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An Introduction to the Troubled Teen Industry

Nora Ashleigh Barrie | September 24, 2022

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A child who has experienced trauma will sometimes show they feel connected to an attachment figure by releasing all their big emotions in their presence. What may appear as disconnection may actually be a sign of trust

– J. Milburn

The Troubled Teen Industry (TTI) is a network of private, for-profit programs designed around the concept of helping troubled teenagers improve their lives through strict routine, rigid structure, psychological treatment, and education. This industry is made up of many different types of programs including, but not limited to, wilderness therapy programs, residential treatment centers, therapeutic boarding schools, drug rehabilitation centers, therapeutic religious schools, educational consultants, and juvenile transportation companies that focus on using non-traditional approaches to therapy and mental health care for teenagers in crisis (Krebs, C., 2021).

One issue that needs to be considered when debating the TTI is what is actually being bought and sold in the name of helping teenagers minimize negative and maladaptive behavior development during adolescence. This is a hugely lucrative industry. In government funding alone, programs receive over $23 billion annually. Many state governments send children, especially those in the foster system, to out of state programs using funding from sources including Medicaid and Medicare. There are no records on how much is spent privately on the industry through means such as parents paying fees and tuition for their children to attend TTI programs, but it is thought that more money is spent privately in this industry than is provided by government funding. This could easily be a $100 billion or more industry, but this is unknown due to the lack of recordkeeping and oversight. It is estimated that around 120,000-200,000 students reside in TTI facilities in the United States at any given time. One of the most significant problems within this industry is how it is affecting the long-term mental health of the adolescents that attend these programs (Krebs, C., 2021).

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In the 1950’s, German psychologist Erik Erikson developed his theory of psychosocial development. This theory involves eight stages of development, each with a crucial crisis that must be resolved in order for the associated aspect of human development to be solidified and self-actualized. In what he referred to as the identity vs. role confusion stage, an adolescent between ages twelve and eighteen must overcome the obstacle of figuring out who they are and what their place is in the world. Teenagers spend this period of development testing boundaries and coping techniques while in a state of self-discovery (Erikson, E., 1959).

When this crisis is resolved in a healthy way, it will lead to security in an individual’s sense of self and confidence in who they are as an adult individual as they move into the next stage of development. When an adolescent becomes stuck in a position of role confusion, this can impact their psychosocial relationships with others and themselves. This may present as commitment issues, increased issues with mental health, a diminished sense of self and a lack of self-confidence. If this confusion is not resolved, it can carry these issues over into the next stage, impacting the healthy development that should be occurring during that stage. Sometimes, in the case of children who have experienced significant trauma, some of these issues may already exist as one begins to enter the identity vs. role confusion stage. Because these issues often deal with identity and sense of self, the identity crisis may begin earlier than normal for these children, leaving them in a state of role confusion much earlier in this phase with maladaptive habits that have already solidified within the ego (Cherry, K., 2002).

Role confusion can often lead to many maladaptive behaviors in adolescents. Maladaptive behaviors are behaviors that develop in response to significant stressful stimuli and affect how a person adapts to and overcomes difficult changes. These can lead to many kinds of developmental issues such as social, emotional, and health related problems. In the case of role confusion, these maladaptive behaviors can have significant impacts and outcomes, including dropping out of college, changing majors, drifting from one low-level job to another, difficulty with confidence, and trouble in forming meaningful bonds with others, including their parents, due to problems trusting others. Some examples of maladaptive behaviors during this role confusion might include substance use and abuse, risky sexual activity, self-harm, spending increased time with other adolescents who exhibit and encourage the maladaptive behaviors, and other physically or emotionally dangerous activities. Other traits of those with role confusion are an inability to bond with one’s guardians as well as others around them and feeling as though one has no hopes for their future, leading to a further decrease in self-esteem and an insecure sense of self (Cherry, K., 2002).

When adolescents are sent to TTI programs, there are a variety of reasons, usually based on dangerous, maladaptive behavior. Because maladaptive behaviors can mildly to severely impact an individual’s ability to function in a healthy way, they are many times the main factor in seeking psychological and therapeutic intervention (Gray, 2013). Parents are usually the ones who assess these behaviors in their children and make the decision of whether interventions are needed.

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These parents as well as other caregivers and responsible parties that choose these programs for children, look at these behaviors and compare them to what behaviors society expects from adolescents and desired behaviors parents want their children to exhibit. This comparison is often the deciding factor in choosing these programs. If the individual assessing the child’s behavior determines that maladaptive behaviors are affecting the child or family dynamic enough, they may choose to send a child to one of these therapeutic programs with the intention of helping the child develop healthy behaviors and break their maladaptive habits. (Olson, S., 2019).

