Donate

These reports represent hundreds of hours of research by the Unsilenced Investigative Research Team. As you review this report, please consider donating. Your contribution will help us continue our work advocating for survivors and youth. Every donation makes an impact, no matter the size. Thank you for your support!

Completed by:

The Unsilenced Investigative Research Team

The Troubled Teen Industry in North Carolina

Impact Report

2022

Impact Report

2022

Introduction

The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry’s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.

Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts’ individualized education programs, and by parents.

Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.

An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.

It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.

Introduction

The ‘troubled teen’ industry is a network of residential programs that claim to provide treatment for the behavioral and developmental needs of youth. The industry’s lack of transparency and accountability has led to widespread abuse of youth, resulting in hospitalizations, prolonged trauma and death.

Today, there are an estimated 120,000 – 200,000 minors in residential programs across the United States. These youth are placed each year by state child welfare agencies, juvenile justice courts, mental health providers, refugee resettlement agencies, school districts’ individualized education programs, and by parents.

Many of these youth have trauma histories, which are only exacerbated by being removed from their communities and institutionalized. Youth with lived experience describe these programs as being carceral, harsh, and abusive.

An estimated $23 billion dollars of public funds annually are used to place youth in residential programs. Daily rates for residential treatment ranges from $250-$800, costing up to $292,000 per year, per child.

It is overwhelmingly clear that our communities and agencies are over-relying on residential placements that are negatively impacting the youth they serve.

North Carolina Statistics

$100+

Million Dollars

North Carolina spends every year placing youth in Residential Facilities despite evidence indicating that these facilities are ineffective

$423

Per Day Per Child

North Carolina pays facilities on average, and advocates report that the state spends up to $800 per day for children with complex needs

4,308

Children Under 12

placed in residential facilities through Child Welfare programs in 2019

744

Juvenile Justice Youth

placed in residential facilities through Juvenile Justice programs in 2019

  • 591 minors were committed to a residential facility as part of a court-ordered disposition
  • 138 minors were detained in a residential facility while awaiting a court hearing, adjudication, disposition or placement elsewhere
  • 6 minors were voluntarily admitted to a residential facility in lieu of adjudication as part of a diversion agreement

North Carolina Statistics

$100+

Million Dollars

North Carolina spends every year placing youth in Residential Facilities despite evidence indicating that these facilities are ineffective

$423

Per Day Per Child

North Carolina pays facilities on average, and advocates report that the state spends up to $800 per day for children with complex needs

4,308

Children Under 12

placed in residential facilities through Child Welfare programs in 2019

744

Juvenile Justice Youth

placed in residential facilities through Juvenile Justice programs in 2019

  • 591 minors were committed to a residential facility as part of a court-ordered disposition
  • 138 minors were detained in a residential facility while awaiting a court hearing, adjudication, disposition or placement elsewhere
  • 6 minors were voluntarily admitted to a residential facility in lieu of adjudication as part of a diversion agreement

A North Carolina Problem

A team of researchers reviewed 230 studies of residential treatment facilities from around the nation and found there was no evidence that they were effective.

North Carolina has 328 Licensed Residential Facilities with a total capacity of 4,028 minors 

The facility types with the highest capacity for housing minors in North Carolina are:

  • Residential Child Care Facilities with a capacity of 1,607 minors
  • Staff-Secure Residential Treatment Facilities with a capacity of 1,212 minors
  • Residential Therapeutic Camps with a capacity of 301 minors

North Carolina in a one-year period shipped at least 227 kids in foster care to psychiatric residential treatment facilities in other U.S. states, including centers with a history of allegations of abuse and mistreatment

Illustration by Spencer Holladay, USA Today Network; Getty Images

“Many kids don’t get help. Others never needed institutional care in the first place.”

Fred Clasen-Kelly, Amritpal Kaur Sandhu-Longoria, Rachel Berry, Brad Zinn, Kristen Johnson, Brian Gordon
The Fayetteville Observer

Current Oversight

North Carolina requires Residential Facilities serving minors to obtain a license but does not provide adequate oversight. It is only a misdemeanor for a residential facility to operate without a license.

Robin Deacle, DHHS spokeswoman, reports “state regulators were not responsible for tracking abuse that happens inside group foster homes licensed by the state.”

Republican Senator Jim Burgin…

who oversees NCDHHS in his role on several legislative committees, described oversight in North Carolina as, “one of those situations where a lot of people are supposed to be doing things and, so, it’s kind of like everybody is responsible but nobody is responsible”

NCDHHS spokeswoman…

told WBTV in 2022 that the division does not disclose when child abuse—including sexual abuse—is reported inside a regulated facility.

Oversight bodies in the state

The North Carolina Department of Health and Human Services is responsible for licensing child-caring institutions and residential child-care facilities that serve minors. NCDHHS relies in part on assessments provided by the Council on Accreditation (COA), the Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Quality and Leadership (CQL) when evaluating residential facilities for licensing.

