Exploitation of Youth & Families: Perspectives on Unregulated Residential Treatment
By Allison Pinto, Ph.D., Monica Epstein, Ph.D., Paul Lewis, B.B.A., Kathryn Whitehead, B.A.
Presented to APA Convention, August 12, 2006

On August 10, 2006, the American Psychological Association issued a statement reaffirming its unequivocal position against torture and abuse. APA President Gerald P. Koocher, Ph.D., stated, "Our intention is to empower and encourage members to do everything they can to prevent violations of basic human rights - at Guantanamo Bay or anywhere else they may occur. It is not enough for us to express outrage or to codify acceptable practices. As psychologists, we must use every means at our disposal to prevent abuse and other forms of cruel or degrading treatment (APA Press Release, August 10, 2006)."

This presentation focuses on mistreatment, abuse and human rights violations that youth have been experiencing in unregulated residential treatment facilities in states across the U.S., and calls for psychologists to actively respond in order to safeguard and protect youth and their families from mistreatment at the hands of U.S. owned and operated companies and programs.

To place the current concerns in context: Note that it is now illegal to use any of the following practices with regard to the treatment of U.S. detainees in Guantanamo Bay and other facilities:

  • Use of phobias & fears to induce stress
  • Physical training (forced calisthenics)
  • Exposure to cold weather
  • Sleep Deprivation
  • Nutritional Deprivation
  • Slapping face or stomach
  • Stress positions (e.g. prolonged standing)
  • Isolation greater than 30 days
  • Forced Labor
  • Denial of Use of Bathroom
However, each of these practices is being used to "modify the behavior" of U.S. adolescents in unregulated, private residential facilities, in the name of "therapeutic" schooling and programming.

Dr. Monica Epstein will provide an overview of the phenomena of unregulated residential treatment for youth. She will describe the private industry of residential programs that has flourished over the past 10-15 years, claiming to meet the needs of children with emotional and behavioral problems and their families. Marketing themselves as therapeutic boarding schools, emotional growth programs, and wilderness programs, among other labels, these programs offer an "innovative alternative" to families in crisis. In many states, these programs are not required to meet state licensing requirements for the residential mental health care they provide because they are not publicly funded or because they self-identify as schools rather than mental health treatment programs.

Highly disturbing reports have been published in the public media describing harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions conducted by unqualified staff, medical and nutritional neglect, and rights violations.

Kathryn Whitehead, B.A., will provide a first-hand account of her experience as an adolescent who attended an unregulated residential facility, where she experienced forced labor, exposure to extreme environmental conditions, mandatory exercise, humiliation, and patient as well as human rights violations. She will also share quotes illustrating the experiences of other youth who have recently responded to an online survey conducted by Allison Pinto, Ph.D., Whitehead, and colleagues at the University of South Florida to clarify the experience of adolescence in residential facilities. Youth experiences, in their own words, include:

  • They "scared me into submission… I felt I was entering a teen prison…"
  • "…had to get naked and squat while turning around in circles…"
  • "I was made to get naked and humiliated- do jumping jacks…"
  • "They didn't talk to me like a human or try to comfort me as I cried…"
  • "Physical activity was endless…it was meant to break us…"
  • "Sleep deprivation in the longer 3-5 day workshops accompanied by very cold room temp. and carefully chosen music played at high volumes, was at times agonizing…"
  • Newer students "were denied sleep until the older students were satisfied with the newcomers 'progress' each evening…"
  • "Girls peed themselves…"
  • "Many times I was hungry after I ate and couldn't get more food…"
  • "They treated us like we had no rights…we had no locks on the bathroom…staff would watch us dress, shower and sometimes even use the toilet…"
  • "Some people were in isolation for months, lying on their stomach eating out of a bowl…"
  • "The room was 7x7 feet, it was always cold…I remember screaming a lot…when I wasn't, I would curl up in a ball in the corner and sing to myself…"
  • "I was sexually abused while in restraints…"
  • "I was pepper sprayed…"
  • "My therapist stood behind me and whispered things about my rape, while playing the song I was raped to, for 4 consecutive groups sessions…"
  • "At times we were forced to eat our food in the 'push up position' like dogs…"
  • "I broke my finger while in the program and was not allowed to go to the doctor…"
  • "I tried telling my parents what actually going on at that place, I was severely disciplined and my parents were told I was being manipulative…I was only telling the truth"
  • "I still wake up with nightmares…"
Paul Lewis, B.B.S., will provide a first-hand account of his family's experience with unregulated residential programming. The Lewis' sent their 14-year-old son to a wilderness program where his rights were denied and he was mistreated, leading to his death. Mr. Lewis will explain that the intent in enrolling his son was to help improve his self esteem, learn strategies to deal with his depression and earn the necessary credits to complete 8th grade. Once enrolled, his son was not allowed to communicate with his parents, and when his parents called each day to inquire about how he was doing, they were told he was fine and assured he would be safe. They only found out later that this was not the case. On the sixth day in the program the Lewis' son slashed his arm four times with a program supplied pocketknife; he then approached the adults in charge and told them, "Take this away from me before I hurt myself any more, I can't take it any more. I want to call my Mom and I want to go home". The next day the head therapist, who was not trained as a therapist, decided their son was just trying to manipulate them to get out of the program and go home, so he ignored their son's cry for help. That night, their son hung himself only several feet from his makeshift campsite.

Allison Pinto, Ph.D. will present preliminary findings from an online survey of young adults who participated in residential programs as adolescents. She will report findings based on information from the 162 respondents who described their experience in 36 programs in 17 states labeled as therapeutic boarding schools, emotional growth academies, and behavior modification programs (as opposed to licensed residential treatment centers), in which they had no opportunity to contact an advocate if they had concerns or complaints while attending the program. Preliminary findings reveal that "patient" rights violations, inhumane treatment and abuse were reported by many youth.

With regard to "patient" rights violations, 120 youth reported that their rights were never described to them upon admission, 125 reported that their calls were monitored, 123 had letters monitored, and 114 indicated their conversations or letters were filtered or interrupted.

In terms of the violations of patients' rights to least restrictive intervention, 82 experienced seclusion and 42 experienced restraint, and these interventions were often prompted not only by evidence of danger to self or others, but rather breaking a program rule (N = 90), saying something disrespectful (N = 68), cursing (N = 62), making a face (N = 42), or talking out of turn (N = 40).

Program practices reflective of inhumane treatment were reported by many youth, in terms of forced labor (N = 92), denial of access to bathrooms (N = 87), scare tactics (N = 84), excessive exercise (N = 75), exposure to elements -- extreme heat or cold (N = 74), sleep deprivation (N = 61), nutritional deprivation (N = 51), and physical punishment (N = 36).

Furthermore, 76 individuals reported that they were emotionally, physically or sexually abused by the staff.

In response to participation in residential programming, 57 individuals endorsed items consistent with a diagnosis of Post Traumatic Stress Disorder, although only 2 individuals indicated that they had received a diagnosis of PTSD prior to program participation.

Of the 118 individuals who provided feedback regarding their satisfaction with the program, 90 reported that they would not recommend the program to others.

These findings will be discussed in terms of urgent needs to:

  • Increase family awareness
  • Increase professional/system awareness
  • Increase protections within programs
  • Increase protections within states (with regard to licensing/regulating, suspected child abuse reporting, and protection & advocacy)
  • Conduct research / evaluation
  • Provide resources & supports for youth & families who have been harmed


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