Parents may make this decision based on many factors, primarily factors that are affecting the child’s relationships within both the family and society. In some cases, the parent is embarrassed by the maladaptive behaviors the child exhibits and chooses to remove that source of embarrassment from their home and their local communities. The primary and most common reason is out of desperation to help their child adjust and adapt to being a successful adult member of society. This desperation often comes from the fear of potential outcomes of the child exhibiting maladaptive behaviors, such as the fear of teenage pregnancy after engaging in sexual activity or the fear of a child dying after overdosing on drugs. Another common reason for this fear may be the potential for a child to gain a criminal record due to deviant or delinquent behavior patterns. In many cases, this decision to send a teenager to a TTI program is made without the adolescent’s consent or input (Liston, A., 2019).

TTI programs offer a solution for treating maladaptive behaviors when other solutions have not been effective. These programs are primarily residential facilities and adolescents sent to these programs are removed from their family units and their roles in any family dysfunction that is taking place, allowing the family to recover from the effects of the teenager’s maladaptive behaviors. Some of these programs claim to specialize in certain types of troubled teenagers, such

from the mission mountain school website

as those who are adopted, those experiencing suicidal ideation, or those who have other mental health diagnoses. Different types of programs operate in specific ways based on the type of program they are.

Wilderness therapy programs are ones that remove the child from society entirely, removing all distractions and putting children in a mental state where they cannot take anything for granted. These programs take teenagers into wilderness areas for the duration of their stay, often requiring them to live and survive outdoors. These programs usually operate in three phases. First is a phase of isolation and removal of outside distractions, allowing the teenager a period of turmoil and self-reflection on how their behaviors led to them being there, known as a “cleansing phase”. The responsibility phase comes next. This phase focuses on more self-reflection, taking accountability for the teenager’s role in their family unit dynamic and the negative impact their behaviors have on their familial, social, and educational relationships. The final phase is the aftercare and reintegration phase, when the child prepares to return to society by putting together a plan of action designed to address any issues that may arise after they leave the wilderness therapy program. Much of this plan involves coming up with potential obstacles they may face during the early stages of reintegration and ways they might resolve those issues in a fashion deemed acceptable by society (Russell, K.C., 1999).

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Wilderness programs have a therapeutic component, although this looks drastically different from one program to another. Some programs might have daily therapy with guided journal prompts designed to help the child take responsibility for the actions that led to them entering the program. Others may have a therapist visit field sites weekly for individual therapy sessions. Some programs only offer a therapist session upon entry to and exit from the program and others do not provide any mental health care whatsoever. These programs often do not have an educational component, but some do. However, this education is usually below grade level and does not take the student’s prior or current education into account. During these programs, students may or may not have outside contact with their parents through written letters. Some programs do not

allow any communication outside of the program for the duration of one’s stay, which is an average length of eight to ten weeks. Many teenagers will not return home after these programs, but will be sent to longer term TTI programs including residential treatment centers and therapeutic boarding schools (Russell, K.C., 1999).

Residential treatment centers keep children for longer periods of time, often with no set program length, and can sometimes last years. These children usually have significant mental health issues, and the curriculum is solely focused on therapy, mental health care, and emotional well-being. These treatments will include intensive therapy sessions, in group, family, and individual capacities designed to put a constant focus on the issues the adolescent is facing and ways they can work to resolve those issues. Most of these employ an in-house or on-call mental health support faculty that is available to help with acute crises that may develop. These programs may have an educational component, but often do not, or it is not sufficient to allow students to keep up with their peers academically (Residential Treatment Programs, 2017).

Therapeutic boarding schools are similar to residential treatment centers in that they often follow the same process of using different types of therapy to help a teenager heal from the trauma that is causing their issues and maladaptive behavior. These programs usually do not specialize in those with severe mental health issues the same way residential treatment centers do. Therapeutic boarding schools often do not have support staff

that includes mental health professionals. Another significant difference is that therapeutic boarding schools offer a more comprehensive educational program. These schools often have a team of academic instructors that are responsible for teaching courses to students so that they don’t fall behind their peers. Many of these will prepare students for college, offer age-appropriate courses and extra educational support, and provide students with resources to get accepted into colleges or private high schools once they complete and graduate from the program. These programs also offer to allow students to finish high school education on time so they can move on to higher education (Wilder, J., 2022).

Many different therapeutic techniques and approaches are used by these programs. Some of the most common approaches to trauma therapy are used, such as Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT). Other therapies are also utilized, including Acceptance and Commitment Therapy, Parent Child Interaction Therapy, Play Therapy, Psychodynamic Therapy, Supportive Therapy, and Equine Therapy. These therapies are used in conjunction with one another to provide a full range of treatment to the adolescent within the program. Some of these therapies may have been attempted before the teenager entered the program, however, in most cases they were used on their own and not in combination with other therapy. It is thought that combining these can provide a more effective therapy approach when used in an intensive and consistent way (Psychotherapy for Children and Adolescents: Different Types, 2019).