Residential Maternity Homes are child-caring institutions that provide continuing full-time care for adolescent and adult women during pregnancy and after delivery when delivery takes place in a licensed hospital.These residential facilities are governed by 10A NCAC 70F and 10A NCAC 70K 

Residential Child Care Facilities are placement resources for children with Level I needs These residential facilities are governed by 10A NCAC 70I and 10A NCAC 70J

NCDHHS licensed facility inspections were suspended entirely during the pandemic, despite an increase in admissions reported by some facilities

DHHS spokeswoman Chris Mackey stated, “There is not a mandated time for NCDHHS to follow-up on the facility’s implementation of corrective action”

The Mental Health Licensure and Certification Section of the Division of Health Service Regulation is responsible for licensing and regulating mental health, substance abuse, intellectual disability and developmental disability facilities in North Carolina. NCDHSR relies in part on assessments provided by the Council on Accreditation (COA), the Joint Commission (TJC), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Quality and Leadership (CQL) when evaluating residential facilities for licensing.

Intensive Residential Treatment facilities are locked 24‐hour residential settings that provide a structured living environment for individuals who need more intensive treatment and supervision than a Level III facility. These residential facilities are governed by 10A NCAC 27G:1800

PRTFs are residential facilities that provide care for children or adolescents who have mental illness or substance abuse/dependency in a non-acute inpatient setting. PRTFs provide a structured living environment for children or adolescents who do not meet criteria for acute inpatient care, but do require supervision and specialized interventions on a 24-hour basis. These residential facilities are governed by 10A NCAC 27G:.1900

A Residential Therapeutic Camp is a residential treatment facility provided in a camping environment which is designed to help individuals develop behavior control, coping skills, self-esteem and interpersonal skills. These residential facilities are governed by 10A NCAC 27G:5200

A Residential Treatment Facility is a Level III free-standing residential facility which provides a structured living environment within a system of care approach for children or adolescents who have a primary diagnosis of mental illness or emotional disturbance and who may also have other disabilities. These residential facilities are governed by 10A NCAC 27G:1300

A Staff Secure Residential Treatment Facility is a free-standing residential facility that provides intensive, active therapeutic treatment and interventions within a system of care approach. Staff secure means staff are required to be awake during client sleep hours and supervision shall be continuous. Minors served do not meet criteria for inpatient psychiatric services. These residential facilities are governed by 10A NCAC 27G:1700

A Supervised Living Program is a 24-hour facility which provides residential services to individuals in a home environment where the primary purpose of these services is the care, habilitation or rehabilitation of individuals who have a mental illness, a developmental disability or disabilities, or a substance abuse disorder, and who require supervision when in the residence. These residential facilities are governed by 10A NCAC 27G:5600B

A Supervised Living Program is a 24-hour facility which provides residential services to individuals in a home environment where the primary purpose of these services is the care, habilitation or rehabilitation of individuals who have a mental illness, a developmental disability or disabilities, or a substance abuse disorder, and who require supervision when in the residence. These residential facilities are governed by 10A NCAC 27G:5600D

Abuse and Neglect

Youth residing in Residential Facilities in North Carolina are at risk for abuse, neglect, and long-term harm.

Youth who previously resided in Residential Facilities in North Carolina describe experiencing degrading punishments in lieu of evidence-based treatments. One North Carolina teen stated, “The most traumatic and defining experience of my life was not my suicide attempt — it was how I was treated after. Seven years later, I’m still haunted by what happened there”

40 citations including sexual abuse…

Between January 2019 and April 2019, Carolina Dunes, a Residential Facility for minors in North Carolina, was cited 40 times for rules violations including allegations of sexual abuse.

Physical restraint and seclusion…

Between 2019 and 2021, workers at Residential Facilities for minors in North Carolina utilized physical restraints, seclusion or other restrictive interventions hundreds of times.

DHHS investigates death…

In 2014, a 17-year-old youth ran away from Trails Carolina, a therapeutic wilderness camp, and was found dead nearly two weeks later. In an interview with DHHS investigators after the youth’s death, a sheriff’s deputy involved in the search said rescue crews would have had a better chance of finding him alive had Trails staff not waited until after dark to call and report him missing

North Carolina allowed state funding for treatment programs that performed discredited conversion therapy on LGBTQIA minors until Governor Roy Cooper stopped the practice by executive order in 2019. Studies show that youth who undergo conversion therapy are twice as likely to commit suicide as their peers.

North Carolina released a report in March 2021 detailing that nurses at Strategic Behavior Health facilities gave children medications like Benadryl, Vistaril, Zyprexa and Thorazine injections without notifying doctors

2019 and 2020 data collected on selected residential treatment facilities in North Carolina revealed that less than a third of children discharged from the centers went to a community-based program, the desired goal. Some were sent to another psychiatric residential treatment facility, a possible sign that treatment failed.

Youth attending Trails Carolina, a wilderness therapy camp, were regularly refused contact with their parents despite a state law protecting this right. A June 2021 inspection by DCHHS indicated that the program failed to properly administer medications, did not allow participants to call their parents and had begun making physical improvements to the facility without permission from state regulators, which is required.

Youth who previously resided in Residential Facilities in North Carolina describe experiencing degrading punishments in lieu of evidence-based treatments. One North Carolina teen stated, “The most traumatic and defining experience of my life was not my suicide attempt — it was how I was treated after. Seven years later, I’m still haunted by what happened there“

Media Coverage

Additional Information

Unsilenced Program Database: North Carolina Programs

Contact: info@unsilenced.org

The information provided within UnSilenced.org is for general informational purposes only. All information is provided in good faith. However, we do not warrant, endorse, guarantee, or assume responsibility for the accuracy or reliability of any information offered by third-party posters, testimonials, comments, or submissions. Most information posted reflects the opinion of the writer and does not directly reflect the views, or positions of the owners of UnSilenced.org
Read More