Partnering with the Judiciary to End Institutional
Child Abuse in Residential Treatment Centers

In my junior year of high school, I was expelled from my prep school for underage drinking. Despite being a high-performing student and varsity athlete, I had a serious eating disorder, a “wild” streak, and the early signs of anxiety and depression, conditions with which I still struggle today.

My parents hired an educational consultant who advised them to send me to a notoriously abusive “therapeutic boarding school.” While I was there, I was sexually assaulted by the headmaster who had been convicted of sexually assaulting another young woman at the school. Despite the prior conviction, the judge gave him only a small fine and community service, a punishment described by the local media as, “An inexplicably mild sentence.” To this day, I think about how different my entire life could have been if that judge had understood the prevalence and severity of abuse in residential treatment centers and prevented him from preying on young women.

Sadly, my story is not unique. Far too many vulnerable youths experience trauma such as this and this abuse has been occurring for decades. Meaningful change will require a multifaceted approach including legislative changes at the federal, state and local level and increased stakeholder participation throughout the legal system. In particular, an educated judiciary is one of the most powerful and effective tools for protecting children. This article will provide a brief overview of the issue as well as a checklist for judicial officers to limit dangerous placements.

What is the “Troubled Teen Industry”

The “troubled teen industry” is a term loosely applied to privately owned youth residential treatment centers located throughout the United States and abroad. This term may refer to group homes, therapeutic boarding schools, short term residential treatment centers and many other confusing terms. The facilities are inconsistently regulated, and may simultaneously house children placed by juvenile justice, child welfare, school districts, Medicaid and private insurance.

Authorities have known of the abuses for decades, with the Senate conducting investigations into youth treatment facilities as far back as 1974. Additional investigations from the Government Accountability Office followed in 2007 , 2008 , and 2022. Despite this awareness, little has been done to eliminate documented abuses including death, sexual assault, and human rights violations.

It is difficult to quantify the problem, though research indicates that between 120-200,000 children are impacted each year and over $23 billion in public money is used to fund placements in teen treatment centers, with fees as high as $800 per day. There is little consistent oversight between states and youth are often sent to out-ofstate facilities.

Interstate placement leads to increased confusion over jurisdiction, choice of law, and applicable reporting and licensing standards, creating confusion for courts and attorneys. Additionally, complicated profit motives and private equity funding have created a lucrative business model for investors at the expense of children within these facilities. Complicated profit motives are not limited to corporate operators either–in the 2007 “Kids for Cash” scandal two former judges were convicted of accepting over $2.8 million in illegal payments in exchange for sentencing children to certain facilities. Concerns over abuses are so extreme, the American Bar Association passed a 2023 resolution urging for increased regulation to prevent institutional child abuse.

Judicial Checklist and Considerations

As an attorney and a survivor, I’ve worked with survivors, other attorneys, members of the judiciary, policymakers, legislators, researchers and others to share resources and information regarding these abuses. Robust participation in this conversation by the judiciary will go a long way towards solving these problems. Below is an 8-step checklist for consideration prior to placing a child in a residential facility.

1. Pre-Placement Considerations: Prior to placement, a number of factors should be considered to make sure a residential placement is necessary and reduce the use of out-of-state placements. The Interstate Compact on Placement of Children, which is effective in all fifty states, should be scrupulously followed, but is often simplified or eliminated when placing children in residential treatment centers.

2. Compliance with IDEA and ADA: Both the Individuals with Disabilities Education Act (“IDEA”) and the Americans with Disabilities Act (“ADA”) require that children with disabilities are educated in the Least Restrictive Environment. Members of the judiciary should ensure that all placements are fully compliant with this statutory mandate.

3. Human Trafficking Risk Assessment: Advocacy organizations and the legal system are beginning to understand the enormous human risks to children placed in residential facilities. Group treatment centers have increased incidents of both sex trafficking and labor trafficking, and traffickers often target the vulnerable residents of these facilities.

4. Communication and Reporting Standards: Many youth residential treatment centers consider communication to be a privilege and a child’s outbound communication with parents, lawyers, doctors, teachers and safety networks is extremely limited. Judges can help by ensuring that facilities allow open and confidential communication with adults, especially attorneys.

5. Facility and Client Visits: It is very important that judges and attorneys visit facilities, unannounced, if possible. If a child in your court is placed in a facility, they may have very limited contact with outsiders, as mentioned above. It is critical that child has a means of reporting abuse and ensuring adequate investigation of claims of mistreatment. If a child reports abuse, please visit the facility, ask questions and ensure adequate investigation.

6. Health, Medical and Safety Standard: Often times treatment centers lack even basic standards for health and safety. Children may be denied the ability to shower, and medical requests may go unheeded and result in unnecessary deaths. Sleep deprivation is common, as is overextension and debilitating physical injuries from strenuous labor. Children also frequently report inadequate mental health treatment as well as regular over and under medication.

7. Abusive Practices: If a child must be placed out of state, there should be a special emphasis on harm reduction practices. Investigate the policies on abusive practices such as strip searches, isolation and confinement, restraint, forced silence, physical punishment and aversive therapeutic practices. Few lawyers and judges realize the ubiquity of these practices in youth treatment centers and the long-term damages can be crippling to survivors.

Contracts and Legal Considerations:

Treatment facilities may use deceptive marketing techniques by advertising treatment options and therapeutic services that are not provided. Staffing levels may be overstated and background checks may not be consistently completed. Judges can help by ensuring facilities are licensed, accredited, adequately insured, and have updated internal policies and procedures for addressing items on this checklist. Abuse in youth treatment centers has been occurring for decades, and meaningful change will likewise take time to implement. But we must get started, immediately. A single judge can make a huge difference to a child facing placement in an abusive facility.