User:Shuniw/Island View Residential Treatment Center

Island View Residential Treatment Center was a Delaware limited liability company that operated a residential treatment facility in Utah and closed in 2014. Aspen and CRC Health determined the program no longer fit their strategic objectives and no longer wished to operate the program.

Background
The Syracuse campus opened in 1994 as the Island View Residential Treatment Center. Its founders were Lorin Broadbent, DSW, Jared Balmer, PhD, and W. Kimball DeLaMare, L.C.S.W. DeLaMare had previously served as the director of Utah KIDS, a controversial drug and alcohol treatment program that lost its license in 1990.

Along with individual and family therapy, the facility utilized "Positive Peer Group" psychotherapy sessions that were held 5 to 6 times per week. According to the program philosophy, such "peer feedback is often far more powerful than the expert opinion of a professional, well-meaning parent or other well-meaning adult." In 2004, the residential treatment center was acquired by Aspen Education Group. CRC Health Group, a company owned by Bain Capital, purchased Aspen Education for $300 million in 2006. Aspen and CRC Health Group owned and operated the Syracuse campus until 2014.

In April 2014, Island View closed and replaced by a newly created program with different ownership and management. As of April 2014, Island View's no longer had a business license to practice in the city of Syracuse where their campus based.

Residential Treatment Program
Before its closure, Island View treatment center provided subacute care to troubled adolescents experiencing mood and behavioral dysregulation, substance abuse, and difficulties at home or school. Care at the residential program costs upwards of $10,000 a month and requires a $10,000 deposit. The 90-bed lockdown facility provided care to students ranging in age from 13 - 17.6 years. Most of the students there come from an upper-middle-class background. According to the program's website, the average length of stay at the treatment center was 8–10 months. Teenagers at the residential program were monitored 24 hours per day, seven days per week, by team directors and houseparent staff. While at the facility, students were generally only allowed to communicate with their parents. Island View was akin to a cross between a reform school and psychiatric security hospital. According to an Order by the state of Oregon, Island View "seems about as restrictive a placement as can humanely exist."

Life at the Syracuse campus was described, in a court proceeding, by an Island View therapist:


 * "There are locked doors on all the dormitories, and the school area, there are alarm doors in the back, and then there are staff down the hall towards the front, so it would be difficult for a kid to get past them, should that be an indication. They aren't allowed in the front lobby unaccompanied, so if a kid was wandering out there a staff would go with them. They are not allowed to travel across the campus or even be outside without staff presence. Typically, two staff if there's more, more than, I can't remember what exact number is, but, you know, say a handful of kids, if there's more than three or four kids, there is going to be need to be two staff there. There are also restrictions on the use of telephone, internet, and so forth. There are no telephone calls to parents by the [students] during the first two weeks. After the first two weeks telephone calls are generally limited to just parents. Any phone calls to anyone other than parents have to be approved by parents." [The therapist] also discussed disciplinary procedures. "At Island View girls are not be talking to boys unless they are in school, and only then it is supposed to be about school-related things. [The therapist] testified that there was a point at which [a] student was placed on communications restrictions where she was not allowed to talk to any resident. She was only allowed to talk to staff for at least a little while. Island View's records also indicated that when [a] student left campus with parents [he or] she was required to go through a "Change of Clothes Procedure" to search for contraband upon [his or] her return."

The program offered a range of critical support services to troubled teens, including a therapeutic, positive peer environment and individual, group and family therapy (generally by teleconference as most students were from out of the area). Specifically, residents received subacute care involving intensive therapies, behavior modification, psychopharmacology, nursing assessment and intervention, diagnostic evaluation, and educational planning. Residents typically received seven therapy sessions a week, in the form of five group, one individual, and one family therapy session. It should be noted, however, that the majority of the "therapy" was done in groups and led by the unit staff who were not licensed therapists. The program used a "levels" structure - as a student’s behavior improves, he or she was advanced to the next level with rewards such as extra phone privileges attached to each higher level.

