operate programs whose efficacy has not been
proven empirically, such as boot camps, tough love, and ``scared
straight'' programs, and require the closing of such facilities. The
law should provide for such facilities to be replaced with: better
access to preventative services, with a focus on family involvement and
community-based resources wherever possible; and carefully regulated
``residential treatment facilities'' that are reserved for youth whose
dangerous behavior cannot be controlled except in a secure setting.
These recommendations are a step towards achieving these goals.
State and federal legislators have begun to take action in light of the
abuses that have befallen children and youth placed by their parents in
unregulated private residential treatment facilities. However, there is
no comprehensive collection of data available about the number of
programs that exist or the extent to which they are licensed, monitored
or regulated. In many states there is a paucity of regulatory oversight
or monitoring for these programs and as of yet, there is no federal
guidance on the issue. It is time for the ABA to respond to these
problems. The ABA must educate itself on the issues relating to this
disturbing trend and encourage change that emphasizes the regulation,
monitoring, and evaluation of unregulated private residential treatment
facilities.
Respectfully submitted by Dwight Smith, Chairperson, Commission on
Youth At Risk, February 2007.
Executive summary
1. Summary of the Recommendation
This recommendation encourages efforts to require the licensing,
regulating, and monitoring of residential treatment facilities that are
not funded by public or government systems, but are privately-operated
overnight facilities that offer treatment to at-risk children and youth
for emotional, behavioral, educational, substance abuse, and social
issues and problems, including strenuous athletic, mental health, and
tough love programs.
2. Summary of the Issue Which the Recommendation Addresses
This recommendation addresses the lack of government oversight and
monitoring of private unregulated residential treatment facilities by
outlining aspects of government regulation that should be instituted to
impose minimum legal requirements to operate and maintain these
facilities, including standards regarding residents' physical and
emotional safety.
3. Explanation of how the proposed policy will address the
issue
This resolution calls attention to the problems that face thousands
of children and youth who are sent to private residential treatment
facilities that are not regulated or monitored by government. It
encourages such regulation and promotes the use of community-based
services to ensure that these children and youth receive appropriate
assistance that meets their educational, mental health and other
treatment needs in a physically and emotionally safe environment. By
bringing the ABA's influence to bear on the entities that should
oversee these programs, this resolution will encourage greater
awareness, increased knowledge, improved laws and policies for these
children and youth at risk.
4. Summary of Any Identified Minority Views or Opposition
No opposition to this recommendation has been identified.
ENDNOTES
\1\ ``Evidenced-based'' refers to intervention and prevention
programs that have been carefully assessed to determine their long-term
positive outcomes.
\2\ Pinto, A., et. al., Exploitation in the Name of `Specialty
Schooling:' What Counts as Sufficient Data? What are Psychologists to
Do? Tampa, FL: Louis de la Parte Florida Mental Health Institute,
University of South Florida, 2005. .
\3\ Gorenfeld, J. ``No More Nightmares at Tranquility Bay?''
AlterNet, January 2006; Dibble, S. ``Scrutiny Increased on Centers for
Teens,'' The San Diego Union Tribune, January 2005; Rowe, R.
``Tranquility Bay: The Last Resort,'' BBC News-World Edition, December
2004; Labi, N. ``Want Your Kid to Disappear?'' Legal Affairs, July/
August 2004; Kilzer, L. ``Desperate Measures,'' Denver Rocky Mountain
News, July 1999.
\4\ The Bazelon Center for Mental Health Law. Fact Sheet: Children
in Residential Treatment Centers. Washington, DC. .
\5\ Chen, M. ``At Some Youth `Treatment' Facilities, `Tough Love'
Takes Brutal Forms.'' The New Standard, November 2005.
\6\ Szalavitz, M. ``The Trouble with Tough Love,'' Washington Post,
January 2006.
\7\ Pinto, A., Specialty Schooling, 2005.
\8\ ``Desperate Measures,'' July 1999.
\9\ Licensure of Programs and Facilities, Utah Senate Bill 107
(2005).
\10\ Bazelon Center. Fact Sheet; see also U.S. Department of Health
and Human Services. Mental Health: A Report of the Surgeon General--
Executive Summary. Rockville, MD: U.S. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration,
Center for Mental Health Services, National Institutes of Health,
National Institute of Mental Health, 1999, 169-171.
\11\ Surgeon General, Mental Health, 1999, 169-171; McKechnie, M.
Children's Mental Health System in Oregon--Past, Present and Future.
Portland, OR: Juvenile Rights Project, Inc., 2004. ; Chamberlain, P. ``Treatment Foster
Care.'' Washington, DC: Juvenile Justice Bulletin, U.S. Department of
Justice, Office of Justice Programs, Office of Juvenile Justice and
Delinquency Prevention, 1998.
\12\ Surgeon General, Mental Health, 1999, 169-171.
\13\ President's New Freedom Commission on Mental Health. Achieving
the Promise: Transforming Mental Health Care in America. Washington,
DC, 2003. .
\14\ National Institutes of Health. Preventing Violence and Related
Health Risking Social Behaviors in Adolescents: an NIH State of the
Science Conference Statement. Rockville, MD: U.S. National Institutes
of Health, 2004.
\15\ See, e.g., Bay, Gorenfeld, J. ``No More Nightmares at
Tranquility Bay?'' AlterNet, January 2006; Rowe, R. ``Tranquility Bay:
The Last Resort,'' BBC News-World Edition, December 2004.
\16\ U.S. Department of State. Fact Sheet: Behavior Modification
Facilities. Washington, DC: U.S. Department of State, 2004. .
\17\ End Institutional Abuse Against Children Act, H.R. 1738, 109th
Cong. (2005).
______
[Letters submitted for the record follow:]
October 15, 2007.
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: As the mother of a 17 year old son who went
through an exemplary wilderness program for eight weeks at the
beginning of 2007, and is now in his sixth month of an 18 month program
at a top notch therapeutic boarding school, it was with great interest
that I watched the approximately two hour hearing referenced above. I
want to commend the House Committee on Education and Labor for taking
up this important matter. Nothing could possibly be more important than
the safety and welfare of our children, especially when we are seeking
help for them to overcome serious problems.
Our particular story began in August 2006 just prior to our son
starting his junior year in high school. Throughout August, we
discovered that our son had been leading a double life, having
successfully hidden his drug abuse from us. I refer to a ``double
life'' because our son did not ditch school, always maintained a grade
point average of at least 3.0, was not disrespectful to any large
degree, participated in family life, was not out until all hours, etc.
We discovered that most of his drug use was done (sometimes daily) at
our local public high school in our upscale Southern Orange County,
California neighborhood in the bathroom during school hours, and went
completely undetected. Nevertheless, when it became apparent that our
son was troubled more than what we considered to be within the range of
normal adolescence angst, we took immediate action to get to the source
of the problem. When he admitted to drug use, we took him to an
adolescent psychologist, and a local drug education program followed by
an intensive outpatient program through a hospital. In addition, at his
request, he transferred schools so he could get away from his negative
peer group. I cannot adequately express the hell we went through for
six months frantically trying to get local help for our son. To say
that we were in a state of shock, confusion, exhaustion and fear would
be an understatement. Although our son managed to stay off drugs, we
could see that his life was still not working; his grades began to
fall, he seemed depressed, and appeared to need more help than we were
able to find for him locally. When we came across a communication he
had with a friend that indicated that although he had stayed away from
substances, he missed them, he still identified with that way of life,
and he was considering returning to using drugs, we knew we had to look
for a different intervention.
Finding a safe, effective residential program proved difficult at
first. The personnel at the local drug education program suggested a
small boys program in Utah. When we investigated the program and called
parents whose children were at the program, we determined that it would
not be an appropriate placement for our son. We were then referred by
our psychologist to a marketing representative of a particular company
that ran a number of programs in different states. She tried to
convince us over the phone that we should send our son to one of their
programs. Feeling uncomfortable with the limited choices that we were
uncovering, I went on the internet and found an educational consultant.
I called the consultant who spent a great deal of time explaining
options to me, and then gave me other families he had worked with to
call as a reference. I finally felt like I found someone who knew this
industry well and would be diligent in finding a placement for our son.
What still bothers me to this day is that as well read, involved
people, my husband and I had no idea where to turn when we needed help
for my son. We had to learn by trial and error about the options
available, and could have very well made a terrible mistake.
Sending our son out of state for treatment was one of the hardest
decisions my husband and I have ever had to make. We are so grateful
that through our educational consultant we were able to place our son
in two superb programs. We believe with all our heart that our son's
life was saved by these programs, and if you spoke directly to him, he
would say the same thing. He was never in any physical or emotional
danger while in the wilderness or at his school. Quite the contrary--he
has been helped by highly competent, dedicated, trained and educated
professionals who have mentored him with skill, honesty, love,
understanding and compassion. The wilderness program has an incredibly
high staff to student ratio, uses the highest quality equipment and
communication systems, makes sure the participants are well fed and
hydrated, checks their feet for frost bite daily (my son was in Utah
during the winter), and watches the students' physical health (my son
had a case of shingles when he was there and he was immediately put
under the care of a physician who prescribed antibiotics). The clinical
staff at the wilderness program are nothing less than brilliant, and
they got through to my son with counseling, activities in the great
outdoors, assigning books for him to read, having him do written
assignments, etc. They included our family every step of the way with
weekly family phone sessions and written communications, as well as two
visits while our son was there. In March, our son left the wilderness
to become a student at a therapeutic boarding school. He has continued
on his journey of self-discovery, is taking a full load of college
preparatory classes, will graduate high school, and we anticipate that
he will go on to college after completing the program. He is
rediscovering his talents and passions, and wants a different, better
life for himself. Last week, I spoke to his college counselor at his
boarding school for over an hour. I am so grateful for this because
with the kind of substance abuse in which our son was involved, we very
well could have been talking to law enforcement, hospital emergency
personnel or even to a morgue instead of a college counselor. Although
no one can predict the future, we feel so much hope and confidence for
our son's life.
After watching the hearing, and listening to the anguished stories
of the parents who testified and the wrenching information brought out
in the case studies that the Government Accountability Office (GAO)
presented, there is no doubt in my mind that regulation, oversight,
licensing and monitoring are needed. As Mr. McKeon so rightly stated,
there are ``bad actors'' in every industry. The programs that deliver
unsound, unsafe, abusive, neglectful, and sometimes even fatal,
services to our children should be held accountable for their appalling
actions. My heart goes out to the parents whose children died, and I
understand that they shared their stories to prevent other families
from having their children put in perilous situations.
That being said, I hope that the more extensive industry-wide
review that the GAO is preparing to present in early 2008 will include
information on the many wonderful, clinically sound programs that have
not only saved countless lives, but have given the teens the tools they
need to have the opportunity to live full, productive and joyous lives.
I encourage the Committee to take a bi-partisan approach (what could be
more bi-partisan than our children?) in delving deeper into this issue
in a careful, deliberate manner. We need sensible legislation, not
legislation that could throw the baby out with the bath water and
hamstring credible programs from helping our youth. There are programs
that are operating ethically and effectively, and they should be
consulted as a resource for safe standards and appropriate regulation.
I'm sure that the ethical programs do not see it as a benefit to the
industry to have substandard, dangerous programs in operation.
The most disappointing facts to come out of the hearing is that the
criminal justice system has not properly prosecuted the wrongdoers, and
that the Forest Department wasn't even aware that one of the programs
in question was in arrears on its rent and that its permit had expired
eight years ago. These examples prove that legislating regulation is
just the start; making sure that the initiative is backed by funding
and training for those charged with oversight, is the only way to make
a real difference.
I realize this communication is lengthy; however, this issue is of
the utmost importance to me. Please do not hesitate to contact me if
you would like any other information.
Respectfully,
Marla Kaufman.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller:
I am requesting that these comments be placed on the Official
Record regarding the October 10, 2007 House Committee on Education and
Labor hearing on cases of child abuse and neglect at residential
treatment centers.
My daughter and our family were the grateful recipients of the
highly professional services of a therapeutic boarding school and a
wilderness program. She was heavily into drugs and alchohol, and was
eventually date raped, after dropping out of High School. We chose,
after much research to not have her be part of the ``system'' that
gives her a number and wants her to be like everyone else. We chose a
wilderness program that had a great reputation with the backing of many
educational conslutants. After this program, we sent her to a
therapeutic emotional growth boarding school. To put this into
perspective, we saved her life and have our independent, strong,
willful, and beautiful daughter with us today. No, she is not the
perfect person that we all envision as parents, however she is not
branded after being in a ``system''.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few result in harm to
the majority. The majority can be effected by the few, so, I am
requesting that your Committee defer from drafting a bill until
complete due diligence is done on the complete impact of the entire
situation, which is your responsibility, is known.
Sincerely,
Gregg Heyne.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I request that these comments be placed on
the Official Record regarding the October 10, 2007 House Committee on
Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
I am the parent of a child who has completely turned his life
around as a result of both having a ``wilderness'' experience with
highly trained and skilled psychologists and counselors and then being
placed in a therapeutic residential campus where he has been able to
learn the kinds of life skills that will allow him to be a productive
and contributing member of society. This would not, under any
circumstance, have happened had he not been spirited away from his
destructive home environment and placed in the kind of supportive and
substance free environment that allowed him to achieve his potential.
One year ago, I would have guaranteed that he would be dead today.
Sending him away, against his will (to the extent he had any
independent judgment) was the hardest most wrenching moment of my life.
He is now my best friend, has become the kind of man I dreamed he would
become and is ready to take on society fully aware of his weaknesses,
but with a determination to overcome them.
I am concerned that the proposed legislation is seeking to address
admittedly harmful ``schools'' by creating a one size fits all
solution. My son's school is fully accredited by both the state and the
independent accrediting bodies. It has a staff of highly qualified
psychologists and persons trained to deal with adolescents who are at
extreme risk. It is also expensive and my greatest sadness is the
inability of so many other parents with lesser means to find schools
like it. Not only will the creation of additional regulatory bodies
create additional regulatory compliance- and yet more expense for
parents who are truly at the end of all other options (and often of
their finances), but variations among the states will create a
nightmare for schools simply seeking to care for their wards. As a
former school board president, I know that California's rules relating
to residential facilities were created, much like the current proposed
legislation, to prevent abuse by effectively banning residential care
schools and non-voluntary programs. While this prevents abuse at one
level, it does not save the children most in need. Applying those rules
to schools in other states would effectively bar California children
from participating in programs that are often a last resort.
The wilderness programs of 8-10 weeks where most of the children
are first taken before they can enter a therapeutic school are
tremendous first steps and have a remarkable track record of awakening
kids to the desperate state of their lives. These are regulated by the
states and should remain as such. Without this first introduction to
assuming responsibility for their actions, the children would never
succeed in the longer programs at the therapeutic schools.
I would hope that before this bill is reported out there will be
some effort by members or staff to visit some of the very successful
schools. If any of those members or staff have teenage children, there
first response will probably be: ``How I wish my child were in a school
like this!'' Stories of abuse are legion in our society. Preventing
families from having the opportunity to take their children out of a
poisonous environment (for the child) and placing him or her in a
responsible and caring institution would be just as abusive as the
supposed cure.
Thank you for your consideration.
Sincerely,
Dewey Watson,
Tierney Watson & Healy, Cornerstone Law Group, San Francisco, CA.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son/daughter and our family were the grateful recipients of the
highly professional services of a therapeutic boarding school and a
wilderness program. My daughter had serious problems when she was a
young teenager that led us to send her first to a wonderful wilderness
program and then to an emotional growth boarding school. The daughter
who came back to us after almost 2 years was a changed child and is now
a productive young adult. Without these programs we do not think she
could have become the person she is.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Sincerely,
Ilene Ferber.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son and our family were the grateful recipients of the highly
professional services of a therapeutic boarding school and a wilderness
program. My 16 yr. old son was suffering from emotional issues ( poor
identity, needy, phony face, mother issues, anger, violence, etc) which
resulted in his joining a gang and dealing in drugs for acceptance
while flunking out of a high quality high school. He has an IQ over
160. We had him abducted into a wilderness program in Utah for 6 weeks
which was the best thing in the world for him at that time. I visited
the nomadic troop of troubled teens in the winter for only two nights
but it was long enough to see the care, concern and love the 2 or 3
ever present counselors had for the 10 or 12 in their particular group.
There is no abuse, physical touching, corporal punishment or cold or
hunger issues. They were fully equipped for the elements and I was
impressed with how these VERY troubled inner city gang members
eventually began to pull together, to hold each other accountable, to
accept responsibility, to join in and follow the rules and to work like
men. No matches, (rub sticks together for fire). They cook their own
food over the fire every meal and change camp sites every day packing
everything they own on their backs. No knives except with counselors
for food preparation, no flash lights, no watches * * * only the sun to
keep time. Some kids stayed for 4 to 5 months until clean and
emotionally ready to move on. These kids were happy and proud, even
while reluctantly accepting the idea of rules and responsibility.
After the wilderness program he attended an emotional growth school
for 24 months where he truly gain the life skills to put his life back
on track. He accelerated his education (no TV, no phones, no ipods, no
electronic games, etc.) and graduated from high school with a 3.1 GPA
while also graduating from the schools emotional growth program. My son
is now 19 and is a sophomore at Portland State University with a 3.2
GPA. He chose to live with me rather than his mother and has become a
very squared away young man. I am very proud of the work he did for
himself at both wilderness program and the emotional growth school. He
and many others would be lost with out these services. I feel sorry for
the many families who cannot afford or are not aware of these fine
schools. Unfortunately, many of kids will end up in our court and penal
systems instead of these much better programs. The government should
help fund, but not regulate this work. Look what the government has
done to most school systems. Free enterprise does a much more
efficient, effective and economical job.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Mike Duyn,
Macadam Forbes, Oncor Intl., Portland, OR.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I have heard about the bill you are
sponsoring about child abuse at Residential treatment centers. I surely
applaud any desire to end abuse, but wanted you to know the tremendous
good the legit schools do. My son was going down a path of failure and
drug abuse in high school. We had tried at the normal ways of helping
him, drug counseling, tutors, special education plans, etc. but nothing
worked. We were at wits end. Although we are middle class, I am a
construction super and my wife was a gov't secretary, we got a second
mortgage on our house and got a educational consultant involved. She
found a wilderness program for my son, and then a residential emotional
growth school. We were reluctant at first of course, sending away our
son for someone else to parent. And we had heard some of the horror
stories about programs (in Costa Rica I think). But we visited some
schools and found one that fit. Our son spend two years there. Two
years he may not have had otherwise. the school was amazing, full of
love and caring people who helped not only my son, but my wife and I as
parents also. My son learned so much there, mainly to have the self
esteem to value himself more than he did. He still struggles, as most
young people do, but he is alive and happy and drug free. That was a
gift to us beyond value. So I wanted you to know that there are many
good programs out there. And they do tremendous good for so many
families. We could barely afford the school, and I am worried that the
passing of this bill as is will only escalate the costs so only the
very rich can afford them.
So please in your efforts to help, consider the effect this bill
will have on the good, no LIFESAVING programs. The added paperwork and
buracratic requirements will only make it harder for the schools to
exist.
I have read that many of the states that have abuse problems are
handling it themselves with their own bills too. I am sure there are
State's right's issues here also. A federal bill might make a school in
one state have to meet the licensing requirements in the home state,
further adding to the mess.
Your bill is for a noble cause, but please be careful you don't
harm more families than you help.
Please add my comments to the Official record regarding the Oct. 10
2007 House Committee on Education and Labor hearing on cases of child
abuse and neglect at residential treatment centers.
Thank you for you time,
Charles H. Bird Jr.,
Waldorf MD.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son and our family are the grateful recipients of the highly
professional services of a therapeutic boarding school and a wilderness
program. Our son was going down a dangerous path of self-destruction
and oppositional behavior. Without access to the wonderful wilderness
program and unbelievably effective therapeutic boarding school that he
is at, he would never have been able to make the incredible changes
that were necessary to turn his life around. If all children could
attend school like this our jails would be empty.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Please exclude emotional growth and therapeutic boarding schools
from your proposed bill. It will only serve to place an undue burden on
the children, parents, and administrators of such schools by making
them devote more time to filling out government forms than teaching and
helping.
Thanks for your time.
Sincerely,
Denise J. Grigst.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that my comments be placed on
the Official Record regarding the October 10, 2007 House Committee on
Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son has been through an excellent Wilderness Program and is
currently in a wonderful Therapeutic Boarding School. He has never been
more happy or productive in his life. I think the end result of this
therapy will be to develop a productive member of society in a young
man who had little chance of this a year ago.
As in most things, there are good and bad. My wife and I personally
put in a great effort and expense to find the right placements for our
son and I urge other families to do the same. I hope that your
Committee will not throw the baby out with the bath water regarding
these treatment programs. Please find a way to preserve the good ones
without making them more expensive. They are already a financial burden
for most of us who have had to send our child there in the hope of
saving their life.
Respectfully,
Stephen J. Folzenlogen,
Houston, Texas.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My daughter and our family were the grateful recipients of the
highly professional services of a therapeutic boarding school and a
wilderness program. Our school district had no viable options for my
daughter, and she was on a risky and self-destructive path. At our
wits' end, our family life in disarray, we turned to an educational
consultant who after meeting with us and interviewing my daughter
recommended a wilderness program and therapeutic boarding school that I
believe may have saved my daughter's life. As a result of this
intervention, today my daughter is doing very well as a healthy and
productive student at a major college of art.
I'm sure you would agree that the vast majority of therapeutic
emotional growth boarding schools and wilderness programs are
professional, experienced, ethical and extremely valuable to children
and families in crisis. As in our case and many others, they save lives
and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until care and complete due diligence is accomplished
on the complete impact the bill will have on the entire situation.
Thank you.
Respectfully,
Neal Hirsch,
Highland Park, IL.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son and our family were the grateful recipients of the highly
professional services of a therapeutic boarding school and a wilderness
program. My son had issues growing through adolescence, which as a
family we were not able to solve at home. We tried for nearly 15
months. He was and is an exceptionally bright child, who was heading on
a path to jail or death. Until his issues surfaced, he was a perfect
son, so to speak. Our need was to protect him, and provide a means for
him to grow emotionally, in a safe and therapeutic environment. The
program he attended was great for him and for our family. We re-
connected and learned a lot about his inner issues and his poor coping
mechanisms to deal with stress. He graduated high school at his
emotional growth boarding school, came home for the summer and now is
off at UC Berkeley. Had we not intervened with this therapeutic
boarding school program, he would probably be in a juvenile hall, and
if lucky rebuilding his life through community colleges.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families. I appreciate the need to
ensure ALL program are run safely, and as a parent it was a very scary
process finding a good one. We found that educational consultants help
identify schools, through their network and expertise.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Placing a bureaucracy upon a system that in the most part is working,
may increase costs and dis empower the schools to provide the structure
they need. Unfortunately most of these kids have come from public
schools, where for various reasons, all administration keep arms length
with any issues with the kids, thus creating the legislated low-
boundary type environment that kids with emotional issues just flounder
in.
Thank you for reading my comments,
Elaine Wuertz.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: Please place the following comments on the
Official Record regarding the October 10, 2007, House Committee on
Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
I understand that some recent, high-profile cases are propelling
you to take action on wilderness programs and residential treatment
centers. I would like to urge you to proceed with caution.
My son recently spent several years attending wilderness programs
and a therapeutic, emotional growth boarding school, following his
explusion in rapid succession from several private and public schools
in the Bay Area.
He was making extremely bad choices and his behavior was out of
control.
Although he is extremely bright, my son also has ADHD, and his many
teachers through the years had managed to instill in him the belief
that he was stupid because he couldn't sit still in class. His recourse
was to try to position himself as a ``bad boy,'' and he was able to
indulge that fantasy to the extreme in the toxic social environment
that children encounter in the Bay Area. I had to get him out of there
and away from all the terrible peer pressure.
My son spent 10 weeks in a Wilderness Program where he was able to
detoxify his body, start to explore his behavior and motivations, and
develop tremendous pride in his ability to ``bust'' a fire and move
through the mountains without leaving a trace. He then spent a year at
an emotional growth boarding school where he was enveloped in a loving
culture far from the influences of TV, video games, gangsta rap, drugs,
and negative peer pressure. He developed respect for his own intellect
and started to do very well in his academic classes. He also learned to
cook for the school, fell trees and remove tree stumps, care for the
farm animals, sew clothes, cross-country and telemark ski, and numerous
other skills that he never would have developed in the fast-paced,
self-indulgent Bay Area.
Our path was not a straight one. My son was not ready to give up
his old image that easily, so he ended up back at Wilderness for
another 10 weeks, and then attended a residential treatment center for
about a year. He was finally able to leave the world of programs to
attend his senior year at a more traditional boarding school, and he
excelled. He is now enrolled as a freshman in the business school of a
California university and is eager to get on with his life. He also
believes that he has been fortunate to develop more emotional skills
and maturity than any of his peers.
The programs my son attended, along with the vast majority of
wilderness programs, therapeutic emotional growth boarding schools, and
residential treatment centers, are professional, experienced, ethical,
and extremely valuable to children and families in crisis. As in our
case and many others, they save lives and families. My son continues to
tell me that he would be dead by now if I hadn't sent him away.
I am extremely concerned that the problems of a few programs might
result in harm to the majority of them because of legislative over-
reaction and heavy handedness. Harm to the programs will result in harm
to the families that depend on them. Bad or unnecessary legislation
will result in:
Higher costs and loss of resources to administrative
functions. These programs are already extremely costly and present
significant financial hardship to the families that rely on them. If
they were to become more expensive due to unecessary bureaucracy, many
families would find them completely unaffordable, and many children
would be at risk.
The lumping of successful and ethical schools with abusive
fringe programs.
Sensationalism that will further stigmatize the parents
and children who have benefited so significantly from these programs.
Most of us have had little support from our family and friends in this
process because they just don't get it--they haven't had to live with
our troubled children, and they don't understand what these kids need
to get better.
I understand the current hearings are based, in part, on a report
requested by you and issued by the Government Accountability Office,
entitled ``Residential Treatment Programs: Concerns Regarding Abuse and
Death in Certain Programs for Troubled Youth.'' It should be noted that
many of the cases cited in the report are over 10 years old. States
have been and are currently adopting oversight and safety standards in
response to these and other cases. This issue is a state's rights (10th
Amendment) issue: the states should retain the authority to regulate
such programs as each state feels is appropriate. The concerns are
already being dealt with responsibly at the state level so no federal
government action should be needed at this time.
In conclusion, I am asking that your Committee defer from drafting
a bill until complete due diligence is done and the complete impact of
the entire situation is known. Children's lives are at risk if you make
these programs less affordable and accessible. We need them.
Sincerely,
Barbara B. Kamm,
Los Altos, CA.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son and our family were the grateful recipients of the highly
professional services of a therapeutic boarding school and a wilderness
program.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Sincerely yours,
Seth Finklestein, M.D.,
Biotrofix, Inc., Needham, MA.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers. There must be a distinction drawn
between the types of programs that any new law would cover. The
radical, 60 Minutes type of hysteria of the yelling and screaming drill
instructor is far different than the type of program my daughter
experienced during her seven weeks spent in wilderness and then
eighteen months at her boarding school.
My daughter and our family were the grateful recipients of the
highly professional services of a therapeutic boarding school and a
wilderness program. The program is a highly successful emotional
growth, therapeutic boarding school that provided a miracle by allowing
my child to become a happy, resilient, contributing member of society.
Many methods were employed to achieve this result, the greatest of all
was learning to trust in a very loving encouraging atmosphere. No
`military' tactics were ever allowed, it was not consistent with the
founders vision.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Howard L. Page,
Residential & Commercial Broker.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
Our daughter and our family were the grateful recipients of the
highly professional services of a therapeutic boarding school and a
wilderness program. Our daughter, outside her past environment, has
matured. She is now able to articulate her feelings and addressed many
issues that were preventing her from being the whole and beautiful
young woman, and better citizen, that she is now. This has changed our
lives. If there were more attention being paid to the local public
schools in our country, many of these problems would be lessened for
sure.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families. The word
``professional'' is key here. The professional schools are not the
problem. They do not need the burden of beuracracy and they need to be
subsidized, if anything.
I am extremely concerned if problems of a few, and scattered,
results in harm to the majority, that is doing good. So, I am
requesting that your Committee defer from drafting a bill until
complete due diligence is done on the complete impact of the entire
situation, which is your responsibility, is known. STOP THE DRAFTING OF
THIS BILL.
Don't burden the parents and programs that are professional and
well respected.
I am a California resident, a citizen, a voter and a caring parent
(who has to struggle with this issue, in large part, because of the
abysmal public schools!).
Very sincerely yours,
Bill Smitrovich.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
Our son's life was saved by the Wilderness Program and following
that, the emotional growth boarding school he attended. He went from
being a child lost, on his way to certain death via drugs and alcohol
(at the base of this behavior--low self-esteem) to a happy, productive,
amazing young man who will contribute greatly to our society.
We understand that there are programs that are unethical and can be
abusive to children. This was our greatest fear in sending our son
away. We did maniacal research on schools and while were fortunate to
have found safe and beneficial environments, we certainly read about
unethical facilities in business to profit from the tragedies and
desperation of families in crisis. We are in complete agreement that
these facilities should be closed. However, widespread legislation that
forces the places that are helping our children, would be devastating.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. I can't imagine
where we would be if we hadn't found such a place.
It is vital that the schools that do help our youth are not
negatively impacted by this bill. I am requesting that your Committee
defer from drafting a bill until complete due diligence is done on the
complete impact of the entire situation.
I am happy to share our story and have attached a presentation that
discusses the impact that low self-esteem can have on individuals and
how powerful the change can be when they are in a safe, nurturing
environment, with people who know how to deal with these issues. Please
feel free to call us if you would like further information.
Regards,
Shelly and David Seeger,
Symantec Corp.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
Our daughter and our family were the grateful recipients of the
highly professional services of a wilderness program and a therapeutic
emotional growth boarding school from September 2005 through June 2007.
Our daughter, who had previously been an honor student and positively
active teen, reacted to a boyfriend breaking up with her by slipping
into depression and trying to ease those feelings with dangerous
behaviors around alcohol, sexual promiscuity, and drugs. During a
turbulent downward spiral the summer of '05, she grew angry and defiant
and in August ran away to California. We found her 9 days later and
brought her home, but she believed her life was over and was intent on
destroying herself. We understood that we needed to take action for our
daughter and we sought out the help of an educational consultant who
helped us to select the right wilderness program for our daughter (she
was there for 9\1/2\ weeks) and also the emotional growth boarding
school where she enrolled in November 2005 and from which she graduated
in June 2007. These programs saved her life and our entire family has
benefited from the experiences The emotional growth school she attended
is founded on the values of honesty and love. We/she wish that all
students could grow and flourish in the positive environment that her
emotional growth school provided and continues to provide. (Yes, she
went back to visit over Labor Day and stays in contact with both staff
and other students from the school.) Our daughter is now a freshman at
University of Colorado--Colorado Springs and is pursuing a degree in
psychology which will allow her to work with troubled teens and ``give
back''.
While there are some less than desirable programs/schools, the vast
majority of therapeutic emotional growth boarding schools and
wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families. The current expense
structure was a significant hurdle for us but we found a way through a
second home equity loan to pay for the help our daughter needed. These
costs are already extremely high and it is wrong to put more
bureaucratic cost onto the backs of parents when it is not needed.
Please find a way to bring the poorly run programs into line without
adding cost to programs that are well run and extremely effective in
saving/changing lives.
I am concerned that your committee will let problems with a few
programs/schools result in harm to the majority of well run and
effective programs/schools. I am requesting that your committee defer
from drafting a bill until complete due diligence is done on the
overall impact of the entire situation. It is your responsibility to
act with complete knowledge and not with a partial understanding of the
``sensational'' situations that are in the minority but get all the
media attention and coverage. Please take into consideraton what
federal legislation will do to the majority of programs, such as the
ones our family experienced. Our daughter will tell you that they
``saved my life''.
Sincerely,
Debra R. Bryant,
Monument, CO.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: We are requesting that the following comments
be placed on the Official Record regarding the October 10, 2007 House
Committee on Education and Labor hearing on ``Cases of Child Neglect
and Abuse at Private Residential Treatment Facilities''.
Our daughter completed a 2 month wilderness program and is
currently enrolled in a therapeutic boarding school. Prior to enrolling
her in these programs we were keenly aware of, and were very concerned
about of mistreatment in such programs.
Of course, we wanted to ensure that our daughter was placed in an
environment that was, first and foremost, safe and one where she would
receive the type of care she and our family needed to get our lives
back on track. We conducted extensive research and engaged with an
educational consultant to assist us in our search.
We learned that there is a broad range of programs which may be
referred to as ``Residential Treatment Facilities''. We were convinced
that the vast majority of wilderness programs and therapeutic boarding
schools which we investigated are professionally run, experienced,
ethical and, most important extremely valuable to children and families
such as ours. Such programs have saved lives and families.
We are happy to report that our daughter has made remarkable
progress as a direct result of the outstanding care and treatment she
has received in both the wilderness program and the therapeutic
boarding school.
We agree that there is a need to put an end to all mistreatment but
we believe this may only occur at only a small percentage of wilderness
and residential treatment programs and it is not clear that
mistreatment at residential treatment facilities is on the rise or
decline. We are extremely concerned that increased regulation, aimed at
addressing the problems of a few, could become intrusive and harmful to
many reputable programs and affected families such as ours.
We believe it is the committee's responsibility, as it is ours as
parents, to do what is in the best interest of our children and for our
families. We hereby request that your Committee refrain from drafting
legislation or taking any action until due diligence is done to more
completely assess the situation.
Respectfully yours,
Richard and Diane Scheno,
Fremont, CA.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My daughter and our family were the grateful recipients of the
highly professional services of a residential treatment center and a
wilderness program in Utah.
Our 15 year old daughter had become practically non-functional due
to emotional issues. We had a team of therapists and doctors here at
home working with her but it was only when she went to a wilderness
program that we started to see real progress. After wilderness, she
went to a residential treatment center where she got the care and
support of an amazing therapeutic team. It is here that she learned the
skills needed to cope with her emotional problems; it was here that
real and lasting change was made.
These two programs saved our daughter's life. Many of the
therapists and counselors who work at these programs are performing
miracles every day, changing the lives of so many troubled teenagers.
While reading the GAO's report of abuse at some facilities is
heartbreaking, I believe that the vast majority of residential
treatment centers, therapeutic boarding schools and wilderness programs
are professional, experienced, and ethically run. I also believe that
continued regulations and oversight are critical for the safety of the
residents in the programs. However, I hope that the problems caused by
a few will not result in harm to the over all industry.
These facilities provide a much needed level of service for so many
families in crisis. Please don't throw the baby out with the bath
water.
I am respectfully requesting that your Committee defer from
drafting a bill until an assessment of the entire situation is done.
Sincerely,
Ann and Phil Sheridan,
San Jose, CA.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: As a lifelong democrat and former constituent
from the East Bay, I always supported your efforts and hope you will
continue to reward my faith. I have some concerns regarding the October
10, 2007 House Committee on Education and Labor hearing on cases of
child abuse and neglect at residential treatment centers. I am
requesting that my comments be placed on the Official Record regarding
this hearing.
Our daughter and our family were the grateful recipients of the
highly professional services of a therapeutic boarding school and a
wilderness program beginning in 2005. Our daughter had previously
fought severe depression and low self-esteem which lead her into self-
destructive behavior. After years of therapy and even moving to a rural
environment in a new state, my wife and I became desperate. We took
what we believed to be a huge step and enrolled her in a wilderness
program followed by a therapeutic boarding school. We found both
programs to be highly professional and rewarding. Our daughter turned
18 while attending the boarding school, and stayed on another 9 months
of her own choice as an adult in order to graduate. She is now living
at home, attending college full time and working part time. Those
programs saved our daughter and positioned her to thrive.
The vast majority of therapeutic emotional growth boarding schools
and wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned that problems with a few abusive programs
may result in harm to the majority of programs. So, I am requesting
that your Committee defer from drafting a bill until complete due
diligence is done to thoroughly explore the residential treatment
situation and how legislation might effect the good ethical programs as
well as the bad. I agree that abusive programs must be ``cleaned up''
as quickly as possible, but I hope you can find a way to do that
without encumbering the beneficial programs with unnecessary
bureacrasy, while burdening the families with added costs.
I wish you well in your efforts.
Sincerely,
Pete Small,
Ridgefield, WA.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: We are requesting that these comments be
placed on the Official Record regarding the October 10, 2007 House
Committee on Education and Labor hearing on cases of child abuse and
neglect at residential treatment centers.
Our son and our family are the VERY grateful recipients of the
highly professional services of a residential treatment center (RTC)
and a therapeutic wilderness program. We are quite sure that without
the assistance of the professionals at the RTC and the amazing
therapist he worked with in wilderness, he would be part of the
juvenile system and most likely, hopelessly addicted.
We believe our story is typical for a child without underlying
mental illness. The short version is that our son started to experiment
with marijuana with his friends at about the age of 14. In his freshman
year, his grades nose dived; he was using more and a greater variety of
readily available street drugs. Out patient therapy was ineffective in
getting the behavior under control. We dug into our retirement funds to
send him to a non-therapeutic boarding school that offered ``success
through structure.'' Unfortunately, that school enrolled a large group
of adolescents that really needed a therapeutic environment because
they had serious drug use and behavioral issues. Many of those children
got worse, not better. The result for our child is that he used more
drugs more frequently, despite the punishment of longer and longer
detention and more severe campus restrictions, and he began to get in
trouble with the authorities. He was arrested twice--once for assault
and once for minor in possession. The frightening thing for us was that
we could tell that he was scared and he was trying to change, but he
couldn't * * * he didn't have the skills and by this time, he was not
only scared, but angry and defiant. As parents, we knew that at the
young age of 16, he was on the verge of making decisions that would
have negative, life changing consequences.
We decided to send him to a Wilderness Therapy program that came
highly recommended by our educational consultant * * * we hired ed
consultants because we realized that doing it on our own had led us to
the first bad choice for placement. The wilderness program we used
operates in the Blue Ridge Mountains and undoubtedly uses Federal
lands. His initial reaction was to try to run and he resisted for about
2 weeks. But, then he finally ``worked the program.'' The program in
this case was to help him reconnect with his old self, to become sober,
to understand his anger and motivations and to become open to change.
He was guided in this journey by a wonderful therapist with over 25
years of experience in working with adolescents. It was hard for him,
but he was never in danger physically. We realize wilderness therapy
isn't for every kid, but his personnel growth during that period was
phenomenal. In his own words, it was the ``best worst thing I ever
did'' and he thanked us for sending him.
We followed wilderness therapy with a private and well respected
Residential Treatment Center in Utah (for this we have remortgaged our
home). He is thriving. He has the guidance of a skilled therapist, is a
leader among the other teen boys (strong positive peer culture
environment); he is working a 12-step program to deal with addiction
issues, his health has improved and his grades are up. Again he has
thanked us. On the home front, we are participating in family therapy
with him and with our other children to shore up our parenting skills
and the extra skills we will need to support him when he is back. We
are working toward bringing him home early next year.
Prior to hearing about your inquiry at the Committee level, we had
considered writing to our congressional representatives (Blumenauer,
Smith and Wyden) to urge them to help families pay for this kind of
life saving intervention. Our insurance (Federal Employee Program
through Blue Cross Blue Shield) categorically excludes residential
treatment and wilderness. The result is that we have sacrificed
retirement and home equity. But we feel fortunate that we had those
resources to tap into. Most families that we talk to who are also using
these programs make these same sacrifices to afford the care their
child needs. Many families cannot afford it and their children are at
the very least jeopardizing their health and future, if not filling up
juvenile detention facilities and jails. We ask that you avail
yourselves to recent studies on the successful outcomes of children
placed in well run private RTCs, therapeutic boarding schools and
wilderness programs. Take input from juvenile probation officers and
others in law enforcement, most of whom consider these interventions as
positive alternatives to the juvenile court system.
We realize there has been a virtual boom in the adolescent
treatment industry and with that has come the establishment of some
disreputable and unsafe places that prey on families in crisis. Our
hearts ache for the parents that have lost children while trying to
save them. Still, you must find a way to support the work of
residential treatment centers, therapeutic emotional growth boarding
schools and wilderness programs that are run by professionals, who are
experienced, ethical and extremely valuable to the recovery of children
and their families. As in our case and many others, they save lives and
families.
We are extremely concerned that the problems with a few bad
programs will result in harm to the majority. So, we are requesting
that your Committee defer from drafting a bill until complete due
diligence is done and the entire situation is known.
Thank you for considering and including our comments.
Very respectfully yours,
Sheryl Carrubba and Mark McClure,
Portland, OR.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
My son and our family were the grateful recipients of the highly
professional services of a residential treatment center and a
wilderness program. We want you to know that at no time in either
wilderness or RTC was there anything remotely close to physical abuse.
This is our son's story:
By April, 2006 our 16 year old son was severely depressed, thought
he was worthless and was failing in school--and had started self-
medicating with a wide range of drugs. We were lucky in that our family
has always gotten along with each other and had open communications. As
parents, we did all we could and still his situation continued to
worsen. We simply did not have the tools, knowledge or skills to help
him. It was only a matter of time before he would be in jail or dead.
And he didn't care.
We did an intervention and sent him to a wonderful wilderness
program. Two months in the Utah desert helped a lot, but he was still
not ready to come home. Although he was now clean, he still hadn't done
the hard work to look deep within himself to change his way of life and
learn the tools that could help him do that. It took 10 months in a
residential treatment center for him get his life in order. The RTC
staff was demanding, but also loving and kind.
Today our son is a mature young man who has been clean and sober
for 18 months. He is happy, confident and looking forward to going to
college to become a therapist in order to give other at risk kids a
reason to live.
He went back to his wilderness program this past summer as a 12-
step volunteer in order to help kids that were like him 18 months ago.
He's been invited to work there next summer because of the positive
impact he had on the kids.
The vast majority of residential treatment centers, therapeutic
emotional growth boarding schools and wilderness programs are
professional, experienced, ethical and extremely valuable to children
and families in crisis. As in our case and many others, they save lives
and families.
I am extremely concerned if problems with a few result in harm to
the majority. So, I am requesting that your Committee defer from
drafting a bill until complete due diligence is done on the complete
impact of the entire situation, which is your responsibility, is known.
