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- [Narrator] On this edition of Utah Insight, we put Utah's youth treatment industry under the microscope, examining why some have called Utah out for having some of the worst youth treatment programs in the nation.

Learn what people are doing to change that and how protecting children who are sent to these programs has become the focus of a growing movement.

(upbeat music) - Thanks for joining us here on Utah Insight.

I'm Liz Adeola.

It is a multi-billion dollar industry here in the United States, funded in part by you, the taxpayer.

The American Bar Association estimates that anywhere between 120 to 200,000 young people are in youth treatment programs and many of their residential facilities are for-profit organizations that use public funds.

The Kem C Gardner Policy Institute analyzed operational data to find the annual gross revenue for these programs.

In 2015, youth treatment programs in Utah brought in more than $328 million.

And the actual number is much higher because 13 programs failed to share the data for that report.

Now, there were 72 youth treatment programs in Utah the year that report was released and now there's more than a hundred with reports of abuse and even deaths at some facilities leading to shifts in policy and licensing.

Here to discuss that and more, we have Trina Quinney-Packard, the CEO and Executive Director of Youth Care, Simon Bolivar, who is the director of the Office of Licensing in the Utah Department of Health and Human Services.

And Jenny Magill, a youth treatment program survivor and CEO of Breaking Code Silence.

Simon, I wanna start with you.

What is being done right now to shift government oversight of these programs from reactionary to a proactive stance to prevent issues like child abuse?

- Well, that's a good question.

There are many things that are being done right now.

So we have more transparent process in which we help the public understand what we're doing by giving them access to every provider's compliance history.

We're working with providers to make sure that we are a team to help keep these kids safe.

We have come up with better and clear regulations to help providers understand the requirements.

We have come up with a new system in which we can track compliance history.

So there are many things that are being done right now to make sure that we are protecting the health and safety of these kids.

- I hear inspections have increased as well, right?

- That is correct.

Now we conduct four inspections every year instead of two like in the past.

And these inspections are unannounced.

And so we're also training our staff to make sure that those inspections are not only visits but there are compound of technical assistance and guidance to providers and opportunities to really see what is happening at those facilities.

- How has staffing changed or increased to meet the needs of the oversight of these of these facilities?

- We have created a new team actually to conduct complaint investigations as well.

Providers are required to report to us critical incidents and situations that happen at their facilities and we have an entire team dedicated to conducting these investigations to make sure that the facility is in compliance with the regulations.

- Jenny, could you shed some light on who's being sent to these programs and who's making the call to send children to these programs?

- Absolutely.

So there's multiple pipelines for children coming into these programs.

Parents, what we call parent choice programs, where parents choose to send their children there.

Often with consultation from individuals who are called educational consultants and from referral organizations.

There's also children who may come in with a combination of their parents and a local school district footing the bill.

Also children in foster care, there are also children who are either diverted and or placed by the juvenile court system.

So it's a variety of children sent there and also a variety of reasons.

We're talking about everything from a child with mild learning disabilities to a child with a severe behavior problems and a history of juvenile court involvement.

So it's a very wide range.

- Wow.

A very wide range.

And Trina, can you talk about the staff that works with these children and how they're trained to meet the needs of the kids that are coming into the programs?

- Yeah.

That's a great question.

You know, every different department has different criteria and different things that they're trained on.

Most of these residential placement programs have licensed clinicians who are trained either in the social work or trained as professional counselors or in licensed marriage and family therapy.

You also have others that are trained in the medical field.

There are many of the programs have certified doctors, nurses and then you have all the way down to most programs have those that have academic systems within their organizations.

And so those are teachers that actually have licenses in the state of Utah as an educator.

And probably the one that most people have the most staff is those that are what we would call our frontline staff.

And those individuals receive pretty substantial hands-on training in each one of the organizations.

And because every single kid's problems are different they're looking at different levels of training and different levels of interventions that may be needed by those that are working day-to-day with the students.

- Well, we ask people on social media are youth treatment programs effective?

What changes would you like to see in this industry?

Kathleen Kirby wrote the fact that there are so many youth treatment programs here in Utah might be a good cause for concern.

What sort of legislation is there to govern these facilities?

What sort of surveillance are they required to have?

What physical audits do they go through?

While Scott Armstrong wrote, I was in one of these programs back in the early eighties.

One of the adults was arrested for pedophilia and another one physically punished me causing pain for doing something he didn't like while we were hiking Escalante.

