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10 Harsh Realities Shared by For-Profit Owners of the Troubled Teen Industry

Open Letter from the perspective of current “Troubled Teen” owners and operators.  

To Whom It May Concern, 

The past few years have been tumultuous. More than ever, people – especially Gen Z– are skeptical of churches, schools, teachers, businesses, government officers, and police. The traditional helpers of society are being scrutinized more than ever, especially on platforms like TikTok and Reddit. While I believe this is generally a healthy thing, there’s an unfortunate side effect. The helpers of society are under attack, and mental health field is no exception. 

Paris Hilton has spoken out on her experiences as a teenager in various levels of care and has gained significant national attention because of her brand and platform. Teens and young adults with negative program experiences are flooding online forums to express their anger and frustration at having been sent to a program by their parents or having been held against their will. In some forums, there is talk of trauma, survival, abuse, and mistreatment. The authors commenters of these posts describe being transported against their will or “being kidnapped in the middle of the night.” “How can these programs be allowed to exist?” they ask. 

To be fair, the history of our industry has had its problems. There were and sadly will always be bad actors. You can trace the roots of some programs to questionable leaders, significantly problematic practices, lack of licensing, lack of accreditation, lack of clinical underpinnings, and outcomes-based treatment modalities. State regulations were slim and still are in certain states, and national accreditation ignored this growing field which created trauma in some and success in many. Although not perfect, oversight is growing. Treatment providers interested in best practices are not afraid of this. Over-reporting to a state is not something to be afraid of, even when a program knows it could be used out of context in the media at a later time. We believe in transparency. 

We understand that harsh realities come with mental health and behavioral healthcare treatment. We are in the middle of a widespread mental health crisis. The teen suicide rate is up by over 50% in the last 20 years and is now the second leading cause of death for this age group. In 2021, 9% of high school students reported attempting suicide over the last year. Young people are suffering from anxiety and depression, and families are in crisis. Helping young people struggling with mental health issues is not sexy work. It’s a high-demand, high-risk, and often thankless effort. Why do we do it? Because we believe we can make a difference. We believe in connection, we believe in relationships, we believe families can learn new skills, we believe in the human condition and evolution, and we believe that not all programs are the right fit for a child/teen family.   

Harsh Reality #1 – We know we will be hated by some of our clients. 

Any program that has done formal outcomes-based research knows that, generally, less than 10% of all former participants are unhappy with the experience. There is a portion of the population served that will slander and try to destroy us. You can find negative social media posts and videos regarding every treatment approach. One family member could claim the success of a program because the child is alive, and paying taxes, while another parent or family member could claim it was a waste of time and money. The adult child could state another perspective, and all three of those family members are correct. How outcomes are viewed depends on the person reporting. 

Additionally, there are DSM diagnoses and disorders that can make individuals treatment-resistant. These individuals tend to be very vocal, especially online, about how they are constantly mistreated. This is where it can get very confusing. That said, based on our outcomes research spanning 20 years, including a few meta-analysis studies, an overwhelming majority of the people and families who attend our programs make significant improvements and have a life-changing experience. That is why these therapeutic programs exist. The happy stories are not as exciting. You will rarely hear from the people who are happy with us because they are moving on,living healthy and happy lives. We hope this will change, but families have to put themselves out there, and that is difficult because of the current stigma of mental health and treatment in this country. We see that changing, and we hope more will be vocal. Here are some examples: Op-Eds written by family members.

  • The Charlotte Observer | Opinion – Despite the tragedy at Trails Carolina, families like mine want it to reopen
  • Washington Post | Opinion – A parent’s perspective on the ‘troubled teen industry’

Harsh Reality #2 – We can’t publicly defend ourselves in detail.

We are bound by HIPAA law. That means we can’t share anything about a client with anyone outside of our organizations. HIPAA is a privacy law. It protects the privacy of our clients and it’s a good law. However, if we ever have a disgruntled client who tears us apart in a Google review or a public forum, we cannot say anything in defense of our program as it relates to this client or we will be in violation of this law. We cannot offer context or insight into the accusations being made. A restaurant owner can defend a negative review online regarding a specific incident, and they often do. We cannot. Once in a while, a former staff member of a program will get online to criticize a program. Disgruntled employees are found in every profession, and a program cannot legally share the details about that employee’s tenure or the reason for their termination.

Harsh Reality #3 – We love people and we care. 