At Island View, the majority of residents were organized into teams solely by gender. This structure typically consisted of separate girls' teams and separate boys' teams of 15-19 adolescents each with specifically assigned milieu or residential staff, teachers and others.

Restraints and Seclusion
Parents were required to authorize the facility to use behavior modification such as therapeutic holds and restraints. The program's enrollment agreement authorized staff to therapeutically hold, restrain, control and detain residents by the exercise of necessary techniques and holds when deemed necessary. Therapeutic holding is a treatment technique that the facility uses to "remove a resident from environmental stimulation ... when other forms of intervention failed to assist the resident in gaining control." In the program's Authorization for Treatment and Emergency Medical Care, therapeutic holding was defined as when a "resident is physically held by staff members to prevent self injurious behavior, harm to others, severe disruption of the therapeutic environment and/or destruction of physical property." And seclusion is defined as "the confinement of a resident from the therapeutic environment to the seclusion room or other room. The behavior must create a serious threat of harm to the resident, others, or be a serious disruption of the environment." The program's enrollment agreements had also authorized staff to use other "Special Treatment Procedures," which is a "technique used for residents whose behavior makes them dangerous to themselves or others and/or if a resident's behavior significantly disrupted the therapeutic environment. This technique was only used when ordered by a licensed clinician for a limited, specified period of time or until the resident regained control."

Parent Roles
The program's website at one point said the single most important variable for treatment failure or mediocre outcome is a parents' level of commitment to the process. Parents were coached by Island View on how to respond to their "child's manipulative attempt[s]" to try "every conceivable way to draw" their parents into rescuing them from the program. When a child "puts up a stink," Island View reminded parents, "if you open one of those doors for him, because you feel bad for him or you think you want to help him, both you and Island View stand defeated. At that point, both you and us need to run after him, get him back into the corridor, be sure that door is locked and work on getting him down the hall toward the right door. All of that takes time and resources."

Parents were deterred from what Island View calls "Making a Deal under the Table" because it "sabotaged treatment and rendered Island View powerless in bringing about lasting change with the child." In the Frequently Asked Questions, some examples Island View gives parents of such a "deal" are when a parent, without the treatment team's approval and recommendation, "is pressured by the child into coming home for a visit" or "persuaded by Mr. Manipulation to come home for good as soon as he achieves" a certain level." According to Island View, it is also a problem when "[e]ven though the rules are that a resident on [a certain level] is restricted to one phone call home per week, and the therapist has a weekly phone session with the family, the parent calls [Island View] every day, inquiring of anybody she can get a hold of, about the general well being of her child."

Island View's parenting manual also included instructions for parents on how to deal with their child when that child complains about or asked to be signed out of the program. Parents are warned that shortly after their son or daughter enrolls at Island, he or she may deliberately "attempt to arouse feelings of guilt and anxiety within you." Island View calls this "GUILT-LOADING." The residential treatment center advises parents not to let "guilt-loading" overpower them because they "will help [their] son or daughter the most by no longer allowing him/her to manipulate the way out of consequences." One method of "guilt-loading," parents were told, was "the 'horror story' approach. It is simply misrepresenting, exaggerating, or making up stories. All designed to make you feel guilty. Typical examples were: "They are not feeding me. They are feeding us too much, they are going to turn me into a pig. There is never hot water for the showers. My room mate is totally crazy, if you don’t get me out of here I’ll go mad. Nobody on the entire staff has talked to me for days. I’m the only sane person in this place. Compared to other kids here, I have no problems", etc., etc., etc."

Grievance Procedure
A student at Island View could initiate a complaint or grievance regarding the resident care delivery system but must have followed a long process to do so. The complaints may have included allegations of abuse, neglect, punitive interventions, sexual harassment, etc. A complaint needed to be filed and reviewed by at least seven different staff members before a student could forward the complaint to an independent party. Even then, the complaint would only be reviewed by the State of Utah, Department of Human Resources, and Office of Licensing.

