Aug 25, 2016


Huffington Post



Emily Graeber sat on a plane, her long hair falling over her face, and pressed her nose against the window. Then she leaned back in her seat, trying not to cry.

It was October 2007. Graeber, a 15-year-old from Clayton, Missouri, had just spent a happy week with her family. Now she was headed back to Island View, a residential treatment center in Syracuse, Utah, that prided itself on its therapeutic approach to helping teens with behavioral problems.

Graeber hated Island View. Staff and other kids yelled at her for sins as small as making eye contact with other students. They gave her medication that made her gain weight and feel like a zombie. When she broke even minor rules, they isolated her for days, forbade her from speaking and forced her to sleep on a mattress in a hallway. At night, the bright fluorescent lights would keep her awake for hours until, crying, she fell into an exhausted, restless slumber.

She didn't want to go back. So when the plane landed in Utah, the teenager didn't move. She stayed in her seat and waited to see what would happen. Eventually, the aircraft rumbled to life again. It was heading on to California. She was free.

But when Graeber arrived in San Francisco, she realized her baggage was probably drifting around an airport carousel in Utah, and the clothes on her back wouldn't be enough to keep her warm. With no idea what to do next, she headed for the one place in the Bay Area she had heard of: the San Francisco piers. Hours passed. The sun set. She fell asleep curled up on a bench and woke up the next morning to find other homeless people had bunked down with her.

For two days, Graeber wandered the city streets aimlessly. Tired, she boarded a bus. She sat there for hours. Finally, she met an 18-year-old man who said she could stay with him and his mother in Oakland.

In the meantime, her disappearance started to make headlines, and her parents appeared on local television in St. Louis pleading for her return.

Weeks later, a private foundation that looked for missing children found Graeber in Oakland, staying with the mother and son who had taken her in. Her parents, relieved that she was safe, promised not to send her back to Island View, she told The Huffington Post.

Graeber, now 23, says Island View didn't fix her problems. It made them worse. For two years after leaving Island View, she used heroin. She can't find a job because her time as a missing person comes up in every background search. Even now, she blames her anxiety and post-traumatic stress disorder on her time at the facility. (Her parents did not respond to repeated requests for comment.)

Island View — which housed more than 100 children at a time, aged 13-17, and charged parents at least $10,000 a month — caused lasting damage to its students, a dozen of them told HuffPost. Former residents said the staff tormented and abused them — pitting teens against each other, physically restraining them, secluding them, medicating them with high doses of powerful antipsychotics and forcing them to sit without speaking for hours or days at a time.

It's often hard for people to take the word of "troubled" teens against adults who claim to know what's best, said Ira Burnim, legal director of the Bazelon Center for Mental Health Law, which advocates for people with mental illnesses.

"The staff says one thing, the kids say another thing," Burnim explained. "It's rare the kids would be believed as opposed to the staff."

But court papers, police files and government documents obtained through public records requests back up many of the former students' allegations. Even Vlad Diaz, a 37-year-old who worked at Island View for 11 months in 2008, said the facility's practices disturbed him.

"Some of the things we had to do — it was uncalled for and wasn't fair to these kids," said Diaz, who added that he left because he disagreed with how his colleagues treated the students. "They were treated like crap. I wouldn't treat a dog like that." He also alleged that he saw multiple kids attempt suicide during his tenure.

In January and February 2014, former Island View students and parents sued its parent company, Aspen Education, alleging that the facility maintained a prison-like environment where physical and psychological torture were used against students. In April of that year, Aspen closed Island View — for financial reasons, a former Aspen spokeswoman told HuffPost. That October, Acadia Healthcare, a treatment industry giant, bought Aspen's parent company, CRC Health, in a $1.18 billion deal.

But while Island View supposedly closed, the students stayed. A new company, Family Help & Wellness, took over the property. The facility began to operate under a different name, Elevations RTC. It continues to bring in new students today.