Sincerely,
Barbara Damm and John McKinney,
6th California Congressional District.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: Our daughter and our family are recipients of
the highly professional services of a therapeutic boarding school and a
wilderness program.
Lindsey was fourteen years old when we decided that she could no
longer live at home with us without being a danger to herself. Lindsey
did not want to abide by our rules and no matter the warnings,
consequences, etc. she did not take us seriously. She was drinking,
smoking marijuana and behaving in a manner that was totally out of
control. We hired an educational consultant and by interviews
determined that Lindsey needed to experience being at a Wilderness camp
and then on to some type of boarding school. Lindsey stayed at the
wilderness camp for ten weeks and in those weeks she began to slowly
recognize her lack of self esteem and self confidence that led to her
negative choices. The hard work both emotional and physical was
facilitated by a highly competent and caring staff and therapist who
believed in Lindsey. Although at the end of ten weeks strides of
improvements were made we all knew that she was not ready to come back
home. Lindsey is now enrolled at an emotional growth treatment school
run by a team of administrators, teachers, staff and qualified
therapists where she is being positively challenged to be accountable,
honest, loving and vunerable in academics, emotional issues and
physical abilities. It is good, hard work for her. As her parents, we
are also challenged to do our part to improve our communication and
relationship with each other. We are committed to this school for
helping us navigate through a process of growth which ten months ago
looked bleak.
Families like ours are extremely grateful for these types of
options such as wilderness camp and emotional growth/residential
treatment facilities. This is why we are extremely concerned that
problems with a few such facilities (such as neglect and abuse) result
in harm to the majority. We are requesting that your Committee defer
from drafting a bill until complete due diligence is done on the entire
situation and results are known.
We are requesting that our comments be placed on the Official
Record regarding the October 10, 2007 House Committee on Education and
Labor hearing on cases of child abuse and neglect at residential
treatment centers.
Sincerely,
Kurt and Arlene Bosshard,
Kapaa, HI.
______
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am requesting that these comments be placed
on the Official Record regarding the October 10, 2007 House Committee
on Education and Labor hearing on cases of child abuse and neglect at
residential treatment centers.
Our son and our family were the grateful recipients of the highly
professional services of a therapeutic boarding school and a wilderness
program. Our son had started on a downward spiral in his sophomore year
of high school, smoking marijuana and not doing his school work. He
ended that year using a multitude of different drugs and binge-drinking
alcohol. After desperately exploring what options were available to us,
we heard from a friend of the family about a wilderness program that
had saved his daughter's life. We worked with an educational consultant
whom the friend recommended and chose the same wilderness program. This
program was run in a caring and conscientous manner, and their
counselors and staff are outstanding. Our son ended up liking the
program and learned much about himself. He is even considering working
there when he graduates from high school. He is now enrolled in an
emotional growth/therapeutic boarding school. Whereas the wilderness
program is the first step in taking a young person out of an unhealthy
environment, the therapeutic boarding school provides a deep learning
of healthy habits and cements them in an 18-month program. The program
involves the whole family in this learning process. I can unequivocally
say that this experience has saved our son's life!
I have met and spoken with numerous other parents whose children
have attended similar programs. They all had excellent experiences and
were extremely grateful that those options are available. The vast
majority of therapeutic/emotional growth boarding schools and
wilderness programs are professional, experienced, ethical and
extremely valuable to children and families in crisis. As in our case
and many others, they save lives and families.
I am extremely concerned if problems with a few programs result in
harm to the majority. So, I am requesting that your Committee defer
from drafting a bill until complete due diligence is done and the
complete impact of the entire situation is assessed.
Sincerely,
Inge Jechart,
Pleasanton, CA.
______
[Questions for the record submitted to Dr. Pinto follow:]
Congress of the United States,
Washington, DC, October 15, 2007.
Allison Pinto, Ph.D., Complexity Research & Development,
Children's Board of Hillsborough County, Tampa, FL.
Dear Dr. Pinto: Thank you for testifying at the October 10, 2007
full Committee hearing, ``Cases of Child Neglect and Abuse at Private
Residential Treatment Facilities.'' Enclosed are the questions which
Committee members have asked you to respond for the record. Please send
an electronic version of your written response (in Word format) to the
Committee staff by COB on Wednesday, October 24, 2007--the date on
which the hearing record will close. If you have any questions, please
contact us. Once again, we greatly appreciate your testimony at this
hearing.
Sincerely,
George Miller, Chairman.
Representative Robert Scott (D-VA), has asked that you respond in
writing to the following questions:
1) Do ``tough love'' strategies have an appropriate treatment role
for major psychological disorders? If so, what is that role?
2) Is there currently an obligation for mental health professionals
who recommend these programs to clients to ascertain their safety and
validity as a treatment option?
3) Is there currently any requirement that other treatment options
be utilized to address a child's behavioral issues before sending them
to such a center?
______
[Questions for the record submitted to Mr. Kutz follow:]
Congress of the United States,
Washington, DC, October 15, 2007.
Gregory D. Kutz, Managing Director,
Forensic Audits and Special Investigations, GAO, Washington, DC.
Dear Mr. Kutz: Thank you for testifying at the October 10, 2007
full Committee hearing, ``Cases of Child Neglect and Abuse at Private
Residential Treatment Facilities.'' Enclosed are the questions which
Committee members have asked you to respond for the record. Please send
an electronic version of your written response (in Word format) to the
Committee staff by COB on Wednesday, October 24, 2007--the date on
which the hearing record will close. If you have any questions, please
contact us. Once again, we greatly appreciate your testimony at this
hearing.
Sincerely,
George Miller, Chairman.
Representative Robert Scott (D-VA), has asked that you respond in
writing to the following questions:
1) What percentage of youths attending these programs are
minorities?
2) Will or can the GAO report disaggregate the deaths/abuses being
investigated by the reason the individual is in the program and whether
the individual is taking psychotropic medication?
3) Is there currently an obligation for mental health professionals
who recommend these programs to clients to ascertain their safety and
validity as a treatment option?
4) Is there currently any requirement that other treatment options
be utilized to address a child's behavioral issues before sending them
to such a center?
______
[Questions for the record submitted to Ms. Moss follow:]
Congress of the United States,
Washington, DC, October 15, 2007.
Jan Moss, Executive Director,
The National Association of Therapeutic Schools and ProgramsThe
National Association of Therapeutic Schools and Programs,
Prescott, AZ.
Dear Ms. Moss: Thank you for testifying at the October 10, 2007
full Committee hearing, ``Cases of Child Neglect and Abuse at Private
Residential Treatment Facilities.'' Enclosed are the questions which
Committee members have asked you to respond for the record. Please send
an electronic version of your written response (in Word format) to the
Committee staff by COB on Friday, November 2, 2007. If you have any
questions, please contact us. Once again, we greatly appreciate your
testimony at this hearing.
Sincerely,
George Miller, Chairman.
Representative Robert Scott (D-VA), has asked that you respond in
writing to the following questions:
1) What mechanism is in place to deal with circumstances where your
members have self-certified that they are abiding by NATSAP's ethics
and good practices standards when they are in fact not in compliance
with these standards?
2) Dr. Pinto testified that she has collected 700 concerns on
residential treatment centers over 6 months, while NATSAP has
investigated less than 5 claims against its members. Can you please
explain the discrepancy in these numbers?
3) Is there currently any requirement that other treatment options
be utilized to address a child's behavioral issues before sending them
to such a center?
Chairman George Miller respectfully request that you respond to the
following questions:
1) What is NATSAP's policy regarding the use of its logo by
members. For example, are there any restrictions for using the NATSAP
logo on marketing materials and websites? Are NATSAP members using the
NATSAP logo required to disclose that use of the NATSAP logo does not
represent endorsement by NATSAP of the safety, quality, or
effectiveness of the members' program.
2) Ms. Moss indicated that NATSAP will research complaints or
reports of alleged misconduct by members. What procedures are in place
for reporting misconduct to NATSAP? Are reporting procedures
documented? Does NATSAP make its reporting procedures widely available,
for example on its website? Do members have a duty, arising from their
membership, to report any misconduct to NATSAP that violates NATSAP's
Ethical Principles or Principles of Good Practice? How many complaints
or reports of misconduct has NATSAP received since its formation, and
what steps were taken to research such complaints or reports of
misconduct.
3) Ms. Moss indicated that NATSAP researched at least one instance
where a complaint was made regarding a member's website. Please
describe the complaint, the actions taken by NATSAP, the corrective
actions taken by the member; and provide the identity of the member.
4) What actions does NATSAP intend to take in light of the
testimony given by the U.S. Government Accountability Office regarding
the Alldredge Academy's delinquency in remitting permit fees to the
federal government? Is operating on federal land without a valid permit
a violation of NATSAP's Ethical Principles or Principles of Good
Practice?
5) NATSAP hosts national and regional conferences to foster the
professional development of its members. Have any of these conferences
ever included lectures, workshops, presentations or discussions
concerning cases of abuse, neglect, mistreatment, or death of children;
what led to these horrific tragedies; what needs to change; and what
NATSAP members need to do in response?
6) NATSAP's new membership requirements mandate that members be
licensed by an appropriate state mental health agency, or accredit by a
reputable mental health accreditation organization. On what basis is an
accreditation organization deemed to be ``reputable?''
7) Please provide a chart showing the year in which each NATSAP
member joined NATSAP, or lost its membership due to expiration or
revocation.
8) It is our understanding that the NATSAP board is primarily
comprised of individuals associated with member programs. Given that
NATSAP researches and acts upon complaints against members when they
are reported to NATSAP, please describe NATSAP's policy regarding
conflicts-of-interest for its board members. For example, are board
members required to recuse themselves on matters before the board when,
by virtue of their affiliation with a particular member, their judgment
may be prejudiced in fact or in appearance?
9) Recent reports indicate that a NATSAP member, Youth Care, Inc.,
has been placed on probation by the Utah Department of Human Services
and that criminal neglect charges have been filed against this member
due to the death of a child. Youth Care, Inc. uses the NATSAP logo on
its website to promote their program. Given these reports and the use
of the NATSAP logo by this member, what steps does NATSAP intend to
take to research reports of criminal neglect on the part of Youth Care,
Inc.?
10) Aspen Education Group, which owns Youth Care, Inc., also
operates Aspen Achievement Academy, another NATSAP member. Aspen
Achievement Center is currently being investigated for a teen's
attempted suicide. While local authorities conduct a thorough
investigation, what does NATSAP do to ensure the safety of the students
placed in its member facilities?
______
Chairman Miller. Before proceeding to introduce our
witnesses, let me lay out the process we follow generally in
investigative hearings specific to this hearing.
An investigative hearing differs from a legislative or
oversight hearing in that the investigations may involve
allegations that public officials acting in their official
capacity or private citizens or entities have engaged in
certain conduct that may suggest the need for a legislative
remedy. Because of the importance of getting complete, full and
truthful testimony, witnesses at investigative hearings before
the committees of Congress are sworn in, and our witnesses will
be sworn today.
I understand that some witnesses, as is their right, may be
accompanied by counsel. While counsel are welcome to advise
their clients, they may not coach them or answer questions on
their behalf. House Rule 11 2(k)4 authorizes the chairman of
the committee to ``punish breaches of order and decorum and
professional ethics on the part of counsel by censure or
exclusion from hearings, and the committee may cite the
offender to the House for contempt.''
I will not tolerate any tactics designed to disrupt the
purposes of this hearing, and I must say I do not expect any.
To ensure that we have ample opportunity to flesh out the
relevant facts for the record, I have exercised my prerogative
as chair, pursuant to Committee Rule 2(b), to extend the 5-
minute rule for myself and for Mr. McKeon. Following the
witnesses' testimony, we will each engage in one round of 15-
minute questionings and then go to the other members of the
committee under the 5-minute rule.
I would like now to introduce our panel of witnesses.
Mr. Greg Kutz is currently the managing director of GAO's
Forensic Audits and Special Investigations unit. Mr. Kutz has
testified and written investigative reports about the federal
governments' handling of Hurricanes Katrina and Rita and
military pay problems in Department of Defense and the
smuggling of nuclear materials across our nation's borders,
among other important issues.
He will be accompanied by Mr. Andy O'Connell, who is the
assistant director for investigations at the GAO.
Mr. Paul Lewis is the father of Ryan Lewis, who died in
2001.
Ms. Cynthia Harvey is the mother of Erica Harvey, who died
in 2002.
Mr. Bob Bacon is the father of Aaron Bacon, who died in
1994.
Ms. Jan Moss is the executive director of the National
Association of Therapeutic Schools and Programs created in
January of 1999. NATSAP is a 501(c)6 not-for-profit trade
association that represents therapeutic schools, residential
treatment programs, wilderness programs and other similar
programs.
And finally, Dr. Allison Pinto is a clinical child
psychologist and research assistant professor at the Florida
Mental Health Institute at the University of South Florida
where she coordinates A START, which is Alliance for Safe
Therapeutic and Appropriate Use of Residential Treatment. Dr.
Pinto has coordinated public awareness and advocacy efforts
relating to the mistreatment of children in private and
unregulated residential treatment facilities. She also serves
as a principal investigator of a qualitative study regarding
experience of youth and families who have participated in the
residential treatment programs.
For those of you who have not testified, first, let me
welcome you all to the committee and explain that we will have
a lighting system. When you begin your testimony, there will be
a green light, which is on the table, which will give you 5
minutes to testify. When you see the yellow light, it means you
roughly have 1 minute in which to sum up your testimony. And
with the red light, your time is expired, although we certainly
want you to conclude your testimony in a fashion so you have
properly conveyed those thoughts at that time.
And let me remind you that you have to turn on the
microphones in front of you.
Before we move on to the testimony, if each of you would
stand and raise your right hand for the purpose of being sworn
in.
Do you swear that the testimony that you are about to give,
that you will tell the truth, the whole truth and nothing but
the truth?
Let the record show the witnesses have answered in the
affirmative.
Please be seated.
We will now hear from our first witness, Mr. Kutz of the
GAO.
Welcome.
STATEMENT OF GREG KUTZ, MANAGING DIRECTOR, FORENSIC AUDITS AND
SPECIAL INVESTIGATIONS UNIT, GOVERNMENT ACCOUNTABILITY OFFICE
Mr. Kutz. Mr. Chairman and members of the committee, thank
you for the opportunity to discuss residential treatment
programs for youth.
There are many who claim positive outcomes for troubled
youth at these programs. At the same time, there are widespread
allegations of death and abuse. My testimony today addresses
these allegations.
My testimony has two parts: first, some background on the
scope of our work; and, second, the results of our work.
First, since at least the early 1990s, hundreds of
residential treatment programs have been established across the
United States. There is no standard definition of these
programs and no way to know how many exist. There are no
federal laws that regulate private programs. However, some
states have statutory regulations that require licensing.
Common names for these programs include boot camps,
boarding schools and wilderness programs. The first poster
board shows examples of wilderness program settings which are
typically in the mountains, the forest or the desert. The
second poster board shows first the restrictive nature of some
of these programs which you can see by the fencing and the
cameras and, second, the military theme of other programs.
All of these programs offer in some way to reform the lives
of very troubled youth.
The purpose of our work was to address allegations of death
and abuse at these programs. Our focus was on private programs.
However, our overall analysis of the extent of death and abuse
included both public and private programs. It was beyond our
scope to evaluate the benefits of residential treatment
programs.
Moving on to the results of our work, we identified
thousands of reported cases of death and abuse at these
programs. Sources of these allegations include HHS, state
agencies, the Internet and pending and closed civil and
criminal lawsuits.
Allegations include physical, emotional and mental abuse.
Examples of abuse include: youth being forced to eat their own
vomit; denied adequate food; being forced to lie in urine or
feces; being kicked, beaten and thrown to the ground; and being
forced to use a toothbrush to clean a toilet and then forced to
use that toothbrush on their teeth.
We took an in-depth look at 10 cases that were closed of
teenagers that died between 1990 and 2004. Ineffective program
management played a key role in most of these deaths.
The next poster board shows four key themes from our case
studies, which include untrained staff, misleading marketing
practices, abuse before death and negligent operating
practices. I will now use these case studies to discuss these
four themes.
First, we found program staff with little or no relevant
training. In many cases, program managers and staff
misinterpreted signs of treatable conditions, such as
dehydration. As a result, many of these kids died slowly while
program management and staff continued to believe that they
were faking it. It seems the only way staff could be convinced
that these kids were not faking it was when they stopped
breathing or had no pulse.
For example, in one case, a 16-year-old male exhibited
significant signs of distress for nearly 3 weeks, including the
loss of bodily functions. In 30 days, this 5-foot 10-inch boy
dropped from 131 pounds to 108 pounds. Despite these warning
signs, he was forced to continue hiking. There was no emergency
response until he collapsed and stopped breathing.
Unfortunately at this point, it was too late.
In another case, a 14-year-old male was forced to sit in
the 113-degree sun for hours. He began eating dirt due to
hunger, became dehydrated and appeared to have a seizure. He
was hauled in the back of a pickup truck to a motel where he
defecated and vomited on himself. Staff then pressed his
stomach and mud oozed out from the boy's mouth. They then
cleaned him up, put him into the back of the pickup truck and
took him back to the campsite. He died shortly after this in a
hospital.
Another 14-year-old male showed signs of excessive body
temperature and heavy breathing, but staff assumed that he was
faking it. Although the boy became unconscious, staff continued
to believe that he was faking it. The final check was for staff
to hide behind a tree for 10 minutes to see if this unconscious
boy would actually revive himself. When the staff returned to
the boy, there was no pulse, which finally triggered an
emergency response. But, once again, it was too late.
The second theme was misleading marketing practices. Many
of these programs took advantage of desperate parents
misrepresenting that their programs were a perfect fit for
these kids' unique issues. For example, as shown on the poster
board, one program brochure touted their staff as highly
trained survival experts with experience that was unparalleled.
However, these experts believed that a 15-year-old female
who was not eating, and vomiting water, was faking it. These
experts allowed these symptoms to go on for 2 days until the
girl finally collapsed on the road and stopped breathing. These
experts became so lost that they wandered into another state.
Lacking radios, these experts had to build a fire to signal for
help.
The next poster board shows the body of this girl who lay
dead on the road for 18 hours until help arrived.
Another program marketed its expertise in handling suicidal
youth to the parents of a 14-year-old male who had twice
attempted suicide. This boy committed suicide 6 days into the
program by hanging himself by his tent. The parents later found
that there was no specific suicide expertise in this program.
However, the staff were experts in whitewater rafting.
Our third theme was abuse of these kids before they finally
died. For example, a 14-year-old male was forced to wear black
clothing and stand in direct sunlight for several hours during
the day. Despite strenuous physical exertion, he was fed an
apple for breakfast, a carrot for lunch and a bowl of beans for
dinner.
A 15-year-old male refused to return to a campsite after
urinating. Although his refusal was not violent, two counselors
forced him to the ground and held him face down in the dirt
until he stopped struggling. One of the counselors was on top
of this boy for 45 minutes. This boy died from a severed artery
in his neck.
Another 15-year-old male was dragged around when he was
unable to exercise. As his condition deteriorated and he lost
bodily function, he was forced to wear a 20-pound sandbag
around his neck as punishment. The autopsy report for this boy
showed 30 contusions and abrasions all over his body.
As I am sure you will agree, there is no need for me to
elaborate further on the fourth theme of these cases, the
negligent and reckless operating practices of these programs.
In conclusion, today's testimony reveals disturbing facts
about the world of residential treatment programs. If you had
walked in partway through my presentation, you might have
assumed that I was talking about human rights violations in a
Third World country. Unfortunately, these human rights
violations occurred right in the United States of America.
Mr. Chairman, I want to commend you for holding today's
hearing and putting a spotlight on this important issue. I also
want to thank the parents who represent three of our case
studies for having the courage to testify about the tragic
death of their child.
Mr. Chairman, this ends my statement.
[The prepared statement of Mr. Kutz and the GAO report,
``Residential Treatment Programs: Concerns Regarding Abuse and
Death in Certain Programs for Troubled Youth,'' may be accessed
at the following Internet address:]
http://www.gao.gov/new.items/d08146t.pdf
______
[Responses to questions for the record from Mr. Kutz
follow:]
October 24, 2007.
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Subject: Response to Post-hearing Questions on GAO-08-146T: Residential
Treatment Programs: Concerns Regarding Abuse and Death in
Certain Programs for Troubled Youth
Dear Chairman Miller: On October 10, 2007, I testified before the
House Committee on Education and Labor on the results of our
examination of residential treatment programs. This letter provides a
response for the record to the four follow-up questions submitted by
Representative Robert Scott. His questions and our responses follow.
Question One
What percentage of youths attending these programs are minorities?
Response to Question One
Based on our research, complete information is not available. As I
testified, there is no reliable comprehensive data source on public and
private programs, so we cannot determine what the total number of
children in these programs is or their gender, race, or other
characteristics.
However, as part of GAO's ongoing review of state oversight of
public and private residential treatment programs for the Committee,
GAO has found that information on juvenile offenders placed in various
programs is available. Specifically, the Department of Justice through
its Census of Juveniles in Residential Placement has race data on
children held in various types of public and private residential
placement facilities, including boot camps and ranch/wilderness
camps.\1\ Those data show that, of almost 6,500 children under 21 held
in boot camps and ranch/wilderness programs in 2003, the most recent
year for which data are available, almost 35 percent (2,263) were
black, almost 35 percent (2,257) were Hispanic, over 26 percent (1,714)
were white, with American Indians, Asian/Pacific Islanders, and others
accounting for the remaining 4 percent (252).
---------------------------------------------------------------------------
\1\ Data are available from the Department of Justice's Office of
Juvenile Justice and Delinquency Prevention (OJJDP) within the Office
of Justice Programs. OJJDP's Web site provides access to a variety of
statistics related to the juvenile justice system--see http://
ojjdp.ncjrs.gov/ojstatbb.
---------------------------------------------------------------------------
Question Two
Will or can the GAO report disaggregate the deaths/abuses being
investigated by the reason the individual is in the program and whether
the individual is taking psychotropic medication?
Response to Question Two
As part of GAO's ongoing review of state oversight of juvenile
residential treatment programs, we are attempting to provide a range of
information about oversight, including information on deaths and abuse
at such facilities. This effort has entailed an extensive effort to
survey state agencies involved in the oversight of children in such
programs, including state departments of education, mental health, and
juvenile justice. GAO plans to include information on the cause of
death and maltreatment (abuse) in its upcoming report. However,
obtaining information as to why children are in these programs or the
number of children in these programs who are taking medication was
outside the scope of our recent review. Although the U.S. Department of
Health and Human Services sponsors a national data collection effort
called The National Child Abuse and Neglect Data System (NCANDS) for
tracking the volume and nature of child abuse reporting each year
within the United States, state reporting of information to NCANDS is
voluntary. Moreover, NCANDS does not report on information about why
children are in residential treatment programs or whether they take
medication.
Question Three
Is there currently an obligation for mental health professionals
who recommend these programs to clients to ascertain their safety and
validity as a treatment option?
Response to Question Three
The issue as to whether mental health professionals are obliged or
required to determine the safety and validity of juvenile residential
treatment programs to clients was beyond the scope of our work for the
testimony. The issue of program safety is primarily under state, not
federal, oversight and is being addressed by GAO's ongoing study
regarding these programs. Our ongoing work focuses on treatment
programs but does not cover individual mental health professionals. It
also does not assess the validity of various treatment options, another
complex topic that was beyond the scope of this work.
Question Four
Is there currently any requirement that other treatment options be
utilized to address a child's behavioral issues before sending them to
such a center?
Response to Question Four
The subject of child behavioral treatment options and assessing
which ones are appropriate for a child are complex issues and, as such,
were beyond the scope of our work for the testimony. This is also
outside the scope of GAO's ongoing review of state oversight of
juvenile residential treatment programs.
If you have any further questions, or if you would like to discuss
our response, please feel free to contact me.
Sincerely yours,
Gregory Kutz, Managing Director,
Forensic Audits and Special Investigations.
______
Chairman Miller. Thank you very much.
Mr. Lewis?
STATEMENT OF PAUL LEWIS, FATHER OF RYAN LEWIS
Mr. Lewis. Chairman Miller and members of the committee,
good morning.
I am here today with my wife, Diana, and my daughter, Erin.
The member of our family who is missing today is Ryan.
Ryan lived his life to the fullest surrounded by his
adoring friends and relatives. He was a Boy Scout, a Fire
Explorer. He was an avid outdoor enthusiast. He enjoyed
kayaking, hiking, camping and mountain biking. He read for
hours and was a master at putting together complicated ship and
airplane models. He was an all-American boy with sparkling blue
eyes and a big smile that lit up his freckled face and our
whole world.
Ryan could weave an entertaining story and was oftentimes
hilarious in his presentation. He had a remarkable way of
relating to people of all ages and could draw anyone into a
conversation on a variety of topics. He was sensitive to others
and could articulate his views and feelings way beyond someone
his age.
He was a history buff and could match any adult
conversation about World War II. In fact, one night, we met two
World War II vets in a restaurant, and one remarked that Ryan
knew more about the war than he did, but he had been there.
With all of Ryan's extraordinary qualities, he sadly
suffered from clinical depression. He was a brave and
courageous person who battled the darkness valiantly. But as a
family, we knew that we needed help from professionals and
sought out help from clinical psychologists and a child
psychiatrist. In addition, Ryan needed an integrative program
where he could continue his schooling and receive therapy while
being among his peers.
After exhausting all local resources to help Ryan, we
reached out to Steve Bozak, an education consultant. We
provided him with all of Ryan's educational and medical
records. Given Ryan's background, he strongly recommended a
therapeutic wilderness program named Aldredge Academy in Davis,
West Virginia. He told us this would be the safest place for
Ryan. Ryan's psychiatrist, after speaking to the admissions
department, also agreed that this might meet Ryan's needs.
Educational and medical records were then sent. His
detailed psychiatric information required an extensive
application. We were very hesitant to send Ryan so far away,
but the program's marketing was first class, appearing to be
just what Ryan needed. Aldredge used Ryan's love of the
outdoors as a selling tool. The admissions personnel repeatedly
touted their professionalism and expertise with children who
had the same psychiatric diagnosis as Ryan.
On February 7, 2001, we enrolled Ryan where, again, we were
assured by the program personnel that Ryan would be safe. We
called every day to inquire about how Ryan was doing. We were
assured that he was just fine.
On February 13, only 7 days into the program, we were
startled by a call at 11:15 at night. The news ripped through
us like an explosion tearing us into a million pieces. L. Jay
Mitchell, the owner of Aldredge Academy, informed us that Ryan
had hung himself. He told us that there was no indication that
Ryan was in trouble. It caught them all completely by surprise,
and there was nothing they could have done.
The next day, we flew to West Virginia and met with L. Jay
Mitchell, John Weston White and Lance Wells who repeated the
same story as the night before. The story did not make sense to
me.
The following day, we met with the investigating West
Virginia state trooper who told us we were being lied to about
the circumstances of Ryan's death. This news was like losing
Ryan all over again. In his view, it was a death that could
have been prevented.
He told us that the night before Ryan died, he had slashed
his arm four times with a pocketknife issued to him by the
program. He told them, ``Take this away from me before I hurt
myself anymore. I cannot take it anymore, I want to call my
mom, and I want to go home.'' The counselors talked to Ryan for
a few minutes, and he was told that the people that could help
him were coming out the next day. Then they gave him the knife
back.
L. Jay Mitchell and John Weston White arrived the next day.
Even though they called themselves therapists, neither one of
them had any credentials that could remotely qualify them as
mental health professionals. In fact, L. Jay Mitchell is a
lawyer.
These individuals decided Ryan's desperate cry for help was
manipulation so that he could get out of the program. Ryan was
ignored and, consequently, at approximately 7:30 on a cold,
rainy night, desperate, alone and abandoned, our son hung
himself.
One year later, Aldredge Academy, L. Jay Mitchell and John
Weston White were indicted by the State of West Virginia for
child neglect resulting in death. We were adamantly opposed to
the plea agreement made that allowed Aldredge Academy, the
corporation, to plea no contest in exchange for dropping
charges against the individuals. Aldredge was fined $5,000 for
the horrific death of my son.
We filed a civil suit alleging wrongful death, fraud and a
tort of outrage. Once again, L. Jay Mitchell was unable to
defend himself and acknowledged fault.
In spite of two court verdicts, L. Jay Mitchell continues
in this business today. In my opinion, as we sit here today,
children are at great risk. Incredibly, Aldredge continues to
be a proud member of NATSAP, the National Association of
Therapeutic Schools and Programs.
Losing Ryan has been devastating to our family, our friends
and the people in our community. We miss him terribly and live
with this nightmare every day. All we have left are the fragile
memories of Ryan and the wonderment of the prospects that could
have been.
We do not want other families to suffer the overwhelming
loss of a child in this fraudulent industry. We ask you,
Congressman Miller, to do everything in your power to put an
end to this gross abuse of our children.
Thank you for the opportunity to share Ryan's story.
[The statement of Mr. Lewis follows:]
Prepared Statement of Paul Lewis, Father of Ryan Lewis
Our son, Ryan lived his life to the fullest, surrounded by adoring
friends and relatives. He was a Boy Scout and a fire explorer. As an
avid outdoor enthusiast, he enjoyed kayaking, camping, hiking, and
mountain biking. He read for hours and was a master at putting together
complicated ship and airplane models. He was an all American boy with
sparkling blue eyes and a big smile that lit up his freckled face and
our whole world.
Ryan could weave an entertaining story and was often times
hilarious in his presentation. He had a remarkable way of relating to
people of all ages and could draw anyone into conversation on a variety
of topics. He was sensitive to others and could articulate his views
and feelings way beyond someone his age. He was a history buff and
could match any adult conversation about WW11. In fact, one night we
met two WW11 Vets in a restaurant and one remarked that Ryan knew more
about the war than he did and he was there!
With all of Ryan's extraordinary qualities, he sadly suffered from
clinical depression. He was a brave and courageous person who battled
the darkness valiantly. But as a family, we knew that we needed help
from professionals and sought help from a clinical psychologist and
child psychiatrist. In addition, what Ryan needed was an integrated
program where he could continue his schooling and receive therapy while
being among peers.
After exhausting all local resources to help Ryan, we reached out
to Steve Bozak, an educational consultant. We provided him with all
Ryan's educational and medical records. Given Ryan's background, he
strongly recommended a Therapeutic Wilderness Program named Alldredge
Academy in Davis, West Virginia. He told us this would be the safest,
most appropriate place for Ryan. Ryan's psychiatrist, after speaking to
the Admissions department also agreed that this might meet Ryan's
needs.
Educational and medical records were then sent as well as detailed
psychiatric information required on an extensive application. We were
very hesitant to send Ryan so far away but the program's marketing was
first rate, appearing to be just what Ryan needed. Alldredge used
Ryan's love of the outdoors as a selling tool. The admissions personnel
repeatedly toted their professionalism and expertise with children who
had the same psychiatric diagnosis as Ryan's. On February 7, 2001 we
enrolled Ryan and were again reassured by the program personnel that
Ryan would be safe. We called every day to inquire about how Ryan was
doing and we were assured that he was ``just fine''.
On February 13, only seven days into the program we were startled
by a call at 11:15 at night. The news ripped through us like an
explosion, tearing us into a million pieces. L. Jay Mitchell, the owner
of Alldredge Academy, informed us that Ryan had hung himself. He told
us that there was no indication that Ryan was in trouble, it caught
them all completely by surprise and there was nothing they could have
done. The next day, we flew to West Virginia and met with L. Jay
Mitchell, John Weston White, and Lance Wells who repeated the same
story as the night before. The story didn't make sense to me. The
following day we met with the investigating West Virginia State Trooper
who told us we were being lied to about the circumstances of Ryan's
death.
This news was like losing Ryan all over again since, in his view,
it was a death that could have been prevented. He told us was the night
before Ryan died; he had slashed his left forearm four times with a
program issued pocket knife. He told them, ``Take this away from me
before I hurt myself anymore; I can't take it anymore, I want to call
my Mom and I want to go home.'' The counselors talked to him for a few
minutes and he was told that people who could help him were coming out
the next day. Then they gave the knife back to him. L. Jay Mitchell and
John Weston White arrived the next day. Even though they called
themselves therapists, neither of them had any credentials that would
remotely qualify them as mental health professionals. In fact, L. Jay
Mitchell is a lawyer. These individuals decided Ryan's desperate cry
for help was manipulation so that he could get out of their program.
Ryan was ignored and consequently at approximately 7:30 on a cold rainy
night, desperate, alone, and abandoned, our young son hung himself.
One year later, Alldredge Academy, Ayne Institute, L. Jay Mitchell
and John Weston White were indicted by the state of West Virginia for
`Child Neglect Resulting in Death'. We were adamantly opposed to the
plea agreement made that allowed Alldredge Academy, the corporation, to
plead no-contest in exchange for dropping charges against the
individuals. Alldredge was fined $5000.00 for the horrific death of our
son.
We filed a civil suit alleging wrongful death, fraud, and a tort of
outrage. Once again, L Jay Mitchell was unable to defend himself and
acknowledged fault. In spite of two court verdicts, L. Jay Mitchell
continues in this business. In my opinion, as we sit here today,
children are at great risk. Astonishingly, Alldredge continues to be a
proud member of (NATSAP) National Association of Therapeutic Schools
and Programs.
Losing Ryan has been devastating to our family, our friends and the
people in our community. We miss him terribly and live with this
nightmare every day. All we have left are our fragile memories of Ryan
and wonderment of the prospects that could have been. We don't want
other families to suffer the overwhelming loss of a child in this
fraudulent industry. We ask you, Congressman Miller to do everything in
your power to put an end to this gross abuse of our children. Thank you
for this opportunity to share Ryan's story.
Our family was duped into believing that caring people would help
Ryan who was struggling with a learning disability and clinical
depression. We thought these were professionals who knew what they were
doing. We had no idea that their interest was profit, not healing.
There are also additional details to our story that provide a
deeper understanding of issues involved in this fraudulent residential
facility claiming to help children by providing therapy and education.
We would like to add these to the record.
For example, consider these facts: While he was in the program,
Ryan was 5'1 and weighed 90 pounds. He was forced to carry a makeshift
backpack with approximately 60 pounds of gear. At one point, he was
restrained and had water forced down him.
In addition, Ryan was forced to hike in silence. This was critical
because Ryan was very articulate and was not allowed to express his
feelings. There is no therapeutic justification for such a policy.
Further, once he had cut his arm with the program-issued knife,
there was no monitoring of his behavior. No buddy system was employed
nor were counselors vigilant at staying with him at all times. Though
he was clearly expressing suicidal thoughts and behaviors--and had been
sent to the program with a diagnosis of depression--no mental health
professional was consulted to determine whether he should continue in
the program or be hospitalized. Nor were we even notified that he'd
expressed such despair.
The program was completely unprepared to deal with cases like
Ryan's. It operated under the assumption that all teenage misbehavior
is ``lies'' and ``manipulation'' and that even depression is just
``attention seeking,'' not a mental illness that warrants compassion
and support. We believed we were putting our child in the care of
people who knew what they were doing--and yet the program didn't even
have a protocol in place to deal with suicides. We had no way of
knowing that these people had no business dealing with sick children--
there was no law in place that said they couldn't sell their services
as a treatment for depression.
There were also additional signs of amateurism and complete
insensitivity to the children they were supposed to be helping. For
one, Ryan died at approximately 7:30 P.M. and we were not notified
until 11:15 P.M., a four hour delay. Phone records show that there were
30-40 calls made during that four hour delay. Clearly, they were
scrambling to cover up what had gone on and figure out how to make it
look better.
Another example: in an early press release, Alldredge claimed that
none of the other children saw Ryan. This was not true, in fact,
another child found him. This child has been forever traumatized.
In violation of confidentiality rules, another early press release
provided enough information about Ryan's funeral service to identify
him.
Finally, in yet another press release, personnel at Alldredge
claimed that all the children successfully completed the program. This
was not the case. In fact, two weeks after Ryan died, another child
that had been in his group, slit his wrists. He was evacuated,
hospitalized, and sent home.
Four weeks into the program, a third child in his group threatened
suicide in a note to his mother. He, too, went home. It was too late
for Ryan.
Alldredge Academy has changed its name to Alldredge Wilderness
Journey. Although he is not listed as a staff member, L. Jay Mitchell
is still actively involved in the operation of the program. For parents
in crisis, it would be very difficult to get an accurate history on the
program.
We urge Congress to act to prevent people who do not know how to
treat children with dignity--let alone treat mental illness--from
selling their fraudulent treatment to other vulnerable parents and
children. People with mental illness should have the right to safe,
effective treatment that people with physical illness do--and these
predators should not be allowed to prey on them and their parents.
______
Chairman Miller. Thank you very much, Mr. Lewis, and the
rest of your testimony will be placed in the record in its
form.
Ms. Clark Harvey?
STATEMENT OF CYNTHIA HARVEY, MOTHER OF ERICA HARVEY
Ms. Harvey. Good morning. My name is Cynthia Clark Harvey.
Thank you, Chairman Miller and those committee members
present today for the opportunity to share our family's story.
Our story is a personal tragedy, but please remember that
for each family that has suffered the ultimate damage, the
death of a beloved child, there are perhaps thousands of others
who have suffered physical or psychological neglect and abuse.
For those individual and family victims, there is no public
acknowledgement of their sorrow and pain, as there has been of
ours.
This is Erica. Our first-born, Erica, was an amazing kid.
Everyone says that about their own, but it is true. She was.
So many times during Erica's too short life, she would do
or say or create something that just knocked our socks off.
Erica was an incredible student, straight A's, with gifted
classes in math and language. She was a competitive springboard
diver with dozens of medals. Erica was a musician who played
clarinet and drums, a prizewinning visual artist, a weekly
volunteer with a local animal shelter from the time she was 10
and dragged us along so they got two, three or four for the
price of one determined little girl.
But Erica's bright light seemed to flicker when at 14 and
in the eighth grade she began to experience mental health
problems. Erica became depressed, then suicidal. She engaged in
cutting behaviors. To medicate herself, she began abusing and
using illegal drugs. Erica was hurting in many ways, and our
whole family was suffering.
Erica was in the care of a psychiatrist and a therapist who
both recommended that we consider a residential treatment
program. Michael and I were desperate to find help for Erica.
Our daughter was 15\1/2\ years old when we made the decision to
send her to what we believed was a legitimate treatment
program, a place staffed with people who could help our family
move forward from some very dark times.
We compared several programs over a period of many weeks.
We eventually focused in on Catherine Freer Wilderness because
they were and continue to be leaders in the industry, one of
the founding members of NATSAP and of OBHIC. We chose Catherine
Freer because they have claimed to be fully licensed, because
they were JCAHO accredited, because they claimed experience
with teens being treated with psychiatric medications.
We as parents were interviewed by the program. We laid bare
our hearts, our souls and our story to the program. They told
us our daughter would be treated by experienced staff,
experienced therapists and experienced wilderness guides and
emergency medical technicians. They touted their backcountry
planning and emergency procedures. They told us we could trust
our most precious first-born daughter, Erica, to them.
On May 26, 2002, we arrived at Catherine Freer's Nevada
office. We had been advised by Freer not to tell Erica we were
placing her until our arrival for the family meeting that would
begin the trek. Of all the many profound and tormenting regrets
we have about our terrible decision, agreeing to deceive Erica
is one of the worst. When we told her why we were there, she
was shocked, angry and scared. We will be haunted as long as we
live by Erica's cry of ``Please, Daddy, don't make me go.''
On May 27, 2002, the first full day of Erica's Nevada
wilderness trek, Freer's trusted team mistook a dire medical
emergency for teenage belligerence, and Erica died that
afternoon of heat stroke with dehydration.
Over a period of hours, Erica's condition had worsened as
she was pushed to keep hiking. When Erica's eyes rolled into
the back of her head and she fell off the trail head first into
rocks and scrub brush, she was left to lie where she fell for
45 minutes while two Freer staffers, still unwilling or unable
to recognize what was happening, watched Erica died a slow,
painful death.
When the Freer team finally responded to Erica's last few
tortured breaths, they contacted their on-call medical doctor,
but the doctor turned out not to be a doctor at all, rather a
physician's assistant located in Oregon.
They called the local authorities to ask for help and a
helicopter to get Erica to a hospital, but they did not know
where they were, and they sent a search-and-rescue team to the
wrong GPS coordinates. The helicopter took hours to arrive
because, contrary to the advanced planning that we were told to
expect, no arrangements with local authorities had been made,
nor was any sort of trip plan filed.
Later, we found out that none of the Freer team had
experience with administering psychotropic drugs and no
training in how to evaluate those drugs' effects on an
individual during a trek. We also found out that the EMT on the
team was on his very first trek and had only recently completed
coursework in EMT and had never experienced a real medical
emergency before.
Six days from today, October 16, is Erica's 21st birthday.
The day she was born, we held her and we saw the universe in
her fierce, dark eyes. We filled ourselves with dreams for her.
We imagined who she would be at 2, at 10, at 12, 21, 30. And
today, we are only left with memories--some of them beautiful,
some of them harsh--and no dreams for Erica's tomorrows.
[The statement of Ms. Harvey follows:]
Prepared Statement of Cynthia Clark Harvey, Mother of Erica Clark
Harvey
Thank you, Chairman Miller, and those Committee members present
today for the opportunity to share our family's story. Our story is a
personal tragedy, but please remember that for each family that has
suffered the ultimate damage, the death of a beloved child, there are
perhaps thousands of others who have suffered physical or psychological
neglect and abuse. For those individual and family victims, there is no
public acknowledgement of their sorrow and pain, as there has been of
ours.
Our first-born, Erica, was an amazing kid--everyone says that about
their own, but it's true, she was. So many times during Erica's too-
short life, she'd do or say or create something that just knocked our
socks off. Erica was an incredible student, straight A's, with Gifted
classes in Math and Language. She was a competitive springboard diver
with dozens of medals. Erica was a musician who played clarinet and
drums, a prize-winning visual artist, a weekly volunteer with a local
animal shelter from the time she was 10 (and dragged us along, so they
got two, three or four for the price of one determined little girl.)
Erica's bright light seemed to flicker, when at fourteen and in the
8th grade, she began to experience mental health problems. Erica became
depressed, then suicidal. She engaged in cutting behaviors. To medicate
herself, she began abusing illegal drugs. Erica was hurting in many
ways and our whole family was suffering.