The majority of troubled youth are transported to these programs by juvenile transportation companies. These companies operate in some extremely questionable ways. In most cases, teenagers are woken up in the middle of the night by strangers, even to their parents, and taken under the cover of darkness from their homes and transported to TTI programs. It is thought that using this method of surprise while disturbing sleep will prevent adolescents from attempting to run or get away from the transporters. While being transported, many of these children are physically restrained with handcuffs, leg shackles, and/or blindfolds. This is not short-term physical restraint, as most children are restrained for the duration of their transportation, which can last anywhere from a few hours to days at a time (Solomon, S., 2016).

One tactic these programs use to encourage parents to send their children to them is deceptive marketing. As defined in the Oxford Dictionary, deception means “giving an appearance or impression different from the true one; misleading” (Oxford Dictionary, 2022). Manufacturers in the United States are required

to follow strict regulations and guidelines with oversight from the Federal Trade Commission (FTC) when marketing their products. According to the FTC, advertisements for products “must be truthful, not misleading, and, when appropriate, backed by scientific evidence.” The way companies market their products and the claims they make about those products are closely monitored by the FTC, specifically for deception (Federal Trade Commission, 2022). The FTC has also begun to crack down on for-profit colleges that use deceptive marketing. However, unlike product manufacturers and other types of for-profit schools that have significant monitoring and oversight, TTI programs have no such supervision or requirements on how they may market or operate their programs. In addition, most states completely exempt religious boarding schools from licensing and from oversight that may be required by states for other, non-religious schools. A significant portion of TTI programs claim to be religiously based, but provide no religious services, practices, or education. Furthermore, there are no scientific studies or research that provide evidence that these programs are effective treatment options for troubled youth. Many adolescents come out of these programs with more issues with mental health than they had going in (Krebs, C., 2021).

from the mission mountain school website

These programs claim to want to help children, but there have been numerous and consistent reports from former students and staff of physical, emotional, and sexual abuse, medical neglect, child trafficking, child labor, and many more issues within the TTI since its inception in the 1970s. TTI programs are neither therapeutic or educational. Much of the therapy used is disturbing and unrelenting and is often harsh and confrontational in nature. The use of attack-type therapies in these programs was first developed by a cult called the Church of Synanon, which has strong ties to the TTI today. The first group of TTI programs was established as CEDU, a collection of programs based on the practices of Synanon, by Mel Wasserman in 1976. Wasserman had been a high-ranking member of the Church of Synanon (Szalavitz, M., 2007).

Teenagers are severely isolated from the outside world and their families and contact with their families is greatly controlled. Phone contact with families is often supervised

by staff members while on speaker phone and these phone calls are sometimes recorded. Written communication with families is often read and monitored by staff. This makes it incredibly difficult for students to express concerns about their treatment in the program to their families. Sometimes, if a student attempts to notify their parents of abusive practices within the program, their phone calls will be ended immediately, they will no longer be able to contact their parents by phone, and letters they try to send with any negative information about the program will be destroyed and not be mailed (Use Caution with “Struggling Teen” Therapeutic Boarding Schools, 2014).

Photo credit: diamond ranch academy

The abusive practices these programs utilize are extremely detrimental to students and in some cases, lead to the deaths of children. Deaths within these programs from physically or emotionally abusive and neglectful practices have reached over 380 since 1971. Charles “Chase” Moody was sent to On Track, a wilderness program run by the Brown Schools group of TTI programs in Texas, on October 8, 2002. Within six days, he was dead. Chase had been told to go to bed and stop speaking with other students, but he continued talking. After being told a second time to be quiet and go to sleep, he said no. Chase was then physically dragged from his tent by three staff members before being restrained face-down in the dirt by all three for over 50 minutes, the entire time it took a sheriff’s deputy to arrive (Kotb, H., 2005). When he finally pulled up to the field site, deputy Harold Low witnessed Chase being held, still chest-down on the ground, under three staff members. After handcuffing one wrist, Low turned Chase face-up, and noticed that he was covered in vomit and not breathing (Osborne, J., & Ward, M., 2003). Chase’s official cause of death was ruled as traumatic asphyxiation by the Travis County Medical Examiner, meaning when he was restrained, the pressure on his body caused him to vomit, then he choked on his own vomit (Kotb, H., 2005).

Texas had already banned face-down restraint techniques in their state. However, the staff members that restrained Chase claimed to have done so accidentally. State investigators discovered 28 state regulation violations connected to the incident that ended in Chase’s death. Despite these findings, no sanctions, fines, or other consequences were imposed on On Track, the Brown Schools, or the untrained staff members involved in his death. Chase’s father, an attorney who had defended the Brown Schools in a previous case regarding the face-down restraint death of Brandon Hadden, a child in the care of one of their residential treatment facilities in 1988, filed his own lawsuit against his former client, the Brown Schools. He, like Brandon’s mother, spent years fighting a legal battle with the Brown Schools before agreeing to settle out of court (Kotb, H., 2005).

Article by Nora Ashleigh Barrie | September 24, 2022