Outcome Surveys and Research
According to Island View, the program was effective because there was data to back it up. On its old website, Island View stated that "[t]hirteen years of consumer satisfaction studies and outcome surveys from Island View graduates and their parents tell us that approximately 85% of parents have found the program effective or highly effective in returning their child to emotional health. Since we follow all Island View graduates for two years following graduation,we know that the maintenance effect of changed behavior is enduring at a similar level. Change at Island View is not short lived, or a 'flash in the pan.'" The actual data or findings of the outcome surveys or research was not made available on the website.

Media coverage
Troubled teens and their families were featured on several Dr. Phil shows, who then offered them free therapy for the teen at Island View. A couple whose troubled daughter was featured on an episode of Dr. Phil was reportedly suing the television personality with claims that he had a hand in traumatizing her during treatment at Island View. In January 2014, the facility, its owners, and Dr. Phil were sued by the family of a student who had attended Island View after being featured on the show. The lawsuit, which alleged mistreatment at Island View, received extensive media coverage.

Controversy
Island View had been criticized for loose oversight and accused of abuse and neglect, of residents. Island View also had a reputation for discrimination, abuse, and harassment of staff, who offered constructive feedback about the programmatics.

Abuse Lawsuits
Accusations: Island View had been accused of, amongst other things, "slavery," "abuse," "negligence" and "false imprisonment" of teenagers. In January 2014, the family of a teenage girl who claims she was berated on television by Dr. Phil and then sent to a residential treatment center in Utah where she was falsely imprisoned, filed a civil lawsuit.

About a year earlier, the girl's mother went on the "Dr. Phil" show with her daughter. In the episode, the daughter admitted to having sex with adult men she met online, which the family called "bizarre and dangerous conduct" in their lawsuit. The parents enrolled the girl. In their suit, they now call the facility a "private prison" and claim their daughter was placed there "for the purpose of forcing her to become obedient instead of truant by depriving her of freedom, privacy, education, and subjecting her to involuntary servitude, and unjust unusual punishments." The teenage girl apparently refused to obey staff members who told her to get off of her bed. When several staff members tried to pull her off and restrained her, her right arm "was badly and perhaps irreparably broken, and its main nerve severely damaged," the lawsuit states.

On April 3, 2014, another lawsuit was filed by a mother from Houston, Texas in Utah Federal Court against Aspen Education Group, Aspen Institute of Behaviorial Assessment, Bain Capital, Guardians of Hope, Harris County Office of Human Resources and Risk Management, lead defendant Jack Nuszen, and Norma Willcockson, the alleged child trafficker that transported the teenage girl from Houston, Texas to Syracuse, Utah forcibly against her will to be locked up in Aspen RTC. In the lawsuit, the mom called the place a private prison.

In 2014, another former student sued Island View, along with the Provo Canyon School, for personal injuries, demanding $800,000. In the federal lawsuit, the student claimed that Island View putting him into a "private prison[] violated his constitutional rights to privacy, due process, both procedural and substantive, equal protection, free speech, false imprisonment, right to a speedy trial, freedom from seizure, involuntary servitude, and cruel and unusual punishment."

In responding to the lawsuits, Island View expressed concern over the use of "advocacy by insult." In court documents, Island View asserted that certain statements should be disregarded because they were "immaterial, impertinent, or scandalous" such as that Island View staff purportedly "had dangerous propensities to abuse teenagers entrusted to their care," that a former resident received "mindless discipline, manhandling, and drug induced controls," and describing Island View as "an academy of no particular merit." Island View maintains that such statements do nothing to help a situation and everything to hinder progress.

