In 2005 I heard the first rumor about Paris Hilton going to one of the now-defunct CEDU programs. Folklore or truth, it did not matter because it is a fantastic story. And the truth is the CEDU model, the CEDU schools, therapeutic boarding schools, or the Troubled Teen Industry was no laughing matter in the 80’s and 90’s. Many who attended these programs in those years are still struggling with their experiences and yet, like with any story, there are those who believe the experience changed their lives or kept them safe from themselves.
This blog is not intended to negate the experience of those who were not hurt, or those who may still struggle with their own experiences.
The first goal of this blog is to discuss some of the changes and developments in the industry from the perspective of current professionals in the field, some of whom are former students who worked at or attended CEDU Programs during the 1980’s and 90’s. (The included stories do not include identities, to allow people to maintain requested confidentiality.)
The second goal is to directly address the profound and critical differences between what happens today in licensed, nationally accredited behavioral healthcare treatment programs, as opposed to the troubled teen programs, such as CEDU, from the 1980’s and 90’s. Discussing the two time periods is like comparing a Commodore 64 to an iPhone - both are computers and there is a historical thread that can even link the latter to the former - but they are not the same, and comparing them as such is unfair to both iterations. While they share some history they are and not the same thing.
Research, best practices, state regulations, and in- or outpatient options have changed drastically in the last 20+ years, and continue to evolve based on brain research and research on diagnosis like autism, anxiety, depression, trauma, addiction/recovery, etc. These 12 characteristics are just some of the many changes that have improved the field from the earlier days. As I was recently told, by a former client who is involved with a teen program now, “Nothing is the same from where I work and what I do and that is ok with me.”
1. There were no treatment plans in the early days. Clinicians were not even employed at the CEDU programs until 1995 or 1998 (depending on the program). NOW: All teens and young adults in treatment programs have a treatment plan that is developed and tracked by the clinician/clinical team. The treatment plan is developed shortly after enrollment, and it is required to be kept up to date by most state licensing regulations and nationally accrediting bodies. The key now is that licensed therapists are part of a clearly-articulated treatment plan.
2. Smooshing was the practice of laying on one another and often included males and females, and often mixed staff with students. This was not required. However, Now, this would be a reportable offense to the licensing department in the state that the treatment program or therapist is licensed. While the intentions of the practice were reportedly to provide connection and attachment to participants, the long-time abandonment of this downright creepy practice is a very good thing.
3. CEDU did not have licensed clinicians until 1998. CEDU programs were not clinical in nature when they first began. They were, at best, behavior modification programs with levels and “workshops” that were not clinical nor did they have any clinical underpinnings. Workshops were described by many as a “break you down and build you up again” model for intervention. While this approach may have been effective for some participants, it also threatened to traumatize or retraumatize participants (see 4 for why this could have been a problem). The goal in this was to have the student expose the darkness they lived in and believed about themselves, and then bring them into the light, with the goal to provide space for the student to get rid of their shame and guilt, therefore, allowing them to be happier and lighter. NOW: If a treatment program has behavior modification as part of its treatment program or milieu it is an integrated approach with licensed clinicians, a treatment plan from the onsite as part of the treatment of the teen’s process. Clients are not forced to reenact traumas, nor are they “broken down to be built up.”
4. Admissions Criteria CEDU was putting students in their programs without a focus on the clinical diagnosis of the student (anxiety, depression, ADHD, etc), the application of diagnosis-driven treatment, or any consideration of the implications of indiscriminately mixing certain types of clinical or behavioral profiles. There were students enrolled who struggled with anxiety and those who acted out behaviorally. They were all mixed together and the staff generally treated the group, rather than the individuals. Additionally, there were not the clinically-informed options for families in the 80’s that are available out there today. If a child attempted to hurt themself, run away, or was using drugs there were no IOPs and few outpatient clinicians where a family could seek counseling. NOW: There are treatment programs that are gender-specific, not just coed, and often group membership and group treatment goals are based in terms of the diagnoses that they treat. Clients receive best-practice informed interventions specific to their diagnosis, and therapeutically-managed milieus are actively managed and monitored to protect clients, staff, and the program culture.
5. Communication/Access to Home and ‘Real-World’ The CEDU model was “incredibly restrictive” when described by a former student, in regards to access to family and past friends. There was 1 phone call every 2 weeks for 15 minutes between student and parent, and these calls were monitored by senior students or by staff members. Letters that came into CEDU were screened going out and coming in. (Remember, that long-distance calling cost money during this time & communication prior to cell phones and email was very different than it is today.) NOW: Today each residential treatment program varies in how they handle family communication, depending on the state that the treatment program is operating in and the level of care that the student is enrolled in. Communication with family is now tied to treatment goals, the level of treatment that the teen is enrolled in, and tied to the treatment plan. Therefore, some treatment options are highly restrictive in terms of communication and privileges, while others allow enrolled students to have cell phones (social media, etc) from their enrollment date. There are others who allow for calls once a week and slowly work up from on-campus visits with family to off-campus visits in the community and eventually developing home visits and access to electronics and social media as an integrated part of a comprehensive treatment plan.
6. Average Length of Stay - CEDU parents who enrolled their teens were told the average length of stay was 26-30 months, with graduation dependent on the successful completion of a level system. NOW: Average length of stays can be 9 months to a year plus, and progress is monitored by treatment goals.
