Understanding the “Troubled Teen Industry”: When Treatment Becomes Traumatic
by Heather Hayes, M.ED., LPC, CIP, of Heather R. Hayes & Associates
When I think back on the trajectory of my career as a counselor and intervention specialist, I am extremely grateful for the progress I have witnessed and helped facilitate in these 40 years. The ethical practitioners I have had the good fortune to work with across many fields have facilitated change and saved the lives of countless youths and adults, who have benefitted from the treatment and resources we were able to provide.
Many of my current efforts stem from prior professional experiences and accepted customs that did not sit well with me, even at the time. For instance, early in my career, after returning from graduate school in Boston, I helped establish an adolescent unit in Atlanta. I was the only woman in our small counseling group, which led me to my being assigned to work with most of our female clients. These clients’ particular situations required me to learn more about trauma, eating disorders, self-harm, and substance use disorder. The evolution of this field over time with respect to trauma and various disorders has been extraordinary, and I am thankful for the opportunities my colleagues and I have had to determine and address the root causes of the challenges so many people face along their journeys to recovery.
During that period, I was also frequently asked to take our male clients, many of whom were angry and volatile, and I worked hard to develop strategies to de-escalate these hostile situations. However, while effective in the moment, de-escalation didn’t address the sources of these clients’ problems, which I soon realized were tied in part to the jarring intervention process itself.
I will never forget one of our first clients, Daniel, who was 17 years old when he was forced into treatment. He arrived via a transport team that came to his house in the middle of the night and forcibly took him out of his familiar surroundings against his will. His parents, who wanted nothing more than to help their son, had been asked to leave the home so that the transport team could work unimpeded. Understandably, Daniel was startled and confused by the team’s militant presence and initiated a fight.
Daniel was duct-taped, carried to the car, and forced into treatment, without being allowed to say goodbye to his parents or to understand their benevolent motive for this intervention. Throughout his treatment, Daniel continued to have frequent angry and explosive episodes, often triggered by his continued resentment over how he arrived. While he ended up staying in treatment for about six months and did exceptionally well, even formulating a strong plan for sustainable recovery, his progress was in spite of, rather than due to, his transport.
Five years after his departure from our facility, I ran into Daniel at a mall. He looked great, had finished college and started a career he was proud of, and was still sober. Yet, he indicated to me that he was still angry about how he had been taken to treatment. I found myself empathetic to his criticism of the process and vowed to learn from his example and work toward a better system moving forward. The truth is, I had always felt uncomfortable with this process and didn’t understand why he and other teens were brought into treatment so violently.
Even though it was the accepted transport method at the time, it seemed traumatic, unfair, and abusive to pull a child out of bed in the middle of the night without warning and separate them from their family without explanation. I couldn’t understand why their loving parents and family members were required to leave the home, and I wondered how a child could differentiate between being sent to treatment for help and being forcibly restrained and abducted. It also puzzled me how parents could stand to send a child away without a loving conversation explaining their decision, and it never felt to me like they were given a choice in the matter.
This experience galvanized my resolve to formulate a more humane way to get teenagers to treatment that would minimize fear and anger and emphasize the fact that treatment is one of the most loving gestures parents and family members can provide their loved ones. The resulting product was the Heather R. Hayes, Inc. Respectful Adolescent Transport Protocol (RATP) ®
I. RATP ®
When a family hires a transportation company, they should feel confident that the care their child receives is grounded in a model that accounts for traumatic stress, adolescent development, and protective factors. Thus, RATP ® is more than just a ride to and from treatment. The Respectful Adolescent Transport Protocol ® (RATP) involves two trained Trauma-Informed Therapeutic Transport Specialists who are aware of the client’s history, including their history of trauma, substance use, and mental health concerns. Our Trauma-Informed Therapeutic Transport Specialists provide companionship, security, and accountability, ensuring that clients get safely to their destination and on to the next step in recovery with the least amount of stress. All of our Therapeutic Transport Specialists have attended a 16-hour in-person training on Trauma-Informed Responsive Transport Protocol™ and the Respectful Adolescent Transport Protocol ® taught by my team members and me. The benefits of therapeutic transportation include a reduced risk of relapse, companion services during potentially risky or stressful circumstances, and enhanced safety for the person entering treatment. Having a trained support person during these vulnerable times can make a huge difference in a person’s chances for a successful recovery.