In 2015, the sisters of a former Island View resident brought a suit against the father of the girl, alleging personal injury, false imprisonment, intentional infliction of emotional distress, invasion of privacy, child abuse, and negligence. The plaintiffs alleged that "Island View’s philosophy was to deprive its participants of all contact with the outside world, to treat them with rudeness and hostility, and to punish them for disobedience by deprivation and physical abuse. Island View has been and continues to be the subject of much litigation and controversy over its mistreatment of the captive children under its supervision and control. The tuition costs are enormous for a program run by amateurs who have no concept of proper health care administration or behavior. It has received much notoriety and adverse comment on survivor sites for its maltreatment of adolescents kept captive in its care."

Lack of Oversight
Island View had an A+ Better Business Bureau ranking with zero complaints recorded in its final 3 years, but one of its corporate parents, Aspen, was criticized in an article in Salon, for their legacies of abuse, neglect and wrongful death allegations. The article, "Dark Side of a Bain Success," found an alleged culture of what appears to be systemic abuse and neglect at treatment centers owned by CRC Health Group, including Island View. The Salon article builds on previous reporting by Time Magazine's Maia Szalavitz, who broke the story in 2009 that the now-closed Mount Bachelor Academy, owned by CRC, encouraged lap dances as part of what an Oregon agency determined was therapy that incorporated abusive "sexualized role play." An Order by the State of Oregon, shutting down the CRC-owned therapeutic boarding school, outlines findings of abuse and neglect of students and violations of state licensing rules. The Salon's Art Levine reports serious allegations of abuse and neglect at Island View too. "With rare exceptions," he says, "such incidents have largely escaped notice because the programs are, thanks to lax state regulations, largely unaccountable."

Complaints against CRC have rarely led to consequences for their formerly owned treatment centers like Island View because "the troubled teen industry in particular is a regulatory Wild West." "There are significant disparities from state to state," said Kimball DeLaMare, the co-founder of Island View. "Over all, they have not done too much, which is one of the reasons we are trying to develop our own standards." Although Utah has a licensing system for residential programs, the state has been criticized for being unable to guarantee patient safety.

Regulators often shield the teen care industry from genuine scrutiny, according to investigations by the GAO, congressional hearings in 2007 and 2008, and reports by such mental health advocates as the Bazelon Center and Mental Health America.

The apparent lack of oversight in the teen industry, combined with a widespread view by providers that their residents are manipulative troublemakers, has allowed a toxic culture of psychological abuse and medical neglect to prevail, according to parents, alumni and federal officials. It has been reported that culture is visible at Island View. For years, Island View even included on its website some examples of the ways a child might try to manipulate parents to recuse the child from the program. One former student at Island View, corroborates this view, by recalling "her alarm when she coughed up blood one morning as she stood at the bathroom sink. She says she was never allowed to see a doctor because by the time the nurse wandered by a few hours later, another student had rinsed the blood from the sink. '[Island View staff] assume you’re lying,' she says." The Salon's Art Levine was an eyewitness to this culture of abuse and neglect when, after being denied press access to CRC facilities, he visited Island View in August 2011 posing as the father of a troubled girl. During that visit, director Laura Burt confirmed the skeptical stance toward potential medical emergencies. She told him that the medical staff would see his daughter immediately in case of a medical crisis but would monitor her if they suspected fakery: "We’re not going to rush her to the hospital if she’s just saying that and there is nothing that says it."

Psychological and Corporal Punishment
Before the program's closure, and following its change of ownership Island View used what the teen treatment industry calls a "levels" model that grants more privileges and freedoms as students follow the rules, but imposes sanctions of varying severity on those who slip up or disobey. In a lawsuit against the residential treatment center, the complaint describes a former resident's experience stating that "[o]nce confined, no contact with the outside world was allowed and [the student] knew that any disparaging remark or complaint about the prison would be punished by isolation and losing all privileges earned, meaning making the teenager start at the bottom anew to rise from level to level by successfully completing mindless tasks of blind obedience enforced by cruel punishment."

