As much as we appreciate Representative Miller’s efforts in introducing H.R. 911, and the bill’s efforts to stop Child Abuse and Neglect in Residential Programs, we would like to address how this bill does not deal with the issue of whether a particular form of residential treatment is either therapeutic or appropriate, and how we as a community can address these issues on a grassroots level.
While it is easy to identify practices that are clearly abusive, as the stories that Nick, Kat, and Chris shared with us clearly demonstrate, there is a gulf between what research tells us is effective treatment, and the actual practice of at least some residential programs. Research done on Wraparound Milwaukee, one of the most well known and cited systems of care projects, identified these principles when it comes to using residential care as a best practice:
• Residential treatment is part of the continuum in systems of care.
• Residential treatment should be short-term, anywhere from 30 to 90 days.
• Targeted behavioral and mental health needs should be the focus of residential treatment.
• Care planning should remain with the child and family team and not switch to a different team that just focuses on the residential treatment.
• Family involvement should be supported and families should be drivers of the plan, and youth should have the opportunity to guide the plan.
• The outcomes for the residential treatment stay should be very clear and time-limited.
• Residential treatment centers should provide a broader continuum of care.
These are widely accepted principles that are shared not just by community-based service providers, but by the same residential providers that came out in support of H.R. 6358 (now H.R. 911), including the Child Welfare League of America and the American Association of Children’s Residential Centers.
However, not everyone feels that residential treatment should be short-term, individualized, and targeted.
Take CRC Health for example. CRC Health is the largest private behavioral health agency in the country. Aspen Education Group is their subsidiary which runs their residential programs for youth. The following is taken from their website:
CRC Health's Youth Division consists of therapeutic and educational programs for children and adolescents struggling with academic, emotional, and behavioral issues that have hindered their success at school or at home. Whether a child is confronted with learning disorders, ADD/ADHD, Asperger's syndrome, or high-functioning autism, or is displaying defiance, low self-esteem, anger management issues, negative peer relationships, adoption issues, or depression, CRC has a program that can help.
CRC has a program that can help. Name the problem and they have a solution. They even have weight loss camps you can send your kid to for thousands of dollars a month.
I have had the opportunity to see the mechanics of these programs, and witness firsthand how far in opposition to well-established research and system of care principles that these programs operate.
I had been working with a youth as a care coordinator whose mother was struggling to find appropriate treatment for her daughter. Even before her first hospitalization, her psychiatrist was recommending that she consult with an educational consultant for a therapeutic boarding school. The consultant recommended New Leaf Academy in North Carolina. A little about New Leaf Academy from the company’s website:
At the time of admission, our students are between 10 and 14 years of age. As peer pressure, family relationships, hormonal and physical development, and academic pressure begin to collide, they can create "the perfect storm" in a young girl's life. The result can be anger, frustration and doubt. Our 18-24 month program teaches positive self-expression, responsibility and helps troubled young girls and their families transition to a better place.
Just let that soak in for a little bit. The answer to teenage angst is…another program! Not family therapy, not a mentor, not some kind of in-home behavioral therapy. Aspen once again has the solution to your family’s problem, send your kid to them and take the next couple years of parenting off, all it will cost you is about $120,000.
This was a child that barely qualified for our Wraparound Services, and would have never qualified for our long-term RTF level of care, yet at the same time, New Leaf was ready to accept her with open arms and her psychiatrist who should have known better was ready to send her, irrevocably separating parent from child at a critical stage of adolescent development.
My other anecdote comes from a program that is about to be the subject of a Supreme Court case. A case that I’m sure many of you will be writing or participating in an Amicus Brief, where you’ll be supporting the parent’s right to receive a Free and Appropriate Education from their school district, even if they never received special education services from that school district before.
The program that the parents bypassed their local district’s special education services for is Mount Bachelor Academy, another Aspen program.
In preparation for our own Amicus Brief we spoke to some students who attended the program, here are some of things they told us about Mount Bachelor Academy:
1. The only communications that students are allowed to make to the outside world are 10 minute calls to parents once a week that are strictly monitored. All letters are censored coming in and coming out.
2. Most of the traditional treatment is done via 5-hour-long group therapy sessions, where students are required to reveal their innermost secrets and deal with them in front of an entire group. Individual therapy is not offered. And no drug use, abuse, or addiction specific treatment is given at any time during the course of the program.
3. The climax of the "treatment" offered by MBA is the Lifestep (tm) known as Promises. One youth reported being woken up at 2:00 in the morning, and driven to Portland, Oregon in a van where she was dropped off in the city’s sex district for four hours to fend for herself because one of the issues the program said she needed to deal with was her promiscuity. They told her that unless she decided to “work the program” that the street corner they dropped her off on is what she could be looking forward to in the future. For the young people who used drugs before coming to the program a common drop-off point was under a bridge in Portland where it was common for the homeless to congregate.
I chose to share this information about Mount Bachelor Academy and New Leaf Academy specifically for the reason that they are not considered the worst programs. Mount Bachelor Academy is even regulated and accredited by the appropriate agencies in the State of Oregon. While H.R. 911 as currently written would at least lift the communication restriction that MBA uses, it wouldn’t require it to change much of their program practices.
The take away I would like to leave you with today is again something taken from the mouths of CRC themselves in their annual report:
We face significant competition from established treatment providers as well as new entrants. We compete directly with a wide variety of non-profit, government and for-profit treatment providers, and this competition may intensify in the future. Non-profit and government providers may be able to offer competitive services at lower prices, which may adversely affect our revenue in regional markets and service categories in which we compete with non-profit and government providers.
Even after we ensure the physical safety of youth that go these programs, what we are still left with are money making enterprises that develop relationships with key entry points into residential care, use slick advertising to create an artificial demand for their services, enroll youth who in our public system would never even see the door of a long-term residential program, and then use social isolation, sleep deprivation, and community pressure to conform as their primary tool for treating young people, and creating their next generation of social marketers. This is not therapy, this is thought reform.
It will take the entire advocacy community that knows and understands this key distinction between therapy and thought reform, to starve this beast by reducing the demand for these programs through the education of parents, the education of schools, and the education of providers, both public and private. CAFETY has started this process by conducting workshops at a series of National Conferences, by identifying young people who have attended programs to provide testimony at legislative hearings, and by organizing letter writing campaigns to Congress. If you have any additional questions about the Supreme Court case or about how you can get involved in some of the grassroots efforts that are already underway, I would be happy to speak to you once our presentation is over.
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