MORE THAN TROUBLING

THE ALARMING ABSENCE OF ‘TROUBLED TEEN INDUSTRY’ REGULATION AND PROPOSALS FOR REFORM by Morgan Rubino

Published in Notre Dame Law School Journal of Legislation, 2024, Volume 50, Issue 2 pp. 429-456

TRIGGER WARNING: description of abduction, verbal, physical, and psychological abuse p. 431

Introduction begins with Paris Hilton’s survivor story

Kids end up in the TTI via their parents, school districts, mental health providers, juvenile justice systems, child welfare services, and refugee resettlement agencies p. 431

Many kids leave TTI facilities worse off than they were when they arrived because of the abuse and trauma they experience p. 432

TRIGGER WARNING: description of abusive restraint, child death p. 432

120k-200k kids in TTI programs in the US right now p. 432

Past legislation attempts to regulate the industry have been inadequate pp. 432-433

History of the TTI reviewed briefly pp. 433-435:
Founding of Synanon by Charles Dederich in 1958, closed 1991
Founding of CEDU in 1967, considered the first therapeutic boarding school, charged $30k-80k per year, closed in 2005
Establishment of The Seed in 1971

TRIGGER WARNING: medical neglect, child death p. 437

Types of TTI programs: 

• Boot Camps–usually privately owned, target families with kids who have a history of “delinquency”, average length of stay 90 days, average cost $2k-$10k, involves physical and psychological abuse from staff and peers pp. 435-436
• Wilderness Camps–target families with kids who have emotional or behavioral problems, average cost $558/daily with $3.1k enrollment fee, average length of stay ranges from one to several months, no strong evidence of effectiveness, fosters abuse that sometimes leads to death pp. 436-437
• Therapeutic boarding schools–residential facilities that have an academic and therapeutic component, kids may be sent for self-destructive behaviors or behaviors that parents disapprove of, average cost $30k-$100k annually, sometimes involve contracts preventing kids from leaving before 21 months of treatment (or longer), 90% of adult survivors report having “negative” or “very negative” experiences pp. 437-438

Congress has been unsuccessfully trying to pass regulations for the TTI for over a decade p. 438

2008 bill (110th session): Stop Child Abuse in Residential Programs for Teens Act (SCARPTA) pp. 438-439

Identical versions of the 2008 bill were reintroduced in 2009, 2011, 2013, and 2015 and died each time p. 439

2017 – bill submitted again, referred to House Committee on Education and the Workforce, died again p. 439

2020 release of This is Paris and 2022 release of Trapped in Treatment Podcast made the TTI more visible in the public eye p. 439

2023 Stop Institutional Child Abuse Act (SICAA)  is still pending in House and Senate pp. 439-440

• Would establish a work group to develop and publish recommendations on a national database that compiles important information about TTI programs, would be required to publish more recommendations every two years
• Would require the National Academies of Sciences, Engineering, and Medicine to study conditions in TTI programs and make policy recommendations

California passed SB 524 in 2016:

• requires all TTI facilities to be licensed as non-profit group homes, therefore subject to tighter regulations
• Kids and guardians entitled to an accurate written treatment plan,
• Restraints are prohibited
• Plans for training staff have to be written in detail and submitted p. 440

Montana passed HB 282 in 2019: explicitly states that people receiving treatment at RTFs cannot consent to sexual activity with RTF staff p. 441

Montana passed SB 267 in 2019: dozens of complaints about RTFs weren’t being addressed, so this law put the Department of Public Health and Human Services in charge of regulation and licensing p. 441

Montana passed HB 218 in 2023: 

• Amends SB 267 by banning physical punishments and requiring programs to report use of restraints within one business day 
• Requires each program to post instructions on how to submit reports to police or DHHS p. 441

Utah passed SB 127 in 2021: 

• Forbids “cruel, severe, unusual, or unnecessary” actions, strip searches, humiliation, physical restraints, and seclusion (“without a showing of absolute necessity or direct authorization”)
• Requires programs to report use of restraint, use of seclusion, or “critical incidents” to the Utah office of licensing within one business day
• Requires programs to make sure kids have weekly phone calls with parents, guardians, and siblings pp. 441-442