An essential element of this protocol is the constant involvement of parents and others in the family support system. Prior to the physical transport, our clinical team prepares the family with respect to what to say to their child about the transport process. This preparation includes a meeting with transporters, family, and other loved ones to outline the transport process and coach the family on how to speak to their child about the transport. As part of this process, parents and family members are asked to write a letter to the young person being transported. The focus of this letter is two-fold. First, the letter emphasizes the family’s love for their child and their child’s positive qualities, strengths, and resilience. Second, the letter further reinforces that the family has made this decision with their child’s best interest in mind and will not back down from their decision to seek treatment on their child’s behalf. This letter provides a solid foundation for the introduction of our transport service, emphasizing both the family’s love for their child and supporting the family in being accountable for their decision to engage in treatment. Our protocol respects and supports the dignity of each child being transported and focuses on parental accountability, building rapport with the young person, and acknowledging their resistance and frustration in a trauma-informed way. In addition, the family is not asked to leave the home while the transporters are speaking with the child. The child’s potential responses are normalized and predicted for the parents. Safety and containment are always prioritized, and the child understands that this is the decision that has been made by the family. Having the family express their love and rationale for their decision to send their child to treatment also supports the paradigm of healing and change for the entire family system and reduces abduction trauma.
II. Contrasting Other Protocols to RATP ®
There is a stark difference between the care, or lack thereof that Daniel received and the protocol that his experience inspired. On a practical level, this means that we do not wake children in the middle of the night and escort them out of the home. This act alone is traumatic and unnecessary and has garnered the nickname of “gooning’ by its adolescent victims and advocates alike. As described in an article titled, The Legal Industry for Kidnapping Teens:
Gooning is a form of legal kidnapping, occurring predominantly in the United States, in which parents hire rehabilitation organizations to seize children they perceive as troubled and transport them to boot camps, behavior modification facilities, residential treatment centers, substance abuse treatment facilities, wilderness therapy, or therapeutic boarding school. In most cases, the organizations send a group of people to show up by surprise and force the teenager into a vehicle, often under cover of darkness. Children who resist are frequently threatened, restrained with handcuffs or zip ties, blindfolded, or hooded.
This would traumatize me as a grown adult, let alone as a child, and would be made worse by my loved ones watching this happen.
Following Paris Hilton’s documentary, “This is Paris,” there has been an increase in media related to “The Troubled Teen Industry.” In the film, Hilton describes her traumatic experiences at a Utah boarding school, where she was subjected to punitive behavior, verbal abuse, and deceptive marketing practices. After her negative experiences, she vowed to not “give up until she sees a real change in the adolescent industry.” It would be remiss to group all adolescent treatment facilities into the type that Paris experienced because there are many reputable trauma-informed/responsive adolescent facilities. The awareness of disreputable facilities brought by this media attention, however, highlights the continued need for regulation in the treatment industry and for ethical trauma-informed/responsive healing. Working in a trauma-responsive manner entails first understanding that the majority of teens that facilities treat have experienced trauma and subsequently creating a safe space for healing that seamlessly integrates their family systems. Thanks to streaming apps, social media sites, and the internet as a whole, victims are given a platform to display their courage, share their experiences, and advocate for change. As professionals, it is important that we continue to create safe spaces for these victims to come forward, share their traumatic experiences without fear, and heal without further harm. It is imperative that we honor these victims by not diminishing or dampening their stories, hold those accountable who harm others, and continue to advocate for provider accountability and patient safety on a legislative level.
III. Legislative
I am proud to be a part of this profession, whose best providers continually seek ways to improve upon the past in order to provide ethical, compassionate treatment for people of all ages in their greatest time of vulnerability and need. Over the last few years, I have increased my dedication to and participation in advocacy and change on a legislative landscape. I was a founding member of the Association of Mediation and Transport Services (AMATS), and I have helped the states of Oregon, Washington, Utah, and Georgia pass and enact state legislation protecting patients and providing provider accountability. Most recently, I have gone to Washington DC to advocate, as an expert witness for the Stop Institutional Child Abuse Act (SICAA), for our lawmakers to enact federal legislation to protect our most vulnerable population.
Going through addiction early in life and finding a positive path forward has made me much more committed to helping others see the possibility of overcoming obstacles and going on to lead healthy and productive lives.
Conclusion
The greater professional community to which I belong has made outstanding strides in the fields of patient transport and addiction therapy, and we are continually looking for new ways to improve upon past strategies to make the profession more compassionate and family-oriented. I am grateful and proud to be a clinician for over 35 years and to lead a team of experts with such monumental impact due to their extensive years of combined experience and intimate knowledge of the industry. The Heather R. Hayes & Associates team constitutes a family’s invaluable, ethical guide through the treatment and recovery process, and we will always be your advocate in agency and empowerment throughout your healing journey.
