Can the $300 million ‘troubled teen’ therapy sector be reformed by legislation and public pressure?

Laws can increase oversight and accountability. But do they really get to the root of the problem?

On an afternoon episode of his namesake show in late 2019, Dr. Phil recommended that two parents send their child to Turn-About Ranch. The program, located in Escalante, Utah, touts the ability to help “troubled teens” find their way.

Less than two years later, on Feb. 24, 2021, Hannah Archuleta, the teen who was sent to Utah from her home in Colorado at the behest of Dr. Phil, again appeared onscreen, this time alongside women’s rights attorney Gloria Allred. She was there to announce a lawsuit against Turn-About. Archuleta alleged that a male staffer twice touched her inappropriately during her two-month stay at the ranch in 2019, and she wanted accountability.

The press conference coincided with the Utah Legislature’s debate over SB127, a regulatory bill aimed at curbing abuse at the 100 or so “troubled teen” programs scattered across Utah.

Among other things, the legislation bans sedation without prior authorization and requires facilities to implement suicide prevention programs and report the use of a restraint or seclusion “within one business day after the day on which the use of the restraint or seclusion occurs” to the Utah Department of Human Services’ Office of Licensing. It also increases the number of yearly inspections — both announced and unannounced — from one to four, while increasing funding to the Office of Licensing to hire additional staff.

In short, its goal is to make abuses harder to perpetrate and hide in an industry that’s been heavily criticized for its lagging government oversight. It’s also an entrenched industry, worth more than $300 million in Utah alone, according to a 2016 research brief from the University of Utah’s Kem C. Gardner Policy Institute.

Paris Hilton in support of changes to Utah’s troubled youth industry.
Paris Hilton holds a copy of a bill after joining Utah Gov. Spencer J. Cox, Lt. Gov. Deidre Henderson, Sen. Mike McKell and Rep. Brady Brammerat a ceremonial signing of SB127, April 6, 2021. SB127 increases transparency in Utah’s troubled youth programs. | Scott G Winterton, Deseret News

The legislation’s most prominent supporter was heiress-turned-activist Paris Hilton, who in the mid- to late-1990s attended Provo Canyon School, a Utah troubled teen program.

Hilton says she was abused during her 11-month stay at the school. Bolstered by her own and similar testimony, the bill passed with near unanimity in the Utah House and Senate and was signed into law in March.

It was Utah’s first attempt at enhanced regulation of the industry in 15 years, and increasingly influential activist groups applauded the effort. But as the state moves to implement the new regulations, is the industry — in Utah and beyond — capable of change? Or are abuses bound to recur?

Paris Hilton backs Utah bill to regulate troubled teen centers: ‘You can’t silence me’
House, Senate bills passed by Utah Legislature

The beginning

The industry’s roots in Utah go back to 1968, when a Brigham Young University professor named Larry Dean Olsen led a group of failing college students on a 30-day wilderness expedition that started near Green River and wound up heading south through Robbers Roost, then west into Capitol Reef and over Boulder Mountain. He’d convinced the school that a month in the wilderness could help the students get back on track.

He was so impressed by how the experience taught them to better approach challenges that he started a survival course at BYU. That course eventually became Boulder Outdoor Survival School, and Olsen eventually founded the Anasazi Foundation — one of the most well-regarded teen wilderness therapy programs.

The natural beauty of the landscape (the thinking goes), combined with the bare-bones way of life results in “a change in one’s whole way of walking in the world,” to borrow from early Anasazi Foundation literature. Since then, the industry has ballooned in Utah, with over 100 residential youth treatment programs taking root. Among them are established names like Second Nature wilderness therapy — which also operates in Georgia — as well as the Provo Canyon School. Thousands from across the country have attended.

Wilderness teen therapy programs and other residential youth treatment options exist in varying capacities, often with varying methods aimed at the same result: changing teens into who their parents want them to be.

It’s only natural that Utah might hold the answer to such questions. The state has played a central part in the industry’s development, given its wide-open spaces and laissez faire business regulations. In wilderness therapy programs across the state, teens hike, set up camp and hike some more. The idea of “natural” consequences is central: If you don’t properly secure your tarp, for example, a storm might blow through and leave you soaked in the dark.

Escalante Canyons — a maze of domes that cap the Wolverine Bench — in the Grand Staircase-Escalante National Monument, Utah.
An undated photo of the Escalante Canyons — a maze of domes that cap the Wolverine Bench — in the Grand Staircase-Escalante National Monument, Utah. Utah’s wilderness areas make it a prime location for programs designed to help troubled youth. | Jerry Sintz, Associated Press

Wilderness participants are often sent against their will, taken from their homes with parental permission by “transporters.” They also have no idea how long they’ll be staying, and often have limited, highly monitored contact with the outside world. This can lead to an atmosphere of exploitation, as exemplified by entrepreneur Steve Cartisano.