Erica was in the care of a psychiatrist and a therapist, who both
recommended that we consider a residential treatment program. Michael
and I were desperate to find help for Erica. Our daughter was 15 and a
half years old when we made the decision to send her to what we
believed was a legitimate treatment program, a place staffed with
people who could help our family move forward from some very dark
times.
We compared several programs over a period of many weeks. We
eventually focused in on CF because they were, and continue to be,
leaders in the industry, one of the founding members of NATSAP, and of
OBHIC. We chose CF because they claimed to be fully licensed, because
they were JCAHO accredited, because they claimed experience with teens
being treated with psychiatric medications. We, as parents, were
interviewed by the program. We laid bare our hearts, our souls and our
story to the program. They told us our daughter would be treated by
experienced staff: experienced therapists and experienced wilderness
guides and emergency medical technicians (EMTs). They touted their back
country planning and emergency procedures.
They told us we could trust our most precious firstborn daughter,
Erica, to them.
On May 26th, 2002, we arrived at CF's Nevada office. We had been
advised by CF not to tell Erica we were placing her until our arrival
for the family meeting that would begin the trek. Of all the many
profound and tormenting regrets we have about our terrible decision,
agreeing to deceive Erica is one of the worst. When we told her why we
were there, she was shocked, angry and scared. We will be haunted as
long as we live by Erica's cry of Please, Daddy, don't make me go.
On May 27th, 2002, the first full day of Erica's Nevada wilderness
trek, CF's trusted team mistook a dire medical emergency for teenage
belligerence and Erica died that afternoon of heat stroke with
dehydration. Over a period of hours, Erica's condition had worsened as
she was pushed to keep hiking. When Erica's eyes rolled into the back
of her head and she fell off the trail, head first, into rocks and
scrub brush, she was left to lie where she fell for forty five minutes,
while two CF staffers, still unwilling or unable to recognize what was
happening, watched Erica die a slow, painful death.
When the CF team finally responded to Erica's last few tortured
breaths, they contacted their on-call medical doctor, but the
``doctor'' turned out not to be a doctor at all, rather a physician's
assistant located in Oregon. They called the local authorities to ask
for help and a helicopter to get Erica to a hospital but they didn't
know where they were and sent the search and rescue team the wrong GPS
coordinates. The helicopter took hours to arrive because, contrary to
the advance planning that we were told to expect, no arrangements with
local authorities had been made, nor was any sort of trip plan filed.
Later we found out that none of the CF team had experience with
administering psychotropic drugs and no training in how to evaluate
those drugs' effect on an individual during a trek. We also found out
that the EMT on the team was on his very first trek, had only recently
completed coursework in WEMT and had never experienced a real medical
emergency before.
Six days from today, October 16, is Erica's 21st birthday. The day
she was born, we held her and we saw the universe in her fierce dark
eyes. We filled ourselves with dreams for her. We imagined who she'd be
at two, at ten, at twelve, twenty-one, thirty. Today we're left with
only memories, some of them beautiful, some of them harsh, and no
dreams of Erica's tomorrows.
______
Chairman Miller. Thank you very much.
Mr. Bacon?
STATEMENT OF ROBERT BACON, FATHER OF AARON BACON
Mr. Bacon. Chairman Miller and committee members, my name
is Bob Bacon, the father of Aaron Bacon. Speaking for my wife
and Aaron's mother, Sally, his brother, Jared, and his sister,
Tia Sullivan, and speaking on behalf of the many families not
at this table whose lives have been shattered by these
fraudulent programs, we deeply appreciate your efforts to put a
stop to this country's growing industry of institutionalized
child abuse.
During our search for the best alternative, the remaining 3
months of Aaron's sophomore year of high school, my wife and I
spoke with therapists, counselors, pastors and doctors until we
were eventually referred by friends to North Star Expeditions,
a now defunct but formerly licensed Utah-based program that
billed itself as a wilderness therapy program for troubled
teens.
After reading their very compelling brochure, speaking to
their office by phone, and finally meeting with the owners for
a personal interview, we thought we had found the perfect
situation--caring people who were experienced in counseling
kids who were struggling with drugs and social pressure--and to
top it off, writing in a daily journal we were told was an
integral part of their so-called counseling program. As a
writer, we felt journaling would help Aaron to sort things out,
and we were certain that, as a poet, Aaron would find the
awesome beauty of southern Utah to be inspirational and
spiritually healing.
Of course, being normal, trusting and honest people
ourselves, we assumed we were being told the truth. We were
dead wrong. His mother and I will never escape our decision to
send our gifted 16-year-old son to his death at North Star. The
guilt of our apparent naivete was crippling. We were conned by
their fraudulent claims and will go to our graves regretting
our gullibility.
Adding further to our regret, we were talked into using
their escort service. Aaron was taken from his bed at 5:00 a.m.
on Tuesday morning, March 1, 1994, by two burly strangers who
announced to Aaron with a tone of authority that any resistance
on his part would be countered with whatever physical force was
necessary. He was not allowed to speak with us or to put on any
shoes. His eyes expressed a strange mixture of anger, despair,
fear and loving sadness.
I was able to manage only the briefest of hugs which, being
restrained, he could not return. In the trauma of this surreal
instant, I offered words of comfort without thinking of their
potentially ominous meeting when I said, ``Aaron, I know you
will find God in the wilderness.'' Little did I know that these
would be the last words I would ever speak to my youngest son.
His mother managed only a fleeting moment to cradle his
face in her hands and utter her spontaneous words of love and
the assurance that he would later see that this was really for
the best.
I cried inconsolably from the depths of my soul as the
escort van backed out of our driveway with our terrified son
pleading silently with his sad eyes for us not to send him
away. This excruciating scene would have to serve for the rest
of our lives as the last living memory of our beautiful son.
Aaron arrived in the Escalante wilderness area of southern
Utah that same night and waited a few days for a brief intake
exam, indoctrination into the rules of the program and the
issue of ill-fitting shoes and clothing.
Aaron's body and bloody and tattered journal, in fact,
would contain no poetry, but would record in his own words an
unbelievable account of torture, abuse and neglect, a horrific
tale that is corroborated by the journals of the so-called
counselors, along with the journals and sworn testimony of his
troubled young cohorts.
A calendar was assembled by criminal investigators that
chronicles 21 days of ruthless and relentless physical and
psychological abuse and neglect. Aaron spent 14 of his 20 days
on the trail without any food whatsoever while being forced to
hike eight to 10 miles per day. On the days he did have food,
it consisted of undercooked lentils, lizards, scorpions, trail
mix and a celebrated canned peach on the 13th.
On top of this, with temperatures below freezing, he
endured 13 of 20 nights with only a thin wool blanket, plus
five nights without any warmth or any protection whatsoever.
Aaron complained of stomach pain and asked to see a doctor
as early as the third day of hiking, and by the 10th day, he
had lost all control of his bodily functions. But unbelievably,
as he got weaker and lost nearly 20 percent of his body weight,
they repeatedly refused to send him to a doctor.
Taken from what appears to be the industry's handbook,
their policy had predetermined that these kids are all liars
and manipulators and, therefore, Aaron was faking. This
grotesque skeleton is what Aaron looked like the evening before
he died.
He was seen by Georgette Costigan, the registered EMT who
is still insisting that he was faking, did not even take his
vital signs, but instead took the occasion to barter a meager
piece of cheese in return for his promise to try harder and to
hike the following day. This company-employed EMT and relative
of owner Bill Henry dismissed his final desperate plea to see a
doctor who could prove he was not faking and made a conscious
decision to prove a point, rather than render aid, thus
effectively killing our son rather than saving him.
What you cannot see in these photos are the bruises, cuts,
lesions, rashes, blisters and open sores that covered Aaron's
body from head to toe. These scars of abuse and the dried skin
stretched taut over his bones is what his mother and I were
left to discover without any warning when the sheet was pulled
back in the mortuary. ``This,'' we screamed, ``could not be our
son,'' as we grabbed each other and collapsed to our knees, but
the scar above his now sunken right eye, told us that it was.
It was in that one shocking moment of proof that our lives
changed forever.
The stories of Aaron's death and the others who have died
or survived the abuses of these programs are chilling reminders
of the dangers of absolute power and point out the extremely
high risk we take in allowing these programs to operate without
strict regulation and oversight.
This country, this Congress and this committee are faced as
never before with several urgent and critically important
choices. If we choose economic growth over human rights, if we
choose no growth in government over the safety of our children,
if we continue to place our faith in the self-regulation of
private enterprise over the mandate of our government to
protect our nation's health, safety and welfare, we are
choosing to fail in our sacred obligations to our children, our
families and our future.
I implore you, as I know Aaron would, to please stop paying
lip service to family values and start placing value in
families. We can do this in part by investing the resources of
the American people in our children who will soon inherit our
challenging legacy, and we can start now by putting a stop to
these fraudulent and destructive programs of institutionalized
child abuse.
[The statement of Mr. Bacon follows:]
Prepared Statement of Bob Bacon, Father of Aaron Bacon
Chairman Miller and Distinguished Committee Members: My name is Bob
Bacon, the father of Aaron Bacon.
Speaking for my wife, and Aaron's mother Sally, his brother Jarid
and his sister Kia Sullivan; and speaking on behalf of the many
families not at this table whose lives have been shattered by these
fraudulent programs, we deeply appreciate your efforts to put a stop to
this country's growing industry of institutionalized child abuse.
During our search for the best alternative to the remaining three
months of Aaron's sophomore year in high school, my wife and I spoke
with therapists, counselors, pastors and doctors until we were
eventually referred by friends to North Star Expeditions, a now
defunct, but formerly licensed Utah-based program that billed itself as
a ``wilderness therapy program for troubled teens.''
After reading their very compelling brochure, speaking to their
office by phone, and finally meeting the owners for a personal
interview, we thought we had found the perfect situation: Caring people
who were experienced in counseling kids who were struggling with drugs
and social pressure--and to top it off--writing in a daily journal we
were told was an integral part of their ``counseling'' program. As a
writer, we felt journaling would help Aaron to sort things out; and we
were certain that, as a poet Aaron would find the awesome beauty of
southern Utah to be inspirational and spiritually healing.
Of course, being normal, trusting and honest people ourselves--we
assumed we were being told the truth. We were dead wrong. His mother
and I will never escape our decision to send our gifted 16 year old son
to his death at North Star. The guilt of our apparent naivete was
crippling. We were conned by their fraudulent claims, and will go to
our graves regretting our gullibility.
Adding further to our regret, we were talked into using their
escort service. Aaron was taken from his bed at 5:00 AM on Tuesday
morning, March the 1st, 1994 by two burley strangers who announced to
Aaron with a tone of authority that any resistance on his part would be
countered with whatever physical force was necessary. He was not
allowed to speak to us, or put on any shoes.
His eyes expressed a strange mixture of anger, despair, fear and
loving sadness. I was able to manage only the briefest of hugs which,
being restrained, he could not return. In the trauma of this surreal
instant I offered words of comfort without thinking of their
potentially ominous meaning when I said, ``Aaron, I know you will find
God in the wilderness.'' Little did I know that these would be the last
words I would ever speak to my youngest son!
His mother managed only a fleeting moment to cradle his face in her
hands and utter her spontaneous words of love and the assurance that he
would later see that this was really for the best.
I cried inconsolably from the depths of my soul as the escort van
backed out of our driveway with our terrified son silently pleading
with his sad eyes for us not to send him away. This excruciating scene
would have to serve for the rest of our lives as the last living memory
of our beautiful son.
Aaron arrived in the Escalante Wilderness Area of southern Utah
that same night and waited a few days for a brief intake exam,
indoctrination into the rules of the program, and the issue of ill-
fitting shoes and clothing. This picture of him was taken on March 8th,
when he was noted as weighing 131 pounds on a lanky 5'-11'' frame.
Aaron's bloody and tattered journal would contain no poetry, but
would record in his own words an unbelievable account of torture, abuse
and neglect; a horrific tale that is corroborated by the journals of
the so-called ``counselors'', along with the journals and sworn
testimony of his troubled young cohorts.
This calendar was assembled by criminal investigators from program
records and chronicles 21 days of ruthless and relentless physical and
psychological abuse and neglect. Aaron spent 14 of his 20 days on the
trail without any food whatsoever, while being forced to hike 8-10
miles per day. On the days he did have food it consisted of undercooked
lentils, lizards, scorpions, trail mix, and a celebrated canned peach
on the 13th. On top of this, with temperatures below freezing, he
endured 13 of 20 nights with only a thin wool blanket, plus 5 nights
without warmth or protection of any kind. Aaron complained of severe
stomach pain and asked to see a doctor as early as the third day of
hiking, and by the tenth day had lost all control of his bodily
functions; but unbelievably, as he got weaker and lost nearly 20% of
his body weight they repeatedly refused to send him to a doctor. Taken
from what appears to be the industry handbook, their policy had
predetermined that these kids are all liars and manipulators and
therefore ``Aaron was faking.''
[Slide #3] This grotesque skeleton is what Aaron looked like when
he was seen the evening before he died by Georgette Costigan, the
registered EMT who, still insisting that he was faking, didn't even
take his vital signs, but instead took the occasion to barter a meager
piece of cheese in return for his promise to try harder and hike the
following day. This company employed EMT, and relative of owner Bill
Henry, dismissed his final desperate plea to see a doctor who could
prove he wasn't faking and made a conscious decision to prove a point
rather than render aid, thus effectively killing our son rather than
saving him.
What you cannot see in these photos are the bruises, cuts, lesions,
rashes, blisters and open sores that covered Aaron's body from head to
toe. These scars of abuse and the dried skin stretched taut over his
bones are what his mother and I were left to discover without any
warning when the sheet was pulled back at the mortuary. This, we
screamed, could not be our son as we grabbed each other and collapsed
to our knees, but the scar above his now sunken right eye told us that
it was. It was in that one shocking moment of proof that our lives
changed forever.
The stories of Aaron's death and the others who have died, or
survived the abuses of these programs, are chilling reminders of the
dangers of absolute power, and point out the extremely high risks we
take in allowing these programs to operate without strict regulation
and oversight.
This country, this congress and this committee are faced as never
before with several urgent and critically important choices.
If we choose economic growth over human rights; if we choose no-
growth-in-government over the safety of our children; and if we
continue to place our faith in the self-regulation of private
enterprise over the mandate of our government to protect our nation's
health, safety and welfare, we are choosing to fail in our sacred
obligations to our children, our families, and our future.
I implore you, as I know Aaron would, to PLEASE stop paying lip
service to ``family values'' and start placing ``value-in-families.''
We can do this in part, by investing the resources of the American
people in our children who will soon inherit our challenging legacy;
and we can START NOW by putting a stop to these fraudulent and
destructive programs of institutionalized child abuse.
______
Chairman Miller. Thank you.
Ms. Moss?
STATEMENT OF JAN MOSS, EXECUTIVE DIRECTOR, NATIONAL ASSOCIATION
OF THERAPEUTIC SCHOOLS AND PROGRAMS
Ms. Moss. Mr. Chairman, Mr. McKeon, members of the
committee, good morning. I am Jan Moss. I am a mother of two
grown children and a grandmother of three.
To those of you who have spoken today of your devastating
losses, I express my condolences, respect and utmost deference.
I have not suffered the loss of a child. I do, however, have a
nephew who suffered abuse in an offshore program.
I am here as the executive director of the National
Association of Therapeutic Schools and Programs, generally
known as NATSAP. We were established in 1999 in an effort to
raise the bar of the private therapeutic programs serving
children and families in crisis. Among our goals is the
complete elimination of the abusive and neglectful practices we
have heard about today. Clearly, we still have a very long way
to go.
Chairman Miller, you acknowledged in your December 2005
letter to the Government Accountability Office that there are,
indeed, programs that provide high-quality services to help
troubled adolescents get back on track. We are committed to
ensuring that these programs remain available to families in
dire need of help. We are working to ensure that the only
programs on the market are those of the highest quality.
NATSAP is the only entity in this country working with
therapeutic schools and programs to improve them. We are a
trade organization. We do not provide certifications nor do we
conduct investigations.
Our principles of good practice are based on our 12 ethical
principles and were formulated using the standards set by the
joint commission which accredits nearly 15,000 care programs in
the United States. We will not accept or retain members that do
not abide by our ethics or attest to following our principles
of good practice.
When we receive notification of a concern about one of our
members, we review evidence from state licensing authorities,
attorneys general, accrediting bodies and other third parties.
If a member has acted in a manner inconsistent with the law or
our principles, we proceed on a case-by-case basis, either
requiring the program to implement change or canceling its
membership.
NATSAP will review the findings of the GAO's investigation
into NATSAP member programs and will take action as
appropriate.
Our professional development activities include a national
conference which over 700 people attend annually. We hold six
regional conferences with an estimated total attendance of over
800 individuals. Each conference provides continuing education
courses led by industry experts, university researchers and
other clinical professionals.
In 2006, NATSAP launched its first professional journal.
Dr. Michael Gass of the University of New Hampshire is the
managing editor.
In 2007, NATSAP launched its research initiative which will
provide members an affordable data collection tool to evaluate
the effectiveness of their clinical work. The University of New
Hampshire will house the database, making it available not only
to internal but also external researchers.
Dr. Keith Russell from the University of Minnesota has just
released the results of his 4 years of research on outdoor
behavioral treatment.
In 2007, the NATSAP board of directors strengthened its
membership requirements. We now require members to be licensed
by the appropriate state mental health agency or accredited by
a reputable mental health accreditation organization, such as
the joint commission.
Unfortunately, not all states have licensing requirements.
We are working to address this inadequacy. We have worked
successfully with the State of Utah to establish regulations
for therapeutic boarding schools which had previously escaped
licensure requirements by claiming plain boarding school
status. In Montana, we worked diligently to have appropriate
licensure requirements put into place, but the stringent bill
that we favored lost to a less rigorous bill.
We continue to push for strong state licensure and
monitoring requirements. We are hopeful that Chairman Miller,
Ranking Member McKeon and this committee will help us in these
efforts. We need your assistance.
The American Bar Association has submitted to this
committee the ABA's recommendations for legislation to assure
the safety of children and youth placed in private residential
treatment facilities. We are in fundamental agreement to the
extent that the ABA recommends licensure and monitoring of
these facilities. We expand on the ABA's recommendations by
supporting the licensure and monitoring of all adolescent
treatment facilities, including those that are funded by public
entities.
Mr. Chairman and Mr. McKeon, NATSAP extends its sincere
appreciation for your commitment to eliminating deceptive,
abusive and neglectful programs by encouraging state licensure
and enforcement. We are committed to working with this
committee, other organizations and parents to draft and enact
meaningful legislation to put an end to the horrific pain and
suffering we have heard today.
Thank you.
[The statement of Ms. Moss follows:]
Prepared Statement of Jan Moss, Executive Director, National
Association of Therapeutic Schools and Programs
Mr. Chairman, Mr. McKeon, members of the Committee, thank you for
the opportunity to participate in this hearing. I am Jan Moss.
I am a mother of two grown children and a grandmother of three. To
those of you who have spoken today of your devastating losses, I
express my condolences, respect and utmost deference. I have not
suffered the loss of a child. I do, however, have a nephew who suffered
abuse in an offshore program.
I am here as the Executive Director of the National Association of
Therapeutic Schools and Programs, generally known as NATSAP. We were
established in 1999 in an effort to raise the bar of the private
therapeutic programs serving children and families in crisis. Among our
goals is the complete elimination of the abusive and neglectful
practices we have heard about today. Clearly we still have a long way
to go.
Chairman Miller, you acknowledged in your December 2005 letter to
the Government Accountability Office that there are, indeed, ``programs
that provide high-quality services to help troubled adolescents get
back on track.'' The three personal narratives I am attaching to my
written testimony underscore the value of high-quality therapeutic
schools and programs. We are committed to ensuring that these programs
remain available to families in dire need of help. We are working to
ensure that the only programs on the market are those of the highest
quality.
NATSAP is the only entity in this country working with therapeutic
schools and programs to improve them. We are a trade organization. We
do not provide certifications or conduct investigations.
I am attaching the Ethical Principles of the National Association
of Therapeutic Schools and Programs to my written testimony. Our
Principles of Best Practice are based on our 12 Ethical Principles and
were formulated using the standards set by the Joint Commission, which
accredits nearly 15,000 health care programs in the United States. We
will not accept or retain members that do not abide by our ethics or
attest to following our Principles of Good Practice.
When we receive notification of a concern about one of our members,
we review evidence from state licensing authorities, attorneys general,
accrediting bodies, and other third parties. If a member has acted in a
manner inconsistent with the law or our Principles, we proceed on a
case-by-case basis, either requiring the program to implement change,
or cancelling its membership. NATSAP will review the findings of the
GAO's investigation into NATSAP member programs and will take action as
appropriate.
Our professional development activities include a national
conference, which over 700 people attend annually. We hold six regional
conferences, with an estimated total attendance of over 800
individuals. Each conference provides continuing education courses led
by industry experts, university researchers, and other clinical
professionals.
In 2006, NATSAP launched its first professional Journal. Dr.
Michael Gass of the University of New Hampshire is the managing editor.
In 2007, NATSAP launched its Research Initiative, which will provide
members an affordable data-collection tool to evaluate the
effectiveness of their clinical work. The University of New Hampshire
will house the database, making it available not only to internal, but
also external researchers. Dr. Keith Russell, University of Minnesota,
has just released the results of his four years of research on outdoor
behavioral treatment.
In 2007, the NATSAP Board of Directors strengthened NATSAP's
membership requirements. We now require members to be licensed by the
appropriate state mental health agency, or accredited by a reputable
mental health accreditation organization, such as the Joint Commission.
Unfortunately, not all states have licensing requirements. We are
working to address this inadequacy. We have worked successfully with
the State of Utah to establish regulations for therapeutic boarding
schools, which had previously escaped licensure requirements by
claiming plain ``boarding school'' status. In Montana, we worked
diligently to have appropriate licensure requirements put into place,
but the stringent bill we favored lost to a less rigorous bill.
We continue to push for strong state licensure and monitoring
requirements. We are hopeful that Chairman Miller, Ranking Member
McKeon, and this Committee will help us in these efforts. We need your
assistance.
The American Bar Association has submitted to this Committee the
ABA's recommendations for legislation to assure the safety of children
and youth placed in private residential treatment facilities. We are in
fundamental agreement to the extent that the ABA recommends licensure
and monitoring of these facilities. We expand on the ABA's
recommendations by supporting licensure and monitoring of all
adolescent treatment facilities, including those that are funded by
public entities.
Mr. Chairman and Mr. McKeon, NATSAP extends its sincere
appreciation for your commitment to eliminating deceptive, abusive, and
neglectful programs by encouraging state licensure and enforcement. We
are committed to working with this Committee, other organizations, and
parents to draft and enact meaningful legislation to put an end to the
horrific pain and suffering we have heard about today.
attachment 1.--testimony of trevor miles heaton
Chairman Miller and Honorable Committee Members, I would like to
thank you for the opportunity to share my testimony of hope and success
with you.
To understand my viewpoint regarding the issue at hand, a brief
history of my past is necessary. My name is Trevor Heaton. I am a 19
year old recovering heroin addict living in Salt Lake City. I began
smoking pot at age 13. From there I rapidly progressed to pain
medications and eventually became confined to a vicious heroin
addiction. I have been to four different treatment facilities, both in
and out of Utah. I have been admitted to the psychiatric ward several
instances for drug related problems. I have also been part of the
juvenile court system. I stole, lied, cheated, abused, neglected, and
rationalized my way through my addiction. My story is no different than
any other addict out there in such that I have the disease of addiction
and must do everything in my power to keep this demon in remission.
It took years of using and several treatment programs for me to
finally make the decision to change my life around. Obviously, the
choice to stay sober is made by myself, and only for myself, but the
treatment programs I attended were influential in helping me make this
choice. The reason I did not remain sober after my first programs was
do to a conscious decision on my part. The treatment centers provided
me with all the necessary life skills, coping mechanisms, and tools to
remain sober, but I simply chose not to apply the knowledge and skills
I had been presented with. Two of the programs I went to were very
impressive, and two were not. I can't blame a program for my relapses
because although a program may not have been as quality as another, I
was still made aware of my addiction, yet chose to ignore all the
instruction I had been given.
I feel very fortunate to be alive today. I live a wonderful life
and could not be happier. I am about to graduate from Salt Lake
Community College with my Associates of Science Degree in Social Work.
I have a 4.0 college GPA and plan to go for my Masters degree. I have a
stable job. Relationships with family and friends have been restored to
the fullest. I attend A.A. meetings regularly. I am on the Alumni
Council of the National Association of Therapeutic Schools and
Programs. I am also on the Salt Lake Mayors Coalition for Alcohol,
Tobacco, and Other Drugs. As I said, life is beautiful at the moment. I
have been given a second chance at life. This second chance was made
possible by the many professionals and staff I encountered at various
treatment centers throughout my journey. As we are all aware, the price
of drug rehabilitation is quite expensive, but the lessons learned and
the tools that are provided through such programs are priceless.
I am very grateful to my family for providing me with such
resources as drug rehabilitation. I am also grateful for those
individuals who have helped shape my life into something truly amazing.
I respectfully ask that do all you can to eliminate abusive and
neglectful programs while also doing whatever is necessary to preserve
options for children and families in need of specialized treatment and
educational services. Treatment is the greatest tool we have in the
fight against addiction. I am proof that there is hope and that
recovery is able to breed success and triumph. If you would like more
information on my experience, you may contact me at any time. Once
again, thank you for the opportunity to participate in this
extraordinarily important hearing.
Respectfully submitted,
Trevor Miles Heaton,
Riverton, UT.
attachment 2.--written testimony of thomas and emily vitale
Chairman Miller and Honorable Committee Members, thank you for the
opportunity to share our testimony with you. Chairman Miller, we share
your urgent desire to ensure that abusive and neglectful ``boot camps''
and ``tough love'' programs do not harm adolescents in need of special
care and nurturing.
However, most therapeutic schools and programs do provide healthy,
positive environments in which children may learn while healing. Our
daughter Caroline is one child who benefited greatly from a therapeutic
boarding school. She had been in and out of many ``regular'' high
schools, never able to get her homework done (she is extraordinarily
bright so teachers assumed she was lazy). As she spiraled into
depression and self-injury, we realized she needed a school where she
would be both safe and able to work on the issues that caused her to
de-rail.
Caroline spent 18 months at the King George School, an emotional
growth boarding school in Northern Vermont. During that time she
attended academic classes, excelled in therapeutic art classes,
participated in group and individual therapy sessions. At no time was
she or any student there forced to participate in programs like those
which you aim to eliminate. Her experience there has changed her life
and ours. She is currently back at a ``regular'' high school and is
applying to college for next year. She would never have been able to do
this without the support and nurturing of the King George School.
Certainly, you must eliminate abusive and neglectful programs. You
must also preserve options for children and families in need of
specialized treatment and educational services.
If you would like more information on our family's experience, or
better yet, if you would like to hear from our daughter, Caroline,
please contact us.
attachment 3.--testimony of alexandrine lyons-boyle
Chairman Miller and Honorable Committee Members, I sincerely
applaud your desire to ensure that abusive and neglectful ``boot
camps'' and ``tough love'' programs are not able to harm children who
need therapy and care, and need to get on the right track. I've seen
news programs that horrified me regarding these programs.
However, I sent my daughter to a wilderness therapy program that
was not a boot camp, not a tough love program, but was an outstanding
therapeutic program that saved her life.
My daughter had always been a happy child, a good student, and a
sweet daughter until she reached high school. At that time, for many
reasons, including depression, ADD, and the innate meanness of many
teenage girls (the way ``her friends'' treated her would make you cry),
she began to abuse drugs. She was so depressed that she would lie on
our kitchen floor and just cry. She went from being an A-B student in
high level classes (honors and advanced grades), to receiving straight
F's, and being told by the high school principal that they were
processing her to have her removed from the school. She was arrested
repeatedly.
When I learned of Catherine Freer Wilderness Therapy from her
psychiatrist, I immediately sent her to this program. She spent 3 weeks
hiking in the wilderness with 5 other teenagers, and 3 adults--two of
the adults were trained counselors, and one a licensed therapist. All
operated in close contact with a licensed therapist back in the home
office who was in constant contact with the parents. These were
wonderful, caring people, who, through their program, changed my
daughter's life.
They taught her self-reliance and self confidence (she had to cook
for herself, set up her own tent at night, and carry her own supplies
during the day). She is proud of what she did. They structured all
conversation so the kids couldn't just trade war stories, but had to
really think about why they had made the decisions they had made, what
they wanted from life, what their values were, and were they living by
those values? How had they affected the people in their lives? What was
their future going to be like? For 24 hours a day, every day for 3
weeks, my daughter was in therapy--caring, educational, and successful
therapy. She was also in the healing environment of nature, which is
awesome and cannot be duplicated indoors.
After only 3 weeks, she was a changed person. The last day, when
she walked into the room where her family was waiting, she had a huge
smile on her face, she looked tanned, a bit heavier, much healthier;
she looked confident and proud of herself, and happy! I was amazed! She
was proud of all she'd accomplished, of how she'd changed, and she was
looking so forward to sharing her experiences with her family.
Much, much more amazing is how now, six months later, she is again
an ``A'' student, a smiling, happy person, who has excellent values. In
fact, she has an appreciation for life that she never had before.
She has thanked me many times for sending her to Catherine Freer
Wilderness Therapy. She changes her mind frequently now about what she
will major in at college, but neither of us have any doubt that she
will be a college graduate, a responsible member of society, and a good
person.
I could give you much more detail, but in the interest of being
brief, I will simply say that you are welcome to contact either my
daughter or myself to learn more of the outstanding wilderness program
she attended.
The people at Catherine Freer are very, very caring. They are
NOTHING like I've seen on the news programs about the boot camps and
tough love programs. Please, please do not lump them in with those
other extremely scary, dangerous, and ineffective programs that harm
children rather than helping them.
Thank you for protecting our youth from those harmful programs, and
thank you for finding a way to differentiate the good from the bad in
your legislation, and making sure programs like Catherine Freer
continue to help children like my daughter.
Sincerely,
Alexandrine Lyons-Boyle,
Mother of Leilagh Boyle, Schaumburg, IL.
attachment 4.--natsap ethical principles
Members of the National Association of Therapeutic Schools and
Programs (NATSAP) provide residential, therapeutic, and/or education
services to children, adolescents, and young adults entrusted to them
by parents and guardians. The common mission of NATSAP members is to
promote the healthy growth, learning, motivation, and personal well-
being of our program participants. The objective of all our therapeutic
and educational programs is to provide excellent treatment for our
program participants; treatment that is rooted in good-hearted concern
for their well-being and growth; respect for them as human beings; and
sensitivity to their individual needs and integrity.
In applying to become or continue as a member of The National
Association of Therapeutic Schools and Programs, we agree to:
1. Be conscious of, and responsive to, the dignity, welfare, and
worth of our program participants.
2. Honestly and accurately represent ownership, competence,
experience, and scope of activities related to our program, and to not
exploit potential clients' fears and vulnerabilities.
3. Respect the privacy, confidentiality, and autonomy of program
participants within the context of our facilities and programs.
4. Be aware and respectful of cultural, familial, and societal
backgrounds of our program participants.
5. Avoid dual or multiple relationships that may impair
professional judgment, increase the risk of harm to program
participants, or lead to exploitation.
6. Take reasonable steps to ensure a safe environment that
addresses the emotional, spiritual, educational, and physical needs of
our program participants.
7. Strive to maintain high standards of competence in our areas of
expertise and to be mindful of our limitations.
8. Value continuous professional development, research, and
scholarship.
9. Place primary emphasis on the welfare of our program
participants in the development and implementation of our business
practices.
10. Manage our finances to ensure that there are adequate resources
to accomplish our mission.
11. Fully disclose to prospective candidates the nature of
services, benefits, risks, and costs.
12. Provide informed, professional referrals when appropriate or if
we are unable to continue service.
______
[Additional materials submitted by Ms. Moss follow:]
October 23, 2007.
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: The National Association of Therapeutic
Schools and Programs (NATSAP) respectfully requests the enclosed
information be submitted for the record in regards to your hearing
``Cases of Child Neglect and Abuse at Private Residential Treatment
Facilities''.
1. Summary of Research from 1999--2006 and Update to 2000 Survey of
Outdoor Behavioral Healthcare Programs in North America--Dr. Keith C.
Russell, Ph.D., College of Education and Human Development, University
of Minnesota
2. Incident Monitoring in Outdoor Behavioral Healthcare Programs: A
Four-Year Summary of Restraint, Runaway, Injury, and Illness Rates--Dr.
Keith C. Russell, Ph.D., University of Minnesota, and Nevin Harper,
M.A., University of Minnesota
3. A Multi-Center, Longitudinal Study of Youth Outcomes in Private
Residential Treatment Programs--Ellen Behrens, Ph.D. and Kristin
Satterfield, Ph.D. of Canyon Research and Consulting
4. Copies of agenda for the NATSAP Annual and Regional Conferences,
which demonstrates the high quality of education, presented by
credentialed individuals, that is provided at these conferences.
5. Volume I, Numbers I and II of the Journal of Therapeutic Schools
and Programs (JTSP); Managing Editor Dr. Michael Gass, University of
New Hampshire.
Thank you.
Sincerely,
NATSAP Board of Directors.
______
[The technical report, ``Summary of Research From 1999-
2006, and Update To 2000 Survey Of Outdoor Behavioral
Healthcare Programs in North America,'' by Keith C. Russell,
Ph.D., Director, Outdoor Behavioral Healthcare Research
Cooperative (OBHRC), College of Education and Human
Development, University of Minnesota, dated May 2007, may be
requested at the following Internet address:]
http://www.obhrc.org/
______
[The risk incident paper, ``Incident Monitoring in Outdoor
Behavioral Healthcare Programs: A Four-Year Summary of
Restraint, Runaway, Injury, and Illness Rates,'' by Keith C.
Russell, Ph.D., Director, Outdoor Behavioral Healthcare
Research Cooperative (OBHRC), College of Education and Human
Development, University of Minnesota, may be accessed at the
following Internet address:]
http://cehd.umn.edu/kin/research/obhrc/publications/
incidentnatsap001.pdf
______
Bylaws of the National Association of Therapeutic Schools and Programs
(A Tax-Exempt/Non-Profit Corporation)
Article 1.--Offices
SECTION 1. REGISTERED AND PRINCIPAL OFFICES
The registered office of The National Association of Therapeutic
Schools and Programs, Inc. (the ``Corporation'', a tax-exempt, non-
profit Corporation, shall be 126 North Marina, Prescott, Arizona 86301;
and the name of the registered Agent at this address is Janice K. Moss.
The mailing address of the initial principle office of the Corporation
shall be 126 North Marina, Prescott, Arizona 86301. The registered
office need not be identical with the principle office of the
Corporation and may be changed at any time by the Board of Directors.
SECTION 2. OTHER OFFICES
The Corporation may also have offices at such other places, within
or without the State of Arizona, where it is qualified to do business,
as its business may require and as the board of Directors may, from
time to time, designate.
Article 2.--Directors
SECTION 1. POWERS
All corporate powers shall be exercised by or under the authority
of, and the business and affairs of the Corporation managed under the
direction of its Board of Directors, subject to any limitation set
forth in the Articles of Incorporation, other provisions of these
Bylaws relating to action required or permitted to be taken or approved
by the Members, if any, of this Corporation, the activities and affairs
of this Corporation.
SECTION 2. NUMBER AND ELECTION
The Corporation shall have no more than sixteen Directors excluding
ex-officio Members, unless changed by amendment to these Bylaws.
Collectively, they shall be known as the Board of Directors. Elections
for available board positions shall be held by ballot. The exact number
of Directors shall be fixed within the limit by a resolution adopted by
the Board of Directors.
SECTION 3. TERMS OF OFFICE
All Directors elected to the board shall serve for two-year terms
and may be appointed at the pleasure of the board to serve one
additional two-year term. The term of Directors begins and expires at
the Annual Member meeting following the annual election.
SECTION 4. QUALIFICATIONS
Directors of the Corporation shall be a Member of the Executive
Committee with decision-making authority, or be owner, president, chief
executive, or Director of Member programs in good standing
SECTION 5. DUTIES
It shall be the duty of the Directors to:
(a) Perform any and all duties imposed on them collectively or
individually by law, by the Articles of Incorporation of this
Corporation, or by these Bylaws;
(b) Appoint and remove, employ and discharge, and, except as
otherwise provided in these Bylaws, prescribe the duties and fix the
compensation, if any, of all Officers, Agents and Employees of the
Corporation;
(c) Supervise all Officers, Agents and Employees of the Corporation
to assure that their duties are performed properly;
(d) Meet at such times and places as required by these Bylaws;
(e) Register their addresses with the Secretary of the Corporation
and notices of meetings mailed or telegraphed to them at such addresses
shall be valid notices thereof.
SECTION 6. VACANCIES
Vacancies on the Board of Directors shall exist (1) on the death,
resignation, removal, or expiration of term of any Director, and (2)
whenever the number of authorized Directors is increased.
Vacancies on the board may be filled by the (1) the Members, (2)
the Board of Directors, or (3) if the Directors remaining in office
constitute fewer than a quorum of the Board, they may fill the vacancy
by the affirmative vote of a majority of all the Directors remaining in
office.
SECTION 7. RESIGNATIONS
A Director may resign effective upon giving written notice to the
President, the Secretary, or the Board of Directors. A resignation is
effective when the notice is delivered unless the notice specifies a
later effective date.
SECTION 8. REMOVAL OF DIRECTORS
A Director may be removed, with or without cause, upon the
affirmative vote of not less than a majority of the Directors.
SECTION 9. COMPENSATION
Directors shall serve without compensation except that they shall
be allowed reasonable advancement or reimbursement of expenses incurred
in the performance of their regular duties as specified in Section 5 of
this Article. Reasonable expense limits shall be determined by
resolution of the Board of Directors. Directors may not be compensated
for rendering services to the Corporation in any capacity other than
Director unless such other compensation is reasonable and is allowable
under the provisions of Section 10 of this Article.
SECTION 10. RESTRICTION REGARDING INTERESTED DIRECTORS
Notwithstanding any other provision of these Bylaws, no persons
serving on the board may be interested persons. For purposes of this
Section, ``interested persons,'' means either:
(a) Any person currently being compensated by the Corporation for
services rendered it within the previous twelve (12) months, whether as
a full- or part-time Officer or other Employee, Independent contractor,
or otherwise, excluding any reasonable compensation paid to a Director
as Director; or
(b) Any brother, sister, ancestor, descendant, spouse, brother-in-
law, sister-in-law, son-in-law, daughter-in-law, mother-in-law, or
father-in-law of any such person.
(c) Any person so deemed by vote of the existing board of
Directors.
Article 3.--Meetings and actions of the board of directors
SECTION 1. PLACE OF MEETINGS
Meetings shall be held at such place within or without the State of
Arizona, which has been designated by resolution of the Board of
Directors. Any meeting, regular or special, may be held by conference
telephone, electronic video screen communication, or other
communications equipment. Participation in a meeting through use of
conference telephone constitutes presence in person at that meeting so
long as all Directors participating in the meeting are able to hear one
another.
SECTION 2. NOTICE OF MEETINGS
Notice of the date, time, place, or purpose of annual and other
regular meetings of the Board of Directors need not be given. Notice of
any special meeting, setting forth the date, time and place of the
meeting, shall be given to each Director by oral or written notice not
less that two (2) days before the meeting. The notice need not describe
the purpose of the special meeting unless otherwise required by the
Articles of Incorporation or other provisions in these Bylaws.
SECTION 3. QUORUM FOR MEETINGS
At all meetings of the Board of Directors, a majority of the
Directors then in office shall constitute a quorum. If a quorum is
present when a vote is taken, the affirmative vote of a majority of
Directors present is the act of the Board of Directors unless the
articles of Incorporation, other provisions of these Bylaws or the Code
otherwise require the vote of a greater number of Directors. If a
quorum shall not be present at any meeting of the Board, the Members
present at such meeting may adjourn the meeting from time to time,
without notice other than announcement at the meeting, until a quorum
shall be present.
SECTION 4. PRESUMPTION OF ASSENT
A Director who is present at a meeting of the Board of Directors
when corporate action is taken is deemed to have assented to the action
taken unless 1) his dissent or abstention from the action taken is
entered in the minutes of the meeting, or 2) he delivers written notice
of his dissent or abstention to the presiding offer of the meeting
before its adjournment or to the Corporation immediately after
adjournment of the meeting. The right of dissent or abstention in not
available to a Director who votes in favor of the action taken.
SECTION 5. CONDUCT OF MEETINGS
Meetings of the Board of Directors shall be presided over by the
President of the Corporation or, in his or her absence, by the Vice
President of the Corporation or, in the absence of each of these
persons, by a Chairperson chosen by a majority of the Directors present
at the meeting. The Secretary of the Corporation shall act as secretary
of all meetings of the board, provided that, in his or her absence, the
presiding Officer shall appoint another person to act as Secretary of
the Meeting.
SECTION 6. ACTION BY WRITTEN CONSENT WITHOUT MEETING
Any action required or permitted by the Board of Directors under
any provision of law may be taken without a meeting. Such action by
written consent shall have the same force and effect as the majority
vote of the Directors. Any certificate or other document filed under
any provision of law which relates to action so taken shall state that
the action was taken by unanimous written consent of the Board of
Directors without a meeting and that the Bylaws of this Corporation
authorize the Directors to so act, and such statement shall be prima
facie evidence of such authority.
SECTION 7. NON-LIABILITY OF DIRECTORS
The Directors shall not be personally liable for the debts,
liabilities, or other obligations of the Corporation.
Article 4.--Officers
SECTION 1. NUMBER OF OFFICERS
The officers of the Corporation shall be a President, a Vice
President, a Secretary, and a Chief Financial Officer who shall be
designated the Treasurer. The President shall serve as Chair.
SECTION 2. QUALIFICATION, ELECTION, AND TERM OF OFFICE
Officers of the Corporation must either be an owner, a member of
the Executive Committee with decision-making authority, or be
president, chief executive, or Director of member programs in good
standing. Officers shall be elected by and from the Board of Directors.
