Paris Hilton has become the face of the movement against the so-called troubled teen industry as she describes her personal experience at Provo Canyon School in Utah in her documentary “This Is Paris.” Hilton has campaigned in various states for legislative changes and, most recently, from the steps of Capitol Hill advocating for the Accountability for Congregate Care Act, which would establish more stringent oversight and regulations for residential programs geared toward troubled teens.
To her credit, she has partnered with former foster youth on this mission. However, a rich white woman who has spoken out about her experience as a “troubled teen” is not the true face of this issue. The fact is that most youth in these kinds of institutions are not rich white kids who are acting out. They are poor and system-involved, disproportionately of color, and who lack the public platform to voice their experiences.
The massive residential behavioral health services is a huge industry in the United States which preys on states and child welfare systems that are suffering severe shortages of foster care and community-based therapeutic placements, as well as adequate mental health providers and treatment strategies.
States pay anywhere from $300 to over $900 a day to warehouse the youth that they have taken custody of in these residential facilities. But staff are paid minimum wage, lack relevant experience, and are poorly trained, and many of these institutions have been the subject of criminal and licensure investigations. Youth of all ages are involuntarily placed on cocktails of off-label psychotropic medications, which are used as a form of chemical restraint, without addressing their underlying and ongoing trauma, incurred in part perpetrated by the foster care systems they come from.
One of the youth failed by these institutions was Cornelius Frederick. The same month that George Floyd was murdered, and as protests began across the country decrying his death, 16-year-old foster youth Cornelius Frederick placed at Lakeside Academy in Michigan, also died after crying out, “I can’t breathe.” His crime? Throwing a sandwich whereupon he was restrained by 7 people, at least two of which laid across his chest, for 12 minutes.
But as an attorney for children in foster care, and a national expert in children’s rights, advocacy and litigation, I can tell you with certainty that there are far more tragic outcomes from residential care that you will never hear about, because nobody died, or didn’t involve a celebrity. I have heard directly from youth placed by their state’s child welfare system in the institutions run by the behavioral health industry.
A 6-year-old boy, who was physically and sexually abused by the older youth in his cottage. “Was I bad?” he once asked me.
A 9-year-old girl, weighing about 80 pounds, placed in a four-point restraint (pinned by an adult on each limb) in order to inject her with so-called “booty juice,” when she had a tantrum. “Being in a residential facility did not help me,” she explains. “It only gave me more reasons not to trust.”
An 11-year-old girl was on seven different medications, including off-label psychotropics. “They kept switching them around, but nothing made a difference,” she recalls, “they just made me into a zombie.”
A 13-year-old girl isolated in a room with a cot on the floor and steel toilet, such as you would see in a jail cell. She only received tampons for good behavior. After her attorney complained, she was given access to three free tampons at a time, but only if she turned over her used hygiene products to staff. In disbelief she states, “they acted like I was a criminal when I was just a foster child.”
A 14-year-old girl who escaped from a trafficker only to be coerced into sex by a staff member. “The system pimped me out again when they were supposed to help me,” she complains.
A 15-year-old boy who suffered an orbital fracture during a restraint but was denied medical treatment. “Nothing changed,” he explains matter-of-factly, “even when I finally made it to the hospital.”
One might think that children and adolescents who generally enter the foster care system through no fault of their own would be considered in the most positive light, thus maximizing access to resources and positive outcomes. But they face a number of stereotypes and experience social stigma individually and collectively from a very early age.
Oddly enough, this may be due to more common knowledge about the negative outcomes that foster youth face if they age out of the system along into adulthood — including substance abuse, homelessness, incarceration or death. Or, the fact that they are in institutional care in the first place, thereby suggesting that there is something wrong with the youth and not the system itself. A bitter irony, indeed, for the image of youth living in foster care to be shaped by our failure to help some of those who have already experienced the system.
Ultimately, the general public, and prospective pool of foster and adoptive parents, need to have a better understanding of the issues that land foster youth face in inappropriate institutionalization, and states need to build an array of quality foster care capacity for youth to return to. It is not enough for youth to leave these institutions when they can end up in the same or worse conditions due to a lack of therapeutic placement in their home states.
First, the warm and fuzzy PSAs produced by agencies to promote foster care need to be offset by other educational devices showing the reality of the system when seeking to attract foster and pre-adoptive parents. For example, agencies should emphasize children’s physical, mental, or emotional disabilities in relation to adolescent behavior and development and provide ongoing training and support to address them.
Second, there should be ongoing educational requirements on adolescent behavior and development combined with agency support and 24-hour crisis intervention to help support placements.
Third, more comprehensive evaluations of the child should be performed when a child comes into foster care, and during the life of their case. In the short term, more thorough evaluations may assist in the creation of a treatment plan that can best help the children through the trauma they have experienced. In the long term, these evaluations can provide important information as children grow up in the system and can help inform if the proposed placement is indeed equipped to handle the needs of the youth. Moreover, emphasis must be placed on identifying and securing quality and consistent mental health services.
Finally, the predatory nature of the behavioral health industry needs to be widely reported, and foster youth who have first-hand knowledge of the programs should be profiled. Youth like Cornelius Frederick, who while no longer among us, can still help to draw attention to the abuses which occur and the fact that states are desperately in need of service and placement array to care for the youth that they are obligated to parent.
Ultimately, these youth need homes, not institutions. And as a society, we need to care for all children, not just the ones that most resemble us.