QUESTION: As a parent who has gone through this, it was not typical teenage behavior, it went far beyond it. I do think there should definately be regulation of these types of programs. The question is, can our government do well regulating? They sure haven't done much with the foster care system and other programs. What options will parents have if they do not have the wilderness programs or RTC choices? What happens then?
ANSWER :
To be clear, the bill is to intended to protect youth from child abuse, not to shut down residential treatment centers. (See 'On Coercive Treatment of Adolescents ' by: Dr. Huffine
In my experience, being through the system and working for the Mental Health Association- trying to keep struggling youth in their communities, it's clear that there are far more empowering alternatives to residential care. It's also clear that there is not nearly enough funding that goes into these alternatives and that not enough families are aware of how to navigate the system and find resources for much needed support to keep their families together and youth in their home. This is a serious problem and it is my estimation that this is why the private 'troubled teen' industry has grown exponentially.
Additionally, the trend away from state sponsored segregated care has also declined in favor of the far more cost-effective, safe and successful community-based alternatives to residential treatment - likely also contributing to the rise in private placement. In NYC, for instance, an effort has been made to move away from institutionalization. For youth to be placed in residential care (regulated by the Office of Mental Health - unlike 'therapeutic' boarding schools in NY State like Family Foundation School or Ivy Ridge Academy ) in NYC, an independent committee called the Pre-Admissions Certification Committee must review the application to ensure the appropriateness of such restrictive placement and that all community based alternatives have been exhausted.
Inconsistent with the principles of least restrictive care - of note and problematic - are the fact that many youth are involuntarily detained for years, at the behest of parents, educational consultants and school, who are likely unaware of the quality, lack of regulation, outcomes or peer reviewed studies (or lack there of), and strength based alternatives that are family driven and youth guided.
Due to this lack of due process and failure of the government to disseminate this information, many youth are effectively segregated inappropriately, in stark contrast with mainstreaming and the spirit of the IDEA designed to desegregate & integrate struggling youth. CAFETY opposes this lack of due process and we are especially concerned by the characteristics of the industry where care is far more restrictive than that of other programs - state funded, regulated and accredited, as they detain youth significantly longer, often prevent/monitor/censor contact with family, do not allow access to advocates and, in general, impose treatment by force rather than work collaboratively with youth and families.
These programs may claim otherwise or frame the process differently, but as far as I can tell this is never really the case. I am cautious about speaking in absolutes, but I have not heard of an unregulated or alternative program that does not use such methods and I have had contact with literally over a thousand youth.
This is also not to say that youth themselves have not advocated such disempowering methods based on their experiences. As in my program, several survivors speak to the trauma, but frame the 'breaking down' of youth part of the program differently (see link above). It is with great ease that survivors can easily become complicit in their own mistreatment. The fear based and manipulative message 'without us you'll probably die' being ingrained over a few years (as in my case) is not a message easy to get out of your head (also, in my experience). The use of thought control, as somewhat bizarre as it may sound to the general public, is not an uncommon practice - this is as a result of the cumulative effect of isolation, group pressure, the strict control of environment and information and other conditions Dr. Singer identifies linked above. No doubt in my mind exists that this is why it take many years for youth to speak out - often between 2 and 3 years.
I cannot tell you how many youth I've been in contact with that do not tell their family about the painful aspects of their experiences for fear of making their family feel bad - though I can say they number in the majority. All too frequently, simply, they did not know they were abused, or worse, that the abuse was justified and necessary for them to 'get better'. I defended my program, beleiveing that it was therapy, for many years after I left. For more on the experience I defended so vigorously you can watch my testimony here. I have heard from youth who attended Mission Mountain School as late as 2005 that are still experiencing the same harmful practices - those designed to humiliate and undermine self-respect.
In response to your question, is regulation the answer - I don't believe it is, but I do think it's an important first step and is one answer to a multitude of questions and challenges we face in the protection and advancement of the rights of youth and those with disabilities.