When a board member is elected to serve as an officer his/her term on
the board is extended to coincide with the term of the office Each
officer shall hold office for two years and may serve an additional
two-year term pending an affirmative vote of the majority of the Board
of Directors at the regular meeting immediately preceding the end of
the Officer's first term. No President may serve more than two terms.
Each officer shall hold office until his or her term expires or until
he or she resigns, is removed, or otherwise is disqualified to serve,
or until his or her successor shall be elected and qualified, whichever
occurs first.
SECTION 3. REMOVAL AND RESIGNATION
Any officer may be removed, either with or without cause, by a
majority vote of the Board of Directors, at any time. Any officer may
resign at any time by giving written notice to the Board of Directors
or to the President or Secretary of the Corporation. Any such
resignation shall take effect at the date of receipt of such notice or
at any later date specified therein, and, unless otherwise specified
therein, the acceptance of such resignation shall not be necessary to
make it effective.
SECTION 4. VACANCIES
Any vacancy caused by the death, resignation, removal,
disqualification, or otherwise, of any officer shall be filled by the
Board of Directors. In the event of a vacancy in any office other than
that of President, such vacancy may be filled temporarily by
appointment by the President until such time as the Board shall fill
the vacancy. Vacancies occurring in offices of officers appointed at
the discretion of the board may or may not be filled, as the board
shall determine.
SECTION 6. DUTIES OF PRESIDENT
The President shall be the chief executive officer of the
Corporation. The president shall have general executive charge,
management and control of the properties, business and operations of
the Corporation with all such powers assay be reasonably incident to
such responsibilities. The President shall have the authority to agree
upon and execute all leases, contracts, evidences of indebtedness and
other obligations in the name of the Corporation; and, shall have such
other powers and duties as designated in accordance with these Bylaws
and as from time to time may be assigned by the Board of Directors.
SECTION 7. DUTIES OF VICE PRESIDENT
In the absence of the President, or in the event of his or her
inability or refusal to act, the Vice President shall perform all the
duties of the President, and when so acting shall have all the powers
of, and be subject to all the restrictions on, the President. The Vice
President shall have other powers and perform such other duties as may
be prescribed by law, by the Articles of Incorporation, or by these
Bylaws, or as may be prescribed by the Board of Directors.
SECTION 8. DUTIES OF SECRETARY
The Secretary shall keep the minutes of all meetings of the Board
of Directors and the minutes of all meetings of the Members, in books
provided for that purpose; the Secretary shall attend to the giving and
serving of all notices; may, in the name of the Corporation, affix the
seal of the Corporation to all contracts of the Corporation and attest
the seal of the Corporation thereto; shall have charge of such books
and papers as the Board of Directors may direct, all which shall at all
reasonable times be open to inspection of any Director upon request at
the office of the Corporation during business hours; and shall in
general perform all duties incident to the office of Secretary, subject
to the control of the President and the Board of Directors.
SECTION 9. DUTIES OF TREASURER
The Treasurer shall have responsibility for the custody and control
of all the funds and securities of the Corporation. The Treasurer shall
perform all acts incident to the position of Treasurer subject to the
control of the President and the Board of Directors; and shall, if
required by the Board of Directors, give such bond for the faithful
discharge of duties in such form as the Board of Directors may require.
Article 5.--Committees
SECTION 1. EXECUTIVE COMMITTEE
The Officers of the Corporation will constitute the Executive
Committee. The Board of Directors may delegate to such Committee any of
the powers and authority of the board in the management of the business
and affairs of the Corporation, except with respect to:
a) The approval of any action which, under law or the provisions of
these Bylaws, requires the approval of the Members or of a majority of
all of the Members.
b) The filling of vacancies on the board or on any committee, which
has the authority of the board.
c) The fixing of compensation of the Directors for serving on the
board or on any committee.
d) The amendment or repeal of Bylaws or the adoption of new Bylaws.
e) The amendment or repeal or any resolution of the board, which by
its express terms is not so amendable or repealable.
f) The appointment of committees of the board or the Members
thereof.
g) The expenditure of corporate funds to support a nominee for
Director after there are more people nominated for Director than can be
elected.
h) The approval of any transaction to which this Corporation is a
party and in which one or more of the Directors has a material
financial interest, except as expressly provided in Arizona Nonprofit
Corporation Law.
SECTION 2. OTHER COMMITTEES
The Corporation shall have such other committees as may from time
to time be designated by resolution of the Board of Directors. Such
other committees may consist of persons who are not also members of the
board. These additional committees shall act in an advisory capacity
only to the board.
SECTION 3. MEETINGS AND ACTION OF COMMITTEES
Meetings and action of committees shall be governed by, noticed,
held and taken in accordance with the provisions of these Bylaws
concerning meetings of the Board of Directors, with such changes in the
context of such Bylaw provisions as are necessary to substitute the
committee and its members for the Board of Directors and its members,
except that the time for regular meetings of committees may be fixed by
the committee. The time for special meetings of committees may also be
fixed by the Board of Directors. The Board of Directors may also adopt
rules and regulations pertaining to the conduct of meetings of
committees to the extent that such rules and regulations are not
inconsistent with the provisions of these Bylaws.
Article 6.--Members
SECTION 1. IDENTITY OF MEMBERS
The Members of the Corporation shall be composed of those Members
who have been elected as such by a majority of the Board of Directors;
and shall retain their status as Members so long as they continue to
meet the standards of membership as determined by the Board of
Directors and pay any and all annual dues imposed by the Corporation
upon its Members in a timely fashion.
SECTION 2. MEMBERSHIP STANDARDS
The Board of Directors shall establish by resolution standards for
each category of membership, if any. The standards for membership may
be changed from time to time at the discretion of the Board of
Directors. Some categories of Members may not have voting rights.
SECTION 3. MEMBERSHIP DUES
Membership dues shall be set by the Board of Directors from time to
time in such amounts, as the Board of Directors deems appropriate. The
dues amounts may differ among categories of membership. Membership dues
shall be paid annually and the Treasurer shall be responsible for
mailing an annual dues statement to each Member.
SECTION 4. ANNUAL MEETING
The annual meeting of the Members shall be held at the national
conference of the association of each year or such other date as
designated by the Board of Directors. The date, time and place of the
annual meeting shall be designated by the Board of Directors and stated
in the notice of the meeting. The business to be transacted at the
annual meeting shall include the transaction of business as may
properly come before the meeting.
SECTION 5. SPECIAL MEETINGS
Special meetings of the Members may be called at any time for any
purpose by the President or a majority of the Board of Directors and
shall be called by an Officer or Director of the Corporation upon the
request in writing of a majority of the Members. Such request shall
state the purpose or purposes of the meeting. Business transacted at
all special meetings shall be confined to the purpose or purposes
stated in the notice of the meeting.
SECTION 6. NOTICE OF MEETINGS
The Corporation shall notify Members of the date, time, and place
of each Annual and Special Members' Meeting no fewer that ten (10), nor
more than sixty (60) days, before the meeting date. Unless the Arizona
NonProfit Corporation Code (the ``Code'') or the Articles of
Incorporation require otherwise, the Corporation is required to give
notice only to Members entitled to vote at the Meet. Unless the Code or
the Articles of Incorporation require otherwise, notice of an Annual
Meeting need not include a description of the purpose or purposes for
which the meeting is called. Notice of a Special Meeting must include a
description of the purpose or purposes for which the meeting is call.
If not otherwise fixed pursuant to the Code, the record date for
determining Members entitled to notice of an Annual or Special Members'
Meeting is the close of business on the day before the first notice is
delivered to Members. Unless other provisions of these Bylaws require
otherwise, if an Annual or Special Members' meeting is adjourned to a
different date, time, or place, notice need not be given of the new
date, time or place if the new date, time or place is announced at the
meeting before adjournment. If a new record date for the adjourned
meeting is or must be fixed pursuant to these Bylaws, however, notice
of the adjourned meeting must be given under this Section to persons
who are Members as of the new record date. Any Member may waive notice
of any meeting by written waiver filed with the records of the meeting
either before or after the holding of such meeting. If mailed, such
notice shall be deemed to be delivered when deposited in the United
State s mail with first class postage thereon prepaid, addressed to the
Member at his address, as it appears in the Corporation's record of
Members. If telexed, such notice shall be deemed to be delivered the
day such notice is telexed to the Member
SECTION 7. WAIVER OF NOTICE
A Member may waive any notice required by the Code, the articles of
Incorporation, or these Bylaws before or after the date and time stated
in the notice. The waiver must be in writing, be signed by the Member
entitled to the notice, and be delivered to the Corporation for
inclusion in the minutes or filing with the corporate records. A
Member's attendance at a meeting (1) waives objection to lack of notice
or defective notice of the meeting; and (2) waives objection to
consideration of a particular matter at the meeting that is not within
the purpose or purposes described in the meeting notice, unless the
Member objects to considering the matter when presented. Unless
otherwise required by these Bylaws, neither the business transacted nor
the purpose of the meeting need be specified in the waiver; provided,
however, that any waiver of notice of meeting required with respect to
an amendment of the articles of Incorporation pursuant to Code, as
amended, a plan of merger pursuant to Code, amended, or a sale of
assets pursuant to Code, as amended, shall only be effective upon
compliance with Code, as amended.
SECTION 8. QUORUM
Members entitled to vote may take action on a matter at a meeting
only if a quorum of those Members, present in person or represented by
proxy, exists with respect to that matter. Unless the Articles of
Incorporation, other provisions of these Bylaws or the Code provides
otherwise, ten percent (10%) of the votes entitled to be cast on the
matter by the Members constitutes a quorum for action on that matter;
however, unless twenty percent (20%) or more of the voting power is
present in person or by proxy, the only matters that may voted upon at
an annual or regular meeting of Members are those matters that are
described in the meeting notice. When a quorum is once present at a
meeting, it is not broken by subsequent withdrawal of any of those
present.
SECTION 9. VOTING
If a quorum exists, action on a matter by the Members is approved
if the votes cast favoring the action exceed the votes opposing the
action, unless the Articles of Incorporation, a Bylaw adopted by the
Members pursuant to the Code, as amended, or the Code requires a
greater number of affirmative votes. Unless otherwise provided in the
Articles of Incorporation, Directors are elected by a plurality of the
votes cast by the Members entitled to vote in the lection. Unless the
Articles of Incorporation or these Bylaws provide otherwise, each
Member is entitled to one vote in person, by proxy on each matter voted
on at Member meeting or called for via mail or electronic mail. A
Member may appoint a proxy by an instrument in writing not more than
one month prior to the meeting, unless such instrument provides for a
longer period. Such proxy shall be dated, but need not be sealed,
witnessed or acknowledged.
SECTION 10. REPRESENTATION OF MEMBERS
Each Member school shall be represented at any meeting of Members
by an individual designated in writing to the Corporation by the chief
administrator of the Member program. Any action by such representative
shall be deemed to be the action of the Member so represented.
SECTION 11. CHANGE OF MEMBER'S REPRESENTATIVE
If any person serving as a representative of a Member program
ceases to be an Employee of or associated with the Member school, such
person shall cease to be a representative of such Member school or an
Officer or Director of the Corporation, as the case may be.
SECTION 12. TERMINATION OR SUSPENSION OF MEMBERSHIP
(a) Grounds for Termination or Suspension. The membership of a
Member shall terminate or be suspended upon the occurrence of any of
the following events:
Resignation of the Member;
Expiration of the period of membership, unless the
membership is renewed on the renewal terms fixed by the board;
The Member's failure to pay dues, fees, or assessments as
set by the board within sixty days after they are due;
Upon his or her notice of such termination or suspension
delivered to the office of the Executive Director of the Corporation
personally or by mail, such membership to terminate or suspend upon the
date of de1ivery of the notice or date of deposit in the mail.
Upon a determination by the Board of Directors that the
Member has engaged in conduct materially and seriously prejudicial to
the interests or purposes of the Corporation.
(b) Procedure for Termination or Suspension. Following the
determination that a Member should be terminated or suspended under
subparagraph (a) of this section, the following procedure shall be
implemented:
A notice shall be sent by first-class or registered mail
to the last address of the Member as shown on the Corporation's
records, setting forth the termination or suspension and the reasons
therefor. Such notice shall be sent at least fifteen (15) days before
the proposed effective date of the termination or suspension.
The Member being terminated or suspended shall be given an
opportunity to be heard, either orally or in writing, at a hearing to
be held not less than five (5) days before the effective date of the
proposed termination or suspension. The hearing will be held by the
Board of Directors in accordance with the quorum and voting rules set
forth in these Bylaws applicable to the meetings of the Board. The
notice to the Member of the termination or suspension shall state the
date, time, and place of the hearing.
Following the hearing, the Board of Directors shall decide
whether or not the Member should in fact be terminated, suspended, or
sanctioned in some other way. The decision of the Board shall be final.
Any action challenging a suspension or termination of
membership, including a claim against alleging defective notice, must
commence within one year after the date of termination or Suspension.
If this Corporation has provided for the payment of dues
by Members, any Member terminated from the Corporation shall receive a
refund of the current years dues already paid. The refund shall be
based on the effective date of the termination.
SECTION 13. RIGHTS ON TERMINATION OF MEMBERSHIP
All rights of a Member in the Corporation shall cease on
termination or suspension of membership as herein provided.
section 14. amendments resulting in the termination of memberships
Notwithstanding any other provision of these Bylaws, if any
amendment of the Articles of Incorporation or of the Bylaws of this
Corporation would result in the termination of all memberships or any
class of memberships, then such amendment or amendments shall be
effected only in accordance with the provisions of Arizona Nonprofit
Corporation Law.
Article 7.--Indemnification
section 1. indemnification by corporation of directors, officers,
employees and other agents
To the extent that a person who is, or was, a Director, Officer,
Employee or other Agent of this Corporation has been successful on the
merits in defense of any civil, criminal, administrative or
investigative proceeding brought to procure a judgment against such
person by reason of the fact that he or she is, or was, an Agent of the
Corporation, or has been successful in defense of any claim, issue or
matter, therein, such person shall be indemnified against expenses
actually and reasonably incurred by the person in connection with such
proceeding.
If such person either settles any such claim or sustains a judgment
against him or her, then indemnification against expenses, judgments,
fines, settlements and other amounts reasonably incurred in connection
with such proceedings shall be provided by this Corporation but only to
the extent allowed by, and in accordance with the requirements of,
Arizona Nonprofit Corporation Law.
section 2. insurance for corporate agents
The Board of Directors may adopt a resolution authorizing the
purchase and maintenance of insurance on behalf of any Agent of the
Corporation (including a Director, Officer, Employee or other Agent of
the Corporation) against any liability other than for violating
provisions of law relating to self-dealing (Arizona Nonprofit
Corporation Law) asserted against or incurred by the Agent in such
capacity or arising out of the Agent's status as such, whether or not
the Corporation would have the power to indemnify the Agent against
such liability under the provisions of Arizona Nonprofit Corporation
Law.
Article 8.--Execution of instruments, deposits and funds
section 1. execution of instruments
The Board of Directors, except as otherwise provided in these
Bylaws, may by resolution authorize any Officer or Agent of the
Corporation to enter into any contract or execute and deliver any
instrument in the name of and on behalf of the Corporation, and such
authority may be general or confined to specific instances. Unless so
authorized, no Officer, Agent, or Employee shall have any power or
authority to bind the Corporation by any contract or engagement or to
pledge its credit or to render it liable monetarily for any purpose or
in any amount.
section 2. checks and notes
Except as otherwise specifically determined by resolution of the
Board of Directors, or as otherwise required by law, checks, drafts,
promissory notes, orders for the payment of money, and other evidence
of indebtedness of the Corporation shall be signed by the Treasurer and
countersigned by the President of the Corporation.
section 3. deposits
All funds of the Corporation shall be deposited from time to time
to the credit of the Corporation in such banks, trust companies, or
other depositories as the Board of Directors may select.
section 4. gifts
The Board of Directors may accept on behalf of the Corporation any
contribution, gift, bequest, or devise for the charitable or public
purposes of this Corporation.
Article 9.--General provisions
section 1. maintenance of corporate records
The Corporation shall keep at its principal office in the State of
Arizona:
(a) Minutes of all meetings of Directors, committees of the board
and, if this Corporation has Members, of all meetings of Members,
indicating the time and place of holding such meetings, whether regular
or special, how called, the notice given, and the names of those
present and the proceedings thereof;
(b) Adequate and correct books and records of account, including
accounts of its properties and business transactions and accounts of
its assets, liabilities, receipts, disbursements, gains and losses;
(c) A record of its Members, if any, indicating their names and
addresses and, if applicable, the class of membership held by each
Member and the termination date of any membership;
(d) A copy of the Corporation's Articles of Incorporation and
Bylaws as amended to date, which shall be open to inspection by the
Members, if any, of the Corporation at all reasonable times during
office hours.
section 2. fiscal year of the corporation
The fiscal year of the Corporation shall begin on the first day of
January and end on the last day of December in each year.
section 3. corporate seal
The Board of Directors may adopt, use, and at will alter, a
corporate seal. Such seal shall be kept at the principal office of the
Corporation. Failure to affix the seal to corporate instruments,
however, shall not affect the validity of any such instrument.
section 4. annual statements
No later than three (3) months after the end of the fiscal year,
the Corporation shall prepare:
(a) A balance sheet showing in reasonable detail the financial
condition of the Corporation as of the close of its immediately
preceding fiscal year, and
(b) A profit and loss statement showing the results of its
operations during the preceding fiscal year.
(c) Form 990EZ will be filed for each fiscal year.
Upon written request, the Corporation shall promptly mail to any
Member of record a copy of the most recent such balance sheet and
profit and loss statement.
Article 10.--Amendment of bylaws
section 1. amendment
These Bylaws may be amended by a two-thirds vote of the Board of
Directors of the Corporation. The Members will be notified of the
change to the Bylaws. Upon notification a simple majority of the
Members may overturn the Board's decision to amend the Bylaws. The
membership at large is also empowered to amend the bylaws by proposing
a change to the membership at an annual meeting or in writing. Such
proposed change in the Bylaws must pass with a simple majority vote of
all eligible Members. The membership may also provide by resolution
that any Bylaw provision repealed, amended, adopted or altered by them
may not be repealed, amended adopted or altered by the Board of
Directors.
Article 11.--Amendment of articles
section 2. amendment of articles
After Members, if any, have been admitted to the Corporation,
amendment of the Articles of Incorporation may be adopted by the
approval of the Board of Directors and by the approval of the Members
of this Corporation.
section 3. certain amendments
Notwithstanding the above sections of this Article, this
Corporation shall not amend its Articles of Incorporation to alter any
statement which appears in the original Articles of Incorporation of
the names and addresses of the first Directors of this Corporation, nor
the name and address of its initial Agent, except to correct an error
in such statement or to delete such statement after the Corporation has
filed a ``Statement by a Domestic Non-Profit Corporation'' pursuant to
Arizona Nonprofit Corporation Law.
Article 12.--Prohibition against sharing corporate profits and assets
section 1. prohibition against sharing corporate profits and assets
No Member, Director, Officer, Employee, or other person connected
with this Corporation, or any private individual, shall receive at any
time any of the net earnings or pecuniary profit from the operations of
the Corporation, provided, however, that this provision shall not
prevent payment to any such person of reasonable compensation for
services performed for the Corporation in effecting any of its public
or charitable purposes, provided that such compensation is otherwise
permitted by these Bylaws and is fixed by resolution of the Board of
Directors; and no such person or persons shall be entitled to share in
the distribution of, and shall not receive, any of the corporate assets
on dissolution of the Corporation. All Members, if any, of the
Corporation shall be deemed to have expressly consented and agreed that
on such dissolution or winding up of the affairs of the Corporation,
whether voluntarily or involuntarily, the assets of the Corporation,
after all debts have been satisfied, shall be distributed as required
by the Articles of incorporation of this Corporation and not otherwise.
Certificate
This is to certify that the foregoing is a true and correct copy of
the Bylaws of the Corporation named in the title thereto and that such
Bylaws were duly adopted by the Board of Directors of said Corporation
on the date set forth below.
______
Responses to Questions for the Record From the National Association of
Therapeutic Schools and Programs
Chairman Miller and Members of the Committee on Education and
Labor: We appreciate the opportunity to appear before your committee
and address the important issues relating to abuses in private
residential treatment of children and adolescents. The National
Association of Therapeutic Schools and Programs is fully in support of
stopping abusive, irresponsible practices in residential treatment of
children in both public and private settings.
We appreciate your leadership and focus in pushing for responsible,
informed legislation aimed at improving safety and quality of care for
troubled children and adolescents who must be placed in out of home
residential settings. We too feel that strong, well-informed licensure
and regulation is called for, and is in fact available in many states.
It should be encouraged and available in all states.
We are enclosing answers to your specific queries as well as a
brief statement of background information that provides a context to
better understand both the evolution of private residential care and
the evolution of NATSAP as a professional and trade organization
committed to improving the quality of care for children and their
families.
A Brief History of Private Therapeutic Schools and Programs
There has been a rapid growth of private residential treatment
programs in the past 20 years. Figure 1 demonstrates the acceleration
of growth by simply plotting the number of NATSAP programs founded by
decade revealing a rapid acceleration of programs in the past two
decades.
figure 1
*2000-2010 is estimated based on the number of programs founded from
2000-2005.
Prior to 1980 there were in fact few options for treating troubled
adolescents. For the first half of the century one could summarize the
approaches as follows: reformatories (prisons), military academies, the
military, boarding schools, the unskilled labor market in factories,
mines, and farms, or for the most seriously disturbed and wealthiest
families--long term, psychoanalytically inspired, psychiatric
facilities.
In the 1960s and 70s a number of alternative approaches for
treating adolescents emerged. They stood in stark contrast to
treatments offered by the penal system or by mainstream medicine and
psychiatry. Many of the early programs opposed the ``medical model'' by
explicitly rejecting the use of professional therapists and
psychotropic medication.
What principles guided these programs? Mel Wasserman, the founder
of the CEDU programs, stated that the path of a troubled adolescent is
built on a foundation that is not ``plumb and square.'' To correct this
problem, children needed the elements of strong parenting such as
adult, attention, supervision, clear structure, and accountability. In
brief, the early models suggested that adolescents should not be
pathologized or diagnosed; they didn't need therapy. Instead they
needed a chance to grow up and develop character in a new environment,
free from the obstacles that interfered with normal emotional
development.
In the 1980s, program growth began to accelerate and led to spin-
offs from the original alternative programs such as the CEDU programs.
Wilderness programs also began to emerge and provided a natural way to
address psychological defenses by placing adolescents in challenging
natural situations that took away their ingrained but maladaptive
strategies of dealing with society. Wilderness programs also provided
meaningful accountability. In addition, they added a spiritual element
by forcing self-centered adolescents to confront and be inspired by
natural forces much larger than themselves. Wilderness programs also
provided the format for a rite of passage and a chance for adolescents
to see themselves in a new perspective.
These approaches were quite diverse in style and inspiration, but
shared a common belief that in order to correct the dangerous
trajectory of troubled youth they must be removed from toxic
environments in their communities and placed in situations that
provided increased adult supervision and structure. These programs
provided alternative environments aimed at teaching skills, reducing
maladaptive behaviors, and providing time for adolescents to return to
the path of developing a healthy character structure. With few
exceptions these programs remained outside the mainstream practice of
psychiatry.
Rise and Fall of Inpatient Psychiatry
Mainstream psychiatry underwent many changes that profoundly
influenced the rise in alternative programs. In the late 1970s and into
the mid 1980s, psychiatry underwent a rapid growth in residential
programming. Hundreds of adolescent psychiatric hospitals, both public
and private, opened throughout the country. These facilities offered
treatment with medium length of stays up to a month or more, and served
thousands of troubled adolescents. The initial growth of psychiatric
hospitals was in response to a clear need to address the increasing
struggles of youth in a modern American culture that had lost the
presence of adult supervision, and structure for youth.
These hospitals provided a bio-psychosocial form of treatment, but
the environment and management style were heavily influenced by the
general medical-hospital model. Psychiatric hospitals were staffed with
attending psychiatrists and skilled nursing staff. Treatment included
medication management, individual and family therapy, as well as milieu
management generally provided in locked and secure facilities with the
ability to physically restrain patients when necessary.
However, the rapid expansion of conventional residential
psychiatric facilities ground to a halt in the latter half of the
1980s, due in large part to managed care and Prozac (or more accurately
stated, to the powerful organizations behind these concepts: insurance
and pharmaceutical companies). Insurance and pharmaceutical companies
were the agents that dramatically changed the direction of mainstream
psychiatry. Reacting to rising costs, marketing corruption and greed,
insurance companies began to manage and restrict length of stay to the
point that psychiatric hospitals became strictly emergent, short-term,
palliative treatments for the acutely suicidal. At the same time,
psychiatry became enamored with the power of neurotransmitters and in
1985 we entered the age of Prozac, a new antidepressant with fewer side
effects that could change an individual's mood quickly by altering the
level of serotonin available at the synapse.
For a variety of reasons, beyond the scope of this introduction,
short term palliative and medication based treatments in unstructured
community settings fail to address the needs of thousands of struggling
adolescents. And so, these changes in mainstream psychiatry in the
latter half of the 80s and first half of the 90s created the
environment that led to the rapid growth of private residential
programs, many of which are members of NATSAP.
In the past decade we have seen the emergence of creative
alternative residential programs that combine the best of the earlier
alternative and wilderness programs with the sophistication and
professional training of psychiatry, psychology, social work, and
family therapy. The NATSAP member programs represent unique blends of
these various influences, in environments that provide a much needed
and less expensive level of care than offered by in-patient psychiatric
hospitals.
The National Association of Therapeutic Schools and Programs (NATSAP)
The National Association of Therapeutic Schools and Programs
(NATSAP) was itself formed in 1999 in an effort to raise awareness of
these relatively new levels of care. The founding members sought to
create a professional organization that would support the work of
treating adolescents in non-traditional residential settings. The first
priority of this fledgling organization, unanimously endorsed by the
early members, was to develop a common set of ethical principles and
best practice standards. Our goal was to educate and increase awareness
among all programs of practices that would create safe environments for
working with adolescents and their families.
For the past eight years NATSAP has maintained an ongoing process
of evaluating and improving our practice standards. We have annual
conferences attended by over 700 individuals as well as 6 regional
conferences attended by over 800 this year. The conferences focus on
continuing education for professionals in our programs as well as
educating all member employees as to best practice standards. In
addition, we have launched a professional journal, publish a quarterly
newsletter, and have begun a long term outcome research project in
cooperation with the University of New Hampshire that will examine
program effectiveness and create a long term data base to facilitate
further research by independent investigators. A number of our member
programs have also supported major research efforts by independent
investigators in the past eight years*. In particular, Dr. Keith
Russell (associate professor at the University of Minnesota) has
published a number of articles on the short and long term effectiveness
of wilderness programs. Dr. Ellen Behrens has published several
articles documenting the effectiveness of longer term therapeutic
programs.
It is important to understand that NATSAP is a professional and
trade organization. We strive to educate, exchange information, and
raise practice standards. We are not an accrediting or licensing agency
although we have asked that all members provide evidence that they are
licensed by a state agency charged with monitoring the well being of
participants in behavioral health settings, or if state licensure is
not available, programs must be accredited by a national entity that
accredits behavioral health programs. We also require that a member's
clinical program be directly supervised by an independently licensed
clinician.
We do not speak for programs that are not members of our
organization, but as a group of programs we have taken a clear public
stand against all abusive practices with children. We have continuously
educated programs and staff in models and methods of handling
adolescents with the aim of eliminating the use of potentially abusive
methods. Our practice standards specifically preclude:
procedures that deny a nutritionally adequate diet;
physically abusive punishment;
any behavior support management intervention that is
contrary to local, state and/or national licensing or accrediting
standards; and,
the application of consequences that are not in accordance
with the program participant's basic and fundamental rights and
protections.
We are as opposed to the abuse of children as much or more than
anyone who has testified at your hearings. At the same time we
recognize the importance and value of residential treatment offered by
NATSAP member programs, and we ask that the House Committee on
Education and Labor take time to study and understand this important
level of care. Our member programs now serve nearly eighteen thousand
children annually. Families who seek private alternatives do not do so
lightly or capriciously, but generally out of desperation. They look
for alternatives because they see their children failing and unable to
get back on a trajectory that will make it possible to become
independent, productive young adults. Children end up in residential
treatment only after they have failed in numerous attempts in
outpatient and community based settings. Parents make the difficult
decision to send their child to a residential program only when they
realize that, despite their best efforts, their home environment is
failing support their child's growth and development in healthy ways.
Parents see that their children are lost, anxious, depressed, failing
in school, or engaging in behavior that is risky and dangerous. Many of
these children drift into a world filled with alcohol, drugs, and a
dangerous lack of respect and empathy that compromises society's
collective values. Parents have no choice but to separate these lost
adolescents from their toxic community environments.
It is the failure of community based service that has given rise to
the growth of private residential programs. It is vitally important
that legislators understand the importance of this level of care, and
understand how many lives would be at greater risk if private
residential programs were not available. Of course such programs should
be licensed and regulated in a manner that adequately assures the
safety and well being of participants, but it is also essential that
regulation be well designed and informed so as to support the
important, life saving environments and levels of care that such
private programs offer.
We further ask that any legislative effort take into consideration
the major distinctions in types of programs that are available and not
proceed as if all private residential programs are the same. They are
not. NATSAP member programs include the following basic types of
programs:
Therapeutic Boarding Schools
Small Residential Programs
Residential Treatment Centers
Outdoor Therapeutic and Wilderness Programs
Specialty Psychiatric and Behavioral Health Programs
Transitional or Young Adult Living Programs
Each of these program types requires basic practice standards,
coupled with standards that reflect the differences in setting and
level of structure required in each setting.
Outside of NATSAP, there remain a number of ``boot camps'' or
punishment based programs that employ degrading, abusive behavioral
management techniques that are in direct violation of NATSAP practice
standards. Many of these programs are public or state contracted
corrective facilities, not private programs. If such a program is a
member of NATSAP, and we become aware of an inappropriate practice, we
will ask the program to stop and correct such practices immediately or
be removed from membership. If such a program is not a member of NATSAP
we, of course, have no influence over it. Therefore, we educate the
public of the differences between programs that ascribe to our
published practice standards and those that do not.
Finally, our hearts go out to those brave individuals who testified
about the circumstances of their adolescent's deaths in programs. Due
in large part to their heartfelt testimony, we have recently enacted a
``sentinel event'' policy (attached) that will require reporting,
review and data sharing in an effort to learn from past mistakes and
prevent future serious injury or loss of life in our member programs.
We are working with an extraordinarily troubled population of
adolescents who have failed to respond to numerous medications,
outpatient care, and other community-based treatments. Working with
such a population is inherently risky. Nonetheless, we must not ignore
or give up on these adolescents at a time when they need our help most.
NATSAP is committed to ensuring that families in desperate need of
specialized treatment services for their adolescents may choose
confidently from an array of nurturing, safe, and effective programs.
We continue our mission to improve adolescent residential care with
renewed vision, vigor, and optimism. ,
research references
Behrens, E. (2006). An evidence-based practice model for residential
treatment programs. Journal of Therapeutic Schools and
Programs, 1 (2), 33-65.
Behrens, E. & Satterfield, K. (2007). Longitudinal family and academic
outcomes in residential programs: How students function in
important areas of their lives. Journal of Therapeutic Schools
and Programs, 2 (1), 81-94.
Russell, K.C. (2003). Assessing treatment outcomes in outdoor
behavioral healthcare using the Youth Outcome Questionnaire.
Child and Youth Care Forum. 32(6), 355-381.
Russell, K.C. (2002). Assessing outcomes in outdoor behavioral
healthcare. Behavior Management, March/April, 22(2), 12-18.
Russell, K. C. (2002). Does outdoor behavioral healthcare work? A
review of studies on the effectiveness of OBH as an
intervention and treatment. Journal of Therapeutic Camping,
Summer/Fall, 2(2), 5-12.
Russell, K. C. and Hendee, J.C. (1999). Wilderness therapy An emerging
treatment for adolescents with behavioral problems. Proceedings
of the 6th World Wilderness Congress, Bangalore, India. Watson,
A. ed., Rocky Mountain Research Station, US Forest Service,
USDA, Ogden, UT.
In Response to Representative Robert Scott
1. What mechanism is in place to deal with circumstances where your
members have self-certified that they are abiding by NATSAP's ethics
and good practices standards when they are in fact not in compliance
with these standards?
If a member program is not complying with the signed ethics and
good practice standards we encourage employees, other programs, or
families to submit a specific written complaint. The complaint process
is as follows:
a) Any complaint against a member program must be submitted to
NATSAP in the form of a signed letter to the Executive Director of
NATSAP.
b) If the complaint involves a specific program participant the
Executive Director must obtain an appropriate release of information
permitting NATSAP to access and review personal and confidential
information.
c) After receiving a written, signed complaint, the Executive
Director will contact and inform the President of NATSAP.
d) The Executive Director and President will review and determine
whether the complaint involves a potential violation of ethics or
practice standards. If so the complaint is referred to the Ethics
Committee Chairperson.
e) The Ethics Committee Chairperson will establish a 3-5 member
subcommittee to review the complaint.
f) Oftentimes, problems are resolved by directly addressing issues
with the member program. If it agrees to change its practices to
correct any deviation from our standards the issue is typically closed.
Depending on the severity of the infraction and its consequences, the
subcommittee might recommend the program's membership status be made
conditional or be terminated.
g) The subcommittee reports its findings and recommendations back
to the President and Executive Director.
h) If membership sanctions are recommended, the matter will be
brought to the Board of Directors, and the Board will follow Section 11
(Termination or Suspension of Membership) of the organization's by-laws
(attached).
2. Dr. Pinto testified that she has collected 700 concerns on
residential treatment centers over 6 months, while NATSAP has
investigated less than 5 claims against its members. Can you please
explain the discrepancy in these numbers?
Dr. Pinto and her colleagues have been engaged for several years in
efforts to draw attention to private ``institutional abuse'' of
children. They have collaborated with advocacy groups and have
contributed as ``experts'' to several web sites and blogs that are
intended to expose the horrors of abusive private adolescent treatment
programs. Dr. Pinto's recent testimony before the House Committee on
Education and Labor suggested that she actively solicited narratives
from victims of adolescent maltreatment as part of her efforts to
collect and draw attention to reports of abuse and neglect in private
residential treatment settings. Dr. Pinto's high visibility among, and
active outreach to, communities of victims of abuse and neglect were
likely the greatest factors contributing to the large quantity of
narratives she managed to gather.
NATSAP does not solicit reports of abuse and neglect; however,
anyone who affirmatively contacts NATSAP via email, telephone, or our
website receives information as to how an ethical or practice complaint
about a NATSAP member may be filed with NATSAP. NATSAP has prepared for
the Committee on Education and Labor a summary of some 17 complaints it
has received regarding member programs. NATSAP does not accept
complaints about non-members, yet it does refer to governmental and
credentialing entities those individuals who contact NATSAP seeking to
file a complaint against a non-member.
3. Is there currently any requirement that other treatment options
be utilized to address a child's behavioral issues before sending them
to such a center?
We are aware of no legal or industry requirement that other
treatment attempts be made prior to an adolescent's placement in a
private residential program. As a matter of practice, however, families
typically make numerous unsuccessful attempts at treatment and exhaust
all other options prior to placing their son or daughter in a private
residential setting.
The NATSAP principles require programs to establish specific
admission criteria used to distinguish between those candidates for
treatment who will, and those candidates who will not, be best served
by their program.
Principle 4.0--Admission/Discharge Policy The program/school will
have a written Admission Policy, which defines the enrollment criteria
and delineates inclusion and exclusion criteria. Such criteria will be
consistent with the mission of the program/school. Admission forms will
provide pertinent history including family, medical, psychiatric,
developmental, and educational background information.
Principle 4.1--The Admissions screening process will examine the
physical, emotional, behavioral, and academic history, in order to
determine whether the program is appropriate in light of the respective
participant's needs and limitations.
In Response to Chairman George Miller
1. What is NATSAP's policy regarding the use of its logo by
members? For example, are there any restrictions for using the NATSAP
logo on marketing materials and websites? Are NATSAP members using the
NATSAP logo required to disclose that use of the NATSAP logo does not
represent endorsement by NATSAP of the safety, quality, or
effectiveness of the members' program?
All members of NATSAP are encouraged to use the logo to indicate
they are a member of an association that promotes ethical practices and
standards that are openly available to the public. To be a member of
NATSAP, programs have to submit annually an affidavit affirming that
they are in compliance with our ethical principles. On our website and
in our directory we clearly indicate that our members endorse our
principles of good practice and ethics, but we are not and make no
claim to be an accrediting or licensing agency. We operate much like
most other professional organizations such as the American
Psychological Association, or the American Psychiatric Association, or
the Association of Licensed Social Workers. All of these associations
ask members to attest by signature that they are in compliance with
membership standards. Sanctions are applied to a member only upon
discovery that the member has failed to comply with standards or made a
false representation in this regard. We operate in the same fashion.
2. Ms. Moss indicated that NATSAP will research complaints or
reports of alleged misconduct by members. What procedures are in place
for reporting misconduct to NATSAP? Are reporting procedures
documented? Does NATSAP make its reporting procedures widely available,
for example on its website? Do members have a duty, arising from their
membership, to report any misconduct to NATSAP that violates NATSAP's
Ethical Principles or Principles of Good Practice? How many complaints
of misconduct has NATSAP received since its formation? And what steps
were taken to research such complaints or reports of misconduct?
The procedures for handling complaints regarding ethical or best
practice standards are outlined in the first answer to Representative
Scott above. In addition, NATSAP members are encouraged and expected to
report to NATSAP any misconduct that violates NATSAP's Ethical
Principles or Principles of Good Practice. The 2008 NATSAP membership
agreement will state this obligation as a duty of membership.
NATSAP has no record of complaints concerning its members submitted
or reviewed prior to 2002. Since 2002, 17 complaints have been filed
with NATSAP. Twelve of these complaints were submitted after the
current complaint procedure was published. Please see our summary of
complaints for greater detail on NATSAP's responses to reports of
misconduct.
3. Ms. Moss indicated that NATSAP researched at least one instance
where a complaint was made regarding a member's website. Please
describe the complaint, the actions taken by NATSAP, the corrective
actions taken by the member, and provide the identity of the member.
NATSAP[MB1] received this particular complaint in June 2006 and
forwarded it to Gil Hallows, Ethics Chair. The complaint and NATSAP's
internal reporting on the matter (printed in italics) read as follows:
a) Program listing on their website and on the NATSAP website
stated ``individual therapy twice per week, flexible lengths of stay,
daily group sessions''.
Rick Meeves, Executive Director of Outback Therapeutic Expeditions,
acknowledged the statement was in error in the NATSAP Directory (and
website) and on the program's website and stated it was an
unintentional oversight on their part. He committed to reviewing all of
their marketing literature and correcting this misstatement. He
authorized NATSAP to change the statement to ``weekly individual
therapy sessions'' on our website and would make sure that next year's
directory is accurate. Mr. Meeves also committed to clarifying the
statement ``daily group sessions'' to more accurately reflect that two
groups are conducted by therapists and the balance are educational or
process groups conducted by other staff.
b) Generally not delivering what they said they would:
Parent weekend was minimized compared to what they were
told
Couldn't see the camp or other kids because of ``3 hours
of HIPAA paperwork''. Verbally and on website ``supposedly take part in
desert rituals and rites of passage. There was no exposure to camp
rituals, understanding the process, etc.; no rites of passage that are
talked about and that staff [previously informed me] would be part of
the parent visit when I checked [my son] in.''
[Cancellation] of a family therapeutic experience on the
parent visit should not have been blamed on ``the wilderness is both
advantageous and difficult, and today we got the bad, sorry. There were
things we had to deal with and we didn't get to you. Bye.''
Mr. Meeves further committed to reviewing all of the written
material Outback uses pertaining to their parent visits in the context
of what they are actually doing to insure they are accurately
representing this part of their program. He believes that they
occasionally have a therapist who may not deliver the full extent of
services to parents during the parent visits, and committed to
monitoring this more closely, but believes overall they deliver what
they say they will to parents.
I feel confident that Rick [Meeves] will follow through with his
commitments. I will check in with Rick [Meeves] in the near future to
hold him accountable for making the stated corrections and completing
the internal reviews.
4. What actions does NATSAP intend to take in light of the
testimony given by the U.S. Government Accountability office regarding
Alldredge Academy's delinquency in remitting permit fees to the federal
government? Is operating on federal land without a valid permit a
violation of NATSAP's Ethical Principles or Principles of Good
Practice?
NATSAP reviewed Alldredge Academy's application carefully when it
applied for membership in late 2003. We interviewed the ownership and
management, as well as talking directly to the licensing agency in
their state. After careful consideration and deliberation we admitted
them to membership status in late 2004. There are a few facts that we
were unaware of that emerged from your hearings and in your question
that we will consider to be a written ethical complaint. These issues,
and the delinquency in remitting permit fees to the federal government,
have been referred to our ethics committee for review and
investigation. We are willing to provide you with a copy of our
findings. We respectfully request copies of the GAO and Committee on
Education and Labor's investigations and sources of information that
indicate a failure on Alldredge Academy's part to comply with specific
ethical and practice principles.
5. NATSAP hosts national and regional conferences to foster the
professional development of its members. Have any of these conferences
ever included lectures, workshops, presentations or discussions
concerning cases of abuse, neglect, mistreatment, or death of children;
what led to these horrific tragedies; what needs to change; and what
NATSAP members need to do in response?
Agendas for NATSAP's past five national conferences are attached.
Examination of the agendas makes it clear that most of the topics are
related to improving the clinical treatment of children in our members'
programs. The aim of the conference is to exchange information,
generate enthusiasm for best practices, and support those who work
directly with children. Inherent in the presentations are many ways to
approach children that obviate the need for confrontational
interactions that have the potential of leading to abuse. We also have
had many direct presentations at both national and regional conferences
that address specifically prevention of abuse and deaths in programs.
