Despite mounting pressure and evidence of physical, sexual and emotional abuse of children in residential treatment centers nationwide, legislation to curb harmful practices in the “troubled teen industry” has so far failed to reach the halls of Congress.
But lawmakers and advocates for young people who have survived traumatic experiences in centers housing foster children, youth on probation and teens placed by parents, say legislation is forthcoming.
Oregon Sen. Jeff Merkley (D) and California Rep. Ro Khanna (D) told The Imprint that they intend to introduce a bill called the Stop Institutional Child Abuse Act. Key Republican support is now being sought.
Merkley’s office described the future legislation as “a federal-state partnership to significantly increase individual protections and accountability for youth in residential facilities and programs.” It would achieve that through expanded licensing and a “best-practices commission.”
In an emailed statement, a congressional staffer described the negotiations under way:
“Sen. Merkley is working with Republican colleagues on changes to put forth a strong bipartisan bill in the coming months.”
Last fall, Khanna and several other Democratic lawmakers appeared alongside an unlikely ally in socialite and media executive Paris Hilton — who has gone public with her abusive experiences in a Utah treatment program where she was sent as a teenager. They vowed to introduce legislation to increase accountability, create a bill of rights for youth in congregate care and set national standards that licensed residential programs must meet or be forced to close.
An initial proposal emerging from that event, the Accountability for Congregate Care Act, was renamed the Stop Institutional Child Abuse Act in May. Several Republican lawmakers tweeted enthusiastically about their meetings with Hilton, and supporters say the bill’s provisions have since been under negotiation between Democrats and Republican lawmakers.
Among the key proponents of federal legislation is Breaking Code Silence, an advocacy group for young people sent to residential centers where they experienced harm. They refer to former residents as “survivors,” and have partnered with the hotel heiress to advocate for federal legislation to curb the group home industry.
Breaking Code Silence’s main aim is passage of a bill of rights for all children placed in congregate care settings, and guaranteed protections from forced seclusion, physical restraints and monitored phone calls, so that residents can speak privately with family. A bill of rights would also require basic necessities, which activists say are not always provided in group care settings, such as sanitary conditions, adequate food and medical care.
“We’re really trying to make sure that the children are protected first, and then we start working towards making sure the staff is fully licensed and that they have the credible background that they need to actually work in that industry and work with those children,” said Bobby Cook, chief operating officer for Breaking Code Silence.
Cook, who was sent to Hidden Lake Academy in Georgia between 2002 and 2004, said his group wants to make sure “no child will ever experience the trauma that we went through again” — whether it was two or 20 years ago.
Activists also want public attention brought to the taxpayer interests in these programs: agencies that are heavily reliant on public health and education funds from states and the federal government.
Hundreds of thousands at risk
A brief published by the American Bar Association defines the multibillion-dollar “troubled teen industry” as “a network of private youth programs, therapeutic boarding schools, residential treatment centers, religious academies, wilderness programs, and drug rehabilitation centers” that date back at least 50 years. The facilities are run by private companies, nonprofits and faith-based groups, under agreements that they will help children and teens with mental health problems, addictions and antisocial behaviors.
Hundreds of thousands of children are placed in these institutions through the foster care and youth justice systems, and tens of thousands more are placed by their parents. Yet “despite numerous allegations of serious abuse that date back decades, they continue to operate in a largely unregulated way,” American Bar Association attorney Cathy Krebs stated.
Exposés include “Far from Home, Far from Safe,” a December 2020 investigation by The Imprint and The San Francisco Chronicle that revealed children sent to facilities run by the for-profit Sequel Youth & Family Services had been slapped, choked and punched by staff members. The news followed national outcry after a 16-year-old boy was killed by Sequel staff who pounced on him for tossing a sandwich.
Physical, sexual and emotional abuse has also been exposed at facilities run by nonprofits Devereux Advanced Behavioral Health, the Glen Mills School in Pennsylvania, and a network of Christian-run homes known as Teen Challenge, exposed by The New Yorker last year. Many more abuses are listed at facilities nationwide, documented by disability rights monitors.
Diane Smith Howard, a managing attorney with the National Disability Rights Network, has been working with lawmakers crafting federal legislation to address these harms, providing information on residential care and sharing clients’ experiences with members of Congress.