I think many programs do not train their staff to note signs of mental and emotional distress, nor are trained in process of reporting abuse as mandated reporters... I think this is why abuse is as widespread as it is and why some staff engage in abuse, sometimes without knowing it to be such - and sometimes is even, abhorrently, called therapy.
I certainly don't think that all abuse will be eliminated, but I know after speaking to countless former program participants that maltreatment and disempowering practices are widespread. In regulated RTF's it is clear that the systems in place are designed to protect youth are by no means flawless. Equally clear is that many practices (often incorporated into the therapeutic milieu ) are not acceptable, are understood to be traumatic or inappropriate in regulated and accredited RTF's, yet these practices are being used in unregulated RTF's.
For this and many other reasons, along these same lines, is why we're not hearing from all that many youth from regulated & accredited facilities or non-private programs. The outcry and sense of disempowerment and injustice is not there. In my opinion, a flawed system is better than no system at all and will give us building blocks to work off of.
The reality is, 'big brother' doesn't exist and we can't watch youth at all times - for this reason CAFETY's advocates open access to campus and that youth are not sent far from home. For this reason we advocate parents listen to their sons or daughters when they object and do not send their child to programs designed to further create a sense of distrust. We are appalled by programs that use escort services, encourage parents to deceive their child and censor contact.
Youth, just like adults, have to form a therapeutic alliance based on trust. To begin therapy from a non-collaborative place does not lay the ground work necessary for real work to begin. For this reason, we opposed involuntarily placement unless a youth is an imminent threat to himself or others.(Also see: The Right to Consent, Competency and Responsibility in Teens - Charles Huffine, M.D.)
What regulation would not do is resolve the aforementioned issues regarding least restrictive care and ensure that best practices (evidence based and practice based evidence) are being used, but my hope is that parents, the state, accrediting bodies and educational institutions will listen to the real consumer, the youth, before shipping them away and detaining them, censoring them, etc etc and that the value of hearing youth is understood, valued and implemented. Such principles must be protected as rights - these are not to be understood as privileges granted. Much of this industry are using youth as guinea pigs - this is not ok. Many programs are using methods that are known to be harmful, this is also not ok. Rights delineated within the Children's Rights Covenant (which the US has not ratified and is the only country that has not besides Somalia - that does not have a recognized government) are those CAFETY would like to see implemented in practice, by law. Programs that do not adhere to strict ethical codes of conduct must be held accountable for human rights violations and social conscious must be elevated to understand the practices that can occur when we ignore these rights or justify human rights violations in the name of therapy.
To be clear, this is not to say that some time apart - away from family, time to ones self and some aspect of wilderness programs aren't helpful or healing in some way. Respite care exists for a reason - as part of keeping youth from being institutionalized. I think that's why these alternative programs are so popular and make sense in a lot of ways. Yet their approach remains inherently flawed in its coerciveness.
Outward Bound is great, for instance - youth are there by choice. Incorporate therapy and willingness, right to consent, right to contact parents, and other appropriate safegaurds, avenues to express grievances, etc, great! As I'm sure you are aware, this is not the case at wilderness programs at present time. There are many aspects that aren't helpful and that can be/are harmful - for instance, I do worry that some (though I have not heard of any exception) wilderness programs use coercive methods, ie. the initial intake process of using escorts or deceit that produce feelings of powerlessness at being kidnapped, confined and isolated (in the wilderness) indefinitely, the manner by which programs hijack legitimate therapeutic terms such as positive peer culture to justify forcing youth into changing (rather than growing), the lack of parental involvement and the general ineffectiveness of forcing change that fails in practical day to day application because real life struggles are very different that those in the wilderness - this as opposed to teaching tools where such tools would be applied and where youth have a chance to practice, fail, learn and struggle applying the tools they learn - which can only happen in the community. I think it goes without saying that abuse and unqualified staff are also of concern.
CAFETY does not pretend to have all of the answers to the problem of struggling families, however we are certain that human rights violations should never be used to justify therapeutic interventions - that human rights violations are precisely counter therapeutic.
Sincerely,
Kathryn Whitehead
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