This work is a calling. We care immensely about the people we serve in our programs. We are often referred to by people who know us as bleeding hearts. Some people in the press and some loud critics have painted us to be mysterious villains who love to see kids suffer while we secretly count our millions. It’s simply not true. Most of us are highly educated and well-respected in our communities. We are caring fathers and mothers, husbands and wives, friends and dog owners. We just want to help. 

Harsh Reality #4 – The media will almost always portray us negatively.

Negativity and controversy sell in the media. Anyone working with kids is susceptible to intense scrutiny by the press—and rightly so! We believe in freedom of speech and the role the media plays in society. We also understand that the good we do will never make headlines and that our mistakes, real or perceived, will be attractive to the media. We know this when we sign up for this work.  

Harsh Reality #5 – We dislike bad programs and players too.  

The genogram of our field is complex. This is an evolving field. While it would be easy to say, “That’s not us” when looking back on older programs and outdated practices seen on documentaries now, there is a harsh reality that some of the former staff/clinicians/participants of those controversial programs have gone on to start programs of their own and still work in this field. What is also true, is that these individuals are looking back on those experiences and recognize all that was wrong and are actively correcting them in programs moving forward.  Here are just a few that jump out immediately:

  • Staff training, screening, education levels, etc.
  • Milieu management
  • Incorporating whole person and family healing and growth
  • Allowing & encouraging more communication with families
  • Clinical oversight 
  • Licensed clinicians (smaller caseloads)
  • Treatment plans 
  • Educational plans
  • Formal group therapy, family therapy, individual therapy
  • Risk management protocols 
  • Inviting oversight and licensure and engaging with licensing bodies 
  • And so much more.

Harsh Reality #6  – We are all not in this for the money. 

The programs that are created to make money do not last, they go out of business, and often for many, not fast enough. Noone enters the  mental health field for the money. It is a high-demand, high-risk, and difficult career. We are always on call. We work nights, weekends, holidays, and vacations. While this field, like many others, can be profitable and even at times lucrative, it is nothing compared to other professions that offer more financial security and with less risk.  Many of us could have been doctors, dentists, lawyers, and investment bankers, and we would be far more wealthy. We are not motivated by money or status. There is a reason that there is only one private equity firm that currently owns a wilderness therapy program. The economy has been shifting and changing. Finding quality staff in the post-2020 era means paying better salaries – yet the margins are slim for many owner-operated programs. We are in this because we care.

We wish there were more affordable price point options available for families, and recognize that our programs are prohibitively expensive for too many families. Our tuition goes into our staff, our training, and our facilities;it provides complex clinical care, exceptional education, and safe and supportive supervision. This is a resource-intensive service, and this is a societal problem we are addressing. The need for these programs, and the tuition needed to sustain them, is a symptom of a larger societal problem we care about deeply – and we cannot do it alone. We need everyone’s help in supporting legislation that values the rights of individuals, recognizes mental health needs (like the current parity laws), provides resources, and helps bring better options to a wider range of families. 

Harsh Reality #7 – People can, and will, die in our programs. 

This is a devastating reality. It keeps us up at night. It haunts us and impacts our mental health. With unintentional drug overdose and suicide among the leading causes of death for teenagers, we know we are working with a vulnerable population. We spend immense time and resources to run the safest programs we can for the vulnerable population we serve. We have accreditations and licenses. We invest in high staff ratios, medical staff, vehicles, and facilities with safety in mind. Risk management and safety are prime reasons for the high cost of our programs. We invite any and all regulations along with accountability and oversight. Our critics will say we are not federally regulated, which is true, but that does not mean we are unregulated. Healthcare service providers are licensed and regulated by state governments, and we are regulated by the states in which we operate.We also willingly invite more regulations if it will help us help others. Over the years, we have made vast strides in improving the safety of wilderness therapy. We have collectively tracked our safety records for the last two decades and have shown that wilderness therapy. We are not perfect. The research is still happening. However, no matter how hard we try, there will always be a possibility that someone can have a medical – and fatal – incident. We know that if this happens, we will be treated unfairly in the press, our reputations could be destroyed, and our programs may be closed regardless of the circumstances of the death. As program owners, we sometimes fantasize about quitting and taking a job as a barista. We don’t quit because we care – and if we don’t do this work, who will? 