The perks of being in the middle of nowhere with no cameras.

And Jenny, I know that you have an unfortunate personal story come from being in a youth treatment program.

What's your response to people wondering if there's surveillance and in Scott's case pretty much saying that it was his word versus the staff?

- Well, I think that is an ongoing issue both back in the eighties when Scott was there when I was in programs 2000 through 2002, as well as today, there are cameras in a lot of programs.

Cameras can't necessarily solve systemic problems which is a lot of the issues in these programs.

The treatment is the problem in a lot of these places where punitive measures are being used to try to heal children when evidence-based actual therapy is really needed.

So cameras can catch more overt measures which is wonderful.

There have been multiple times just the past few years where completely inappropriate and sometimes physically harmful behavior has been caught both by staff as well as by other children in these programs harming each other.

But with the nature of these programs and then especially when you're looking at things like wilderness programs, cameras aren't really going to be an effective option.

So we're looking at other ways to protect such as with the first comment, legislative regulations and the recently passed state bill 127 which working with the Department of Licensing and Simon and his colleagues getting unannounced inspections, having a much more comprehensive list of requirements.

So trying to fix the problem from the internal system instead of the frontline workers.

'Cause these individuals, despite some on the job training when you're only requiring a high school diploma for most of the time, these staff are the ones working with the individuals, you have to have a network to support them.

That's based on evidence-based treatment and support instead of punishment.

So that's what we've been working on with the Department of Licensing to try to get that to be underlying these programs instead of a bandaid approach to bad actors.

- Yeah.

And speaking of Senate Bill 127, weekly confidential communication with parents was one of the things that was implemented, one of the changes implemented.

Trina, what else is happening in local programs to make sure that the voices of children are not only heard but believed when they say that they need help or that there's abuse?

- Yeah, I think the confidential phone calls was a great intervention.

And I think that it's been proven effective time and time again where kids have accessibility to their parents whenever need be.

Some of the other things that I think have been very, very helpful has been is many programs have instituted student advocate processes where students have the ability to go ahead and send communication to their parents without it being reviewed or re-read where they have the ability to report that.

In addition to that every residential treatment facility is required to go ahead and post a call number where they could call the state at any given time and could make a phone call if they are concerned about anything that may be occurring or happening at the facility.

And that is in every living environment where the students do live.

And that is something that all residential programs are required to train new students on as they orient them to some of the things that are happening in the facility to protect them.

- And Simon, you talked about a new system a little bit for penalties starting in July where it's not gonna be the same warning over and over again.

Can you dive a little bit deeper into that?

- Sure.

Yes.

This is a system, not only the system itself but the process that we use.

We want to make sure that providers, the public everyone understand that we're working to help providers be in compliance with the rules.

But sometimes providers might not be in compliance and sometimes it seems like we give them a slap in the hand in that set, right.

What we're doing right now is that we are doing a tier system in which is if something is found out of compliance, they'll get depending on the level of harm, they might get a warning.

Then if it happens again, they might get a citation, they might get a civil money penalty, they might get an intent to revoke.

So it is progressive instead of doing exactly the same.

So providers understand, we're not joking about the health and safety of kids.

We're telling you if you don't fix what needs to be fixed, then we'll go with harder and perhaps stringent penalties.

And that includes, sorry, civil money penalties that will start July 1st as well increasing civil money penalties for lack of compliance or repeat lack of compliance as well.

So it's not only just saying, okay you have a warning or you have a citation.

We'll also added monetary civil money penalties.

- So many people wonder why facilities get so many chances and why if a child dies a place isn't closed.

Can you share why that doesn't happen or if that's happened since this new bill has been adopted?

- Yeah, there are many issues to be looked at.

We act within the scope of our authority.

We don't go above or and beyond or under our authority, but when something happens, we have to evaluate it according to our rules.

We make sure that the rules are or are not in compliance.

And this new system that I'm telling you about has different levels in which there is an extreme level as well.

If something is extreme, like for example, the death of a child because of lack of compliance, because yes a child could die not because of lack of compliance but if it is lack of compliance we have the opportunity and the authority to act right away and take more punitive actions.

- Did you wanna add anything to that, Trina?

- Just in terms of that question.

Yeah, I think that as we look at these kinds of situations, if programs are out of compliance and they're not following the regulations then there will be consequences.