In 1988, the BYU dropout started a program called Challenger that blended the low-cost structure of wilderness therapy with military-style discipline and turned what had been relatively low-profit ventures into a bona fide industry. The idea, he liked to say, was to “break kids down and build them back up.”

His program flourished until 1990, when a Florida teenager named Kristin Chase died at Challenger. Cartisano was charged with negligent homicide and child abuse, but he was acquitted on all charges. Still, state regulators determined that the charges against him were so serious that he shouldn’t be allowed to work with youth in Utah. His solution? He began operating programs under fake names in the Caribbean and Samoa.

He was never convicted of a crime and died in 2019. The Deseret News contacted Cartisano’s former attorney, who stated, “As for criminal cases, I’m unaware of any convictions he had — but I have no knowledge regarding what, if any, lawsuits he was involved with outside of the State of Utah.”

Chase isn’t the only teen to die, nor is Cartisano the only director accused of negligence. Stories of deaths by negligence in these programs are numerous, though the industry insists that they still amount to only a very small percentage of attendees.

“They have a good reason to be really upset,” says Scott Bandoroff, a psychologist with a private practice in Oregon who also does “wilderness family intensives” and is a longtime proponent of wilderness therapy, of parents who’ve lost kids in youth programs. “But I think trying to shut down an industry is not the answer. … The industry as a whole, I think, is pretty well policed these days internally.”

Indeed, the wilderness therapy industry has tried to distance itself from images of hardcore discipline. But the troubled teen industry generally suffers from an abundance of cross-pollination.

Cartisano’s programs, for example, combined boot camp with wilderness therapy, while others combine boarding school with boot camp, or residential treatment with ranching tasks. According to a Government Accountability Office report from 2007, boot camps are also sometimes called “behavioral modification facilities.” The industry became a catchall of program methodology and a murky pool of what’s legitimately effective and what’s harmful.

“It’s enormously difficult for families to get good information,” says Joanna Bettmann Schaefer, a professor of social work and instructor of psychiatry at the University of Utah who has studied wilderness therapy programs. “The majority of these programs are for-profit businesses, so they’re marketing themselves. Because they want students to come.”

Turn-About has faced several lawsuits and allegations over its 30-year history. The most notorious involved a 2016 incident when a 17-year-old bludgeoned a staffer to death with a metal rod. The Deseret News reached out to Turn-About Ranch for comment, but representatives from the program did not want to speak on the record.

Another high-visibility incident occurred at a Cedar City program in June 2018, when a 17-year-old girl punched a staffer in an escape attempt and, as punishment, had her hands zip-tied and was forced to lie down in a horse trough — a practice the program reportedly used regularly as a form of “therapeutic discipline.”

“There seems to be a major problem in Utah at some residential facilities,” attorney Gloria Allred said during the press conference. “This bill will address some of the abuses suffered by children at these troubled teen facilities.”

Some claim SB127 goes too far. “I think that it’s motivated by good intentions,” Ken Huey, executive director of Havenwood Academy in Cedar City, where the trough incident took place, said during an appearance on a local radio talk show, the “Rod Arquette Show.” “But ... it really takes away the ability to take care of some of the tougher kids.”

Legislators don’t see it that way. “When you have made-up therapy, and I’ll call it that, for kids that really need help, it’s just ripe for abuse,” said Sen. Mike McKell, the bill’s Republican sponsor. “This significant industry has grown outside of a regulatory framework, and SB127 provides that framework.”

House Minority Leader Brian King was more open to the potential benefits of teen residential programs, but he also recognized the need for the bill. “You’ve got state laws and regulations that protect individuals from inevitable human behavior,” he said. “I think every state ought to be looking hard at this.”

But while states are moving legislation across desks and into effect, the federal government has yet to take action, despite attempts to create federal oversight of the industry. Former California Rep. George Miller introduced federal legislation in 2008 aimed at regulating the programs nationally. The proposed legislation was in response to a 2007 Government Accountability Office report that found “thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007.”

The bill twice passed the House but was never taken up in the Senate. It’s been reintroduced several times, most recently by California Rep. Adam Schiff in 2017, without much interest. But soon, the climate could be ripe for it — or something like it — to finally become law. When asked why it hasn’t happened yet, McKell didn’t mince words.

“It will,” he says. But so far, it hasn’t.

Do the therapies work?

Cynthia Clark Harvey knows almost too much about those failed efforts. When Congressman Miller began to push the issue, he invited her to testify before Congress. It was an easy decision, she says. She wanted the world to know about her first-born daughter, Erica.