Harsh Reality #8 –  We are conflicted about the practice of ”being gooned” (transport services), too.  

In an ideal world, we would love for every young person who needs help to seek it out and be willing to receive  it. The reality is that some teens and/or their families are too unhealthy and dysregulated to do this. What does a parent do with a child so out of control that they are a true risk to themselves and others? Put them in a hospital against their will? Wait until their child does something so dangerous they are put in jail? Or wait until their child takes their own life or the life of another, whether intentionally or unintentionally? There is no good answer and there are kids out there right now who are at risk of suicide, homicide, drug use, drunk driving, self-harm, sexual abuse, sex trafficking, and more. If not a program like ours, then where? If not willingly, then how? Should these young people be allowed to die? When is it more harmful to do nothing? It’s not okay to do nothing while our young people suffer. Consider yourself lucky if you’re never experienced one of the above scenarios, and don’t pass judgment on a parent who has to make that difficult decision.  

The Association of Mediation and Transport Services (AMATS) worked with the state of Utah to create a registration and best practices. “Being Gooned” is a different process now, and staff are trained in formal de-escalation and trauma-informed skills. To ensure quality, many only have full-time employees on staff, and multiple background checks are completed for each staff member. 

Harsh Reality #9 – We make mistakes. We are not exempt from instances of abuse.

We are evolving, growing, and learning. There are things we were doing ten, twenty, thirty years ago that we have changed. This is true of most fields and industries. For example, lobotomies were widely used from the 1930s to 1950s. Seat belts were invented before automobiles, but not required until 1968. All fields grow and change, and we are dedicated to continuous improvement. Our first duty to our clients is to do no harm. Sometimes we realize a practice or policy we’d created with the best intentions may in fact do more harm than good. Good programs are constantly evolving as we challenge ourselves and work together with other programs to improve our best practices to provide the best ethical care with integrity. We care about our clients and their families and are invested in a positive outcome for every single person in our care. Many of us are investing in extensive research to ensure we are doing right by our clients and their families.  

With approximately 600,000 cases of child abuse reported a year, child abuse is a major problem in America. Even though approximately 97% of abuse is committed by a close family member of the child, we acknowledge the unfortunate reality that abuse can occur in educational institutions, religious organizations, social service agencies, and mental healthcare facilities. Even one occurrence is not acceptable. We are committed to addressing and eliminating this risk to the best of our abilities. In addition to being licensed and accredited, we are dedicated to implementing robust policies, comprehensive training programs, and continuous monitoring to create a safe and secure environment for all clients and employees. Our goal is to foster a culture that prioritizes the well-being and protection of everyone. 

Even when a program is a member of an association, has a national accreditation, practices ethics and values, and is transparent about what they do, does not eliminate risk. If a child or teen needs to be removed from the home, it means that it’s a high-risk situation and that other options have failed. Ideally, policies and procedures are in place to prevent medications being given to the wrong child or teen, and there is still the risk of human error when humans work with humans. This is where parents must investigate, ask questions, research, and accept a calculated risk in enrolling their child. 

Harsh Reality #10 – Why the anonymity? 

Unfortunately, we have seen that there is currently no space in the public dialogue for our programs and our alumni who see their experiences as both positive and negative and are moving forward with their lives and also want to speak about the nuances of their experiences.  We would like to see more alumni and families speak up and add their voice to the conversation, both online and off. 

Our hope is that this open letter is the beginning of a new conversation between programs, regulating bodies, our supporters, and critics. The associations and accreditation bodies to which we belong are committed to ethical and trauma-informed care. We are solutions-focused. We are asking for solution-focused feedback. We as program owners are investing time, money, and resources into more outcomes research. 

If you are a current alumni of a program and that program has asked you to fill out a survey, please take the time to share your honest thoughts, so people can recognize the good we provide and also help us make program improvements. We want to hear from you. We want to work with you. If you are someone who wants to burn it all down, we encourage you to stand up and offer something better. If you’re unable or unwilling to roll up your sleeves and help these young people, we humbly ask you to join us in making things better, and to at least consider the ramifications of removing services without creating viable alternatives. 

To anyone new to this field or seeking a solution for your family: Come visit our programs. We have nothing to hide. Ask us about our rules, food, and policies. Ask us how we screen and train staff. Ask us about our accreditation process and our committed best practices. We care about you and your family. Despite all of the harsh realities, we will not give up. We believe that families can heal.