Below is a listing of such presentations:
NATSAP 2003 Conference
Abuse Risk Management
Risk Management
NATSAP 2005 Conference
Critical Incident Response (4 hour workshop)
Effective Programs and Risk Reduction: It Is All About
Relationships
NATSAP 2006 Conference
A Look At Suicide in Out-of Home Placements
NATSAP 2007 Conference
Behavior Support Management from a NATSAP Perspective (3
hour workshop)
Critical Incident Response
Joint commission--pre-conference workshop (note)
NATSAP 2008 Conference
Risk Management (8 hour workshop--scheduled as of August
15)
Regional Conferences
2006:
Self Harm, Cutting; Dealing With a Growing Epidemic
2007:
Crisis Management
Emergency Preparedness
6. NATSAP's new membership requirements mandate that members be
licensed by an appropriate state mental health agency, or accredited by
a reputable mental health accreditation organization. On what basis is
an accreditation organization deemed to be credible?
The accreditation organization must have standards on Clinical
service, and safety of program participants that clearly define
requirements regarding the treatment being offered and the credentials
of the staff providing the clinical services. Currently NATSAP will
accept the Commission on Accreditation of Rehabilitation Facilities
(CARF), Commission on Accreditation (COA) and Joint Commission (JCAHO).
These three agencies are the most respected independent behavioral
health accrediting agencies in the country. All of these accrediting
agencies require annual reports of compliance and have regular on-site
inspections to assure that programs operate in accordance with their
own, and the accrediting organization's, policies.
7. Please provide a chart showing the year in which each NATSAP
member joined NATSAP, or lost its membership due to expiration or
revocation. [See Addendum A]
8. It is our understanding that the NATSAP board is primarily
comprised of individuals associated with member programs. Given that
NATSAP researches and acts upon complaints against members when they
are reported to NATSAP, please describe NATSAP's policy regarding
conflicts-of-interest for its board members. For example, are board
members required to recuse themselves on matters before the board when,
by virtue of their affiliation with a particular member, their judgment
may be prejudiced in fact or in appearance?
To be considered for election to the board of directors of NATSAP,
an individual must be an owner or an executive of a member program in
good standing. It has always been our practice to have board members
recuse themselves during discussions where conflicts of interest exist
or have the potential to exist. The specific procedure reads as
follows: Conflicts of interest that affect NATSAP at times exist with
individual Board members, the executive director, ad hoc board members,
committee chairs or committee members. During all business meetings it
is necessary and appropriate for the leader of such meeting to ask
members who have a potential conflict of interest to recuse themselves
during discussion and or voting whenever such conflicts arise.
9. Recent reports indicate that a NATSAP member, Youth Care, Inc.,
has been placed on probation by the Utah Department of Human Services
and that criminal neglect charges have been filed against this member
due to the death of a child. Youth Care, Inc. uses the NATSAP logo on
its website to promote their program. Given these reports and the use
of the NATSAP logo by this member, what steps does NATSAP intend to
take to research reports of criminal neglect on the part of Youth Care,
Inc.?
10. Aspen Education Group, which owns Youth Care, Inc., also
operates Aspen Achievement Academy, another NATSAP member. Aspen
Achievement Center is currently being investigated for a teen's
attempted suicide. While authorities conduct a thorough investigation,
what does NATSAP do to ensure the safety of students placed in its
member facilities?
Response to Questions 9 and 10:
Both Youth Care and Aspen Achievement Academy are current members
and we will ask both to respond to our current ``sentinel event review
policy''. Since both are also accredited by the Joint Commission and
licensed by the state of Utah they are required to provide detailed
information regarding all sentinel events. They are also required to
conduct a ``root cause analysis'' to examine the causes of the death
and to determine whether procedures or policies need to be revised to
increase safety in the future. On review we will require a corrective
action plan and, if the deaths resulted from violations of practice
standards or ethical principles, sanctions will be issued.
Add a summary of the complaint and identify the parties.
______
October 23, 2007.
Hon. Dale K. Kildee,
U.S. House of Representatives, Rayburn HOB, Washington, DC.
Dear Representative Kildee: We are enclosing a full accounting of
the ethical complaints received by NATSAP since 2002. We do not have
records of complaints filed prior to 2002 as we changed executive
directors, moved central office location, and did not have adequate
reporting procedures in place. As we compiled existing records since
2002 we realize that while our procedures have improved, they remain
inadequate to ensure accurate registration, recording of deliberation,
and documentation of outcomes. This hearing has made it clear that
NATSAP must move quickly to establish a more transparent and accurate
record of complaints. To this end the Board has already adopted a new
Sentinel Event Policy (enclosed in the report to Chairman Miller) that
creates a mandatory reporting of any events that lead to death or
serious injury. We are now in the process of creating a more
comprehensive system to encourage reporting of all ethical and practice
complaints as well as a process that will ensure accurate and timely
response and record of such complaints.
The following pages provide summaries of all ethical and practice
complaints we have records for from 2002- 2007. We are also enclosing
copies of all of our records of complaints in Appendix A with specific
names removed in order to protect confidentiality of individuals.
Sincerely,
NATSAP Board of Directors.
Ethical and Practice Standard Complaints
1. (February, 2002) Program A--The complaint, filed by the parents
on February 3, 2002 included a) not being responsive to the young man's
need for medical attention; b) violation of privacy by contacting the
parent's school district regarding the young man's crisis prior to
contacting the parents; c) moving the young man to a ``safe house'' and
not disclosing the costs. There is a document marked confidential that
appears to have been faxed to a machine that was out of ink. The
document, however, is included with the other information.
The review information on this complaint is limited except
for a copy of an email sent by Dr. John Santa, then Ethics Chair, that
indicated the complaint needed to be reviewed but first needed to
obtain appropriate releases of information, which were not forthcoming.
The program closed January 2004.
2. (June, 2004) Program B--A former teacher sent email expressing
concern regarding the ownership of the program and requesting
confidentiality. This request for confidentiality and use of his
statement prevented further review.
3. (September, 2004) Program C--A complaint was received from an
educational consultant. Written complaints and releases of information
were received from two parents. The complaints focused primarily on
quality of care and that the executive director was not licensed in
Montana as a therapist.
Gil Hallows, Ethics Chair, reviewed the complaint and,
according to his report, found facts that supported a disgruntled
employee assisted by an educational consultant. Mr. Hallows There is a
document marked confidential that appears to have been faxed to a
machine that was out of ink. The document, however, is included with
the other information, that the Executive Director's role was that of
an administrator with therapy provided by two licensed therapists. The
complaint of a ``misrepresentation of the nature of services'' was not
substantiated but did suggest shortcomings in the areas of quality
assurance and customer service more than a clear-cut breach of ethics.
4. (September, 2004) Program D--The complaint was filed by a NATSAP
member program regarding the recruiting of their employees by another
member program.
Dr. John Santa and Gil Hallows spoke with the individual
filing the complaint and the member program named in the complaint. Dr.
Santa and Mr. Hallows did not find a violation of ethical standards.
They did recognize the potential impact if our members failed to
recruit in open ways. Several articles have been written for the NATSAP
newsletters as well as open discussions held at Regional and National
Conferences regarding ethical practices in recruitment.
5. (March, 2005) Program E--Father wrote letter stating his
daughter was started on medication without his consent. He stated he
shares custody with his ex-wife. He further requested ``anonymity and
the utmost delicacy in approaching the [program]''. While he handwrote
a release to investigate, a NATSAP Release of Information was mailed to
him on March 22, 2005. He failed to sign it and return it.
6. (February, 2006) Program F--Employee complaint. Sharon Laney,
President, in review of the complaint with Jan Moss, Executive Director
found it to be an employee grievance and that the employee had done the
right thing by contacting the Montana Labor Board. The individual was
advised that the incidents reported, which were labor related, were not
addressable under NATSAP's guidelines.
7. (June, 2006) Program G--A parent filed a complaint addressing
the information on the program's website and their delivery of
services. The complaint and the report provided by Gil Hallows (in
italics) follow:
a) Program listing on their website and on the NATSAP website
stated ``individual therapy twice per week, flexible lengths of stay,
daily group sessions''.
The Executive Director acknowledged the statement was in error in
the NATSAP Directory (and website) and on the program's website and
stated it was an unintentional oversight on their part. He committed to
reviewing all of their marketing literature and correcting this
misstatement. He authorized NATSAP to change the statement to ``weekly
individual therapy sessions'' on our website and would make sure that
next year's directory is accurate. He also committed to clarifying the
statement ``daily group sessions'' to more accurately reflect that two
groups are conducted by therapists and the balance are educational or
process groups conducted by other staff.
b) Generally not delivering what they said they would:
Parent weekend was minimized compared to what they were
told
Couldn't see the camp or other kids because of ``3 hours
of HIPAA paperwork''. Verbally and on website ``supposedly take part in
desert rituals and rites of passage. There was no exposure to camp
rituals, understanding the process, etc.; no rites of passage that are
talked about and that staff [previously informed me] would be part of
the parent visit when I checked [my son] in.''
[Cancellation] of a family therapeutic experience on the
parent visit should not have been blamed on ``the wilderness is both
advantageous and difficult, and today we got the bad, sorry. There were
things we had to deal with and we didn't get to you. Bye.''
The program Executive Director further committed to reviewing all
of the written material the program uses pertaining to their parent
visits in the context of what they are actually doing to insure they
are accurately representing this part of their program. He believes
that they occasionally have a therapist who may not deliver the full
extent of services to parents during the parent visits, and committed
to monitoring this more closely, but believes overall they deliver what
they say they will to parents.
I feel confident that [Executive Director] will follow through with
his commitments. I will check in with him in the near future to hold
him accountable for making the stated corrections and completing the
internal reviews.
8. (July, 2006) Program H--The father notified NATSAP of a
complaint filed with the State of North Carolina, Department of Health
and Human Services, Division of Facilities. The email was sent to Gil
Hallows, Ethics Chair, on August 15, 2006. A Release of Information was
not required at the time as this review could be conducted without the
need to question the program about the specific young woman involved.
The complaint covered unauthorized medical treatment. No formal report
was submitted after Gil Hallows' inquiry.
9. (September, 2006) Program I--The complaint focused on disputing
a) a penalty for early withdrawal from the program; b) a delay in the
discussion of a Treatment Plan the parents had received; c) loss of
contact lens; d) requirements for letter writing (program requires
student to write 1 per week; parents received 3 letters in the 10 weeks
their daughter was in the program; e) the consulting psychiatrist
prescribed naltrexone and zonisamide; and f) because of all of the
above they requested a refund of the early withdrawal penalty cost as
applied to their American Express card.
Gil Hallows, Ethics Chair, advised Jan Moss, Executive
Director that the review included requesting a copy of the contract
with the parents and found that the contract advises the parents of the
early withdrawal. Mr. Hallows also advised Ms. Moss the other concerns
raised were ``customer service'' issues as opposed to ethical or
practice violations and that he had counseled the program, encouraging
them to review their practices.
10. (September, 2006) Program J--The parent provided NATSAP with
the complete medical history of the child, police reports and was
advised that the state was conducting an investigation. Sharon Laney
reviewed the situation with an attorney due to the ongoing state
investigation. October 2007, Ms. Laney has followed up with the mother,
who has not responded. We are sending an official request to the State
of Florida Investigation agency for the results of their investigation.
11. (December, 2006) Program K--A mother wrote a letter outlining
her concerns regarding her adult daughter's admission to a young adult
program under the guidance of her father. Due to the age of the young
woman, which would require a Release of Information from her, and her
father's participation in the admission process, NATSAP did not conduct
any review.
12. (December, 2006) Program L--The parents' written complaint
addressed the program's philosophy including
a) Dedicated to the concept of using the least restrictive means
necessary to induce change.
Actual experience: For the first 2 weeks of enrollment, the young
woman was made to sleep on the floor in the common room; was made to
wear shower shoes, inside and out, weather conditions notwithstanding;
all students are given ``time outs for crying. Timeouts consisted of
sitting cross-legged away from the group''.
b) The therapist will contact the parents within the first 2 weeks
of placement to establish a regular schedule of therapeutic phone calls
and begin the therapeutic alliance with the parents. Actual experience:
Received only one phone call and it was a message left on the home
message machine
c) Karate is inherently therapeutic and promotes character
development and physical well-being. Quotes follow from the philosophy
including ``multiple benefits for the students, including * * * a
greater respect for others''; ``increased understanding of self and
increased tolerance for others''; ``students * * * develop
personalities founded on humility and gentleness''. Actual experience:
Daughter was openly chastised in class for not paying attention
(daughter has ADHD).
d) Initial and ongoing assessment of academic needs and academic
programs are individualized. Actual Experience: Two weeks after
enrollment the educational advisor contacted the parents and advised
them that an academic assessment had not been done (normally within two
weeks of enrollment). The assigned educational advisor was ignorant of
the Psychological Evaluation of their daughter, had no knowledge of her
expressive language disorder, nor her diagnosed ADHD.
Executive Director, Jan Moss, directed the parents to the
Utah state licensing agency, Department of Human Services as this
agency has comprehensive behavior management and program management
standards. Note: Copy of the Release of Information has been misplaced.
13. (January, 2007) Program M--The parent submitted a complaint in
writing and release of information. The complaint addressed the school
was dispensing medication without a license to do so. An email request
was placed on April 13, 2007 requesting details that would assist
NATSAP in its review of the complaint with no response. Over the next
several weeks, Jan Moss called several times to confirm academic
licensure status as requested in the complaint, but did not receive a
return call. Ms. Moss was advised months later that no return call was
made due to an ongoing investigation and was advised at that time of
the program closure on August 31, 2007.
14. (February, 2007) Program N--The complaint filed by the parent
outlined that medical treatment was denied to her son initially and
that they waited until he was dehydrated to the point he had to be
hospitalized for 4 days. Jan Moss responded to the email requesting a
signed letter outlining the complaint and attached 2 Release of
Information forms. One form was to be signed by the parent and the 2nd
form by her son, as he was over 18. Due to not receiving the signed
releases, we were unable to conduct a review.
15. (May, 2007) Program O--NATSAP was among 60 organizations and
individuals copied on a complaint filed with the State of Utah
Department of Human Services. The complaint addressed in detail the
parent's view of the program's violation of Utah regulations. Within
the week after receipt, James Meyer, Ethics Chair, inquired with Ken
Stettler of the Utah licensing agency and was advised the complaint was
being reviewed. We will inquire further with the program and with the
state authorities.
16. (June, 2007) Program P--The parent provided email notification
of complaint. Jan Moss sent response to request complaint with
signature plus completion of Release of Information on June 28, 2007.
Due to not receiving the signed releases, we were unable to conduct a
review.
17. (July, 2007) Program Q--The parent complaint addressed
treatment of a sinus infection and misrepresentation of the program's
population. Per procedure, Jan Moss reviewed the complaint with
President, Sharon Laney. Ms. Laney advised Ms. Moss to direct the
parents to the Utah licensing authorities, Department of Human
Services, regarding the treatment of the medical condition and the
misrepresentation to the Ethics Chair, James Meyer. Mr. Meyer reported
that his review found no evidence of misrepresentation. Ms. Moss is in
receipt of a 2nd letter from the parents questioning the review and she
has requested Mr. Meyer to follow-up with the parents. We have not
completed the review of this complaint.
______
Chairman Miller. Dr. Pinto?
STATEMENT OF ALLISON PINTO, PH.D., RESEARCH PSYCHOLOGIST AND
ASSISTANT RESEARCH PROFESSOR, LOUIS DE LA PARTE FLORIDA MEDICAL
HEALTH INSTITUTE, UNIVERSITY OF SOUTH FLORIDA
Dr. Pinto. Good morning, Chairman Miller, Ranking Member
McKeon and distinguished members of the committee.
Thank you for this opportunity to testify before you today,
and I am grateful for your leadership and your efforts to help
protect youth from maltreatment by convening this hearing.
I am Dr. Allison Pinto, and I am a child and adolescent
psychologist licensed in the states of California and Florida.
I am a member of the American Psychological Association and
assistant professor at the University of South Florida and a
researcher at the Children's Board of Hillsborough County, a
children's services council in Florida.
For the past 3 years I have served as the coordinator of A
START: Alliance for the Safe, Therapeutic and Appropriate use
of Residential Treatment.
Each week, I receive phone calls and emails from concerned
youth, family members and professionals who are trying to
navigate the increasingly complex world of residential services
for youth, or to cope with the aftermath of their experiences.
I have also spoken with a variety of individuals associated
with the growing number of programs that are being framed as
alternatives to traditional residential mental health care.
Many parents and professionals are shocked by the
descriptions of institutional abuse that continue to emerge
regarding the care that American adolescents are receiving in
alternative residential programs. In disbelief, they often ask,
``Well, how do you know that these are not just a few isolated
incidents that have been sensationalized in the media?'' or
``How do you know that these are not just the complaints of
manipulative, troubled teens or disgruntled families?''
People are also in shock to learn that in many states these
programs are not required to be licensed or regulated with
regard to the education, mental health care and residential
services that they provide.
In order to address this disbelief and to gain a clearer
understanding of the variety of residential services that are
now available for youth, we posted an online survey to
systematically gather reports from individuals who participated
in residential programs when they were adolescents. Within 6
months, over 700 people responded to the survey.
The detailed descriptions that young adults have been
willing to share through this survey provide data that reveal a
highly disturbing phenomenon. While there are youth and
families who are satisfied with the services that they have
received, a significant number of adolescents report
maltreatment in programs across the country. Survey findings
reveal the following:
Reports of mistreatment, abuse and neglect are widespread.
There were concerns expressed regarding 85 programs located in
23 states and in several foreign countries.
Facilities are not maintaining health and safety standards,
and youth are experiencing medical neglect and educational
deprivation.
Incidents of physical and sexual abuse have occurred that
were never reported by youth due to threatening program
environments or the absence of universal access to protection
and advocacy hotlines.
Treatment is violating human rights. In the guise of
behavior modification, youth are required to earn their basic
human rights to privacy, dignity and contact with family
members. Youth are being deprived of food, sleep and shelter.
They are forced to endure stress positions, humiliation and
intentionally fear-inducing encounters. Programs are also using
cruel and dangerous thought reform techniques.
The use of seclusion and restraint is highly, highly,
grossly inappropriate. These practices are being used as
punishments for rule violations rather than only when a person
is a serious danger to themselves or others. Youth are enduring
painful restraint practices, and isolation for periods of
weeks, even months has been reported.
Youth have expressed profound distress about their
residential experiences. For some respondents, the memories of
their experience remain deeply disturbing and have led to a
pattern of anxiety consistent with post-traumatic stress
disorder.
So are these reports credible? Based on the level of detail
and the overall coherence of the accounts provided and using my
clinical judgment as a child psychologist, I conclude that they
are very credible. If those of us who are mandated reporters of
suspected child abuse were to learn of this type of treatment
occurring in a family's home, we would be required to file a
suspected child abuse report so that the concerns could be
investigated. We must consider the reports of maltreatment and
abuse occurring in residential facilities just as seriously.
Recognizing that the online reports provided are
retrospective and are not necessarily from a representative
sample of all individuals who attended residential programs,
the survey findings, nonetheless, indicate that a serious
problem has emerged.
Because there are now hundreds of reports of abuse and
neglect related to a diversity of programs across many states,
these reports reveal a coherent pattern of institutional
maltreatment. Once a pattern becomes apparent, it is not
appropriate scientifically or ethically to dismiss reports of
maltreatment as a few bad apples or a few noisy complaints.
We must now acknowledge the problem in order to resolve it.
Thank you again for the opportunity to present this
testimony and for your efforts to safeguard and restore the
wellbeing of American youth and families. I would be pleased to
answer any questions.
[The statement of Dr. Pinto follows:]
Prepared Statement of Allison Pinto, Ph.D., Research Psychologist and
Assistant Research Professor, Louis de la Parte Florida Medical Health
Institute, University of South Florida
Thank you, Mr. Chairman and committee members, for this opportunity
to testify before you today regarding the very serious problems of
mistreatment, abuse and neglect of youth in residential facilities.
I am a child psychologist licensed in the states of California and
Florida, an assistant professor at the University of South Florida, and
a researcher at the Children's Board of Hillsborough County, a
children's services council in Florida.
For the past three years I have served as the coordinator of A
START: Alliance for the Safe, Therapeutic and Appropriate use of
Residential Treatment. A START is a national, cross-sector alliance of
mental healthcare and other child-serving professionals, as well as
parents and youth, who have come together in response to growing
concerns regarding the mistreatment and abuse of youth in residential
facilities.
Each week, I receive phone calls and emails from concerned youth,
family members and professionals who are trying to navigate the
increasingly complex world of residential services for youth, or to
cope with the aftermath of their experience in residential programs. I
have also spoken with a variety of individuals associated with the
growing number of residential programs that are being framed as
alternatives to traditional residential mental healthcare.
Many parents and professionals are shocked by the descriptions of
institutional abuse that continue to emerge regarding the care that
American adolescents are receiving in alternative residential programs.
In disbelief, they often ask, ``How do you know that these aren't just
a few isolated incidents that have been sensationalized in the media?''
or ``How do you know that these aren't just the complaints of
manipulative, ``troubled teens'' or disgruntled families?
In order to address these questions, and to gain a clearer
understanding of the variety of residential programs now available for
youth, my colleagues and I posted an online survey to systematically
gather reports from individuals who participated in residential
programs when they were adolescents. Within six months over 700 people
responded to the survey.
The detailed descriptions that young adults have been willing to
share through this survey provide data that reveal a highly disturbing
phenomenon. While there are youth and families who are satisfied with
the care and services they have received in residential programs, a
significant number of adolescents report being mistreated and
maltreated in programs across the country. To give you a sense of the
nature and scope of problems that have emerged, I will be submitting
for the record a preliminary summary of our survey findings, which
reveal the following:
1. Reports of mistreatment, abuse and neglect are widespread. There
were concerns relating to 85 programs located in 23 states, and in
U.S.-owned programs based in foreign countries as well. More than half
of the identified programs are self-described ``therapeutic boarding
schools,'' and more than one third of the identified programs are
members of NATSAP.
2. Youth are being transported to residential facilities by escort
services under threat or use of force, without their consent. Youth
were transported in handcuffs and leg-irons, and experienced these
practice as highly distressing--they frequently felt like they were
being kidnapped with their parents' permission.
3. Facilities are not maintaining health and safety standards.
Youth were not provided with the basics of a sanitary environment,
leading to illnesses such as scabies, and staff supervision was not
consistently provided to ensure the safety of program participants.
4. Amateur psychological interventions are being conducted. In the
guise of ``behavior modification,'' youth were required to earn their
human rights to privacy, dignity, contact with family members, and peer
relations--rights that are now safeguarded for all participants in
licensed and regulated mental healthcare facilities. Youth were
recruited and admitted on the basis of identified psychiatric
disorders, but then received services that ignored established
standards of care specific to their presenting problems.
5. Educational deprivation is occurring. In a variety of programs,
youth were not receiving instruction from trained and qualified
teachers, textbooks and educational materials did not meet state
curriculum standards, and vacuous education is being provided in the
guise of ``independent study.'' Some students returned home to their
original school settings to find themselves significantly behind and
some who ``graduated'' from the alternative residential programs
discovered afterward that the diplomas they received were not
recognized by their home states or college admissions departments.
6. Medical neglect is occurring. Medications were administered
without appropriate supervision by trained medical personnel, as well
as the discontinuation of medications without physician monitoring. The
absence of trained medical providers in residential programs has caused
health problems to go unrecognized and untreated, in some cases leading
to death.
7. The use of seclusion and restraint is grossly inappropriate.
Seclusion or physical restraint were used as a punishment for rule
violations and negative attitudes. Isolation for periods of weeks was
reported, and youth described enduring painful, dangerous and
humiliating restraint practices. In licensed mental healthcare
facilities this would be prohibited, as seclusion and physical
restraint can only be used when a person is determined to be a serious
danger to self or others.
8. Treatment is violating human rights. Youth were deprived of
food, sleep and shelter as a consequence for breaking rules or not
evidencing sufficient progress in the program. Youth have been forced
to endure stress positions, physical pain and fear-inducing encounters
such as being taken into the woods or onto the highway blindfolded.
9. Treatment is explicitly abusive. There were incidents of
physical and sexual abuse that youth never reported due to distrust of
staff, threatening program environments, or the absence of universal
access to child protection and advocacy hotlines.
10. Youth are in distress and suffering. Respondents expressed
profound distress about their residential experiences. Comments
included:
``It was a terrible place. Mentally scarring. 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.''
``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.''
Some youth were informed by staff that their parents were aware of
the maltreatment that they were enduring, and then felt betrayed and
abandoned by their families, causing damage to their relationships that
has been difficult to heal even after families have been reunited. For
some respondents, the memories of their experience in alternative
residential programs remain deeply disturbing and have led to a pattern
of anxiety consistent with post traumatic stress disorder.
Are these reports credible? Based on the level of detail and the
overall coherence of the accounts provided, and using my clinical
judgment as a child psychologist, I conclude that they are very
credible. If those of us who are mandated reporters of suspected child
abuse were to learn of such treatment occurring in a family's home, we
would be required to file suspected child abuse reports so that the
concerns could be investigated. We must consider the reports of
mistreatment and abuse occurring in residential facilities just as
carefully.
Recognizing that the online reports provided are retrospective and
are not necessarily from a representative sample of all individuals who
attended residential programs as youth, the 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 residential programs. Because there are now hundreds of
reports, related to such a diversity of programs, in such a broad range
of states and countries, these reports reveal a coherent pattern of
institutional maltreatment. Once a pattern becomes apparent in this
manner, it is not appropriate, scientifically or ethically, to dismiss
reports of maltreatment as exceptions to the norm. Rather, it becomes
necessary to understand each report in the context of an evolving,
societal phenomenon of institutional mistreatment and abuse, which must
be acknowledged if it is to be eliminated.
Thank you for bringing attention and responding to this disturbing
phenomenon, in order to safeguard and restore the well-being of
American youth and families.
______
[Responses to questions for the record from Dr. Pinto
follow:]
October 24, 2007.
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: Thank you for the opportunity to testify at
the October 10, 2007 hearing, ``Cases of Child Neglect and Abuse at
Private Residential Treatment Facilities.'' I appreciate the
opportunity to contribute what I have learned from youth, family
members, service providers and other child-serving professionals
regarding patterns of mistreatment and maltreatment in residential
programs. I am grateful for your attention and expressed concern about
these problems, and I am hopeful that the Committee will respond both
to protect youth and families from further harm and to restore the
well-being of those who have already been injured in residential care.
To augment my testimony, I am submitting a response to the questions
posed by Representative Robert Scott (D-VA) as well as the following
materials for the hearing record:
``Protecting Youth in Unlicensed, Unregulated Residential
`Treatment' Facilities,'' an article co-authored with Lenore Behar,
Robert Friedman, Judith Katz-Leavy and William G. Jones, which was
published in Family Court Review in July, 2007.
This peer-reviewed article includes preliminary findings
of the online survey of young adults who attended specialty residential
programs when they were adolescents, which I referred to in my
testimony. Analyses of the full set of personal accounts are currently
underway, and will be made available when completed.
``Unlicensed Residential Programs: The Next Challenge in
Protecting Youth,'' an article co-authored with Robert M. Friedman and
other members of the Alliance for Safe, Therapeutic and Appropriate use
of Residential Treatment (A START), which was published in the American
Journal of Orthopsychiatry in 2006.
This peer-reviewed article reviews the phenomenon of
``specialty'' residential programs for youth, describes the efforts A
START, and provides recommendations regarding responses across fields
and sectors.
``The Exploitation of Youth and Families in the Name of
``Specialty Schooling:'' What Counts as Sufficient Data? What are
Psychologists to Do?'' an article co-authored with Robert Friedman and
Monica Epstein, which was published in Summer, 2005 in the APA Public
Interest Directorate: Children, Youth and Families Division News.
This peer-reviewed article provides a summary of
identified problems relating to the phenomenon of private residential
services for youth, based upon an initial review of reports published
in the media prior to the availability of any more systematically
collected information on the issues.
``A START Fact Sheet'' posted on the A START website at
http://astart.fmhi.usf.edu
This fact sheet describes the phenomenon of mistreatment
in private residential facilities for youth, summarizes initial efforts
of A START, and provides a list of warnings for parents considering
residential treatment.
Postings to http://endinstitutionalabuse.wikispaces.com,
an online wiki created less than one week prior to the October 10, 2007
hearing to provide a virtual space where individuals can post letters,
accounts and concerns that they want to share directly with Congress
regarding the abuse of youth in residential facilities. Many people who
submitted letters to this wiki described their personal experiences of
mistreatment and abuse in private residential facilities. The wiki is
also an opportunity for individuals to provide input regarding proposed
legislation to address this issue as a means of participatory
policymaking.
Thank you again for the opportunity to contribute to the
Committee's efforts to clarify and respond to the patterns of
mistreatment and abuse in private residential treatment. If you need
any further information from me, I would be pleased to provide it. A
powerful response is urgently needed in order to protect and restore
the well-being of American youth and families, so your leadership in
these efforts is deeply appreciated.
Sincerely,
Allison Pinto, Ph.D.,
Department of Child and Family Studies, Louis de la Parte Florida
Mental Health Institute.
Response to Questions Posed by Representative Robert Scott (D-VA)
Do ``tough love'' strategies have an appropriate treatment
role for major psychological disorders? If so, what is that role?
``Tough love'' strategies are not appropriate treatment strategies
for major psychological disorders or for other milder social, emotional
or behavioral difficulties experienced by youth. In 2004, the National
Institutes of Health (NIH) issued a State-of-the-Science Conference
Statement regarding the prevention of violence and related health-
risking social behaviors in adolescents. NIH concluded, ``the evidence
indicates that `scare tactics' don't work and there is some evidence
that they may make the problem worse rather than simply not working.''
This report noted that ineffective, inappropriate treatment for
adolescents included programs limited to scare tactics or toughness
strategies. (For further details, go to: http://consensus.nih.gov/2004/
2004YouthViolencePreventionSOS023html.htm)
Often these ``tough love'' strategies are actually referred to as
``behavior modification'' in private residential facilities for youth.
It should be noted that these practices were addressed decades ago in a
1974 study prepared by the staff of the Subcommittee on Constitutional
Rights of the Committee on the Judiciary, U.S. Senate, which was
titled, ``Individual Rights and the Federal Role in Behavior
Modification.'' Even at that time, there was opposition to ``behavior
modification therapies'' on the basis of rights to privacy and mandates
against cruel and unusual punishment, especially with regard to thought
reform techniques. Similar techniques are now being used in numerous
private residential programs for youth, per the reports of former
program participants and staff members (For examples, see the article I
am submitting for the record titled, ``Protecting Youth in Unlicensed,
Unregulated Residential `Treatment' Facilities,'' as well as letters
submitted on the ``End Institutional Abuse'' wiki). These strategies
place all program participants at risk, but especially those youth with
major psychological disorders who are already particularly vulnerable.
Is there currently an obligation for mental health
professionals who recommend these programs to clients to ascertain
their safety and validity as a treatment option?
Psychologists, psychiatrists, clinical social workers and
psychiatric nurses abide by the principles and standards established by
their respective professional ethical codes. For example, the APA
Ethical Principles of Psychologists and Code of Conduct defines
principles of beneficence and nonmaleficence, fidelity and
responsibility, integrity and justice. With regard to justice, the Code
states, ``Psychologists exercise reasonable judgment and take
precautions to ensure that their potential biases, the boundaries of
their competence, and the limitations of their expertise do not lead to
or condone unjust practices.'' With regard to standards of competence,
the Code states, ``Psychologists have or obtain the training,
experience, consultation, or supervision necessary to ensure the
competence of their services, or they make appropriate referrals.''
Furthermore, psychologists do not accept fees for referrals as this is
deemed unethical. (For further details, go to: http://www.apa.org/
ethics/code2002.html)
Each mental health profession has a code that is similar in many
ways to this APA Code for psychologists, and in many states the
licensing of mental health professionals through the Department of
Health and Human Services or Board of Behavioral Sciences is linked to
these various professional codes. As such, there is an accountability
for providing safe, therapeutic and appropriate referrals among
licensed mental healthcare professionals.
There are two dilemmas worth noting, however. First, very little
information is available and accessible at this time with regard to
particular residential treatment programs for youth, especially
programs that advertise themselves as alternatives to traditional
residential mental healthcare. In many states these alternative
residential programs are still not required to be licensed or regulated
with regard to the mental healthcare they provide (e.g. programs that
self-identify as ``therapeutic wilderness programs,'' ``therapeutic
boarding schools'' or ``emotional growth academies.'') This makes it
difficult for mental health professionals, as well as families, to
discern whether a particular program is safe and appropriate.
The other dilemma worth noting is that many families are being
referred to private residential treatment facilities by individuals
other than mental health professionals. Families receive
recommendations from teachers, pastors, legal professionals and friends
and often these recommendations are more compelling to them than those
they receive from mental health professionals (if they seek a
referral), especially if the family has already tried to get their
child's needs met through the formal mental healthcare system without
success. Furthermore, there is an emerging referral ``industry'' of
self-identified ``educational consultants,'' and these individuals are
not required to be licensed. As such, they are not accountable for the
recommendations they provide to families. It should also be noted that
numerous private residential programs pay these referral sources, a
practice that is prohibited in the ethical codes of mental health
professionals.
Is there currently any requirement that other treatment
options be utilized to address a child's behavioral issues before
sending them to such a center?
Through the Individuals with Disabilities Education Act (IDEA),
youth are entitled to receive services in the ``least restrictive
environment.'' The federal law indicates that states must have
procedures in place to assure that, ``to the maximum extent
appropriate, children with disabilities, including children in public
or private institutions or other care facilities, are educated with
children who are not disabled, and that special classes, separate
schooling, or other removal of children with disabilities from the
regular educational environment occurs only when the nature or severity
of the disability is such that education in regular classes with the
use of supplementary aids and services cannot be achieved
satisfactorily.'' Through the Individualized Education Program (IEP)
planning process, students are safeguarded from inappropriate placement
in residential facilities. (For further details, go to: http://
www.wrightslaw.com/info/lre.osers.memo.idea.htm)
The dilemma is that many families are by-passing the IEP process
because they are paying out-of-pocket to place their children in
private residential facilities. Families who choose this route are
often never made aware of the full continuum of educational and mental
healthcare options that might benefit their children. Families who
contact me after having placed their children in private residential
facilities often indicate that they were never made aware of community-
based treatment that could have provided more intensive interventions
than regular education and outpatient psychotherapy, without requiring
them to use out-of-home residential care. This realization is often
quite distressing to parents who say they never wanted to send their
children away but were led to believe that residential treatment was
their only option.
Thank you for the careful attention you are paying to these issues,
and for your leadership in safeguarding and restoring the healthy
development and well-being of youth and families.
Respectfully submitted,
Allison Pinto, Ph.D.
______
[Additional submissions from Dr. Pinto follow:]
Exploitation in the Name of ``Specialty Schooling''
The Exploitation of Youth and Families in the Name of ``Specialty
Schooling:'' What Counts as Sufficient Data? What are Psychologists to
Do?
Allison Pinto, Ph.D., Robert M. Friedman, Ph.D. and Monica Epstein,
Ph.D.,
Louis de la Parte Florida Mental Health Institute, University of South
Florida
Correspondence concerning this article should be addressed to
Allison Pinto, Department of Child and Family Studies, Louis de la
Parte Florida Mental Health Institute, MHC 2222, University of South
Florida , 13301 N. Bruce B. Downs Boulevard , Tampa , Florida 33612 or
[email protected].
A multi-disciplinary taskforce has formed at the Louis de la Parte
Florida Mental Health Institute to study the issues raised in this
article, and the authors wish to thank and acknowledge the other
members of this taskforce: Lenore Behar, Amy Green, Barbara Huff,
Charles Huffine, Christina Kloker-Young, Wanda B. Mohr and Christine
Vaughn.
The Exploitation of Youth and Families in the Name of ``Specialty
Schooling:'' What Counts as Sufficient Data? What are Psychologists to
Do?
Despite an expanding evidence base regarding promising and
effective practices in children's mental health, and the implementation
of these practices in a growing number of communities, an alarming
treatment phenomenon is now occurring. Since the early 1990's, hundreds
of private residential treatment facilities have been established
across the country and abroad, and thousands of American youth are now
receiving services in these institutions. Many of these programs
identify themselves as private ``therapeutic boarding schools,''
``emotional growth schools,'' or ``specialty boarding schools.'' Unlike
accredited and licensed residential treatment centers that are required
to meet clear and comprehensive standards with regard to the treatment
they provide, many of these new programs are not currently subject to
any licensing or monitoring as mental health facilities in a number of
states. It is the unlicensed and unregulated programs that are the
focus of this article.
Highly disturbing reports have been published in the public media
describing financial opportunism by program operators, poor quality
treatment and education, rights violations and abuse of youth in these
facilities (Dibble, 2005; Rowe, 2004; Aitkenhead, 2003; Weiner, 2003d;
Kilzer, 1999). Outrage has been expressed by youth, family members and
program employees (Rock, 2005; Rowe, 2004; Rubin, 2004; Aitkenhead,
2003; Rimer, 2001). The former director of one program expressed her
dismay by sending a letter to the regional Department of Child Welfare
calling for the program to be closed immediately because it ``takes
financial advantage of parents in crisis, and puts teens in physical
and emotional risk'' (Weiner, 2003a, par. 39). Multiple state
investigations have been conducted and lawsuits have been filed in
response to reports of abuse, neglect and mistreatment of youth in
``therapeutic boarding schools.'' In numerous cases the lawsuits have
led to convictions or high cost settlements (Hechinger & Chaker, 2005;
Dukes, 2005; Rock, 2005).
Several states already have good laws on licensing and regulation
of these facilities and other states have responded to these growing
concerns by proposing (and in a few states passing) legislation to
monitor and regulate the full range of residential programs for youth,
including ``therapeutic boarding schools.'' An example of such
legislation is Utah Senate Bill 107, which was signed into law in
March, 2005; this bill defines ``therapeutic schools'' and clearly
specifies that these programs must be licensed and regulated like all
other residential treatment facilities for youth (S. 107, 2005). Beyond
the state level, Federal Bill HR 1738, the End Institutionalized Child
Abuse Bill, was introduced in Congress in April, 2005; this bill
proposes to provide funding to states to support the licensing and
monitoring of the full range of child residential treatment programs.
Although policymakers have begun to take action, there has been
little response from the field of children's mental health. In
particular, there has been no acknowledgement of the reports of abuse
in ``therapeutic boarding schools'' and similar programs by the
American Psychological Association. In one sense, the lack of response
from psychologists is consistent with our epistemological framework and
commitment to the scientific method; we typically gather data first,
and then analyze and interpret it, prior to developing a response or
course of action. Currently, there are no comprehensive, systematically
collected data available about private, unregulated residential
treatment, so the lack of response at this time might seem appropriate.
In addition to valuing the science of psychology, however, we also
aspire to safeguard the welfare and rights of those whom we seek to
serve, and we say that we are aware that special safeguards may be
necessary to protect the rights and welfare of vulnerable persons or
communities (Ethical Principles of Psychologists and Code of Conduct,
2002). It is therefore important that we educate ourselves about the
current residential treatment phenomenon and then respond, as
psychologists, in a manner consistent with our principles and our
mission. Although the increased and unregulated institutionalization of
youth is far from what we may have hoped for or predicted, it is
occurring nonetheless, and we cannot ignore it any longer.
The following review is a summary of the issues that have been
identified in the accounts that have been published to date regarding
residential treatment programs that are not licensed or accredited as
such, but continue to operate. These accounts have been featured in
publications including the New York Times, the Washington Post, and
Time Magazine, and have been aired on BBC News and National Public
Radio. The series of articles published in 2003 by Tim Weiner at the
New York Times is particularly comprehensive, and is based on
interviews and correspondence with more than 200 parents, youth, staff
members and program officials. Lou Kilzer has also reported extensively
on the topic in the Denver-Rocky Mountain News (Kilzer, 1999). It
should be noted that these series do not address all residential
treatment and neither does this article. They specifically raise
concerns about unlicensed and unregulated private programs that serve
youth with emotional and behavioral challenges.
A ``Booming Industry''
It is difficult to determine exactly how many private residential
treatment programs billed as ``specialty schools'' currently exist. In
a white paper titled, ``Unregulated Youth Residential Care Programs in
Montana'' the author noted that, ``Because private behavioral
healthcare programs are not required to be licensed or registered with
any state agency, it is a bit like knowing about an `undiscovered lake'
in the mountains (Montana Department of Public Health and Human
Services [DPHHS], 2003).'' Regardless, an Internet search using the
term ``troubled teen therapeutic boarding school'' easily identifies a
few hundred facilities, many of which are listed on websites such as
strugglingteens.com, familyfirstaid.org and natsap.org. In January,
2004, the Chicago Tribune reported, ``Even in a lackluster economy,
business for therapeutic schools is booming. While exact numbers are
hard to come by, a trade association and other experts say the schools
are a $1 billion to $1.2 billion industry that serves 10,000 to 14,000
school-age children (Rubin, 2004, par. 8).'' Some of these residential
programs house over 500 youth in a single facility (Cole, 2004; Weiner,
2003a; Weiner, 2003d). According to reports in the Wall Street Journal
and the New York Times, the cost of each program generally ranges from
$30,000 to $80,000 per year (Hechinger & Chaker, 2005; Rimer, 2001).
Medicaid and most health insurance plans will not pay for youth to
attend these programs, so families are typically paying out of pocket,
sometimes mortgaging their homes or borrowing money from relatives to
pay for ``tuition'' (Cole, 2004; Rubin, 2004; Rimer, 2001). It is the
very fact that this involves a private transaction between a family and
a program that makes it possible for the programs to operate outside of
public monitoring.
How the Programs Describe and Market Themselves
Residential facilities that self-identify using the labels of
``therapeutic boarding school,'' ``emotional growth school'' or
``specialty boarding school'' seem to emphasize non-pathologizing
approaches in their marketing materials. One program conveys this by
stating, ``Labels and diagnoses are left at the door and students are
identified and accepted as being intrinsically valuable and good.''
Phrases like, ``respecting dignity and integrity,'' ``uncovering true
potential'' and ``accepting personal responsibility'' are frequently
incorporated into the program mission statements. At the same time,
these programs are often quite explicit in marketing to families of
youth with psychiatric diagnoses, claiming expertise in treating a
variety of serious conditions including PTSD, Bipolar Disorder and
Eating Disorders (NATSAP Directory, 2005).