Missouri passed two bills in 2021: 

• Allows programs to continue to operate without licenses but they have to notify the Missouri Department of Social Services that they exist 
• Requires all employees to submit fingerprints and background checks, and allows more people to ask the court to remove children who may be abused or neglected in programs

Oregon passed SB 749 in 2021:

• Educational consultants and other people who make referrals to TTI programs have to tell parents/schools about:
  • Deaths and instances of abuse and/or serious injury within the last two years
  • The licenses held by the program in question
  • The payment they’re receiving from the program in exchange for the referral p. 442-443

Oregon passed SB 710 in 2021:

• Establishes guidelines on use of restraint and seclusion, limiting their use to only when someone is going to get seriously hurt and there are no other options
• Requires programs to notify guardians immediately if a child is restrained
• Requires programs to submit quarterly reports about their use of restraint and seclusion to DHS
• Requires all transporters to be licensed by DHS p. 443

“While these state laws are steps in the right direction toward reforming the TTI, together, they make up a rather messy patchwork of regulation. This lack of standardization and uniformity is concerning as it only widens the gaps for potential oversight.” p. 443

There is a lack of research on TTI programs because there are no federal reporting requirements. We don’t know how many programs exist, where they are, how many children are in them, or how they are run p. 444

Reliable sources of information about the TTI: Government Accountability Office reports in 2008 and 2009, stories from survivors (including Paris Hilton) p. 444-445

TRIGGER WARNING p. 446: medical neglect, abusive restraint, child death

What legislators should work on first:

• Ensuring programs are not operating without an acceptable number of high-quality, well-educated, well-screened staff at any time (strict hiring criteria, more in-depth screening, standardized training, more frequent and intense inspections by the government) pp. 446-447
• -Cracking down on deceptive marketing (disclosing relationships with educational consultants, forbidding misleading statements on program websites, only supplying accurate information about insurance coverage and tax deductions) pp. 447-448
• -Requiring use of restraints and seclusion to be documented and reported, with the ultimate goal of eventually outlawing these practices altogether pp. 448-449

The US is the only UN Member State that has not ratified the Convention on the Rights of the Child (CRC)

“First introduced over thirty years ago, the CRC calls on countries to ensure that children’s rights, including freedom of speech and thought, access to healthcare and education, and freedom from exploitation, torture, and abuse, are uniformly upheld” p. 450

First step for federal reform: ensure the passage of SICAA pp. 450-451

Congress can use the Commerce Clause (part of the constitution) to regulate the Troubled Teen Industry because it deals in economic activity that crosses state lines pp. 451-452

The Supreme Court has upheld that many industries are subject to regulation under the Commerce Clause, including: coal mining, credit cards, restaurants that use interstate supplies, hotels, and farming p. 452

The Commerce Clause only concerns economic activity, not violent crime or abuse p. 452

From 2015-2020, 34% of all kids who went out of state to attend a TTI program ended up in Utah pp. 452-453

Using authority from the Commerce Clause, Congress could regulate licensing and accreditation at a national level, impose federal standards for TTI staff hiring and training, and set up laws to protect parents from fraud/deceptive marketing pp. 453-454

“Finally, Congress could enact national safety protocols that residential treatment facilities must follow in terms of banning the use of restraints and seclusion, requirements for emergency preparedness, reporting on critical incidents, and measures to prevent abuse by staff or other residents” p. 454

States may have to be responsible for legislation if the federal government won’t get involved p. 454

States should create a state-based bill of rights for children in TTI programs, potentially modeled on the Foster Children’s Bill of Rights which has passed in 15 states and Puerto Rico p. 454

Programs Mentioned:

Lakeside Academy–Kalamazoo, MI p. 432

Synanon pp. 433-434

CEDU pp. 433-434

The Seed p. 434

Straight Inc. pp. 434-435