Outdoor Therapy Outfits Get Beat Up

San Antonio – Under the broiling Texas summer sun one day in June, a man known as both pastor and commandant tied 15-year-old Stephanie McClintock to his truck and drove away – slowly enough, he thought, so that she could jog along. She couldn’t; she fell and was dragged along the dirt road.

Charles Flowers – the spiritual leader of San Antonio’s Faith Outreach Center and the chief disciplinarian of its Christian Boot Camp in Corpus Christi, where McClintock was dragged – was charged with abuse and pleaded not guilty. Boot camp watchdogs and various bloggers condemned him, while alumni of his camp credited him with saving their lives and faith leaders led a demonstration here to support him.

That dichotomy typifies the debate over outdoor-oriented private residential programs for youth, which serve primarily middle- and upper-class kids through such strategies as boot camp discipline and wilderness therapy.

Tales of abuse emanate regularly from these unevenly regulated facilities, but many parents swear that the programs have saved their children from drug abuse, prison or death. Now for the first time, the federal government has tried to measure the extent of abuse at such facilities, and lawmakers are vowing to bring them under more government control.

A report released last month by the U.S. Government Accountability Office (GAO) could not identify a single federal agency tracking abuse cases in private residential treatment programs, but did find “thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country from 1990 to 2007.”

It examined 10 of those deaths and found disturbing patterns in staff behavior. House Education and Labor Committee Chairman George Miller (D-Calif.) promised legislation to monitor and regulate the industry. While residential treatment administrators called the report misleading, major trade organizations are racing to help distinguish high-quality providers from abusive ones.

“We don’t want to be known as a group to protect members,” says Craig Lamont, vice president of the board for the National Association of Therapeutic Schools and Programs (NATSAP). “We want to be known for protecting kids.”

Little Self-Monitoring

“What we’re most interested in is making sure that what people are saying in their promotional materials actually supports what’s going on in their real programs, that people aren’t making promises they can’t keep.”

That’s what John Reddan told Youth Today in 1999, when he became the first director of the newly created NATSAP. Eight years later, the mantra remains largely the same.

“Our fundamental emphasis is to create high standards and separate from programs that don’t agree with that,” Lamont says. “We want to move toward helping state agencies govern us.”

But as the dearth of concrete figures in the GAO report shows, there seems to be little, if any, systematic effort to monitor such programs.

And assessments of their effectiveness have been scant. The industry says it is beginning to find statistical backup for its approach.

Ellen Behrens of Canyon Research and Consulting tracked 1,027 adolescents through their first year after participation in one of nine programs run by Aspen Education Group, a major residential treatment provider.

Behrens asked youth and their parents to assess the severity of youths’ behavioral problems and their ability to function in the family, and also tracked their academic performance.

Her April 2007 report, “A Multi-Center, Longitudinal Study of Youth Outcomes in Private Residential Treatment Programs,” said 84 percent of parents reported severe behavioral problems at admission to a program. Twelve months later, only 22 percent reported severe problems.

Both parents and youths reported equally high improvements in family functioning. Grade-point averages for participants went up from a C average to a B-minus.

In some ways, Aspen programs serve as a microcosm of the industry. Its demonstrated success is offset by at least two youth suicides at its facilities in recent years, and one death this summer from a youth who may have been denied proper medical attention. The latter case is under investigation.

Many Allegations

Those stories, as reported by newspapers, sparked the interest of Miller, who in 2005 introduced the End Institutionalized Abuse Against Children Act. It would have rewarded states with federal grants if they did more to inspect and regulate child treatment facilities. It languished in a subcommittee.

Miller’s office says he asked the Justice Department to investigate the extent of abuse at the facilities, but was rebuffed, so he turned to the GAO. The agency set out to determine whether allegations of abuse were rampant at private residential treatment programs, and to examine the circumstances surrounding fatalities.

Its report, “Concerns Regarding Abuse and Death in Certain Programs for Troubled Youth,” essentially says yes to the first question. Among other findings, it says that in 2005, thirtythree states reported 1,619 staff members involved in incidents of alleged abuse in residential programs.

In its review of 10 teen deaths between 1990 and 2004, the GAO noted three common factors: untrained staff, inadequate nourishment and reckless or negligent operating practices. Perhaps most frightening is that GAO found several cases where a staff member was involved in different deaths at different facilities.

“There is a clear need for stronger industry regulation,” Miller says in an e-mail.

The Industry Responds

Industry leaders say the GAO report is misleading. For one thing, they say, it blurs distinctions between different types of facilities, and lumps the facilities together statistically.

The GAO could not separate abuse claims at public facilities from those in private ones, although it set out to focus on the private side. Researchers could find no federal agency that collects comprehensive data on abuse claims at such facilities, so they compiled claims listed in the National Child Abuse and Neglect Data Systems and on websites that post allegations from past participants in residential treatment programs.

In the end, the report concedes, “we could not determine the numbers of incidents of abuse and death associated with private programs.” So the data are about both public and private programs.

“They just took all the private and public data, rolled it into one figure,” says Lon Woodbury, who publishes Woodbury Reports, an online resource for parents who are considering sending their youth to such programs. “I think it’s safe to say the larger part of abuse is in public facilities,” especially if boot camps are included.

Woodbury chafed at the report’s inclusion of boot camps (the vast majority of them are publicly run, he says), which skewed headlines because the camps are a hot public topic.

“The whole industry was being labeled as that in the media,” he says. Flowers’ camp in Corpus Christi takes some youths from public agencies, but most are placed by their families.

At NATSAP, Lamont complains that pooling the data about disparate programs painted the entire field with the same brush. “I get defensive when I clearly can see a difference in quality between [NATSAP members] and public or other private programs,” he says.

At the Albany, Ore.-based Catherine Freer Wilderness Therapy Expeditions, which offers wilderness therapy programs as well as an outdoor therapeutic school, Chief Operations Officer Paul Smith says a case study of a 2002 fatality at his agency was factually inaccurate. The report describes a 15-year-old California teen who died of a heat stroke complicated by recent use of methamphetamines.

“The EMT on the expedition had recently completed classroom certification and had no practical field experience,” the report says.

For starters, Smith says, the teen was from Arizona. More importantly, the staff knew about her recent drug use and allowed her to participate after a thorough examination.

The EMT on the scene was new to Freer but had worked in outdoor settings with other groups, and was accompanied by two staffers trained as wilderness first responders.

Changes Afoot

Despite such complaints, few industry leaders dispute the report’s general point that abuse in the field is a problem that has to be better monitored and controlled.

“We don’t want to be defensive,” Lamont says of the abuse claims. “We are taking that GAO report as an official complaint.” He says NATSAP’s ethics committee will look into some member programs for which the GAO reported abuse claims.

Since the report’s release, Lamont says, NATSAP adopted a plan to track deaths at any of its 181 member programs. In the event of a fatality, the member organization must produce a report stating the facts of the situation, analyze what went wrong and present a plan to correct any problems.

He said NATSAP might impose a damages clause on members, which would allow the association to sue a member if it were “deceived in any way” about the nature of the program or the member’s agreement to adhere to NATSAP standards.

The GAO’s final report on the subject is due in early 2008, according to Miller’s staff.

“The legislation that we introduce would make the federal government and states partners in the effort to regulate the industry,” says Rachel Racusen, spokeswoman for Miller’s committee.

Contact: NATSAP (928) 443-9505, www.natsap.org; Miller (202) 225-2095, www.house.gov/geogemiller; GAO report at www.gao.gov/docsearch/abstract.php?rptno=GAO-08-146T.


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