In terms of the services marketed within these programs, various
mental health interventions are described, including individual, group
and family therapy, substance abuse counseling, cognitive-behavioral
therapy, behavior management (sometimes described in terms of ``point
systems'' and ``level systems''), and the maintenance of a therapeutic
milieu. Other less traditional interventions are described in some of
the institutions, including equine therapy, canine therapy, and
wilderness therapy. The educational opportunities in these institutions
are often highlighted in marketing materials with phrases such as
``extensive college-preparatory curriculum,'' a ``boutique educational
package customized for each participant,'' and education ``custom-
tailored to each student's unique needs (NATSAP Directory, 2005).''
There appear to be three major ways in which these programs are
currently marketed: through the Internet, through ``educational
consultants,'' and through participating family referrals. Many
programs host their own websites and are listed as well on ``referral
sites,'' which offer web-based surveys for parents to complete to
determine whether their children are exhibiting problems that would
benefit from residential placement. ``Educational consultants'' are
also available to connect families with programs. The qualifications
and credentials of these consultants vary (Rubin, 2004) and there is no
evidence of educational requirements or state regulations for this
profession. It is reported that some referral sources receive a
commission by certain residential facilities for each family they
recruit, although this arrangement is not regularly made explicit to
families (Rock, 2005a; Hayes, 2003). Some programs also encourage
families whose youth are attending the program to recruit other
families they know; for each new admission, the referring family
receives a month of ``tuition-free'' services (Aitkenhead, 2003).
Families have reported sending their children to programs on the
recommendation of other parents without ever further investigating the
program or services described (Cole, 2004).
Actual Services Delivered
Although the services and educational resources described in
marketing materials may be highly appealing to families seeking
support, many of these programs seem to provide far less than they
advertise. With regard to mental health intervention, therapy is often
provided by staff members who have no formal clinical training, and
therapeutic interventions suggestive of gross incompetence are commonly
reported (Cole, 2004; Aitkenhead, 2003; Kilzer, 1999; Weiner, 2003a;
Weiner, 2003d). Harsh and punitive behavioral modification practices
have been repeatedly documented (Romboy, 2005; Weiner, 2003c; Kilzer,
1999).
Some youth have reported that they were required to discipline
other youth in the facility in order to progress within the behavioral
modification level system (Lukes, 2005; Weiner, 2003a). Psychiatrists
are not regularly part of the treatment team, and incorrect dosing
(Romboy, 2005) as well as frequent over-medication of program
participants has been reported (Weiner, 2003d). Education has been
described as a series of monitored study halls without trained,
licensed teachers (Rowe, 2004; Aitkenhead, 2003) and some programs
issue ``diplomas'' that would not be officially recognized by state
Departments of Education (Garifo, 2005).
Some facilities are explicit about their refusal to accept
accountability for delivering the services they advertise (Kilzer,
1999; Weiner, 2003a). For example, in one program, parents are required
to sign a contract that ``states plainly that the program `does not
accept responsibility for services written in sales materials or
brochures' or promises made by `staff or public relations personnel
(Weiner, 2003a, par. 25).' ''
Abuse of Youth by Program Staff
Highly disturbing incidents of physical, emotional and sexual abuse
as well as rights violations have been documented in a number of
reports (Hechinger & Chaker, 2005; Rock, 2005; Garifo, 2005; Harrie &
Gehrke, 2004; Bryson, 2004b; Weiner, 2003b; Montana DPHHS, 2003). In
some programs, parents are instructed by staff to immediately dismiss
their children's reports of abuse as attempts at manipulation
(Aitkenhead, 2003; Weiner, 2003c). Emotional abuse has been reported in
terms of verbal abuse, humiliation, forced personal self-disclosure
followed by mockery and extreme fear inducement (Hechinger & Chaker,
2005; Rock, 2004; Aitkenhead, 2003; Weiner, 2003b; Weiner, 2003d;
Kilzer, 1999). Criminal probes relating to allegations of sexual
assault by staff members have occurred in multiple programs as well
(Hechinger & Chaker, 2005; Bryson, 2004b; Hayes, 2003; Weiner, 2003d;
Montana DPHHS, 2003; Kilzer, 1999).
Excessive and Abusive Seclusion and Restraint Practices
In a number of programs, the seclusion and restraint procedures are
significantly more restrictive than the standards generally accepted by
mental health licensing and accrediting bodies. In one program, youth
described lying on their stomachs in an isolation room for 13 hours a
day, for weeks or months at a time, with their arms repeatedly twisted
to the breaking point (Rowe, 2004; Weiner, 2003c; Aitkenhead, 2003). A
youth from one Montana facility reported that he spent six months in
isolation (Weiner, 2003d). Signed affidavits from former employees of a
therapeutic boarding school in northern Utah indicate that youth in
that program were restrained face down in manure (Romboy, 2005;
Stewart, 2005).
In some programs, parents sign contracts authorizing program staff
to use mechanical restraints on the youth for unlimited periods of time
(Kilzer, 1999). The restraint practices in one institution were
described by a former resident as, ``a completely degrading, painful
experience * * * they pin you down in a five-point formation and that's
when they start twisting and pulling your limbs, grinding your ankles
(Aitkenhead, 2003, par. 9).'' Records allegedly documenting the use of
handcuffs, belts, pepper spray and duct tape to restrain youth have
been cited as well (Bryson, 2005b; Dibble, 2005).
Rights violations
Some programs restrict youth rights without clear clinical
justification. Restricted rights include prohibitions against: written
and phone contact with family members for the initial two to six months
(Kilzer, 1999; Aitkenhead, 2003); privacy, even in bathrooms and
showers (Aitkenhead, 2003; Kilzer, 1999); and wearing shoes, which
could facilitate running away (Kilzer, 1999). There is no indication
that families or youth are provided with information about how to
contact advocacy groups if they have concerns about the treatment and
care the youth receives. This is quite unlike accredited psychiatric
hospitals and residential treatment centers, which are required to post
hotline numbers that youth and family members can call if they believe
their rights are being violated.
``Escort'' Services
Families frequently hire ``professional escort services'' to
transport youth to the residential facilities (Bryson, 2005; Rowe,
2004; Cole, 2004; Labi, 2004; Rimer, 2001). It is estimated that more
than twenty escort companies are currently in operation, and to date
they are not state-regulated (Labi, 2004). Parents pay escorts as much
as $1800 to enter their sleeping children's bedrooms in the middle of
the night, awaken them, handcuff and/or leg iron them if they protest
or resist, and travel with them to the residential programs where they
will be admitted (Labi, 2004; Weiner, 2003a). Parents sign a notarized
power-of-attorney authorizing the escort(s) to `` take `any act or
action' on the parents' behalf during the transport (Labi, 2004, par.
16,'' and promising that the family will not sue the escort(s) ``for
any injuries caused by `reasonable restraint' '' (Labi, 2004, par. 16).
Neglectful Conditions
Some of these programs are neglectful, in terms of environmental
safety and cleanliness, nutrition and medical care. Unsanitary living
conditions have been described repeatedly (Bryson, 2005; Romboy, 2005;
Stewart, 2005; Harrie & Gehrke, 2004; Labi, 2004; Weiner, 2003d;
Aitkenhead, 2003; Kilzer, 1999). Youth have contracted scabies while
living at some residential facilities (Romboy, 2005; Weiner, 2003d;
Kilzer, 1999). Unhealthy diets are maintained for youth in a number of
programs (Romboy, 2005; Labi, 2004; Weiner, 2003d; Weiner, 2003a;
Aitkenhead, 2003; Kilzer, 1999). Authorities have reported that they
found expired medications in a program investigated in December, 2004
(Dibble, 2005), and other programs were recently investigated for
medical neglect as well (Rock, 2005; Romboy, 2005).
Limited Rights of Youth
Although numerous lawsuits have been filed to hold programs
accountable for alleged misrepresentation, mistreatment and abuse, it
is commonly understood that youth currently have little legal standing
to challenge their placement in these programs (Kilzer, 1999). Barbara
Bennett Woodhouse, the director of the Center on Children & the Law at
the University of Florida, stated, ``The constitution has been
interpreted to allow teens effectively to be imprisoned by private
companies like [escort services] and private schools like [unregulated
``specialty boarding schools'']--as long as their parents sign off. If
these were state schools or state police, the children would have
constitutional protections, but because it is parents who are
delegating their own authority, it has been very difficult to open the
door to protection of the child (Labi, 2004, par. 79).''
Minimal to Nonexistent Regulatory Oversight
Limited to nonexistent regulatory oversight is evident in many
states and there is a lack of federal legislation requiring oversight
of private residential treatment programs (Hechinger & Chaker, 2005;
Garifo, 2005; Gehrke, 2005; Rubin, 2004). Thus, institutions are able
to market themselves and provide treatment without accountability,
which in turn makes it possible for programs to take advantage of youth
and families. Even when parents inquire about program licensure or
accreditation, the response they receive may be misleading. Programs
often cite accreditation by the regional Association of Schools and
Colleges and Universities as ``Special Purpose Schools;'' however, this
process only relates to the educational component of a program and does
not address therapeutic or behavioral components or standards relating
to overnight care (Montana DPHHS, 2003).
Proposed Response
A number of issues are raised by the current operation of hundreds
of private residential treatment facilities marketed as ``specialty
boarding schools,'' many of which are reportedly exploiting families
and mistreating and abusing youth. The first issue relates to the need
for responsible and effective oversight. As a society, one of our
primary duties is to provide for the protection and safety of our
citizens, particularly vulnerable populations such as minors. Within
health care, concerns about safety contribute to the development of
licensing, regulatory, monitoring, and accreditation procedures for
organizations, as well as for professions. Laws and procedures
regarding the reporting of child abuse and neglect, and the
investigation of complaints, are primary mechanisms to help keep
children safe. In response to the growing number of reports regarding
mistreatment and abuse of youth in ``therapeutic boarding schools'' and
other similar programs, responsible and effective oversight is crucial
in all states. All facilities that serve minors with emotional and
behavioral challenges need to be licensed and regularly monitored, with
particular emphasis placed on those services provided to address the
emotional and behavioral needs of youth. All such facilities also need
procedures in place for the reporting of abuse. This is particularly
important since accounts in the public media indicate that many of the
private treatment facilities are not open to routine visits by family
and/or professionals and operate outside public scrutiny.
The issue we are raising here is not whether residential care is
needed for some youth, or whether private residential treatment
programs are effective. Clearly there is a need for residential care
for some youth, and some programs are likely very high quality. Rather,
the issue of central concern is whether appropriate standards exist
such that all programs providing intervention to youth with identified
emotional and behavioral challenges are licensed and monitored with
regard to the residential treatment they provide, and are maintaining
conditions that protect the safety of those who are served.
A second issue reflected in the recent, dramatic growth of
residential treatment facilities is the need to increase access to
effective care for children and families in their own homes and
communities so that residential care is used only when needed and not
by default because other services are unavailable. Progress has been
made through efforts such as the system of care grant program of the
federal Center for Mental Health Services (2002) and through local and
state initiatives, but there clearly is a need for great improvement,
as described by the President's New Freedom Commission (2003), and the
Child and Family Subcommittee of the President's New Freedom Commission
(Huang et al., in press). Significant progress has been made in
developing individualized, culturally competent, and intensive
interventions to be provided in communities; now the ``reach'' of these
efforts needs to be extended.
A third issue related to the proliferation of unregulated
residential treatment programs for youth is the use of the worldwide
web as a powerful marketing tool. With the growth of access to the
Internet by the general public, the mental health field must recognize
that families will be the target of intensive, impressive, and
effective marketing strategies, and that such marketing makes it
difficult for both families and formal service providers to distinguish
high quality programs from low quality programs. Such marketing creates
a need for professional organizations such as the American
Psychological Association to develop resources and provide information
to help families make considered and sound choices among treatment
options.
There is also a need for professional organizations, including the
American Psychological Association, to take a stand on issues such as
the need for increased oversight of ``therapeutic boarding schools''
and similar programs, and the need for adequate protections for
children in these programs. In the late 1980s, when there was concern
about the marketing practices of private for-profit psychiatric
hospitals, a Resolution on Advertising by Private Hospitals was issued
by APA's Division of Child, Youth, and Family Services (1986). Such
action is needed again in the face of multiple, publicized reports that
families are being exploited and children are being mistreated and
abused in unregulated and unmonitored facilities, and youth have no
mechanism to report abuse.
It would certainly be easier to take a strong stand if there were
an abundance of carefully and systematically collected data describing
who is served in these programs, how they are served, how often abuse
and mistreatment takes place, and what the overall outcomes are for the
programs and youth. Given the fact that the programs of such great
concern are not accountable to the public, these data are unavailable
now and not likely to become available in the near future. In the face
of multiple reports in the media, and multiple interviews with
children, parents, and former staff of such programs, is there not now
sufficient information to take action to protect children from abuse
and families from exploitation? We strongly believe that the answer to
that question is a resounding ``Yes!'' We cannot continue to look the
other way or use the absence of data as an excuse for inaction. The
time for action is now.
references
Aitkenhead, D. (2003, June 29). The last resort. The Observer Magazine.
Retrieved December 16, 2004 from http://observer.guardian.co.uk
American Psychological Association. (2002). Ethical principles of
psychologists and code of conduct. Retrieved May 20, 2005 from
http://www.apa.org
Associated Press. (2004, September 20). Investigation shows troubled
school may be buying interest with lawmakers. The Daily Herald.
Retrieved April 15, 2005 from http://harktheherald.com
Bryson, A. J. (2005, April 21). Utah-based group under fire--
legislation targets association of schools for troubled youths.
Deseret Morning News. Retrieved April 21, 2005 from http://
deseretnews.com
Bryson, A. J. (2005, February 8). Tighter control of youth programs
sought in Utah. Deseret Morning News. Retrieved April 15, 2005
from http://deseretnews.com
Bryson, A. J. (2004, April 17). Problems plaguing program for youths.
Deseret Morning News. Retrieved April 15, 2005 from http://
deseretnews.com
Bryson, A. J. (2004, April 9). Youth programs in Utah targeted. Deseret
Morning News. Retrieved April 15, 2005 from http://
deseretnews.com
Capitol Advantage LLC (n.d.) Legislation Details `To assure the safety
of American children in foreign-based and domestic
institutions, and for other purposes.' Retrieved May 20, 2005
from http://www.congress.org/congressorg/
bill.xc?billnum=H.R.1738&congress=109
Cole, W. (2004, November 22). How to save a troubled kid? Time
Magazine. Retrieved April 15, 2005 from http://www.time.com
Dibble, S. (2005, January 10). Scrutiny increased on centers for teens.
The San Diego Union Tribune. Retrieved April 15, 2005 from
http://signonsandiego.com
Dukes, L. (2005, March 26). Financial troubles shut down CEDU schools.
Bonner County Daily Bee. Retrieved April 15, 2005 from http://
bonnercountydailybee.com
Garifo, C. (2005, February 16). State agencies probe Ivy Ridge.
Watertown Daily Times. Retrieved February 16, 2005 from http://
www.wdtimes.com
Gehrke, R. (2005, February 11). New push for camp regulation. The Salt
Lake Tribune. Retrieved April 15, 2005 from http://
www.sltrib.com
Harrie, D. & Gehrke, R. (2004, September 21). Teen-help operators have
clout--Family behind schools with checkered record
calls in political favors, critics say. The Salt Lake Tribune.
Retrieved February 17, 2005 from http://www.sltrib.com
Hayes, T. (2003, June 18). Boarding schools go unchecked in Utah.
Deseret Morning News. Retrieved April 18, 2005 from http://
deseretnews.com
Hechinger, J. & Chaker, A. M. (2005, March 31). Boarding-school options
shift for troubled teens--shutdown of Brown schools shows
challenge of selecting a `therapeutic' program. The Wall Street
Journal. Retrieved April 7, 2005 from http://online.wsj.com
Huang, L., Stroul, B., Friedman, R., Mrazek, P., Friesen, B., Pires,
S., & Mayberg, S. (in press). Transforming mental healthcare
for children and their families. American Psychologist.
Kilzer, L. (1999, July 18). Desperate Measures. Denver Rocky Mountain
News. Retrieved December 28, 2004 from http://www.denver-
rmn.com
Labi, N. (2004, July/August). Want your kid to disappear? Legal
Affairs. Retrieved January 19, 2005 from http://
www.legalaffairs. org
Licensure and Regulation of Programs and Facilities, S.B. 107, General
Session State of Utah, (2005). Retrieved May 20, 2005 from
http://bb.utahsenate.org/perl/bb/bb find.pl
Montana Department of Public Health and Human Services. (2003).
Unregulated youth residential care programs in Montana. Helena,
MT: Author.
New Freedom Commission on Mental Health, Achieving the Promise:
Transforming Mental Health Care in America. Final Report. DHHS
Pub. No. SMA-03-3832. Rockville, MD: 2003.
Rimer, S. (2001, September 10). Desperate Measures. The New York Times.
Retrieved January 4, 2005 from http://www.nytimes.com
Rock, S. (2005, March 21). Boonville looks to sell old academy. The
Kansas City Star. Retrieved April 15, 2005 from http://
www.kansascity.com
Rock, S. (2005, January 23). Referral agency's connection to boot camp
angers parents. The Kansas City Star. Retrieved April 15, 2005
from http://kansascity.com
Rock, S. (2004, December 19). Teen's death raises concerns. The Kansas
City Star. Retrieved May 20, 2005 from http://kansascity.com
Romboy, D. (2005, March 6). Utah boarding school under fire. Deseret
Morning News. Retrieved April 15, 2005 from http://
deseretnews.com
Rowe, R. (2004, December 7). Tranquility Bay: The last resort. BBC
News--World Edition. Retrieved January 4, 2005 from http://
news.bbc.co.uk
Rubin, B. M. (2004, January 14). The last resort; Therapeutic education
industry booms as parents seek programs for their troubled
children. Chicago Tribune. Retrieved April 15, 2005 from http:/
/www.chicagotribune.com
Stewart, K. (2005, March 1). State's oversight of school lambasted. The
Salt Lake Tribune. Retrieved April 15, 2005 from http://
www.sltrib.com
Stewart, K. (2005, Febrary 5). Licensing for ``therapeutic schools''?
The Salt Lake Tribune. Retrieved April 15, 2005 from http://
www.sltrib.com
The National Association of Therapeutic Schools and Programs, Inc.
(2005). NATSAP 2005 Directory. Tampa, Florida: Author.
Weiner, T. (2003, September 6). Program to help youths has troubles of
its own. The New York Times. Retrieved January 27, 2005 from
http://www.nytimes.com
Weiner, T. (2003, June 17). Parents divided over Jamaica disciplinary
academy. The New York Times. Retrieved January 19, 2005 from
http://nytimes.com
Weiner, T. (2003, May 24). Owner of private discipline academy in Costa
Rica is arrested. The New York Times. Retrieved January 19,
2005 from http://www.nytimes.com
Weiner, T. (2003, May 9). Parents, shopping for discipline, turn to
harsh programs abroad. The New York Times. Retrieved May 9,
2003 from http://www.nytimes.com
______
Protecting Youth Placed in Unlicensed, Unregulated Residential
``Treatment'' Facilities
Lenore Behar, Robert Friedman, Allison Pinto, Judith Katz-Leavy, and
Hon. William G. Jones
Throughout the country, there is considerable inconsistency in how
states regulate residential treatment programs for youth. In states
with little oversight, the health and safety of youth are unprotected
and they may be subject to substandard treatment, rights violations,
and/or abuse. Three initiatives to address this issue are reported:
(1) an Internet survey of youth who are former residents, (2) a
four-state pilot study of how states regulate and monitor residential
programs, and (3) a bridge-building conference between residential
treatment providers and mental health leaders. Recommendations address
the next steps for lawmakers, lawyers, judges, mental health and
education professionals, and parents.
KEYWORDS
residential treatment for youth; licensure/regulation of residential
treatment for youth; abuse in residential treatment; state
responsibility for residential treatment of youth
Introduction
I did not know where I was going when two strangers came to my room
at home at 3 in the morning, handcuffed me and dragged me down the
stairs into a car. While I was at ``name deleted,'' the program used
forced labor, excessive exercise, sleep deprivation, nutritional
deprivation, physical aggression from staff, and threats. We had work
sanctions like carrying rocks, digging holes, in both extreme heat and
in cold and snow/rain. Staff punched kids when restraining them;
restraints were done using duct tape and blankets. Now it is hard to
have lasting relationships, and I don't trust many people. I learned to
``play their game'' * * * make up things and admit anything to get them
off your back.
Quotation from a 20-year-old about treatment that occurred 3 years
before I found this program on the Internet and it looked like it was
perfect for our son, who argued all the time, skipped school and was
disrespectful to me and my wife. We were afraid he would smoke pot and
become a juvenile delinquent. They helped us to get a mortgage on our
house to pay for the care. They told us to lie to him about where we
were taking him, so we did. They told us he would lie to us about what
was going on at the school to manipulate us; they told us to ignore his
letters. We were not allowed to talk to him on the phone. We never knew
what his treatment plan was, but didn't realize that we had the right
to know.
When he ran away and was picked up by a shelter program, we were
ready to send him back but the woman at the shelter told us she knew
from other kids that the stories were true. We found out later that
they used outhouses that they dug themselves. They were punished by
being forced to eat with the hogs, down on their knees, like animals.
There were many punishments that involved isolation or whippings by
staff. They had forced marches and had to carry rocks in their
backpacks. Medical problems, like infections, were untreated. We talked
to other parents who had kids there and got the same stories. We were
horrified about what we did to our son. It has taken years of family
therapy to get past this.
Quotation from a parent.
A parent's decision to place a child in a residential treatment
center is a serious one, usually fraught with anxiety and based on
serious concerns about the child's difficulties, emotional stability,
and/or behavioral problems. The decision is frequently guided by the
recommendations of a mental health professional, school counselor,
juvenile probation officer, or judge. In many cases, the decision comes
after other, nonresidential treatments have failed. The choice of a
residential treatment program is a complicated one, and in the best of
circumstances, the decision is made by matching the child's needs to
the program's strengths and based on the assumption that the program
provides quality treatment, education, medical care, and honors the
rights of children and parents.
As seen in the opening quotations, substantial problems can arise
when placements are made without verifying that these important
elements of residential care are in place. A very basic source of
verification of program quality is that the program is licensed by the
state in which it is located; a higher source of verification is
accreditation by a national organization. Neither is foolproof and
questionable programs may exist with one or both of these seals of
approval. Alternatively, good programs may exist with neither of these
approvals. Thus, the issue of program quality is complex, but extremely
important to the well-being and safety of children entering these
programs and precedes any consideration of treatment effectiveness.
This article addresses the most basic measure of quality--how states
handle the issue of licensure; how they review or monitor the programs
they license; and how they address problems that arise when the
requirements for good child care, good treatment, and good education
are deficient.
Uncovering a problem
One of the strongest reports in the media regarding exploitation,
mistreatment, and abuse of minors in unregulated, private residential
treatment facilities appeared in July 1999 by Lou Kilzer in the Denver
Rocky Mountain News. Over the past 4 years, there have been additional
important and shocking media reports. Most notable are a series of
articles by Tim Weiner, The New York Times (May through September
2003); Bonnie Miller Rubin, ``The Last Resort: Therapeutic Education
Industry Booms as Parents Seek Programs for Troubled Children,''
Chicago Tribune (January 14, 2004); and Maia Szalavitz, ``The Trouble
with Tough Love,'' Washington Post (January 29, 2006). Szalavitz has
further captured the unsavory tactics of some programs in her recent
book, Help at Any Cost (Szalavitz, 2006). Youth who attended such
programs, parents, and former staff have also made powerful public
statements about abusive experiences with some of these facilities.
These issues have been discussed in publications of the American
Psychological Association: Public Interest Directorate (Pinto,
Friedman, & Epstein, 2005) and the American Journal of Orthopsychiatry
(Friedman et al., 2006b) and in presentations at meetings of the
American Bar Association (American Bar Association, 2006), American
Psychological Association (Pinto, Epstein, Lewis, & Whitehead, 2006),
and Research and Training Center for Children's Mental Health (Friedman
et al., 2006a).
Collectively, these reports describe:
basic human rights violations including (1) youth deaths;
(2) inhumane, degrading discipline; (3) inappropriate, often dangerous,
use of seclusion and restraint; (4) medical and nutritional neglect;
(5) severe restrictions of communication with parents, lawyers, and
advocates;
substandard psychotherapeutic interventions and education
by unqualified staff;
failure to assess individual needs of residents;
denial of full access by parents to their children in
residence;
financial opportunism and misrepresentations to parents by
program operators; and
financial incentives to educational consultants who serve
as case finders and recruiters of families.
Investigations have been conducted of abuse and neglect at several
private unregulated residential programs and lawsuits have been filed
as a result; some lawsuits have led to criminal convictions of the
programs' officials or expensive civil case settlements (Hechinger &
Chaker, 2005; Dukes, 2005; Rock, 2005; Rock, 2004).
Some of the unregulated programs mislead parents to believe that
creative programming that rises above regulation and above sound
medical and psychological practices is necessary for their difficult
children. Attractive advertisements, particularly on the Internet, are
aimed at parents who are struggling to find help for their troubled
children. Some parents make these placements at their own expense,
without first seeking professional evaluations of the youth's problems,
and the programs do not require professional assessment prior to
placement. Some programs offer to connect the family with an escort
service to transport a child whom parents anticipate would not
otherwise choose to go to the program, which essentially means that two
or more strong adults physically control the youth and force him or her
to go along, either by car or by plane, to the treatment facility. In
some cases, the parents have not seen the programs, which may be
hundreds if not thousands of miles away from home, and they have no
independent data, other than promotional material, to attest to the
effectiveness of the programs. Many programs severely limit parental
contact, by phone and visits, sometimes for as long as a year
(Szalavitz, 2006). Last year, the American Bar Association Center on
Children and the Law, using data reported by Rubin and Szalavitz,
reported an annual estimate of 10 to 15 thousand American youth being
placed by their parents in these privately run, unregulated residential
facilities, which may also include boot camps or wilderness programs
(American Bar Association, 2006).
Regulation of residential programs
Policies regarding regulation of both public and private
residential facilities are the responsibility of each state. These
policies may be implemented by state legislation, regulation, or other
administrative action. Although many states do oversee residential
programs, in some states private residential treatment facilities for
minors are not subject to regulation, or monitoring either as mental
health facilities or educational facilities. Yet states regulate other
private facilities, such as nursing homes, day care centers, hospitals,
and restaurants. Depending on the state, failure to provide state
oversight of residential programs for minors may occur because these
programs (1) do not accept public funds; (2) are affiliated with
religious organizations; or (3) describe themselves (inappropriately)
as outdoor programs, boarding schools, or other types of nontreatment
programs. In some cases, strong lobbying efforts by interested parties
have contributed to creating and maintaining these exclusions. An
additional problem in some states is that, although regulations exist,
there is ineffective monitoring of programs for compliance; this may be
an issue of insufficient resources being assigned to monitoring, which
ultimately is an issue of insufficient priority.
If a residential program advertises that it addresses behavior
problems and calls itself a ``therapeutic boarding school,''
``emotional growth academy,'' ``behavior modification facility,''
``wilderness program,'' ``boot camp,'' or other similar terms, then it
most likely should be considered a treatment program because it targets
the social, emotional, and/or behavioral functioning of the children.
Certainly some unregulated residential programs are reputable and
likely could meet licensure requirements. However, other programs do
not adequately provide for the safety and well-being of their residents
and cannot meet such requirements, and it is these programs that are
most concerning.
Another aspect of the problem is which state agency is responsible
for the licensing and monitoring of residential programs for youth. In
most states these oversight responsibilities are placed in a health
and/or human services or education agency, where there is considerable
understanding of protection, treatment, and education issues and of the
developmental issues of youth. However, in some states, the oversight
responsibility rests with law enforcement, where tendencies to accept a
more punitive view of corrective programs may prevail.
Beginning to address the problem
The Alliance for the Safe, Therapeutic and Appropriate Use of
Residential Treatment (A START) was initiated by the Louis de la Parte
Florida Mental Health Institute at the University of South Florida to
call attention to this problem and seek solutions that will protect
children in these programs. A START now includes advisors who are
leaders in psychology, psychiatry, nursing, mental health law, policy,
and family advocacy, as well as people with direct experience as
director, evaluator, parent, or participant in such programs. A START
worked with the office of Representative George Miller, now Chair of
the House Committee on Education and the Workforce, to host a press
conference regarding these programs at the U.S. Capitol Building on
October 22, 2005. Major national organizations which endorsed A START's
concerns include the American Psychological Association, American
Association of Community Psychiatrists, American Orthopsychiatric
Association, Child Welfare League of America, Federation of Families
for Children's Mental Health, National Alliance for the Mentally Ill,
and National Mental Health Association. The National Conference of
State Legislatures (NCSL) shares the belief that state policy is
central to addressing this problem and has distributed information,
prepared by A START, to the chairs of relevant state legislative
committees to inform them of the issues (Herman, 2005).
In the past year, A START has highlighted the problems of private,
unregulated residential treatment facilities through presentations at
major conferences of professional and parent organizations (Friedman et
al., 2006a; Pinto et al., 2006) and published papers in key
professional journals (Pinto et al., 2005; Friedman et al., 2006b). To
clarify, the focus has been on facilities that are not licensed and not
operated by public or governmental systems but operate private,
residential facilities for troubled or difficult children or youth
under the age of 18. The focus therefore has not included public or
private boarding schools that provide only education, nor has A START
addressed concerns related to publicly run psychiatric facilities or
private facilities that are licensed and regulated.
The American Bar Association, recognizing the failure of regulation
in some states to cover all residential programs in the state, has
passed a resolution (by the Association's House of Delegates at their
February 2007 meeting) concerning the use of unregulated residential
treatment facilities. The resolution ``urges state, territorial, and
tribal legislatures to pass laws that require the licensing,
regulation, and monitoring of residential treatment facilities that are
not funded by public or government systems, but are otherwise privately
operated overnight facilities for troubled and at-risk youth under the
age of 18'' (see text following this article).
Bringing the problem into focus has been the first step. Efforts
currently underway are described below. These include (1) an Internet-
based survey of youth who have attended residential treatment programs
and a similar survey for parents, (2) a pilot study of four states to
gain understanding of the licensure issues and serve as a basis for a
national, state-by-state study, and (3) a bridge-building task force of
leaders in the child mental health field and directors of residential
treatment centers to develop agreement about important elements in
residential treatment programs.
Youth perspectives on residential programs for troubled teens
In response to reports of institutionalized abuse, one question
that parents, professionals, and residential program operators often
ask is, ``How do you know that these are not just a few isolated
incidents that have been blown way out of proportion?'' Sometimes the
question asked is, ``Yes, but how do you know that these are not just
the complaints of disturbed youth who have already tried to manipulate
their families and the residential programs and now are trying to
manipulate the public?''
As a means of getting better information, an online survey has been
developed and posted to gather firsthand reports from young adults who
attended residential specialty programs when they were adolescents. The
survey is still active, so reports continue to be received. It has
provided an opportunity for hundreds of former program participants to
share their experiences and express their concerns. It is important
that we listen to what they have to say. What follows is only a brief
description of the preliminary findings.
Survey methodology
Participants were recruited to participate in the survey through e-
mail correspondence; links to the survey were posted on various Web
sites. E-mail and Web site addresses were identified based upon
previous contacts to gain understanding about services provided to
youth in unregulated residential facilities for youth (Pinto et al.,
2006). Prospective participants were directed to a description of the
study on surveymonkey.com, and if they then consented online to
participate, they were directed to the survey itself. Participants were
informed that their responses would be anonymous and they would not be
linked to their e-mail addresses. The survey was programmed such that
it would only accept one completed survey from a given e-mail address.
It is recognized that this may not be a representative sample of former
program participants; however, it was not possible to identify such a
representative sample in this type of survey. This sampling procedure
did permit A START to gather information directly from many former
program participants. Participants who had attended more than one
alternative residential program were instructed to choose one 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 comprised 194 questions regarding direct experience in
residential mental health treatment programs. Questions were organized
into sections focused on: (1) basic demographics and program
identifying information, (2) the process leading up to program entry,
(3) program participation, and (4) program effects. Questions were
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 included a
combination of forced choice and free-response questions.
Survey findings
The survey was posted online in July 2006. The findings reported
are for the first 3-month period and include responses of 500
individuals. For the purposes of the current analyses, individuals were
included if they provided the name of the program they attended (N =
376), and the program named was an unregulated therapeutic boarding
school, emotional growth academy, or residential treatment program (N =
298), rather than a licensed residential treatment center or a program
of unidentifiable type. Of these individuals, only 5 reported that they
had received the phone number of an advocacy organization to contact if
they had any questions or concerns while participating in the program
and 63 individuals provided no response to the question about access to
an advocate. Responses from these individuals were removed as well, so
that the sample for the current analyses included 230 individuals who
attended a residential specialty program 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 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.
Who are these youth?
The majority of the 230 respondents are White (87% Caucasian, 6%
biracial/bicultural, 3% Latino/Hispanic, 3% Asian or other cultural
identities) and the majority are 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%). Almost half reported that they were transported to the program
by an escort service (47.6%) that involved strong adults who forced the
youth to leave home and then, using force or the threat of force,
accompanied the youth to the residential program.
What about the programs?
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 United States in Jamaica
(12.2%) or Mexico (7%), and 4% reported attending programs in the
Dominican Republic, Western Samoa, or Costa Rica. Lengths of stay in
both the U.S.-based and foreign-based programs were extended; slightly
over two-thirds (69.1%) reported that they attended the program for a
year or longer.
Concerns that emerged in the reports from young adults
Violations of patient's rights
Many participants reported that they experienced patient rights
violations. In addition to having no access to advocacy contact
information, 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 one participant explained, ``They isolated you
from your family back home. You had no way to freely contact anyone.
They also enacted arbitrary bans to isolate you from friends/ peers.''
Another reported, ``I never spoke to my mom, or even touched a phone
once during the 6 month stay in [program name deleted]. On Christmas
you got to speak with your parents for 5 minutes and I did not get to
talk to my mother because she was never informed of the call.'' And
another: ``As for the e-mails and letters, they read them as they came
in, and before you sent them out. I wrote 7 letters to my mom before
they would send one. It ended up being one big lie, because I could not
tell her I was upset or that I hated it there. At the time, that was
all I was feeling.''
Misuse of seclusion and restraint
Many reported firsthand experience in seclusion (57%) or restraints
(34%), and a number of participants witnessed their peers being placed
in seclusion (45%) or restrained (60%). While the most commonly
reported trigger for seclusion or restraint was aggressive behavior,
especially aggression toward staff (87%), a number of behaviors that
would never warrant seclusion or restraint in a licensed or accredited
residential treatment center were endorsed as well, including breaking
a program rule (67%), saying something disrespectful (52%), cursing
(48%), or making a face (30%).
Many responses were similar to these:
They had a room with tile flooring where the kids went at 6:00 am
until 10:00 pm, where each hour you would rotate positions. One hour
would be lying on your stomach with your chin on the ground, the next
position was standing on your knees for an hour and the next one was
standing for an hour with your nose to the wall.
When participants were being ``restrained'', they were in fact
being tortured. They would be forced face down on the hard tile floor
by 3--6 staff members. One staff would ``hold'' your legs down, which
usually meant they spent their time grinding your ankles into the
floor. One or two other staff held your arms out at your sides,
``held'' in the same way the ankles were. The last staff would keep his
knee in your back as he pulled up one or both arms behind your back to
the point where you could literally touch your ear with the opposite
hand from behind your back.
They would duct tape your hands behind your back then your legs
together then wrap you up in a blanket like a burrito and duct tape
that tighter so you couldn't move or get out. Sometimes it would be so
tight kids would be screaming that they couldn't breathe and really
start panicking. They made the students do this to other students.
Isolation is where you didn't see the sun or other people for weeks
at a time, were given even more unrealistic exercise expectations, were
more easily restrained, given less time to shower, and you were forced
to lay on your face all day unless exercising, for 16 hours each day.
Note that none of these treatments or punishments are acceptable at
any level in regulated programs.
Reports of inhumane treatment
Beyond seclusion and restraint, there were multiple reports of
various forms of inhumane treatment and abuse. Many participants
reported that they 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 was often or sometimes true (45%). It should
be noted that, although each of these practices violates current U.S.
standards regarding the treatment of adults who are prisoners of war
and detainees, they are occurring in youth residential facilities
across the country, without oversight or accountability.
Here is one description that typifies the experiences reported by
participants:
We would be forced to do pushups until some boys got hernias. We
would be put into an `iso' box exposed to extreme heat. We would be
deprived of meals as a punishment. They used stress positions. They
beat people with sticks and their fists and feet. They made kids carry
trash and building supplies up and down the hill above the program.
They made kids move piles of rocks for no reason. They would keep you
up as a way to `break' you.
The distress and suffering
Youth were clearly distressed and suffering. 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,'' and ``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;'' ``The
program helped me realize what a sick sad world we live in;'' ``It was
terrible. I was and still am horrified by the whole experience;'' ``It
was a terrible place. Mentally scarring. I would hope NO ONE would ever
have to go to a place like that. It's worse than jail;'' ``They abused
me. That's what they do. They abuse people;'' ``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.''
What can we conclude?
Recognizing that the reports provided are retrospective and fully
acknowledging that these accounts are not necessarily a representative
sample of all youth who have attended residential specialty programs,
these findings nonetheless provide compelling evidence that widespread
mistreatment is occurring and that youth are suffering in programs
across the country. As for the question that parents, professionals,
and program operators ask, here is a direct answer from one program
participant:
Okay * * * I have a good idea of what you may or may not be
thinking at this point. `This guy's just some defiant little bastard
who hates the world, and sees everyone and everything negatively!'
Understandable, but whether you'll believe it or not, I'm not making
this stuff up. I'm not just some pissed off kid who wants to whine. I'm
a highly intelligent, well-educated, and responsible citizen, and as
such a person, I know very well that my rights were totally and
completely denied.
A study of four states
A study of four states was undertaken as a pilot effort for a
larger, national state-by-state study through a partnership of four
organizations: A START, based at the Florida Mental Health Institute;
the American Bar Association Center on Children and the Law; the
National Disability Rights Network; and the Federation of Families for
Children's Mental Health. The 2-year study will involve (1) an in-depth
review of state laws, policies, and practices regarding regulation and
oversight of residential programs; (2) education of and technical
assistance to state lawmakers and leaders to bring about needed policy
reform; and (3) guidance for parents about placing children in
residential centers. The preliminary findings from the pilot study are
presented because, even with such a small number, it is clear that
there are problems of state policy that contribute to the problem of
mistreatment of children and their families.
Study methodology
While we acknowledge that there are several approaches to remedying
the problems that are described above, we believe the wisest course of
action is to first systematically gather information about how states
handle the issue of licensure and regulation of residential treatment
programs for minors, as well as information on monitoring and quality
assurance requirements. In order to begin this process, we developed a
brief protocol designed to elicit the desired information from state
administrators responsible for licensure of these programs and for
ensuring quality of care, state child mental health administrators, and
other key stakeholders such as the protection and advocacy
administrators. The protocol was designed as a telephone interview and
was expected to take between 45 minutes and 1 hour to complete.
The study was conducted in Connecticut, Missouri, Utah, and
California. These states were selected in order to achieve geographic
diversity as well as diversity in size and history/experience in
regulating residential programs for minors. Respondents were from the
Protection and Advocacy agency, child welfare, education, juvenile
justice, and mental health. We intended to assess: (1) the degree to
which respondents were knowledgeable of the regulations and the
monitoring process and the degree to which they agreed with each other
and (2) the extent to which there were laws, regulations, and policies
in place to address this issue. As the intent was to get an overview of
what problems might exist regarding regulation, rather than to
determine which states did this well or badly, the findings are not
reported by specific state.
Study findings
Most respondents deferred to the individual who was in charge of
licensing for the state. In some states, representatives from other
agencies did not seem to have a working knowledge of how programs were
regulated. The person with this responsibility was variously located in
child welfare, social services, or human services. In general, the
child mental health administrators were less familiar with the state
regulations governing licensure and monitoring and did not see this as
part of their domain. Representatives from the Protection and Advocacy
agency saw this as an important issue, but had not become directly
involved.
All four states had legislation requiring the executive branch to
issue rules/regulations regarding the operation of residential
treatment facilities for minors. However, there was variance as to
which kinds of programs the regulations applied. In one state, the
rules applied only to facilities in which a governmental agency placed
youngsters. In some states, there was an attempt to define levels of
residential care, with more stringent treatment standards applying to
the most restrictive group homes and community treatment facilities.
All four states reported that there are several pathways to
residential placements for minors. Placement could occur through social
services/mental health (into therapeutic foster care, group homes,
community treatment facilities, or hospitalization); juvenile justice
(into boot camps); special education; and private placement.
Respondents also stated that licensing and monitoring of juvenile
justice, mental health, and special education residential programs were
the purview of their respective agencies. None of the states were able
to report how many children were placed privately by their parents or
how many children were placed out of state by local agencies or by
parents, nor was there any attempt to monitor the effectiveness of
those placements.
Programs were able to opt out of the licensing requirements
established for the purpose of providing mental health treatment in
facilities for minors in several ways. In some states, if the programs
were considered to be religious institutions, they were exempt. Also,
in some states, if a program accepted only private placements, it did
not require licensure. In some states, if a program defined itself as a
boarding school or educational facility, it could be exempt from
regulation, even though the services provided were described as
``emotionally corrective'' or ``therapeutic.''
Despite the plan to describe the states with anonymity, it is
important to mention Utah, a state that has had substantial problems
with questionable programs existing and being exempt from regulation.
In 2005, the state legislature amended the licensure law to ensure that
all programs, except legitimate private residential schools, be subject
to state regulation and monitoring (Utah Legislation, 2005). The rule-
making process took over a year, which is not unusual given the
importance of public review and comment. Commendably, Utah is now
implementing its new, more stringent regulations that address how
programs will be included in licensure requirements and will be
monitored for compliance with those requirements. Although it is too
early to understand the impact of new regulations in Utah, this state
certainly bears watching.
All four states reported that they have in place regulations
establishing standards for treatment services, educational services,
and child care/supervision; however, as noted above, these requirements
do not apply to all programs in the state. The basic requirements
included such elements as (1) each child must have an individualized
treatment plan and
(2) the provider must be able to meet the needs identified in the
plan. Monitoring includes assessing (1) the individualized treatment
plans, (2) the individualized educational plans, and (3) requirements
to assess quality of services. In some of the states, there were
requirements related to child care and supervision but these treatment
aspects were not specified except for the higher end, more restrictive
programs.