7. CEDU model was authoritarian, rigid, utilized heavy consequences, and was highly confrontational. All personal work related to ‘propheet’ themes and disclosures that were integrated into +24-hour long workshops that relied on limited food and sleep, as well as other elements, to elicit highly emotionally-charged responses from clients. CEDU students were not supposed to share what happens at the 'propheet’ with other students who had not been to the workshop, adding to a level of secrecy and isolation. A heavy emphasis was placed on any trauma experienced prior to coming to CEDU, or other deeply personal issues from the past, and these were expected to be disclosed and discussed in great detail during these marathon workshops. There were no clinicians running the disclosures or workshops, and the experience was often traumatizing for participants - and some staff. NOW: Licensed therapists offer weekly individual and family therapy sessions as part of a formal treatment plan that exists to move the child forward in treatment. The number of individual sessions depends on the level of care and the treatment model that the program is running. Most treatment programs now focus on being relational, however, how that relational model is executed differs greatly and varies through the level of care. Therapists are assigned to a student based on diagnosis or clinical issues. Therapists communicate with families regularly. While a program can still utilize a “process group” to work on social skills or group dynamics, group therapy sessions are facilitated by a therapist (recreation, equine, art, or otherwise).
8. Music and Freedoms - At CEDU, access to music was tightly controlled. Even saying names of certain bands like Led Zeppelin could land students into trouble. Dress code, jewelry, hair length, and color, or anything that could allow for external expression was not allowed. As a participant progressed through the program, they received more freedom. NOW, the level of care of the residential treatment program governs how much access to music and free time or how free time is monitored. In higher levels of care things related to self-expression are generally permissible during non-academic hours - unless clinically inappropriate, offensive or they pose safety concerns. In general, students have a significant say in many topics that do not involve safety concerns. At many RTCs, clients can even bring any musical instrument they want.
9. Staff Training & Staffing Ratios- CEDU staff was primarily trained by going through the program, and the 'propheet’, with students. Therefore, staff and students could be in the same level of the program. Even in the early days the program was required to have background checks, although fractured reporting systems functionally limited the efficacy of such checks. Once therapists and medical personnel came in to the CEDU programs training did happen with clinicians and senior staff. Additionally, CEDU staffing rations often approached +20:1 because senior students were considered a part of the staffing model, providing direct supervision over newly-enrolled students. NOW, line staff, clinicians, and anyone working at any level of treatment program must pass a comprehensive background check. There are other criteria before being hired that depends on the level of care,like the level of education, minimum age, years in recovery and living a sober life, etc. There are medical directors, licensed clinicians, educators that are state-licensed and trained and hired for teaching. Staffing ratios are now mandated by states and it is not uncommon to have a 4:1 ratio in Wilderness Therapy or residential treatment. The lower levels of care can be 6:1 or 8:1.
10. Academics at CEDU - Students at CEDU did not start full-time academics until 12 months after enrollment. Any academic focus was a distant second to the “emotional growth program” (which was administered without clinical or therapeutic oversight). NOW: Any treatment program that is offering academics has licensed teachers on hand and academic accreditation. Even if there is remote or online learning there are teachers at the treatment program to support the learning process. The level of academic rigor varies from a treatment program to program and the length of the program. The other piece that is different is all high school or middle school treatment programs have an academic accreditation from a third party or the state accredited the school. Some of these programs offer more academics than others.
11. Medication at CEDU was not an option when CEDU first began. Any medication was considered “overprescribed and generally bad”. There was no nursing staff or medical staff in the original programming. NOW: The licensed level of care directs the number of medical personal contracted and on campus. Often, there is a health center and medical director or doctor on the campus. How often a teen sees a medical professional in a treatment program depends on the level of care, urgency, and treatment.
12. Consequences at CEDU were intense, as the practical theory was that verbal and emotionally harsh confrontation created guilt and shame, and that remorse led to “breakthroughs” that made for a healthier child. Peers were expected to assist in this often aggressive confrontation, as the ability to confront peers was one way to “demonstrate progress,” advance through the levels, and get closer to graduation. There were also work assignments and work projects, which varied from practical to arbitrarily punitive. Work assignments could be things that needed to happen on the campus (shovel snow, clean cabins, move mulch, etc), or designed to “prove a point,” such as digging a hole - and then filling it back in - to signify the thoughtlessness of a transgression. Other times, consequences were designed to remove students from the community (“bans” were assigned if a student could be physically present but was not allowed to speak with peers), or provide ways for students to give back to the community after taking something. For instance, a student who needed a foundation for themselves and time to reflect might be asked to build themselves a bench - and then could later be found sitting on it, in either isolation or contemplation - depending on one’s perspective. Guilt, shame, isolation, physical labor, and public humiliation were all considered justifiable consequences for transgressions. NOW, confrontation depends on the level of care and how the treatment model runs, but the goal is growth, not guilt. Generally speaking, consequences are tied to and appropriate to any infraction, justifiable within a treatment team, and they are managed in a way in which a student learns accountability without sacrificing self-worth.
There are many more than just 12 differences between CEDU programs and now. Additionally, the true evolution of adolescent therapy and treatment options has occurred over the past 20+ years. This is a good thing, and teen treatment has gotten significantly safer, more sophisticated, and specialized. There are not as many “one size fits all” programs, and interventions are designed to address specific diagnosis and treatment goals.
If you are a parent investigating treatment options for your child, ask questions, inquire and ask about the treatment program or wilderness therapy programs’ history of the program if it has been around, why a particular treatment model is being used and do not be afraid to ask the direct and hard questions. Also, do not expect to find reputable treatment programs operating in the way they did when Paris Hilton was a client. Avoid comparisons to today’s sophisticated and clinically-informed treatment options with the shortcomings of past program models.