Her Washington, D.C.-based organization released a 2021 report, “Desperation without Dignity,” that described disturbing conditions in for-profit facilities that professed to provide care and treatment — everything from sexual abuse by “trusted” staff to the excessive use of psychiatric medications and chemical restraints.
“The perpetuation of abuse, coupled with insufficient accountability for such behavior, leaves already vulnerable youths subject to re-traumatization and exacerbation of their behavioral and mental health symptoms,” the report concluded.
“The things that we’ve found are just horrific, just like stomach-turningly horrific,” Howard said in an interview.
She and other advocates say states must increase the quality and availability of community-based services for children, so they don’t need to be sent to private residential facilities far from their families.
Federal legislation is also needed, Howard said, because given the heavy reliance on out-of-state facilities, local officials have limited capacity to monitor the facilities and address issues that arise. She added that “an enormous amount of Medicaid funding” is spent on residential treatment and “if Medicaid funds are not being spent appropriately, then that is certainly a federal role.”
‘The kids are not alright’
A February report — published by a watchdog group that works to expose the harms posed to the public by private equity firms — has raised concerns for staff at the facilities, in addition to the youth sent to live in them. In the “Kids Are Not Alright” report, the Private Equity Stakeholders Project identifies Bain Capital, Altamont Capital Partners, Centerbridge Partners, Wellspring Capital Management and Trinity Hunt Partners as working in “key areas of youth behavioral services,” and concluded that the “private equity business model, which focuses on outsized returns over short time horizons, may prioritize profit over the well-being of children.”
The report’s author, researcher Eileen O’Grady, found that “cost-cutting tactics” at private equity-owned companies, such as laying off staff, relying on unlicensed workers and failing to maintain facilities, “can lead to abuse, neglect, and unsafe living conditions for youth.”
O’Grady also described how private equity firms “have in some cases reaped massive profits” off this model. Her report argues the firms’ labor strategy relies on underpaying and overworking employees, offering scant training, and only hiring just enough staff to stay within federal and local regulations.
“Private equity firms’ singular focus, when they buy a company, is how they can generate as much revenue as possible over a very short period of time,” Grady said in an interview. “In many cases, that means that they’re trying to double or triple their money in three to five years.”
Centerbridge Partners, Wellspring Capital Management and Trinity Hunt Partners did not respond to email requests for comment. A Bain Capital spokesperson declined to comment.
The Palo Alto, California-based Altamont Capital Partners acquired a majority stake in Sequel Youth & Family Services in 2017, adding to its diverse portfolio that has included Planet Fitness and Billabong. In August of that year, a previous owner, Alaris Royalty Corp., reported generating a $71 million profit for its investors, amounting to a 23% annual return, on its investment in Sequel, which at the time ran 35 residential treatment centers in 16 states.
Under blistering public scrutiny, Sequel has been forced to shut down or sell many of its facilities, one by one. As of Thursday, the company’s website was a mostly empty landing page with an “Information Request” form.
Sequel representatives did not respond to a request for comment. Altamont Capital also did not respond to requests for comment.
Stiffing workers hurts vulnerable kids and the employees, the nonprofit Casey Family Programs has found. High workloads and high caseloads equal high stress, emotional exhaustion and endemic turnover, causing “a domino effect” that can result in failure to meet professional standards.
Several residential youth workers who spoke to The Imprint on the condition of anonymity said conditions for workers, in turn, make it hard for them to properly care for the often deeply troubled children entrusted to these facilities. Workers in Minnesota and Colorado said they worked successive double and even triple shifts due to a lack of staffing.
And while youth service workers shared stories about the meaningful connections and deep empathy they share with their clients, many felt that the job is virtually unsustainable. Frontline staff make little more than fast-food workers, even those with bachelor’s degrees in psychology, and they manage as many as seven or eight children at a time, young teens who act out volatile emotions and severe behavioral problems.
One worker in Minnesota, who feared having her name and workplace identified would jeopardize her job, said she would leave work so worn out, “it was to a point where it was genuinely not safe for me to drive home — let alone be watching kids who are at risk of harming themselves.”