In 2000, around Erica’s 14th birthday, she started spiraling, experimenting with drugs and suffering from depression. The family tried everything — antidepressants, psychiatrists, drug tests — and nothing worked. The Harveys began searching for some sort of drug treatment program that would also be (at least somewhat) fun. But most places — including the Anasazi Foundation — refused to enroll a teen on prescription medication.

She was eventually accepted at Catherine Freer Wilderness Therapy Expeditions in Nevada. In 2002 they flew from Phoenix to Reno and dropped Erica off for a 21-day stay at a cost of over $11,000. The next day, they flew home and found a message awaiting them: There’d been an “accident.” Erica was dead. The autopsy reported that the cause of death was heatstroke and dehydration.

The Harveys eventually sued the program. “We wanted to hurt them, I’ll be honest about that,” Harvey says. “But the other part of it was always to find out what happened.”

That desire to know more drove her activism and Congressional testimony. She wanted to help create a federal database that could track how many kids attend these programs, how many are injured and how many die. That, she figured, just seemed like common sense. But when the bill was never taken up by the Senate, she “learned a lot” about America’s legislative process. “There’s this saying,” she says. “‘The Senate is where bills go to die.”

The wilderness therapy industry has tried for several decades to fill research gaps to bolster its case of effectiveness and reduce the need for legislative intervention, but does science support wilderness therapy?

Critics say “no” — or at minimum, “we don’t know.” There needs to be more research, for example, to parse out which aspects of wilderness therapy, if any, are most effective. “There should be randomized control trials,” Bettman Schaefer says. “There should be studies that really unpack what are the active ingredients of this kind of treatment.” As in, what parts of the programs are most helpful? Nature? Time away from home? Chores? Isolation? Is the wilderness part really necessary?

In a 2017 meta-analysis published in the Journal of Clinical Child and Adolescent Psychology, researchers examined 50 treatments for adolescent “disruptive behavior,” which they defined as “a wide range of significant adolescent problems (e.g., aggression, property destruction, running away from home, truancy, stealing) resulting in referrals to mental health specialists/clinics or juvenile justice authorities.”

Their study found that two types of treatment — Multisystemic Therapy and Treatment Foster Care Oregon — were “well-established,” meaning they met the highest standards of proven efficacy or effectiveness. Four more treatments were labeled as “probably efficacious,” while everything else fell under possibly efficacious, experimental or questionable. In short, understanding treatments for troubled youth behavior is an ongoing process. As for mental illness, the best treatments vary depending on the illness — such as treating bipolar disorder with medication, for example, versus treating substance abuse with cognitive-behavioral therapy or family therapy.

Many troubled teen programs claim they can treat both types of problems, as well as many of their subcategories. Turn-About, for example, boasts experience in treating everything from bipolar disorder, depression and post-traumatic stress disorder to anger, bad grades and promiscuity. But these issues cannot be solved with a one-size-fits-all approach. It takes specialized professionals to assess the best treatment options. But history shows that since these businesses are in need of clients, they’ll “treat” them regardless.

Some do make an effort to approach each student’s needs individually. “The biggest change over the past 20 years in wilderness therapy has been an increased expertise in treating a wider range of issues that go beyond anger issues or substance abuse,” Steve DeBois, the clinical director of Second Nature, a wilderness program based in Duchesne, Utah, says.

“These include specialty groups to address anxiety, depression, learning differences, autism spectrum disorders, technology addiction and trauma.” And they include a variety of therapeutic approaches, he says.

DeBois boasts the credentials to understand best practices; he has a doctorate in clinical psychology from the University of Tulsa. Many programs elevate someone of similar standing to head clinical operations, while sending licensed therapists to meet with kids at varying intervals. But most staffers are not trained mental health professionals — they’re locals, or they’re recent college graduates who like working in the outdoors and want to help kids.

“Your job is just to keep them safe, and to encourage and promote a good environment emotionally, physically, for them to safely go through all the things that they’re going through,” says Laura Brigham, a former guide at the Anasazi Foundation who studied mechanical engineering.

But even if a program embraces the most up-to-date best clinical practices and hires the most qualified staff in the business, the market’s saturation and fierce enrollment competition means that parents likely wouldn’t be able to differentiate between a clinically focused program and one that embraces manual labor as punishment.

Meanwhile, Archuleta’s lawsuit against Turn-About Ranch continues, with Turn-About working to get the case dismissed. Whether the lawsuit goes forward or not, Archuleta is one among many continuing to blow the whistle on the “troubled teen” industry. For the moment, lawmakers appear ready to listen to the growing chorus of voices calling for change. But will enacting new laws be enough?

Phil Elberg — one of the few lawyers to successfully sue troubled teen programs — believes incremental changes like SB127 are a step in the right direction. However, “What scares me about what’s happening,” he says, “is that as we regulate it, we are institutionalizing something without challenging the basic premises on which the whole thing is based.”

Additional reporting by Fendi Wang