And that's one thing that I certainly think has dramatically changed over the course of the last couple of years is, is there is definitely more structure and more accountability for residential programs than there were previously.

And definitely that is in part because of 127.

I also think that it's also in part because programs want, there are great programs out there and they want to do great work and they want to do a great job helping kids and families.

So I think programs want to comply and they want to be transparent about things that are happening.

And, but it is a complex, it's a complex thing.

I think for the public.

It's an easy thing to say, if this happens in this program this program should be shut down.

And oftentimes we don't always have all of the information but I know for residential programs now there are very clear guidelines around, you know what the consequences will be if programs are not following the rules and the regulations that have been laid out.

And I think that's a good thing for providers and I think it's a good thing for kids.

- Did you wanna add anything to that, Jenny?

- Well, I guess I'm optimistic that this new system is going to improve things and will provide more structure and prevent this ongoing chance again and again and again, despite harm.

I am hesitant to agree with Trina despite I think the best intentions of some providers because we have worked with numerous parents and families since 127 was passed in trying to get programs to comply with the most basic of these requirements.

We have had a case, for example where a child was repeatedly denied a phone call with a parent and the parent knew his rights, knew the bill, asked us for assistance when it wasn't being provided.

And the program through a licensed therapist insisted that they did not have to comply with the bill if they decided that those requirements were not in the best interest of the child.

And that's not a loophole.

But there's definitely multiple ways that programs are already trying to state that these requirements don't apply to them or that they know better than the law.

And this is not something that is going to prevent harm to children.

It's going to unfortunately increase the harm to children the more that programs are not being required to comply.

So I think that there are some programs and providers that definitely have the best of intentions and truly want to help children.

But the model itself and the way that historically it's been run in Utah is not up to those standards.

And it's going to take a whole lot of time and really focus change to be able to comply and feel that they are required to comply with everything the Department of Licensing is stating.

- Well, there are a number of options when it comes to treatment facilities.

One example shown by Utah Insight's RaeAnn Christensen uses a unique approach of replicating a family setting in Tooele County.

- I was really struggling socially in school.

I was struggling at home with family dynamics and anxiety and depression and some other things that were going on.

- [RaeAnn] As a young teenager, Megan Claborn found herself grappling with personal struggles, acting out in ways that signaled a need for help.

- [Megan] Being a teenager is also really hard.

- [RaeAnn] She says her mother faced a difficult decision whether or not to put Megan in a long-term treatment facility.

- If she couldn't be my mom, she wanted somebody to be and somebody to help me in that way and help her learn how to become the parent that I needed.

- [RaeAnn] After some thorough research, it became evident that Alpine Academy in Utah was a good fit.

- I think the whole family dynamic really is a big draw for Alpine.

- [RaeAnn] Alpine Academy uses the teaching family model where married couples serve as primary treatment providers living in homes with the youth.

Among these families are Dustin and Kenz Denning and their children.

- There's so many things that they learn while they're away from their family that they can take with them and apply it to their real life situation.

And it's very beneficial.

- [RaeAnn] From depression, anxiety, eating disorders, anger issues.

The couple says they've seen it all.

- Really all they want is to know that someone is listening and that someone actually cares to hear them out.

- And they're able to focus on themselves and focus on what they need mentally and physically and anything to make themselves a better person.

- [Christian] We've been able to build really excellent facilities where they can feel like they are at home.

- [RaeAnn] Christian Egan is the program director.

- Our board has cared very much about the look and feel of Alpine so that for our youth it feels safe, it feels comfortable, it feels warm and nurturing.

- [RaeAnn] Christian acknowledges there are some teens that have had challenging experiences at Alpine Academy.

- Sometimes maybe our treatment method just wasn't right for that youth and it kind of went the wrong way for them.

Other times, maybe the youth wasn't ready to engage in this intensity of treatment.

Other times maybe there was what we call a bad actor, a particular person who was not working in the right field and who made some poor choices and was abusive, harmful, neglectful or hurtful in some way.

- [RaeAnn] But he says for every teen who's had a bad encounter, there's a multitude of others who have had positive experiences.

- Families could testify and talk about how life-changing it was.

Unfortunately, it will never be 100% successful.

But for the vast majority, it is life altering if not completely life-changing, if not actually lifesaving.

- [RaeAnn] For Megan, she says it was exactly that, lifesaving.

- I don't know where I would be without Alpine.