For programs to which the rules and regulations apply, all four
states reported that specific rules regarding children's rights,
parental rights, punishment, and use of seclusion and restraints are in
place. All four also stated that there are procedures in place for
reporting abuse. These included reporting abuse to a child welfare
hotline and requiring that abuse laws be posted in every facility.
Children must have access to a phone and employees of residential
programs must be trained about the different kinds of employee
behaviors that are not permitted.
While all four states have established licensure requirements and
standards for at least some types of residential treatment facilities
providing services to minors, their ability to monitor compliance was
of concern. Some states monitor compliance with requirements which
govern such things as staff qualifications, staffing patterns, and
number of hours of psychotherapeutic service per week per child.
In some states, following application for licensure, there is an
on-site review of requirements and interviews with staff and
management. There may be unannounced licensing monitoring visits, as
frequently as quarterly. There may also be a requirement for an annual
inspection, which comes with the renewal process. On-site visits may
also be made if a complaint is made, either from staff, clients,
family, or citizens. However, respondents reported that monitoring is
compromised by the number of staff who do the job. In one state, the
monitoring agency is staffed to visit a 10% random sample of licensed
facilities, and this is not as frequent as once per year. States vary
in whether they provide licensing and monitoring at no cost to the
program or whether they charge to cover these services.
Study conclusions
While we recognize that four states are too small a number upon
which to draw conclusions, it was apparent that there is an absence of
data about how effective current laws are. Most agency respondents
deferred to the person who was in charge of licensing and did not see
licensing or in some cases even the monitoring of quality of care
delivered as part of their responsibility. There appeared to be an
assumption that providers will obey the laws, but there were no
safeguards in place to protect children who are placed privately by
their parents. Staff from the responsible state agencies is already
stretched in its ability to monitor the safety and the effectiveness of
the quality of care delivered for the children already in their
custody.
Building bridges with residential treatment centers
The concerns about state policies regarding residential treatment
have been supported by a related development. The Child, Adolescent,
and Family Branch of the U.S. Center for Mental Health Services
convened a meeting in Omaha, Nebraska in June 2006 to address the
historic split between providers of residential care for children with
mental health challenges and advocates for home and community-based
care within systems of care. The meeting brought together
representatives from the federal, state, and local level, youth and
family advocates, system of care council members, tribal
representatives, providers of service, and representatives of national
associations related to children's mental health and to residential
care. Although residential programs which lack oversight were not
represented, the agreements that emerged should serve to inform
parents, professionals who provide referrals to residential treatment
programs, and the operators of residential programs--good and
otherwise--of the expectations that constitute good care and treatment.
The purposes of the summit were to identify areas of agreement in
values and philosophies between the different groups, to identify
emerging best practices in linking and integrating residential services
with home and community-based services, and to set the stage for
strengthening relationships and services partly by developing a joint
statement about the importance of creating a comprehensive and
integrated service array and partly by creating action steps for the
future.
The sponsoring organizations involved with residential care were
largely representative of well-established not-for-profit licensed
residential programs rather than the unlicensed and unregulated, for-
profit programs that have been the primary concern of A START (Friedman
et al., 2006a; Friedman et al., 2006b). However, the summit was of
direct relevance to the concern of A START about protecting children in
residential settings and enhancing the availability of a wide range of
supports and services for children and families.
The summit did result in the beginnings of a ``joint resolution to
advance a statement of shared core principles'' which was then
distributed to participants and modified over a period of several
months. This resulted in a final product, which was distributed by Dr.
Gary Blau, Chief of the Child, Adolescent, and Family Branch of the
Center for Mental Health Services, on September 14, 2006, with a
request for individual, agency, and/or organizational endorsement. This
process of securing endorsements is still ongoing.
As indicated in the preamble to the resolution, the call is for ``a
comprehensive, flexible, family-driven and youth-guided array of
culturally competent and community-based services and supports,
organized in an integrated and coordinated system of care in which
families, youth, providers, advocates, and policymakers share
responsibility for decision making and accountability for the care,
treatment outcomes and well-being of children and youth with mental
health needs and their families'' (Child, Adolescent, and Family
Branch, 2006, p. 1). The joint resolution acknowledges the need for 24-
hour out-of-home treatment settings but indicates that within such
settings children and youth should have a developmentally appropriate
role in their care and in creating rules and that family members should
be viewed as partners and have open access to the setting.
In the section on ``Clinical Excellence and Quality Standards,''
the joint resolution calls for ensuring ``that all treatment services
are licensed and regulated by appropriate agencies, and that monitoring
is performed by well-trained individuals (including families and
professionals) whose values are consistent with the principles
articulated in this resolution'' (Child, Adolescent, and Family Branch,
2006, p. 5). It also indicates in this section that programs should
strive to eliminate coercive interventions such as seclusion,
restraint, and aversive practices and that visits between families and
children should not be restricted for punitive purposes.
The document offers a set of values, principles, practices, and
standards that, if implemented, would go a long way to addressing the
concerns about the protection of children with mental health challenges
and the pattern of sending children hundreds if not thousands of miles
from home to unlicensed programs which reduce their contact with their
families. The document provides important guidelines for policy makers
and advocates who are seeking to develop a comprehensive, integrated
system and also for policy makers who are seeking to develop or
strengthen licensing and monitoring procedures to ensure that children
are treated safely, that they and their families have an appropriate
voice in their treatment, and that the use of coercive and aversive
practices is eliminated. Over the next several years, if the values and
principles of this joint resolution are not only endorsed but, more
importantly, put into practice, they will go a long way toward
ameliorating the risk that children and families are now encountering
because of unlicensed and unregulated programs that are highly coercive
and aversive in their practices.
The importance of action: next steps
The abusive and deceitful practices described in this article are
unconscionable and cry out for remedial action. The following actions
are recommended for questionable practices, to eliminate programs and
protect against further harm to vulnerable children and families:
Identify programs that engage in the practices described
above. Monitoring the Internet is one way of identifying them; this
effort could be undertaken as a project of an organization involved in
the protection of youth and advocacy for them. An additional way to
identify programs is by locating children and families who have had
negative experiences. Several Internet sites, used by youth, provide
for information exchange with a focus on experiences in residential
programs. The information collected should be organized to allow for
systematic review. Similarly, the analysis of data from the current,
ongoing Internet-based survey of youths' experiences in residential
programs (Pinto et al., 2006) should continue to include a focus on
identifying programs that do not meet quality standards for care.
Identify states that do not license or regulate the
operation of residential programs for youth or that otherwise tolerate
the existence of programs with questionable practices. The proposed
national, state-by-state study described above should provide good
information to help states address needed policy changes. Individual
state legislators, state legislative committees, and ultimately each
affected state's legislature must be aware of how their laws and
policies govern the existence of these programs and take necessary
actions regarding licensure, regulation, and monitoring to assure
appropriate care and safety for the youth they purport to serve.
Advocate with the National Conference of State
Legislatures to address these practices nationally and offer guidance
to the states to strengthen oversight of residential programs.
Work with Congress to address the existence of these
programs, including those that operate outside the country, and
determine whether federal action is appropriate to assure that
vulnerable children are not harmed and that parents are not paying
exorbitant prices for programs that are ineffective at best.
Promote the 2006 ``Recommendation from the ABA Youth at
Risk Initiative Planning Conference'' with all legislative bodies to
``[p]rohibit operation of unlicensed, unregulated residential treatment
facilities that operate programs whose efficacy has not been proven
empirically, such as boot camps, tough love, and `scared straight'
programs, and require the closing of such facilities. The law should
provide for such facilities to be replaced with: better access to
preventative services, with a focus on family involvement and
community-based resources, wherever possible; and carefully regulated
`residential treatment facilities' that are reserved for youth whose
dangerous behavior cannot be controlled except in a secure setting.''
Urge vigilance by juvenile probation officers and other
court officials, including lawyers and judges, as well as mental
health, education, substance abuse, and other professionals who
encounter troubled young people, in identifying youth who are at risk
of being placed in one of these treatment facilities; encourage them to
engage the youth and parents in a discussion regarding better options;
impress upon them the necessity of parental involvement in the youth's
treatment; and identify to them the safety risks and the costs
associated with programs that promise a quick fix or an unorthodox fix.
Create a coalition of national advocacy and legal
organizations, mental health organizations, and professional
organizations that promote the well-being of children to demand state
and national action regarding the degrading and demeaning practices to
which children in these unregulated programs are subjected.
Inform civil rights and tort attorneys of the practices in
which these programs engage and encourage them to take legal action
against them.
Also inform attorneys who represent youth in juvenile
court proceedings of the risks these programs pose to their young
clients and of more appropriate, evidence-based alternatives. Ensure
that attorneys have ready access to the National Council of Juvenile
and Family Court Judges' ``Delinquency Guidelines.''
Ensure that schools are cognizant of the risks that face
youth who are placed in these programs and that they disseminate
information to parents about child and adolescent behavior and the best
available treatment programs for youth whose behaviors require
intervention. School psychologists, social workers, and counselors must
likewise be well informed about alternatives, ideally evidence-based
programs.
Disseminate widely best practices that address diagnostic
and treatment issues and placement issues with the collaboration of
state mental health, child welfare, education, and juvenile justice
agencies and by the U.S. Departments of Health and Human Services and
Justice to those involved in the care, treatment, and education of
youth. This information should also be disseminated by parent
organizations and other sources of information for parents.
REFERENCES
American Bar Association, Commission on Youth at Risk. (2007).
Recommendations from the ABA youth at risk initiative planning
conference. Family Court Review, 45, 366--380.
Child, Adolescent, and Family Branch, U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services
Administration, Center for Mental Health Services. (2006,
September). Building bridges between residential and community
based service delivery providers, families and youth: Joint
resolution to advance a statement of shared core principles.
Building Bridges Summit, Omaha, NE. Retrieved February 13, 2007
from http://www.aacrc-dc.org/public/pdfs/FinalBBResolution.pdf
Dukes, L. (2005, March 26). Financial troubles shut down CEDU schools.
Bonner County Daily Bee. Retrieved February 13, 2007 from
http://www.bonnercountydailybee.com/articles/2005/03/26/news/
news01.txt
Friedman, R. M., Pinto, A., Behar, L., Bush, N., Chirolla, A., Epstein,
M., et al. (2006a, February). Unregulated residential treatment
facilities: A present-day threat to youth, families and the
field of children's mental health. 19th Annual Conference of
the Research and Training Center for Children's Mental Health,
Tampa, FL.
Friedman, R. M., Pinto, A., Behar, L., Bush, N., Chirolla, A., Epstein,
M., et al. (2006b). Unlicensed residential programs: The next
challenge in protecting youth. American Journal of
Orthopsychiatry, 76, 295--303.
Hechinger, J., & Chaker, A. M. (2005, March 31). Boarding-school
options shift for troubled teens--shutdown of Brown schools
shows challenge of selecting a ``therapeutic'' program. The
Wall Street Journal, p. D1.
Herman, M. (2005, September 19). Behavioral health news--When is
``tough love'' too tough? States scrutinize boarding schools.
National Conference of State Legislatures State Health Notes:
Forum for State Health Policy Leadership, 26(452), 2--6.
Retrieved February 13, 2007 from http://www.ncsl.org/print/
Health/shn/archive/shn452.pdf
Kilzer, L. (1999, July 18). Desperate measures. Denver Rocky Mountain
News. Retrieved February 13, 2007 from http://www.denver-
rmn.com/desperate/site-desperate/mpg2-desperate.shtml
Pinto, A., Epstein, M., Lewis, P., & Whitehead, K. (2006, August 12).
Exploitation of youth & families: Perspectives on unregulated
residential treatment. American Psychological Association
Annual Meeting, New Orleans, LA.
Pinto, A., Friedman, R. M., & Epstein, M. (2005). Exploitation in the
name of ``specialty schooling'': What counts as sufficient
data? What are psychologists to do? American Psychological
Association: Public Interest Directorate, Children, Youth and
Families Division News. Retrieved September 29, 2005 from
http://www.apa.org/pi/cyf/specialty--schooling.pdf
Rock, S. (2005, January 23). Referral agency's connection to boot camp
angers parents. The Kansas City Star. Retrieved February 13,
2007 from http://www.isaccorp.org/thayer/thayer-learning-
center.01.23.05.html
Rock, S. (2004, December 19). Teen's death raises concerns about boot
camp--Panel: it may have been prevented. The Kansas City Star.
Retrieved February 13, 2007 from http://www.isaccorp.org/
thayer/thayer-learningcenter.12.19.04.html
Rubin, B. M. (2004, January 14). The last resort: Therapeutic education
industry booms as parents seek programs for their troubled
children. Chicago Tribune.
Szalavitz, M. (2006, January 29). The trouble with tough love.
Washington Post, p. B01. Retrieved October 30, 2006 from http:/
/www.washingtonpost.com/wp-dyn/content/article/2006/01/28/
AR2006012800062.html
Szalavitz, M. (2006). Help at any cost: How the troubled-teen industry
cons parents and hurts kids. New York: Riverhead.
Utah Legislation ch. 2, Sec. 62A. (2005). Licensure and Regulation of
Programs and Facilities. Amendment S.B. 107. Retrieved
September 30, 2005 from http://www.le.state.ut.us/?2005/htmdoc/
sbillhtm/sb0107.htm
Weiner, T. (2003, September 6). Program to help youths has troubles of
its own. The New York Times, p. 8. Weiner, T. (2003, June 17).
Parents divided over Jamaica disciplinary academy. The New York
Times, p. 10. Weiner, T. (2003, May 24). Owner of private
discipline academy in Costa Rica is arrested. The New
YorkTimes, p. 2. Weiner, T. (2003, May 9). Parents, shopping
for discipline, turn to harsh programs abroad. The New
YorkTimes, p. 1.
Lenore B. Behar, Ph.D. is the Director of Child & Family Program
Strategies in Durham, North Carolina and she is a founding member of A
START. For 32 years, Dr. Behar served as the director of children's
mental health for the State of North Carolina and brought about major
policy changes which put the state in a national leadership position.
She also served, from 1992 to 2000, on a panel appointed by the federal
court to oversee systems reform in Hawaii through a settlement
agreement involving children's rights to education and treatment.
Robert Friedman, Ph.D. is a Professor and Interim Dean of the Louis
de la Parte Florida Mental Health Institute (FMHI) and he initiated A
START in an effort to ensure that children with mental health
challenges are adequately protected and served and that their parents
are not misled and exploited. For the past 15 years, Dr. Friedman has
been Chair of the Department of Child and Family Studies at FMHI, where
he also has directed one of two federally funded Research and Training
Centers for Children's Mental Health. Dr. Friedman has been a
consultant to over 40 states, has served on many national groups, such
as the Planning Board for the Surgeon General's Report on Mental
Health, and has given testimony to congressional committees and, more
recently, President Bush's New Freedom Commission on Mental Health.
Allison Pinto, Ph.D. is a Research Assistant Professor at the Louis
de la Parte Florida Mental Health Institute. She has served as Director
of Clinical Training and Clinical Program Manager in a community mental
health center and has worked directly with youth and families as a
licensed clinical psychologist. She has been coordinating the efforts
of A START since its inception.
Judith Katz-Leavy, M.Ed. is a consultant in the field of child and
family mental health. She served for over 30 years in high-level
positions related to children's mental health services and systems of
care in the National Institute of Mental Health and the Substance Abuse
and Mental Health Administration. She served during 1992 and 1993 on
the President's Health Care Reform Task Force and in 1999 as Section
Editor for Mental Health: A Report of the Surgeon General, Chapter 3:
``Children and Mental Health.''
William G. Jones, J.D. is a retired Chief District Court Judge from
Charlotte, Mecklenburg County, North Carolina. He is a member of the
advisory panel of the Katie A. vs. Banta lawsuit in Los Angeles County,
which addresses the mental health treatment of children in the child
welfare system. He is a consultant to the American Bar Association
Center on Children and the Law's National Resource Center on Legal and
Judicial Issues, and the Family Violence Department of the National
Council of Juvenile and Family Court Judges.
______
End Institutional Abuse Wiki
The following homepage and posts were downloaded by Allison Pinto
from http://endinstitutionalabuse.wikispaces.com on October 24, 2007 at
3:21 p.m. EST. This online wiki was created on October 4, 2007, less
than one week prior to the October 10, 2007 congressional hearing
titled, ``Cases of Child Neglect and Abuse at Private Residential
Treatment Facilities.'' It was created in order to provide a virtual
space for individuals to post letters, accounts and concerns that they
want to share directly with Congress regarding the abuse of youth in
residential facilities. The wiki is also an opportunity for individuals
to provide direct input regarding proposed legislation to address this
issue. It is intended to serve as a means of participatory
policymaking.
All letters and accounts directed to Congress by the person posting
on this ``End Institutional Abuse'' wiki are included in this document.
Accounts that were submitted that focus on the experience of someone
other than the person directly posting on the wiki are not included in
this document. Newspaper articles posted on the wiki are also not
included in this document. Finally, wiki participants' responses to one
another are not included in this document.
Please note that the accounts included in this document represent
the views and perspectives of the individuals who posted letters and
accounts on the End Institutional Abuse wiki, and are not the views or
opinions of Allison Pinto who created the wiki space. They are spell-
checked but otherwise unedited.
The wiki will remain active online so that members of Congress can
continue to visit it in order to directly access accounts about abuse
of youth in residential facilities as they are submitted.
End Institutional Abuse Wiki Homepage
HELP END INSTITUTIONAL ABUSE
We need to raise awareness in our society about the problems of
institutional abuse and mistreatment. Please help.
This wiki is a virtual grass roots effort to organize and speak
out. We've got less than a week * * *
On October 10, 2007, the Committee on Education and Labor will be
holding a hearing in Congress entitled, ``Cases of Child Neglect and
Abuse at Private Residential Treatment Facilities.''
There will be an opportunity for the presentation of written
personal accounts and position statements regarding issues of
mistreatment, abuse and neglect in youth residential programs, to be
submitted for the record. If you would like to submit a statement,
letter or story to Congress, please click on the ``discussion'' tab
above and post your letter or story.
Please note that this wikispaces site is a public site, so it is
visible to anyone and everyone. Be careful to include only that
information that you are comfortable sharing in the public domain.
Also, please recognize that wiki technology makes it possible for
individuals to respond to one another's contributions. If you choose to
respond to someone else's post, please maintain a respectful stance
that honors the inherent dignity of that individual.
If you would like to provide input, feedback or suggestions
regarding the ``End Institutional Abuse Against Children Act,'' please
click on ``Federal Legislation'' to the left, and submit your ideas on
the corresponding discussion page. This legislation was proposed in
2005 and it is expected that it will be revised before it is
reintroduced in Congress, so your ideas are needed.
Thanks for any help you can provide in bringing attention to these
issues, in order to restore the safety and well-being of youth and
families in our society.
[Editor's Note.--To see all the entries in this wiki please access
the following Internet address:]
http://endinstitutionalabuse.wikispaces.com
______
------
Chairman Miller. Thank you very much for your testimony.
Thank you to all of you for your testimony.
I cannot think of testimony that we have received in this
committee that has caused a greater sense of anger or sorrow
than what we just heard this morning.
Mr. Kutz, I would direct again my fellow committee members
to the first couple of paragraphs in your summary. They are
absolutely astonishing in today's world when you say that ``We
found thousands of allegations of abuse, some of which involve
death, at residential treatment programs across the country in
American-owned and American-operated facilities abroad between
1990 and 2000.
``Allegations include reports of abuse and death recorded
by state agencies, by the Department of Health and Human
Services, allegations detailed in pending civil and criminal
cases with hundreds of plaintiffs, claims of abuse and death
that were posted on the Internet.
``For example, according to the most recent NCANDS data,
during 2005 alone, 33 states reported 1,619 staff members
involved in incidents of abuse in residential programs. Because
there are no specific reporting requirements or definitions of
private programs in particular, we could not determine what
percentage of the thousands of allegations we found related to
such programs.
``We also examined in greater detail 10 closed cases where
teenagers died while enrolled in the private program. We found
significant evidence of the ineffective management in most of
these 10 cases with program leaders neglecting the needs of
program participants and staff. This ineffective management
compounded the negative consequences and sometimes directly
resulted in the hiring of untrained staff, lack of adequate
nourishment, reckless or negligent operating practices,
including a lack of adequate equipment. These factors played a
significant role in most of the deaths that we examined.''
In the 10 facilities that you looked at, Mr. Kutz, where
these children died, could you name those 10 facilities for the
committee, please?
Mr. Kutz. Yes, if you would like me to go on the record
with that, I would.
Chairman Miller. Yes.
Mr. Kutz. We did leave it off, but if you asked that, I
will.
Chairman Miller. I will ask you to do that now.
Mr. Kutz. I will do them one by one.
Number one was Summit Quest. Number two was Challenger.
Number three is North Star. Number four is Obsidian Trails.
Number five is the Aldredge Academy, which was already
mentioned by one of the parents here. Number six was the
American Buffalo Soldiers Reenactment Camp. Number seven was
Red Rock Ranch Academy. Number eight was Catherine Freer
Wilderness, which was also mentioned. Number nine was Skyline
Journey. And number 10 was Thayer Learning Center.
Chairman Miller. Thank you.
A number of these facilities, if I understand correctly,
have remained open. Which facilities are those? Some have
closed either related to these incidents or other reasons, but
which of these remain open after these children have died?
Mr. Kutz. That is correct. Some have closed and there are
five that remain open in some form, and I will go through those
with you also.
Again, Aldredge, which was our case number five. The Red
Rock Canyon School, which was the parents of the Red Rock Ranch
Academy, our case study number seven, is open. Catherine Freer,
which was mentioned, is still open, but it is open now in
Oregon. The Nevada location related to our case study is
closed. The Skyline Journey from our case number nine is
closed, but it now operates as something called Distant Drums.
And then Thayer Learning Center, our case study number 10, is
still operating.
Chairman Miller. From your investigation of these 10 deaths
at these facilities, can you comment as to whether or not these
deaths at these facilities appear to have been fully
investigated?
Mr. Kutz. Not necessarily. I mean, from a criminal
standpoint, we did not do an in-depth investigation of the
quality. I would say that they were not done of equal quality
necessarily, but we did not dig enough into that.
From a criminal standpoint, there really was not a whole
lot of result. There was one individual who was prosecuted and
is serving concurrent 6-and 5-year sentences. The other
prosecutions or pleas resulted in community service or
probation, things like that. And in some cases, there were no
charges at all made at the end of the day.
So it was a wide variety, but very little criminal result
for any one involved in these cases.
Chairman Miller. Thank you.
Ms. Moss, it is my understanding that three of the
facilities that Mr. Kutz just mentioned are NATSAP members--is
that correct--that remain open?
Ms. Moss. Yes.
Chairman Miller. And those are which?
Ms. Moss. Catherine Freer, Red Rock Canyon and Aldredge
Academy.
Chairman Miller. Aldredge Academy.
Mr. Kutz, are there additional members? Were there three,
or was it five?
Mr. Kutz. There are three current. There were two that are
now closed that were NATSAP members. The Obsidian and Skyline
were NATSAP members based on our understanding.
Chairman Miller. Okay, but they are now closed, as I
understand it.
Mr. Kutz. Correct.
Chairman Miller. Let me just ask Mr. Lewis, Ms. Clark
Harvey or Mr. Bacon, in a sense, what would you say to parents
who are considering this alternative for their child, and I
think we all recognize that very often parents are considering
these alternatives because they do not know quite what else to
do. It is not that they have not tried a lot of things with
their children, but they have not worked out the way they had
hoped or had become more difficult or what-have-you. So it is a
very difficult time for parents, but you have been there
tragically. What would you recommend to parents?
Mr. Lewis?
Mr. Lewis. In hindsight, I would not let my son out of my
hand, out of my sight. Nobody loves your children like we do,
and to turn your child over to somebody else and hope that they
are going to love and protect your child, I think, was very
naive on our part.
I think what we need to do as a society and a community is
provide much stronger home-based programs for children that are
struggling so they stay with their families, and they stay with
the community that they know and loves them.
You know, hindsight is a wonderful thing. We thought
Aldredge was an answer to our prayers, and it turned out to be
a living nightmare for us, and I cannot imagine the nightmare
it was for my son.
Chairman Miller. Ms. Clark? Ms. Clark, what do you think?
Ms. Harvey. I would have to agree. There is absolutely no
way for any family to be certain of any of the claims that are
made by these programs. There is just no way to do the amount
of research and to determine whether it is appropriate or not,
so I would make a blanket statement of do not send your child
to a residential treatment program far away from your home
because, as things stand right now, you have no absolutely no
assurance that they will be taken care of.
Chairman Miller. Mr. Bacon?
Mr. Bacon. I would like all of the parents to understand
that the risks involved in sending your child to one of these
programs are far greater than what you can imagine. In our
case, we were weighing the risks of what we thought was an
unhealthy environment in the public high school that our son
attended, whether it was drug use and peer pressure. The risks
that we assumed, and the risk that I think every parent assumes
when they send their child to a residential program, is much
higher than probably any risk that they can face near home.
Chairman Miller. Thank you.
Mr. Kutz, you mentioned one of your discussions was a
question of misleading advertising or marketing or assurances
to parents.
Last night and early this morning, I was on the Internet
and sort of scooting around some of these sites, and it is a
very seductive introduction to parents who are distraught, who
are stressed, who have been dealing with this maybe for
multiple years.
They generally list a series of problems that children
have--bipolar, schizophrenia, depression, drug and substance
abuse, ADD--and the suggestion is that the staff can deal with
all of these. Any one of those is a career for a professional,
and all of my work in mental health and my wife's work in
mental health and involvement with kids, and the idea that you
can just insert a problem and this counselor can take care of
any number of these problems in an effective way is----
I have not seen a practice that way except in these
representations, the suggestion that they are trained effective
counselors for each one of these disorders, and, of course,
most parents in that situation would identify with one or more
on that list, and I just wondered if you might address that.
Mr. Kutz. Yes. And I can speak to the 10 cases in depth,
but the parents were pretty much told what they wanted to hear.
As you said, it almost did not matter what the circumstances
were for the child. The programs were purported to be experts
for those kids.
And it went far beyond that. You had cases where you had no
one that knew CPR in the entire program, you know, just
something basic like that where you are having kids out in the
wilderness or at a boot camp or whatever and no one knows CPR.
And they market to the desperate parents. You heard these
parents today. I mean, they were in a desperate situation. They
were looking for something, and they were probably vulnerable
at the time. I do not want to speak for them, but I think they
probably were. I am a father. I could see how that could
happen.
And I just think what you mentioned earlier and what the
parents mentioned here for parents looking today, it is buyer
beware. Buyer beware. I mean, these are programs, especially
where they are unregulated programs in certain states, you
really do not know what you are getting.
Could I go back to the criminal also? The fact is there
were not a lot of criminal prosecutions and documented evidence
that the people that are dealing with these programs have a
background. When parents are doing due diligence on these
programs, an interesting point here is how do they know that
some of the people who were involved in the abuses and the
cases that we talked about here are not dealing in the current
programs today. The answer is they will not know, and so it is
a very difficult environment out there for parents.
Chairman Miller. Could you elaborate on the Thayer case,
number 10, the 10th case in your item?
Mr. Kutz. Yes. And that is the most recent case from
Missouri. Yes, that was a case I mentioned. That was one where
we believe that there was certainly abuse, and I read the
autopsy report myself in depth twice, and I really could not
believe it actually.
I mean, this kid had bruises, abrasions and kind of signs
of abuse from head to toe, from his head down to the bottom of
his legs, and there were reports that he had been dragged
around, and the other kids at the program had been forced to
drag him around when he was unable to exercise.
And I mentioned to you in the opening statement that when
he was unable to exercise, then the penalty was not medical
treatment, but to put a 20-pound sandbag around his neck and
make him wear it around. So that is a case of absolutely clear
abuse, in my judgment.
Chairman Miller. You know, Dr. Pinto made the point--and I
think it probably strikes all of us here--had any parent
engaged in any of this behavior against a child, they would be
in jail. Almost any singular incident of numerous incidents and
ongoing activities against these children--a parent, a
schoolteacher, a coach--they would all be gone.
I will get into it later because I have a second round of
questioning here, but, you know, my concern is that these
people sort of reinvent themselves. They leave Nevada. They
show up in Oregon. They leave this program. They rename
themselves.
I followed some of these programs now longer than it took
to cross the West by walking. I mean, you know, these people
constantly are morphing themselves, and your point is you do
not know who is ``counseling'' your kid, whether there is
criminal behavior, whether they have their own problems.
But, you know, one of the things that stuns me is the
marketing of the wilderness and the outdoors and nature and
then to take people into the outdoors and the wilderness and
nature and brutalize them in the name of the nature. I do not
get it.
I have backpacked for 30 years. I was on a trip this
weekend in the high rims above Lake Tahoe in the aftermath of a
snowstorm, and in that trip, we must have stopped six or seven
times and checked everybody, saying, ``Are we okay? Can you
proceed? Do you think we should go back? We are this many hours
into it. We have this many hours of daylight. Is everybody
drinking water? Is everybody snacking, because we are burning a
lot of energy because it is really cold?''
For 30 years, I have hiked in that fashion with kids. I
have had kids come into our camp in the middle of the night on
different wilderness programs, but all of them were schooled in
how to deal with the program. They were all given challenges,
massive hikes, really quite stunning what they accomplished,
with a guide, with full education with the dangers of how to
take care of yourself, how to respond, how to handle the worst,
and then the challenge is laid out, and I kind of understand
that. I can see why that is used as a tool.
But the idea that you take a person and you have her walk
out in 100-degree weather and somehow this is good for you and
nobody is paying attention to dehydration and nobody is
paying--in the name of the wilderness that--this is
therapeutic? No, this is abuse.
And back to your point on mismarketing, it is a wonderful
thing for parents to think, ``Gee, maybe I can get my kid out
of this neighborhood, and we can start over, and they can go
out there and, you know, they will be fishing and they will be
swimming and they will be doing all these things,'' you know.
It is just outrageous that they would suggest that somehow you
can have a positive outcome with these children by using the
outdoor experience as an abusive action against children.
It is stunning to me, and it is contrary to any norm of
anybody who has been out in those situations, especially when
you have young people with you in terms of learning about the
outdoors.
I mean, as I went on these Web sites one after another--and
then when you look at the cost--I do not know, Mr. Kutz. I have
about 30 seconds. If you would just outline what you saw in
terms of some of the costs----
Mr. Kutz. Yes, the cost is fairly interesting. I mean, this
is all in 2007 dollars, but the range was $131 to about $450,
and the average was $300 per day, which is about $2,000 a week,
and so the cost of this is very significant, and that is for
the 10 cases that we looked at, certainly. We have looked at
other ones that are in that kind of price range. So $300 a day
was the average cost.
Chairman Miller. Thank you.
Mr. McKeon?
Mr. McKeon. Thank you, Mr. Chairman.
I would just ask the chairman kind of what he plans on
doing about this. It is the first I have heard of these abuses
going on. I have a couple of friends that have sent their
children away to schools and did not have any of these kind of
problems, but one death is more than should be tolerated.
Question: Ms. Moss, in your report, you talk about a joint
commission, 15,000 programs. Was that correct?
Ms. Moss. The joint commission accredits over 15,000 health
care----
Mr. McKeon. Programs such as these?
Ms. Moss. Yes. They are not all like these. There are
psychiatric hospitals----
Mr. McKeon. What is the point----
Ms. Moss [continuing]. Medical hospitals. So it is over
15,000 that they accredit.
Mr. McKeon. How many of these programs are in your
association?
Ms. Moss. That are accredited by joint commission?
Mr. McKeon. Well, just how many are in your program?
Ms. Moss. We have 180 programs, sir, as members of our
organization.
Mr. McKeon. And do you know how many children are enrolled
in these programs, these 180?
Ms. Moss. The information that I received last year when we
did our 2006 annual renewal is that there were approximately
16,000 children served in our in our member programs during
2006.
Mr. McKeon. Sixteen thousand. Do you have any idea how many
deaths have come from those 180 programs or out of those 16,000
youth?
Ms. Moss. In 2006, sir, I do not recall immediately. Our
organization has grown from a starting point of six programs to
the 180 this year. I am sorry I do not have that information at
my hand right now.
Mr. McKeon. Mr. Kutz, do you have any idea from your
investigation how many deaths have resulted from these
programs?
Mr. Kutz. No, we do not. We just know that there are
thousands of cases of reported death and abuse. There is no
real central repository.
Mr. McKeon. Excuse me again. Thousands of----
Mr. Kutz. Death and abuse. Mostly abuse, but there are
other reports of death. There is just no way to quantify. There
is no good centralized source in the federal or state
governments to quantify this.
Mr. McKeon. It is amazing to me. As the chairman said, if a
parent just were reported abusing a child, the children would
be taken away from them, they would probably go to jail, and
they would have to prove their innocence, and yet we have just
from the witnesses here today three deaths, and it looks to me
like there is no criminal action taken, except in the case
where we had a $5,000 penalty and some kind of probation or
something. What are the police doing about this? I mean, deaths
are pretty serious, and nobody is taking any action?
Mr. Kutz. Well, I can just answer this for the 10 cases. We
did look at police reports. There were extensive investigations
done in most of the cases, and, again, only one person is
serving time today, from case study number six, for
manslaughter and I believe another charge, concurrent 6-and 5-
year sentences. Everyone else, as I mentioned, either was
prosecuted or pled, either got community service or time served
or some lesser charge.
So there were really no teeth behind the investigation. It
does not mean they were not good investigations. We did not
really evaluate the quality of the investigations, but there
was really no action on the criminal side here.
Mr. McKeon. This just boggles my mind. I cannot even
imagine how this----
Mr. Bacon?
Mr. Bacon. In the case of our son and North Star
Expeditions, it was a program licensed in the State of Utah. It
was owned by two gentlemen who were previously field counselors
in the Challenger program where a young woman died. In the
investigation on the former death, these two people turned
state's evidence against that owner in exchange for assisting
the State of Utah in writing the regulations for the State of
Utah and a license to operate their own program.
So, when our son died, there was an immediate investigation
that was brought about by the county attorney in Garfield
County. We were very fortunate that in the sheriff's office,
there was an experienced homicide investigator who arrived at
the scene first. From the evidence that she collected, it
became clear very quickly to the county attorney that this was
a very suspicious case, and he called in to the State of Utah,
to the attorney general's office, and asked them to assist in
the investigation.
As a result, both owners--I believe that there were seven
people. I am not sure about the exact numbers--counselors and
EMTs were charged with felony child abuse and neglect to report
child abuse, among other misdemeanor charges. All of them pled
guilty to lesser charges, were given probation and community
service, and told that they could not work in child programs
after this.
There was one counselor who decided that a felony did not
mean that much to him. So, despite the fact that the plea
agreements were supposed to prevent us from the agony of going
through the trial procedure, we had to do that anyway. He was
found guilty of felony child abuse.
The judge sentenced him to 1 year in jail and community
service, he was out in 2 months, and we were informed that at
that point it was no longer about Aaron Bacon, it was about
what was good for Craig Fisher. The judge told us it was no
longer about what was right for Aaron Bacon, it was what was
right for Craig Fisher, and he got off with 2 months and
community service.
Mr. McKeon. I would like to yield to Mr. Platts some of my
time at this time.
Mr. Platts. Thank you, Mr. Chairman and Ranking Member
McKeon.
First, I certainly add my words of sympathy on the loss of
loved ones of our family members here today and thank all our
witnesses, especially you, for your courage in sharing your
family stories that we may do our best to see that they are not
repeated and the tragedy that your families have suffered are
not repeated in other families.
Mr. Kutz, in your investigation, it seems that your focus
was private programs, not public, but you do reference an
ongoing investigation that is going to be more comprehensive.
Is that correct?
Mr. Kutz. Yes, a more comprehensive look at the----
Mr. Platts. Would that include public and private to give
us an understanding of maybe what is better?
Mr. Kutz. Yes, it will include both.
Mr. Platts. What is the timeframe for us getting that
information?
Mr. Kutz. I believe early next year.
Mr. Platts. Okay. In the 10 cases specific that you did
investigate, how many, if any of those, were cases in states
where there was state licensing in place?
Mr. Kutz. Several were, and several were not. It was mixed.
Mr. Platts. And the ones where there was, was the response
then more appropriate?
I mean, I agree with the chairman and the ranking member.
When you read these cases and Mr. Bacon just citing the example
of his son's, the repercussions, the consequences are
unbelievable. There were not any. I mean, lives were taken in a
horrific manner, and was it any better in any sense with those
with state licensing?
Mr. Kutz. With respect to that, where there was state
licensing, there were several cases where the licenses were
revoked, and so there was some action on the license. Again, I
mentioned not much on the criminal side, but on the licensing
side, licenses were revoked or possibly permits on federal
lands. Some of these did that on federal land also, and the
permits were revoked there also.
Mr. Platts. You reference in your written testimony that
the states while they do not often regulate the private that
they more often regulate publicly funded programs. Did you get
in detail in what way they regulate the public funding in this
report?
Mr. Kutz. No, I do not have any direct knowledge of the
public.
Mr. Platts. Okay. Of those that are privately regulated,
private entities that are regulated by states, was there a
state that you would point to us as the best model for us to
look at to say this state seems to be doing it better than
anyone else?
Mr. Kutz. I think that that will be probably in our report
next year, but I know that talking to my staff, Utah has gone
through several revisions because a lot of the cases here
happened in Utah. There have been increases in the requirements
in Utah, I think several iterations of that. Whether that is
the model or not, I cannot speak to that, but there has been a
lot of activity from a legislative standpoint in the State of
Utah.
Mr. Platts. I think that would be helpful.
Chairman Miller. If the gentleman would just yield for 1
second, I just want to inform the members of the committee that
I think there is a little less than 5 minutes now on the roll
call vote. We will recess for the votes, and we will come back
immediately after. Hopefully, that is in 20 minutes or so.
The gentleman is free to go ahead now.
Mr. Platts. Thank you, Mr. Chairman. I will try to wrap up
quickly or give the ranking member back----
Of that ongoing study, I think it would be very helpful if
part of that investigation is kind of the best models out there
that we can learn from to then try to look at how to replicate
elsewhere.
A final question, Ms. Moss. You mentioned 180 programs that
are currently members, and in your testimony, you talked about
they have to have a state license or an accreditation from the
joint commission----
Ms. Moss. Yes. Mental health accreditation. Yes, sir.
Mr. Platts. So all 180 of your programs have that?
Ms. Moss. The board ruling went into effect the 1st of May,
where all new members have to be licensed and-or accredited,
and they also have to have oversight by a licensed clinician,
in other words, somebody that has a state licensure.
The current members, for those that have been members of
our organization, have until January of 2009 to obtain that
licensure and-or that accreditation, and the organization is
working with other states as well as with other accrediting
agencies to make sure that those accreditations are available.
In 2009, if we have a current member, whether it is a
founding member or any other member that has not received that
licensure or accreditation, they will not be a member of our
organization.
Mr. Platts. Okay. Thank you, Ms. Moss.
And to our family members, I especially want to thank you
again. As a parent of an 8-year-old and an 11-year-old, I
cannot imagine the anguish that you have gone through, and your
willingness to be here today is going to help save the lives of
other children in the future, and I sincerely thank you.
I yield back to the ranking member.
Chairman Miller. The gentleman has 2 minutes.
Mr. McKeon. Again, I would like to thank you for being
here.
I would like to thank you, Mr. Kutz, Mr. O'Connell, from
the GAO for this study.
I hope as we move forward on this issue that it does not
become a partisan issue, that this is something that we can
work together on to better the situation. I am sure that there
are young people that have gone to some of these programs that
have benefited, I would imagine out of that many people, but I
think it is something we really need to look at.
What concern I have is, apparently, law enforcement just
does not get involved in these things, so if you can have a bad
actor--and it seems like whatever field you are in, you can
find bad actors. We could find doctors that have had real
problems in their lives. So I think it seems like people just
gravitate to wherever they can do the bad things they want to
do.
My concern is that if there is an incident, such as these,
where deaths occur and abuse and there is some attention
brought to them and maybe there is some slight action taken, as
we have seen here, it might shut them down. They might move to
another state and start all over again, and nobody has any way
of knowing the problems. So that is something that I think that
we really need to look at.
I am generally opposed--as Mr. Bacon maybe pointed out in
his opening comments--I do not like to see federal legislation,
but there are some times where it has to happen, and if you
have a situation like this where people can go from one state
to another to avoid prosecution, it might be that federal
legislation is needed.
I appreciate, Ms. Moss, what your organization is trying to
do where you say if some way you can clean up some of the bad
apples. I have seen it in other organizations that we deal
with, where it has been effective, but sometimes it is not
enough, and I think that is something that we need to address.
And I appreciate the chairman holding this hearing.
Chairman Miller. Thank you very much. We will recess, and,
hopefully, we will be back here in about 20 minutes. Thank you
very much, and thanks for sticking with us because we have a
few more questions we would like to ask you. Thank you.
[Recess.]
Chairman Miller. Thank you very much for bearing with us
here and our busy congressional schedule.
I would like now to recognize Congresswoman McCarthy from
New York for questioning.
Mrs. McCarthy. Thank you, Mr. Chairman, and thank you for
bringing this to everybody's attention.
To the family members, I know it has been a very troubling
journey for all of you, but with you being here today, you are
bringing this to national attention, and with all the pain and
suffering that your families have gone through, you can make a
difference and, hopefully, prevent another family going through
what you have all suffered these last several years, and my
heart goes out to you.
With that, Mr. Kutz and Ms. Moss, many parents put their
children into these programs based on snazzy and, in some
cases, according to your report, misleading marketing products.
I imagine these marketing tools do not include any information
on incidents of crime, violence, accidents or deaths.
In 1990, Congress passed the Clery Act which requires
colleges to notify parents about campus crime annually. I am
shocked that there is no similar requirement for children in
these residential programs who are arguably even more
vulnerable than our college students.
I am also shocked that owners and program leaders are not
required to disclose if they have previously had to shut down a
program and under what circumstances. It is totally
unacceptable that parents are not informed, and families
involved in these programs should have a parents' bill of
rights.