Punishments at Island View were more often psychological than physical. Former students report emotionally brutal isolation punishments and peer-driven encounter "therapies" were commonly employed to break down resistance at Island View. The worst part for the former student who coughed up blood was when students in the program were prodded to confront each other about real or fabricated transgressions in harsh encounter sessions. (In fact, she says, they were very similar to the group therapies cited in the June "torture" lawsuit against Turn-About Ranch.) She further recounts that the sessions were so terrifying that girls resorted to desperate measures to avoid attending. She recalls that some girls choked themselves to induce fainting; one rubbed feces in her own eyes to cause an infection. Another form of punishment used at Island View is to make students sit at their desks and stare at a white wall all day everyday for weeks. Communication restriction (CMR) is also used to restrict residents from speaking to one another when they have misbehaved.

Restraints and isolation rooms were also used at Island View to punish students for breaking the program's rules. An article in the New York Times describes this and explains how in residential treatment centers like Island View, "[v]iolating rules often leads to being placed in isolation, or being 'restrained' — held on the floor for as long as an hour by staff members, who students say twist their limbs in painful positions until they stop resisting."

Island View was sued for the use of restraints and isolation rooms after a teenage girl was badly injured when the facility's workers forcibly tried to remove her from her room. Specifically, when a math teacher at Island View told her to stay after school, she refused and went to her room. He then came after her and ordered her to an isolation room for time out. She refused that to in emphatic and obscene language and told him to leave her alone. He then pulled her off her bed, and called for help from three others to enforce his command. In the melee that ensued, there was a loud 'pop' that stopped everyone in his tracks. S.M.'s right (dominant) arm was badly and perhaps irreparably broken, and its main nerve severely damaged. Given the rapes and murder she had been through, the last thing any untrained male should have done was to assault her."

"They break you down, but they don’t really build you back up," the former student says of the Island View approach. "I have nightmares from it, and the memories are really awful."

Another former resident reported in 2002 in an article in the SF Weekly that "she was traumatized by her time at Island View." The young woman says "she underwent therapy in which she was to say that she loved her father, and that her mother was crazy." She further stated that "[t]hey would tell me, '[y]our dad is not a bad father and your mom is crazy.' They would hold me in there until I would say it. I remember staring at the light reflecting against the wall, and those ideas seeping into my brain. I realized what I needed to do was to pretend that it was working. But I had to stay in touch with both realities at once. There was the me that I was inside, and the me that I showed to the outside world. Every night, it was like that movie Memento, and I would remind myself, 'OK, this is real, and this is real.' I remember thinking, 'This is weird. Is this a movie? Is this my life?'" The girl's mother, however, was not allowed to visit her daughter who "could only make 10-minute calls to her mother after she'd earned phone privileges -- six weeks into her stay. To maintain contact, they sent each other letters, which were screened by the Island View staff." In response, Dr. Jared Balmer, the executive director at Island View at that time said "that many children who enter his facility have similar reactions. 'A majority of the children here think that they have no problems.' he [said]. 'But they think that everyone else has lots of problems.'" Yet the author of another article involving the former resident wrote that investigators of the L.A. Department of Family and Children’s Services were "disturbed at the questionable ethics of Island View, which had admitted Alanna based solely on the father’s bogus descriptions of her 'symptoms.'"

One lawyer spoke publicly on the "racket" he claims the behavioral modification residential treatment center is involved in. "Parents pay enormous funds to get what they expect is really good treatment; instead they get minimal results and abuse," the lawyer said.

Deaths and Bodily Injuries
The program failed to monitor a 16-year-old Pennsylvania boy who hanged himself in a bathroom at Island View in 2004. The teen hung himself from a shower support with a belt after he excused himself from a movie that was being shown before dinner. When staff found him, they tried to revive him but were unsuccessful. Island View was cited for minor issues and required to submit a plan of "corrective action." The death took place before Aspen owned the facility.