It's so far like out of my reality that I don't know what I would've done if my family didn't have that option.

I'm not actually sure I would be here today.

- [RaeAnn] She has returned to Alpine Academy but this time in a different capacity, as an employee.

- Working here has made me a better person than even being a student here because it takes every day I am working those muscles that I learned 10 years ago.

I feel like I've learned so much as a family teacher and an associate family teacher in the homes.

I'm honestly really grateful for the opportunity to work here.

- And Trina, how can we get more positive outcomes for children who like Megan just need help?

- Yeah, I mean, you know that there are so many kids that are like Megan that are out there that that are in need of help.

And I think that that's one of the challenges that we find is is that most residential programs have handfuls of kids that want to share their story and handfuls of families that want to share their story.

And I know for many of them, the way that they do that is as families are trying to decide whether or not this is the right fit for their family, they utilize those kids and those parents as talk to them, you know, have some conversations with them.

I think that's one of the greatest challenges that we have is most people don't wanna hear many of the positive stories that are out there that are to share.

And I know that as our industry continues to grow, that's something that's very important to us.

Every residential facility has some positive stories to share and has an opportunity for those families to talk about their experiences and to become spokesmans for there are great things that can happen in treatment when it may be as she mentioned, the only option for that family.

They may not have any other options or all other options have actually been exhausted.

- Simon what were your takeaways?

- It is true.

No facility's perfect.

And of course they will have successful stories and other stories that are not that successful.

And it is the same like when you go to a therapist sometimes that even though that therapist is licensed that might not be the right fit for you.

Right?

So people need to look for the right place the right fit, the right program, and people need to get informed involved to get the success outcome that successful outcome that they're looking for.

There are many success stories that can be told and licensing provides parents with opportunities to be more educated when they're making these choices on when and where they're going to place their kids.

So parents should be a little more involved and use all of the sources that we not only licensing.

We have the Department of Professional Licensing also that license all these professionals at these facilities.

We conduct background checks for all those individuals.

They are welcome to ask us questions to ask questions to the local authorities as well and see if that facility is business licensed as well.

Andinterview 'em, talk to them, explore the possibilities so they can together not just the facility, together with the parents get the outcome that they're looking for.

We don't want these kids to be warehoused.

We want them to be successful.

- Yeah, it's an entire vetting process that people need to go through.

Jenny, do you have any tips or anything that people should be looking out for when they're researching these programs?

- Definitely.

I think in terms of Alpine Academy in particular, it's a little frustrating listening to the positive outcome.

As much as I'm very happy for Megan and her family that they feel they're in a good place right now.

Alpine does use a level system which has been repeatedly shown to not be evidence-based and not be helpful.

They use physical punishment, they use removal of privileges such as reading.

We have a survivor who was there quite recently within the past few years who that was the main punishment used with them because they would isolate and they'd like to read books.

And so the intervention was simply removing access to all reading materials.

These are clearly not evidence-based supportive therapeutic practices.

I think with looking at programs in general the question that I would ask that I think underlies a lot of the more specific narrow questions we're asking is why are we sending this particular child or children in general to long-term residential care when evidence is not there supporting the need for it?

For the vast majority of cases.

We do have on our website at Breaking Code Silence as well as in general a huge list of evidence-based treatments, most of which are community-based treatments where children are staying in their families, in their communities with brief stabilization beforehand if needed but doing the majority of their healing and the majority of the work that needs to be done with them and the family system within the community.

So I think a lot of times parents think or we're told by educational consultants or other individuals that all possible options have been exhausted when we're not looking at what those other possible options might be.

And looking at the actual research behind practices.

So I would encourage parents to look at what your child's diagnosis is or what is the reason that you are considering residential treatment?

What is the evidence-based treatment that is recommended for that.

For example, a lot of younger teenagers these days deal more with cutting and self-harm.

The gold star treatment for that is DBT, not wilderness therapy.

And that has been a challenge a lot of the times with trying to get the needed therapy for children because the model itself is not what the child needs.

- All right.

Well, thank you all for being here and I'm getting the wrap in my ear.

Thank you so much for being a part of this discussion today.

Next week on Utah Insight we're gonna be talking about reproductive rights.

How will continued abortion banning legislation affect the rights we hold with reproductive rights being questioned?

What's the impact on communities in Utah?

You can respond on social media or give us a call and you just might see your comment or question on the show.

Thank you so much for watching.

We'll see you next week.

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