Do you think these residential treatment facilities should
have to disclose violent incidents, accidents and deaths in
their marketing materials or to the parents of enrolled
children on an annual basis?
Mr. Kutz?
Mr. Kutz. Well, I would say that they did not do that, and
with respect to disclosure to the parents of what was actually
going on, not only did they not tell them what was going on, I
believe in many cases we saw that they lied to the parents, and
they misrepresented what was actually happening.
Certainly, it would seem that that has merit, having some
disclosure requirements here, and, again, you have to have
teeth behind that somehow. I do not know how you get that, but
some teeth behind disclosure of what is going on would have
some merit.
Mrs. McCarthy. In your report, did you find that even those
that were hired into these particular programs--did anybody do
any background checks on them?
Mr. Kutz. I think there were some that did and some that
did not. We did have one case where there was an ex-con that
was handling kids. So somehow that person got through, but I do
not even know what the requirements were. There were no
licensing requirements. There were not any real standards
there, so I do not even know what the criteria was they were
using to bring people in. I believe in some of the states now
that have licensing requirements a background check is one of
the thing that is required in some states.
Mrs. McCarthy. Ms. Moss?
Ms. Moss. On the question of disclosure, one of the things
that we always recommend when a parent calls is they need to
check with the state licensing agency to see if there is
anything in the background of that program. We also stress the
fact that if there is no licensing agency, they need to contact
the attorney general's office to make sure that there is
nothing in that background.
Mrs. McCarthy. But how do we get this information to these
parents? I mean, obviously, usually, the parents are so
distressed by the time they even come to this situation where
they are trying to find the best treatment for their child, and
there are so many programs out there. Half of them are not even
registered with the state. It is kind of hard to guide these
parents.
Ms. Moss. It is very difficult.
Mrs. McCarthy. They did due diligence. They asked the right
questions, and yet they ended up with, unfortunately, their
children dying.
Ms. Moss. I do not think any of our NATSAP programs would
be opposed to disclosure on that.
Mrs. McCarthy. What do you think about having some data
where we can, you know, have data like where parents could go
on to the Web site when they would be looking?
I am sorry. Did you want to ask----
Mr. Lewis. Yes. About 3 or 4 months after the criminal case
was resolved in relation to our son, I had called the people at
Aldredge Academy, and I talked to the woman that we had
originally talked to when we placed Ryan, and I presented
myself as a parent that was looking into the program.
I said, ``I understand you have some legal issues that I
have read about a little bit online, and I am concerned about
it,'' and her response was, ``Well, that has all been taken of,
and the family is very happy with the result,'' and that could
not have been further from the truth.
So that is the information that they were telling people,
if they were to call them and ask about my son's death. They
clearly misrepresented our position on the whole matter.
Mrs. McCarthy. Thank you.
Mr. Bacon, you mentioned earlier in your opening statement
that you were talking about we here have a responsibility
certainly for taking care of and looking to make sure our
children are safe. One of the things that I was thinking of as
you said it, you know, right now we have a mortgage crisis
going on. One of the problems was that those that unfortunately
were doing predatory lending might have been kicked out of the
state, that did not stop them from going into another state and
doing the same thing.
I see that we seem to have the same case where one
particular program was closed, reopened up into another program
in another state. So, again, this is where data and the
collection of data from state to state so the states would also
have that information--do you have any comments on that?
Mr. Kutz. Yes. It is not just the programs moving from
state to state. It is really the people. Because you can change
the name of--we have seen that in a lot of the investigations
we do in many different things. It is easy to start up a new
entity and to shuffle the deck and reemerge somewhere. So that
appears to be a real issue here.
Mrs. McCarthy. I am looking forward to your second report
in February. Appreciate it.
I thank again everybody for their testimony.
Mr. Chairman?
Chairman Miller. Mr. Kildee?
Mr. Kildee. Thank you, Mr. Chairman.
Ms. Moss, you mentioned that when you get a complaint that
you look into that complaint case by case. How many have you
proceeded on case-by-case complaints?
Ms. Moss. Could you clarify proceeded on?
Mr. Kildee. Yes. You stated that when you get a complaint
about an organization, an entity that belongs to your
organization, that you examine that complaint and proceed on a
case-by-case basis. That was your words.
Ms. Moss. Right.
Mr. Kildee. How many have you proceeded on?
Ms. Moss. As far as closing down, canceling their
membership, sir, the two that we would have canceled their
membership were closed prior to cancellation of the membership.
Mr. Kildee. So have you proceeded on any of these
complaints case by case?
Ms. Moss. We did evaluate the Catherine Freer and the
Aldredge Academy cases. There was no criminal negligence found
and no wrongdoing found, sir. Therefore, they remained members.
Mr. Kildee. So there is one or two then that you have
proceeded on a case-by-case basis about?
Ms. Moss. On the ones that had been reported to us, yes,
sir. And in this case in the deaths, yes.
Mr. Kildee. There has only been one or two reported to you?
Ms. Moss. Right. On the deaths. The others that have
occurred, sir, we have received the reports on those and also
have found no negligence, no wrongdoing, no criminal action
found.
Mr. Kildee. So, again, you have only received one or two
complaints, and you have stated that you proceed on a case-by-
case basis. It did not take you very long then if there is only
one or two of those.
Ms. Moss. Sir, I misunderstood the question. I thought you
were referring to the ones here in this hearing. There have
been others.
Mr. Kildee. No. I am referring----
Ms. Moss. Yes, sir. There have been others. I do not have
the numbers that we have----
Mr. Kildee. Do you have any idea about how many you have
proceeded on a case----
Ms. Moss. During my tenure, sir, there has probably been
about five or six.
Mr. Kildee. Could you supply the records of those case-by-
case interviews to this committee?
Ms. Moss. I can certainly try to do that, sir, yes.
Mr. Kildee. Well, I think more than try.
Ms. Moss. Okay. Yes, sir, I can do that.
Mr. Kildee. All right. Because if we do not, Mr. Chairman,
I would suggest that we subpoena the records then. But if you--
--
Ms. Moss. I will provide them to you, sir.
Mr. Kildee. Thank you very much.
Chairman Miller. I thank the gentleman.
Mr. Kutz, let me take you back to the Thayer Learning
Center, if I might. Is it correct that the cause of death to
date is a spider bite?
Mr. Kutz. Yes, Mr. Chairman.
Chairman Miller. And this is the incident which you talked
about earlier where in reading the autopsy report and going
over the autopsy, this was a child that was badly bruised?
Mr. Kutz. Thirty bruises and contusions from head to toe,
yes.
Chairman Miller. So what is your thinking in reconciling
the spider bite as the cause of death and what appears to be
very substantial physical abuse?
Mr. Kutz. Well, I think there were two things going on.
There was the abuse going on, and then there were the signs of
other things related to the spider bite. So there was a medical
issue and then at the same time they were misinterpreting the
medical that he was faking it or for some other reason. So they
were abusing him because he appeared to be lazy or appeared to
not be actually exercising. So I think a lot of the abuse came
because of the spider bite because he was exhibiting symptoms
that, again, they misinterpreted as faking it.
Chairman Miller. And what is the status of that
investigation?
Mr. Kutz. There is no ongoing investigation there that we
are aware of.
Chairman Miller. What is the status of the--is it a closed
case or----
Mr. Kutz. There were no charges filed in that case. There
was a civil settlement for $1 million in that case.
Chairman Miller. And Thayer remains open. Is that correct?
Mr. Kutz. Yes.
Chairman Miller. Well, I do not know. We will have to look
at that. I think there is something glaring in this case, and,
you know, I have previously asked the Justice Department to
look at this business. They have refused, but maybe on a
specific case, they can find new interest. When you have a
child that appears, as you represent the autopsy, to be this
badly and systematically abused, there has to be some other
interest here.
Mr. O'Connell. Mr. Chairman, if I could add something to
the Thayer case?
Chairman Miller. Yes.
Mr. O'Connell. We talked to the prosecutors who said there
was not evidence to prosecute. However, the state's family
services division did find that there were patterns of neglect
and abuse at Thayer.
Chairman Miller. Yes, I think, as you said, if you walked
in in the middle of this testimony, you would think we were
talking about human rights abuses in Third World countries. I
have to believe that there is, in fact, a federal interest in
this in the treatment of these children, and I think that at a
minimum in a particular case we might very well be on solid
ground asking for oversight by the Justice Department of the
death of that individual.
You also mentioned, Mr. Kutz, Aldredge Academy is operating
on federal lands. There with the Bureau of Land Management or
what? Forest Service? Bureau of----
Mr. Kutz. That one is Forest Service, Mr. Chairman.
Chairman Miller. That is Forest Service?
Mr. Kutz. Yes.
Chairman Miller. And they have been on that land how long?
Mr. Kutz. About 10 years, I understand.
Chairman Miller. My understanding is they are in arrears on
their rent?
Mr. Kutz. Correct. They have not filed usage reports for, I
believe, 8 years, and they will owe the federal government tens
of thousands of dollars. So their permit is invalid basically.
Chairman Miller. Would that send you a signal as a trade
association, Ms. Moss, that something might be amiss if people
had not paid their rent for years?
Ms. Moss. Yes, sir.
Chairman Miller. So what have you done in that situation?
Ms. Moss. Haven't paid their rent?
Chairman Miller. Yes.
Ms. Moss. For the federal land?
Chairman Miller. Yes.
Ms. Moss. We are not familiar with what programs operate on
federal land or not, sir. So if they did not pay their
membership dues, their membership is canceled.
Chairman Miller. So it is all about the membership dues?
Ms. Moss. No, sir, it is not. It is not.
Chairman Miller. Well, I am trying to figure out what else
it is about because you cannot find any evidence of abuse, you
do not know the financial situations. I am just trying to
figure out what your association is about.
Ms. Moss. If there is findings of wrongdoing, sir, or
criminal action taken or ethical violations----
Chairman Miller. By outside organizations?
Ms. Moss. Yes, sir. We do not do the----
Chairman Miller. So you do not do your own investigations?
Ms. Moss. We do not do our own investigations, sir.
Chairman Miller. You do not do your own looking at the
quality of these organizations?
Ms. Moss. No, sir, we do not.
Chairman Miller. They essentially self-certify?
Ms. Moss. They are not certified by our organization. We
are not an accrediting agency. We are not a licensing agency.
Chairman Miller. What the hell do you do?
Ms. Moss. We are a trade organization, sir, that is focused
on improving the field of therapeutic schools and programs.
Chairman Miller. But, as I read your testimony, and correct
me where I am wrong, you say that ``we proceed on a case-by-
case basis either requiring a program to implement change''--
where have you done that?
Ms. Moss. There have been ethical violations that have been
filed with us, ethical complaints that have been filed with us.
In one case, there was a marketing issue that there was a
misstatement on their Web site. We researched it, talked to
them, and they removed that false advertising on their Web
site. So they did make the corrective action.
Chairman Miller. Okay. Anything else on that Web site, on
that marketing thing set off any bells and whistles for you?
Ms. Moss. I do not evaluate their marketing, sir.
Chairman Miller. And you have canceled memberships?
Ms. Moss. Counseled them, sir?
Chairman Miller. Canceled?
Ms. Moss. Yes, we have, sir.
Chairman Miller. For what purposes?
Ms. Moss. For an ethical violation. Primarily, most of the
cancellations have come after they have lost their license.
Chairman Miller. Okay. So this would be a violation of your
principles and best practices that you testified to in your
statement? Is that what it is?
Ms. Moss. Yes. I am sorry, sir. I am not understanding the
question.
Chairman Miller. Well, I am trying to figure out what the
ethical violation is. Kids are dying and being abused in a
rather wholesale fashion, and you say that there has been a
cancellation or somebody had something wrong on their Web site
and that violated the ethical standards. I just wonder where
abuse of children falls in those ethical standards.
Ms. Moss. Sir, we look to the third-party investigators to
advise us as to what actions were taken, what their findings
were on these investigations.
Chairman Miller. So, essentially, you are an organization
where these people self-certify that they will adhere to the
principles of your best practices, which are based on 12
ethical principles which were formulated using the standards of
the joint commission. So it is not like they are adhering to
the joint commission. They are self-certifying that they will
adhere to 12 ethical principles that were formulated with those
standards in mind.
Ms. Moss. Yes, sir, but we also require the licensure and
accreditation. I have to have the license on file. We look to
the states, sir, not to this association.
Chairman Miller. What kind of license do you have to have
on file?
Ms. Moss. We have to have a mental health agency license on
file or an accrediting agency which is a mental health
accrediting agency.
Chairman Miller. But you----
Ms. Moss. Those are our new membership requirements.
Chairman Miller. Are there schools in your program that are
members of your trade association that do not have those
requirements because they are not required by the state?
Ms. Moss. At this time, that is true, sir. That will not be
true in 2009, as of January 1 of 2009. That is why we have been
working so hard with----
Chairman Miller. So, if they are not in a state that does
not require this, they will no longer be eligible for
membership.
Ms. Moss. They will no longer be eligible for membership.
Chairman Miller. Do they have to have also a license from
the Department of Education?
Ms. Moss. Could you state that again?
Chairman Miller. Some of these programs represent that they
are also doing schooling at the same time. Do they have a
license from the Department of Education?
Ms. Moss. Most of them do, sir, that do offer high school
credits or high school diplomas, but that will on longer be
accepted as an accreditation or a licensure within our
organization.
Chairman Miller. Would they have to then have both? Would
they have to have mental health and education?
Ms. Moss. If they offer high school credits and a high
school diploma, they will have to be accredited by an academic
accrediting body. The licensing will depend upon the state,
sir. I am not familiar with all of the educational licensing,
so I believe that would happen on a state-by-state basis. Some
states require that the private schools are licensed. Others do
not.
Chairman Miller. Mr. Kutz, what did you find in the
universe of licensing here? Who was licensed, what were they
licensed to do, and was it relevant to what they were doing?
Mr. Kutz. Some of our 10 case studies were licensed, and
other ones--there was no licensing requirement. As I mentioned
in one of the other earlier questions, in some cases, where
there were entities who had deaths and there were violations of
licensing requirements, their license was revoked in the state,
but it was only after a death had occurred that that happened,
which raises questions about what kind of due diligence is
being done absent a death or significant abuse at these places.
I think our broader study is probably going to look at that.
Chairman Miller. But let me ask you this. Are all of the
licenses that they have related to their activities, or do they
also have activities that are not licensed?
Mr. Kutz. There are some activities they were doing that
they were not licensed for, yes. We did see that. I cannot
remember specifics, but----
Chairman Miller. And, again, I do not mean to hold NATSAP
responsible for all of this activity or the industry
responsible for all the activity, but when I look at these
sites, it is very interesting. Sometimes they will tell you,
you know, they are licensed with the State Department of
Education, but they list a whole series of mental health
treatment activities, and there is no mention of accreditation,
licensing or anything, and that would not be true in NATSAP as
of 2009.
But what would a parent rely on? I mean, the words
``accreditation'' and ``training'' are thrown around in these
marketing paragraphs. You know, you would think you were
dealing with Johns Hopkins, okay, but you are not. But they
constantly, you know, intersperse those words in the marketing,
and so you do not know if ``accreditation,'' ``licensing''
pertains to the mental health services, to the educational
services, to the medical services because it--I mean, they are
pretty clever pieces of writing.
Mr. Kutz. It is very difficult. I could not have said it
better than you just said it. I mean, it is very difficult for
a parent to wade through this and figure out what exactly is
going on, and something that might appear to be there that
looks like you said, Johns Hopkins, or something like that,
there might be nothing there. I mean, in some cases, the
medical officer was also running the kitchen, and when you
looked behind the medical officer, they had no medical
training. They were not a licensed anything. So they were self-
proclaimed, in many cases, experts in things with no
credentials behind them.
Chairman Miller. Well, I mean, that is why I worry. Again,
you know, I look, Ms. Moss, at your testimony that you are
holding these people to ethical principles and so forth, and
yet when you look at how a number of these children died--
dehydration, heat exhaustion, dehydration, head trauma which
was probably maybe caused to dehydration, loss of
consciousness, dehydration, heat stroke, hyperthermia, another
form of dehydration--you do not get very far in training before
you tell people how dangerous and fatal dehydration can be,
especially if you have a program that is designed to be in the
desert.
I mean, I do not get the ethical standards here or the
professional standards of the training where people would not
recognize and prevent--in fact, prevent--the dangers and the
fatalities related to dehydration. I mean, this is like Care
101.
Ms. Moss. Sir, this is the first we have heard of the
circumstances of these deaths. We will take these back to the
board, and we will review them in depth.
Chairman Miller. Mr. McKeon said there is a lot of room
here for something in terms of oversight.
I also serve on the Resources Committee, so is the Forest
Service looking at their arrears payment?
Mr. Kutz. That is something that we would refer to them,
certainly. We do referrals of various things, and we will make
sure there is an official----
Chairman Miller. We will do a referral along with you.
Mr. Kutz [continuing]. Notice to them of what we
identified, yes.
Chairman Miller. One of my concerns is, again, my
experience with some of these organizations is, in some cases,
you know, there is a substantial investment being made. In
other cases, there is not much investment at all, and you are
wandering around on federal land. We have had Conestoga wagons
wandering around in the Southwest for a number of years, and
there is really no investment, and when they had trouble in
Arizona, they simply moved north into Nevada and continued
their activities. So, if somebody is not paying their rent,
bells and whistles might go off on whether they are paying
properly trained people and skilled people to watch after these
young people.
Mr. Kutz. Well, in the case here of the Forest Service,
they were not aware that for 8 years they had not been
receiving reports from Aldredge and that the fees had not been
paid until we actually talked to them, and then they were like,
``Oops. Looks like we have a problem.'' So that raises
questions--we did not look at that--on both sides.
Chairman Miller. If you knew how they treated holders on
some federal, you would wonder what they are thinking.
Let me stop there and see if Mr. McKeon or Mr. Kildee----
Mr. Kildee?
Mr. Kildee. Just another question to Ms. Moss. And I do
look forward to some documentation that you will supply us as
to how you responded on a case-by-case basis to the complaints
or information you had received. But what do your members gain
by joining NATSAP?
Ms. Moss. They gain continuing education with our
conferences. They gain the journal. They gain access to others
in this profession. They gain insight into the newest clinical
studies. There are many clinicians in our organizations that
present at our conferences. It is basically an education type
of benefit.
With the new research initiative, they will gain from that.
They will be able to----
Mr. Kildee. Not what they will, what have they. How many
conferences do you have a year?
Ms. Moss. We have one national conference a year, and we
have six regional conferences a year.
Mr. Kildee. It would seem that much of what they may gain--
and this is what I worry about--is that they may gain a certain
credibility that to belong to, you know, this Good Housekeeping
group. I do not think your group exactly is comparable to the
Good Housekeeping seal of approval, but I think that can be
used as an advertising thing, ``We belong to NATSAP, and,
obviously, we are good.''
I think you have something to prove to this committee and
to the American public that you are supplying more than just
credibility to these groups that belong to you, and I worry
about that. I think very often people see a national
organization and feel it is something like the Good
Housekeeping seal of approval. I think you have a long ways to
go before you ever approach that.
I think what I worry about is that you supply them just
credibility.
Ms. Moss. Sir, that is why we are here asking for your help
in state licensure and regulation. We do not want to be the
Good Housekeeping seal of approval. We want to supply services
to our members so that they can improve the care that they give
to children and families.
Mr. Kutz. Congressman, could I add one thing?
Mr. Kildee. Yes.
Mr. Kutz. In the marketing materials--and, again, this is
not NATSAP's responsibility--these entities do market
themselves as being members of NATSAP, and it does provide some
credentials for them, even though they are a trade association
so they are not really required to do due diligence
necessarily. So that is something we saw in the marketing
materials for many of our case studies that were NATSAP members
or other members of other associations or whatever the case may
be.
Mr. Kildee. But an organization could use that in their
advertising, ``We are a member of NATSAP,'' right?
Mr. Kutz. They did. That is not could. They did.
Mr. Kildee. So it is used and it does give them a certain
credibility perhaps to----
Mr. Kutz. Someone who might not be aware of what it exactly
means, yes.
Mr. Kildee. But it sounds good, right, that they belong to
this national organization?
Dr. Pinto. If I could comment because I do receive calls
from families on a weekly basis at this point, and this point
is absolutely what I am hearing from families, that they are
having such difficulty because there is not a place that they
can go on the Web or some kind of a clearinghouse where they
can get information about programs, both good programs and
programs of concern, and so they are desperately trying to make
sense based on the information that is out there.
And absolutely when you have a seal on a Web site that is
the joint commission seal and right next to it you have a
NATSAP logo seal, I have heard multiple parents saying, ``Yes,
but it is a NATSAP-affiliated program. It is a NATSAP-
accredited program.'' So, even though NATSAP says, ``We are not
about accreditation,'' that is how parents are making sense of
it.
I am seriously concerned about the mixed messages that are
going to families, because although NATSAP is saying that they
are trying to help families, I do not understand why, when
NATSAP attended a presentation that Paul Lewis, myself and
several other individuals made last year at the American
Psychological Association Conference, where we indicated that
there were hundreds of reports of mistreatment and abuse in
these kinds of facilities, after that presentation, NATSAP
representatives came up and expressed such concern and said
something very similar to what Ms. Moss just said when she just
said, ``Well, we will take these back to our board and review
them in depth,'' that was the same kind of language that we got
last year.
And what was the response? The response was the open letter
to critics that now is on the NATSAP Web site that describes
the concerns that we have reported in these presentations at
the APA and elsewhere as ``the noisy complaints of a few
individuals.'' So that is not sending a message to families
that NATSAP takes these reports of abuse seriously, and I have
not seen evidence that they have done anything in response to
what we have made very clear in the presentations that we have
done over the last 2 years that this is something that is a
great concern to them.
Mr. Kildee. I really think we are all concerned up here. We
are all parents up here, and I cannot imagine the pain that you
parents have suffered. But really, you know, if you belong to
an organization that deals with the most vulnerable in our
society, the youth, you should be part of the solution and not
part of the problem.
Ms. Moss. Sir, that is why we are here.
Mr. Kildee. After----
Ms. Moss. We want to be a part of the solution.
Mr. Kildee. Go ahead.
Ms. Moss. We want to be a part of the solution. That is why
we are here.
Mr. Kildee. I hope then if you supply us the information I
requested.
I yield back the balance of my time, Mr. Chairman.
Chairman Miller. Thank you.
Either Mr. Kutz or Ms. Clark Harvey, have there been
additional deaths at the program since your daughter died?
Ms. Harvey. Yes, there were two deaths in Catherine Freer
programs after Erica died, one occurred in Nevada close, I
believe, in the same wilderness area that Erica died in, and
that occurred in October of 2002, and then there was a death in
Oregon in, I believe, March of 2003.
Mr. Kutz. That is correct.
Chairman Miller. That is correct with the information you
have?
Mr. Kutz. Yes.
Chairman Miller. Again, I mean, this is not to make this
NATSAP's problem, but you have five out of 10 deaths here that
are facilities that belong to your organization. Two of the
five have been closed. One has had additional deaths since
Erica Harvey. I mean, this is like Casa Blanca. You are shocked
that gambling is going on here.
Something is very wrong inside a trade organization--you
know, one of the things trade organizations have to decide is
you have to get rid of the frauds, and if you want to survive,
and somehow something is wrong here in the review or the
applications or the self-certification or something that people
can bring this kind of history and just continue on.
Now maybe that is fine. You are obviously making a
determination or you are leading this committee to believe you
are making changes, but I just say that there is, you know, a
period of years here when somebody was asleep at the switch
here.
You know, I appreciate the three testimonies that were
attached, Ms. Moss, to your testimony, three statements by
people who had been through different programs, and their
success, and that is what every parent would wish for. I find
that terribly interesting, but not terribly relevant because
that would be the expectation of people who signed up for these
programs.
That would be their hope, not that every kid is going to
come back successful as they have cited--they have gone on with
their lives, they have become productive, and they have done
those things--but that your child would get treatment. At a
minimum, you would expect them to be safely kept while they
were in care, and that minimum was breached here time and time
and time--in fact, thousands of times that that has been
breached by people taking care of these children.
So I guess that, you know, we are here when things go
terribly wrong, and I think Dr. Pinto has pointed out being
subjected to this, people do not lightly disgorge others that
they were abused or that they could not cut it or they could
not do these things, and so I think to have people come back
now in the numbers that they have and talk about it, this
cannot be dismissed as noise.
Ms. Moss. No, sir, it cannot be dismissed as noise, and I
agree with that. NATSAP would benefit from a clearinghouse of
information as much as a parent and family would. We do not
want to be the Good Housekeeping seal of approval. We do want
to raise the bar in the industry. We are a young organization
learning as we are going. We have made mistakes in the past. We
recognize that.
Chairman Miller. There is some duty of care here, which I
think you are missing.
Ms. Moss. Absolutely, sir. I agree with that.
Chairman Miller. I think you are missing it, with all due
respect. You can decide for the moment, but I think you are
missing it. There is some duty of care here, ``as a trade
organization,'' about what happens in your name.
Ms. Moss. I will take that back to the board, sir, very
definitely.
Chairman Miller. It is going to be a very busy board. You
are taking things back that----
Ms. Moss. Yes, sir. Very busy.
Chairman Miller. Thank you for doing that.
Dr. Pinto, you raised the question. I am trying to figure
out what it means, when these are individuals who have gone
through the program, for them to come forward, and what weight
we give that.
Dr. Pinto. Again, I think it is easy for people to presume
that there must be something wrong with these young adults, you
know, ``Well, they were troubled teens to begin with, so they
are probably just still messed up, and that is why they are
describing this and they have it. They are trying to get the
programs.''
However, if you read the accounts--and I was really
surprised when we created this online survey with over a
hundred questions and many free response opportunities--it is
over a thousand pages. Just trying to print out all of the
responses that came back--this is definitely a group of folks
who have not had an opportunity to speak to their experience,
and when you read the accounts, when you hear what people have
to say, there really is a level of detail and coherence to
their accounts--any given account--but then also across
accounts that makes it clear that there is a phenomenon
occurring, a phenomenon of mistreatment and abuse.
And it is not the case that everybody is experiencing this,
but it is the case that there are far more than just a few
cases, and, again, if we heard this from a teenager who was in
their own home or in a public school or in a licensed mental
health care facility, immediately, there would be a response
and it would be an investigation to ensure that that just did
not go overlooked, and that is not happening at this point.
Chairman Miller. In fact, there is an affirmative duty to
report.
Dr. Pinto. Absolutely. In fact, I am a licensed
psychologist, and as such, I am a mandated reporter of
suspected child abuse, and when I first started getting these
reports, I thought, ``My gosh, as a mandated reporter, I need
to follow up with this.''
So I called several states' suspected child-abuse-hotlines,
and I described the situation to them, and they said, ``Well,
can you give us the name of the particular staff member who was
the one to conduct this suspected abuse?'' And I said, ``Well,
no, but I can give you the name of the program.'' And they
said, ``If you cannot give us the name of the individual, then
it needs to go to the agency at the state level that monitors
those kinds of programs. We cannot take a report unless you
give us the name of the individual.''
But then when I would call those agencies, Department of
Education, Department of Health and Human Services, in the
given state, they would say, ``Well, we do not have any
authority over those kinds of programs.'' And so it is a
complete black hole at this point.
Chairman Miller. Well, thank you very much. And I think
that is a problem also that exists between public programs. I
mean, that is one of the reason I fought very hard over the
years to return children to their own states because once you
have crossed the state line, one, whether you have any
authority and, two, getting other people to respond, it just
becomes a huge barrier, and our states now have changed the law
so the kids are placed differently now than they were 20 years
ago, 15 years ago with kids' placement.
Carolyn, do you have additional questions?
Mrs. McCarthy. Actually, she just answered it because we
are giving federal money to the states, and yet they do not
seem to have any control over what that money is doing as far
as these residential programs. So that might be an area we will
look into.
Chairman Miller. Let me follow up on that, Mr. Kutz, if I
might. You were not looking at the question of whether there is
federal money for some of these programs. Do you have any sense
of--you know, we have IV-B maintenance money for children, out-
of-home placements and foster care and whatever. We know in the
past some out-of-state placements were made with IV-B money. We
have juvenile justice money that goes to placement. I do not
know whether some of these contract with school districts to
receive funding within their state or not. Is there any reason
to suspect that there is some federal involvement in the
placement of--I mean, federal dollars?
Mr. Kutz. Not in the cases we looked at.
Chairman Miller. Not in the cases----
Mr. Kutz. They were funded primarily by parents, and in one
case, health insurance paid for maybe $10,000 of the fees.
Chairman Miller. So, as far as you can tell, they are
operating essentially on a tuition----
Mr. Kutz. Yes.
Chairman Miller [continuing]. Payment by parents.
Dr. Pinto. If I could add to that just briefly, I do--if
that is okay?
Chairman Miller. Yes.
Dr. Pinto. It does seem like primarily the parents I have
spoken to are paying out of pocket as well. However, there are
times where a family makes a case, for instance through their
IEP, that the publicly available programs or the nonpublic
schools that are part of that district's list of available
services are not a good fit for their child and they advocate
to have their child sent to one of these kinds of private
programs, and there are districts, I do recall from my clinical
work in California, where that does occur, and therapeutic
boarding schools are paid for through the IEP process.
Chairman Miller. Thank you.
Mrs. McCarthy. Mr. Chairman?
Chairman Miller. Yes?
Mrs. McCarthy. May I follow up with a question?
Chairman Miller. Yes.
Mrs. McCarthy. As we have heard all the testimonies,
especially the data areas where I would like to see if we can
concentrate that in the future if we do legislation, right now,
apparently, HHS does have money that is given to the National
Child Abuse and Neglect Data System. With what we see, where do
you think is--some states will call the child abuse centers.
Some will call the state agencies. As we go forward, what would
be the best area to collect the data and not have several
agencies go through it, but one agency so it is a better
clearinghouse and not a confusion to parents when they need to
know that data? Do you have any idea, or does that come in the
next study?
Mr. Kutz. No, but the data that was collected nationally
was a self-reporting, so it is more than likely very
incomplete. There were 30-some states, I think, that reported,
not that every state has these programs. I do not know whether
they do or do not, but, certainly, some central reliable
repository would be useful, whether it is at the federal level
or not. I mean, maybe from a reporting standpoint, that would
make the most sense. States could report to the federal
government. But, again, that current database that was used--
that is why we cannot say how many thousand or whatever--was
self-reporting.
Mrs. McCarthy. Okay.
And, Ms. Moss, just to finish off with one thing. One thing
I have learned since being here in Congress--I also sit on
Financial Services--is when a trade organization puts their
name out and gives the seal of approval of a corporation or an
entity that they are supporting, the only thing they have is
their reputation, and if you are supporting that reputation,
those clients or family members usually will look at that and
think that you have already done the investigation. So, whether
it is your fault or not, I think you need to look at your
organization and maybe possibly decide that you might be doing
some of your own investigation if you want to keep your
reputation.
With that, I yield back.
Chairman Miller. Thank you.
Any further questions?
Well, let me thank all of you for your time and your
testimony and your expertise in this area. I think it has been
very helpful to us.
Mr. McKeon and I will put our heads together and think
where we go from here. We have a follow-on study from GAO, and,
as you can see, there is considerable interest by the members
of the committee that we somehow get a handle on what is taking
place here and get about trying to keep it from happening. We
will have to figure out what the right vehicle is, but we will
figure that out, I want to tell you that, and with your help. I
hope that you will continue to stay involved with us.
To the family members, thank you for your testimony. I know
this was not easy for you, and thank you, though, for sharing
it with us.
And, Ms. Moss, Dr. Pinto, thank you for your expertise.
And, Mr. Kutz, and Mr. O'Connell, I know this was not an
easy study for you to do, but we appreciate it and appreciate
your frankness in dealing with the committee.
Members will have the ability to submit statements for the
next 14 days.
And with that, the committee will stand adjourned.
Thank you again.
[The statement of Mr. Altmire follows:]
Prepared Statement of Hon. Jason Altmire, a Representative in Congress
From the State of Pennsylvania
Thank you, Mr. Chairman, for holding this hearing on cases of child
neglect and abuse at residential treatment facilities.
Hundreds of residential treatment facilities operate throughout the
United States. These facilities typically serve children with severe
emotional and behavioral issues, however, vary greatly both in the
needs addressed and in the interventions used. Currently, there is no
federal law that specifically addresses residential treatment
facilities. Most of the regulation for these facilities is at the state
level, each with their own way of licensing and monitoring residential
treatment facilities, and some with no regulation at all.
Today, we will hear from three parents whose children were subject
to abuse and neglect at residential treatment facilities. The outcome
in each of these cases was the worst imaginable, the death of the
child. I want to thank all of you for testifying today and extend my
condolences for your loss.
Thank you again, Mr. Chairman, for holding this important hearing.
I yield back the balance of my time.
______
[Statement for the record from the Alliance for the Safe,
Therapeutic, and Appropriate Use of Residential Treatment
(ASTART) follow:]
October 24, 2007.
Hon. George Miller, Chairman,
Committee on Education and Labor, Rayburn House Office Building,
Washington, DC.
Dear Chairman Miller: I am writing to thank you, your staff, and
the entire Committee on Education and Labor for conducting the
investigative hearing on ``Child Neglect and Abuse in Private
Residential Facilities.'' This is a very important and serious issue
that deserves attention at a federal level, and I am delighted that you
and your Committee are giving it the attention it deserves.
I am a psychologist at the University of South Florida who
specializes in children's mental health. About three years ago, after
hearing both from media people and parents about this problem, I began
doing some research to try to understand its scope. I was struck then
by how little is known about the problem, and how silent my mental
health colleagues have been about it, despite fairly widespread
coverage in the general media.
In response both to the seriousness of the problem of abuse,
neglect, and exploitation within private residential facilities, and
the absence of voices within the mental health field that were speaking
up about it, I invited several colleagues to join me in deciding how we
can best help address it. We formed a small group called the ``Alliance
for the Safe, Therapeutic, and Appropriate Use of Residential
Treatment'' (A START--http://astart.fmhi.usf.edu)
Our group held a press briefing, with the support of your office,
in Washington about two years ago, has been involved in several
research and public education efforts, and has prepared some of the
first professional articles about this troubling problem. One of our
members, Dr. Allison Pinto, provided testimony as part of your
hearings.
We have found that the abusive practices are most likely to occur
in for-profit, unlicensed, and unregulated facilities. Although it
certainly does occur as well in licensed and non-profit programs, the
most serious problems of abuse and misleading marketing occur in the
for-profit and unlicensed sector.
We recognize that there is a role for high quality, responsible
residential care within a children's mental health system, but we
believe strongly that there must be proper licensing, regulation, and
accreditation in order to increase the likelihood that youth will be
kept safe and will be provided with effective services. We believe that
proper licensing, regulation, and accreditation will only serve to
improve the quality of programs, and will be of benefit to all. We do
worry, however, that if licensing is not accompanied by adequate
monitoring and regulation, it can give the appearance of credibility to
programs that do not deserve it, and so we would strongly support any
proposal to provide resources to help ensure that there is strong
monitoring and regulation to accompany licensing laws.
We believe that it is unconscionable that within our country there
is no systematic data collection to tell us how many children are
served in residential programs each year, or even how many die or are
seriously injured in such programs. We believe that such data
collection is essential to allow us to understand the scope of the
situation, track it over time, and develop sound policy to provide
appropriate care for youth while at the same time protecting them from
abuse and their families from exploitation.
We recognize that there are many families who are desperate for
help, and that this desperation is partly due to the absence of
adequate services in their own communities, the stigma that is attached
to mental health issues, and the lack of information for parents and
professionals about just what is available. We would strongly encourage
any effort to strengthen community systems of care for children with
special mental health challenge and their families, and to provide
families and professionals with access to complete and accurate
information about alternatives that are available to them.
We also have spoken to parents and youth who describe situations
that are clearly not serious enough to merit residential placement.
However, it has been reported to us that when parents make inquiry
about services, the programs often create a sense of heightened
desperation in order to generate an immediate referral. At this point
it is not possible to know how many youth within these programs are
genuinely experiencing a serious challenge, and how many have ended up
there because programs have created a sense of unwarranted crisis in
their parents.
Our A START group is more than happy to assist you and the
Committee in any way that we can. We include mental health
professionals from a variety of disciplines, former staff of programs,
young adults who were formerly in one or more of these programs,
parents, and advocates. We have prepared a summary of the hearings and
the accompanying GAO report and are circulating this widely through our
own networks in order to better educate professionals and the general
public about this problem. I am enclosing a copy of that summary for
you.
Thank you again for your outstanding leadership on this issue. It
is clearly a reflection on our society that we allow our youth to be
exposed to such cruel treatment rather than providing them and their
families with more humane, supportive, and effective interventions.
Respectfully,
Robert M. Friedman, Ph.D.,
Professor.
______
Statement of Alliance for the Safe, Therapeutic, and Appropriate Use of
Residential Treatment (ASTART)
Now is the time to stop using violence, abuse, isolation, and fear
tactics to adolescents whose family and friends want them to get
better. Now is the time to prevent death and trauma in the name of a
place to get better. Now is the time to provide systems of care that
will help the youth with drug, alcohol, eating disorders, mental health
issues and behavior problems with proven therapies that protect the
youth's human rights and work to repair family units.
We are here today to ask your help to stop physical and emotional
abuse, and even preventable deaths, in places that promise to ``turn
kids with behavioral difficulties around.'' All over this country,
there are young people being held against their wills and coerced to do
and say self destructive things simply to survive. We are speaking of
abuse and neglect in programs across the USA, and in programs around
the world with US ownership. Even the families of those abused youth
are often dragged into unbeneficial and coerced involvement, in efforts
to salvage hope for their children's future. The abuse and neglect must
be stopped at these facilities!
It is a great honor to be a citizen of a nation that provides for
our elected leaders to call for independent investigations by the
Government Accounting Office when a member of Congress believes those
he or she represents are not being appropriately protected under the
U.S. Constitution. This hearing by the U.S. House Education and Labor
Committee is welcomed by those of us who have been working so hard to
bring awareness and justice to the youth and families who struggle to
find effective help.
Thank you for your leadership and making this hearing happen.
In the fall of 2004 a parent asked my aid in getting her son out of
a facility in another state that she believed was hurting him. This boy
was put in an orange jump suit, stripped of his shoes and the
medication his psychiatrist had prescribed, locked in a dorm at night
with no adult supervision. His mail was censored and he was not allowed
contact with his parent until those who had done these things to him
thought it was time. He was constantly shadowed within three feet by
another youth, and denied access to a library, or the use of his
musical instrument. All the while this boy and his family were being
made promises that were rarely kept. The cost to the boy's grandparents
was $85,000 over 12 months. The professional counselor, who had been
working with their grandson in his home city, suggested a place out of
state that he said he, ``didn't think this one is as harmful as some''
and it has a school attached to the drug and alcohol classes. But he
had never been there and didn't actually know about it personally.
While he was in that place the boy was taught to blindly follow orders
and was punished for speaking out. Now, he is finding it difficult to
be independent and think for himself. The trained and experienced
professionals I've talked with are genuinely amazed that places like
this, pretending to do good for the young people under their care,
could be so abusive.
I too was amazed, but also enraged, because I had spent my adult
life working to build systems of care in the United States that would
help youth and their families cope with mental health challenges. As a
Mental Health Assoc executive director, child advocate and educator, I
have visited many of the psychiatric hospitals, group homes and day
treatment programs in the US and Japan, and have seen effective care.
For over 20 years I have served as a member and chair of the advisory
board for the Research and Training Center for Children's Mental Health
at the University of S. FL and turned to my colleagues for help. Our
action was to form the Alliance for the Safe, therapeutic, and
Appropriate Use of Residential Treatment, (A START). We have spent the
past two years studying, investigating and asking for help to educate
families and authorities about this billion dollar industry. We wrote
guidelines for families and set up a website (http://
astart.fmhi.usf.edu).
I worked with another non-custodial family member to help her
daughter get out of a licensed facility that believed in five-point
restraint, and isolation, where employees called the girl a whore when
she wouldn't admit to things that didn't happen to her and prevented
her from speaking to her mother when they learned of her mother's
efforts to get her out. She spent 7 months there and the cost was in
excess of $100,000. The place now calls for a $17,000 deposit for new
admissions. This place told the parents not to believe anything their
child said as the child would be lying and manipulating their family.
The family used all their savings for attorney fees to free her and has
become bitter and untrusting of the judicial system. They asked me to
spread this message: ``Do not to take someone's word that it is a good
place or has a high rate of success.'' The parents told me the place
just trampled all over the child and families rights'' They too ask,
``where is the proof that violence, restraint, and seclusion works''?
Another mom is fighting for her son to get out of an abusive state
run facility. When she asked for his medication for severe bi-polar
disorder to be given back to him, she was given a choice in court to
serve 3-8 hour days of community service or 10 days in jail, and a gag-
ordered against talking about the program or questioning the juvenile
justice system. The judge said to the mom ``You are not the parent
anymore, I am.'' Please help us stop these injustices.
As a child and family advocate I often speak out for those who
can't speak for themselves. The families and youth who face serious
decisions about selecting services for helping the young persons to
change their behaviors, need assurances that they will have options for
safe, high quality and effective treatment NOT exploitation, abuse,
mistreatment, and even death. They deserve child centered and family
focused services that are based on the individual youth's needs and
provided by properly trained professionals. Many parents have reported
feeling desperate and that the sense of urgency in their situation
makes them settle for less. Many parents are also paying huge sums of
money for escort services to transport the child from their home in
handcuffs and for substandard solutions that further alienate them from
their child. The marketing brochures for these facilities don't match
with reality. When our youth go to get their hair, nails done, or teeth
cared for the technician is licensed and trained by law. Why isn't all
the staff in residential facilities also required to be licensed,
regulated, and monitored, and overseen so they are prevented from
abusing their customers, especially in those misguided times when they
appear to believe abuse is appropriate treatment?
For our youth and our families I and others like me will continue
to advocate for safe and appropriate programs. We ask your help in our
efforts. We need your help to prevent even one youth from being
snatched out of their bed and transported to a place of harm. Please
help us prevent more death and life long suffering for youth and
families who need help not abuse. Our youth deserve just and
appropriate care.
Thank you.
______
[Whereupon, at 1:27 p.m., the committee was adjourned.]