"Our treatment team employs a variety of therapeutic methods to help these teens, all of which are in compliance with state regulations and in line with our accreditation," a spokeswoman for Family Help & Wellness, the company that owns Elevations, told HuffPost in a statement. She declined to comment on specific allegations regarding individual students, citing privacy laws.

But not much has changed other than the facility's name, a HuffPost investigation found. Staff are still isolating and physically restraining children. At least one has attempted suicide. Others have tried to run away.

Even the staff is the same: 39 of the 48 employees listed on Elevations' website worked for Island View.



The problems with the troubled-teen industry aren't limited to Island View or Elevations. Parents whose kids are struggling through the

transition from child to adult have long looked for outside help. The idea behind private behavior modification facilities — boarding schools, military-style boot camps, wilderness programs — dates back at least 50 years. For a price, they have promised to treat teens with substance abuse and behavioral or emotional issues, while also letting them take classes to satisfy state requirements for a high school education.

But there's little evidence that "tough love" techniques such as isolation and humiliation actually work. And the basic setup of residential treatment facilities lends itself to abuse, critics of the industry argue.

"If you have an institution where you have vulnerable people, abuses of power will almost always occur unless you have really strong safeguards against them 
especially if you have vulnerable people who can't contact the outside world," said Maia Szalavitz, a journalist who wrote a book, Help at Any Cost, about the troubled-teen industry. "That in itself is a recipe for abuse."

At least 1,500 children in 30 states alleged that they were abused at private treatment facilities in 2005 alone, according to a 2008 Government Accountability Office report. At least 28 states had one or more deaths in residential treatment facilities that year. Island View dealt with a death in 2004, when a boy hanged himself with a belt just a month into his stay. Other allegations in the report included "sexual assault, physical and medical neglect … [and] bodily assault that sometimes resulted in civil rights violations, hospitalization, or death." Teenage victims of abuse often stay silent out of fear, mistrust of authority, or simple ignorance. The number of them abused or neglected at treatment facilities each year, the GAO found, is likely much higher than 1,500.

Despite this record of abuse — which journalists have been writing about for decades — parents upset by their children's treatment at facilities like Island View often have just one option: lawsuits. "It's one of the most horrendous things," said Thomas Burton, a Utah attorney who has helped parents sue the centers. "The state isn't going to prosecute these RTCs, and local law enforcement agencies aren't going to impair the enormous amounts of money being brought into local communities. I mean enormous amounts of money — they're cash cows. So where else can [parents] turn?"

Regulators are little help: The troubled-teen industry is almost entirely unregulated. The GAO data from 2005 are the most recent available because the federal government doesn't track allegations of abuse at treatment centers, let alone investigate them or close down problem facilities.

Congress has repeatedly refused to intervene. In 2011, a federal bill that would have banned physically abusing or starving children at such facilities died in committee. State regulation is patchy at best: Utah, where Island View and dozens of other treatment programs are based, didn't regulate them at all until 2005. It now requires facilities to submit documentation about how they operate, pay approximately $500 for a state license and submit to an annual site inspection. But like most states, Utah has no rules outright prohibiting isolation, humiliation or physical restraint. So facilities like Island View still can — and do — isolate, humiliate and physically restrain children. In many states, they can withhold food and water as punishment. 

Even solitary confinement — which President Barack Obama has banned for juveniles in federal prison — is permitted at many private treatment centers. 

Island View and similar facilities demand one thing from students: absolute compliance.

"My understanding of what I needed to do was to do what they said, no matter what," recalled Xander Niazi, now 24, who attended Island View in 2008. "If I just played their game, maybe I could have my freedom again."

Compliant children were rewarded with special privileges, like trips outside the facility. Noncompliant children were punished with physical restraint and isolation. They were all expected to participate in group "therapy" sessions that required them to complain about and attack each other. Many of them were medicated with high-dose antipsychotics.

Parents and children received Island View's resident manual, which explained how the system worked. And since parents signed over their guardianship rights to Island View — as most residential treatment facilities require — all of it was legal. The contract the parents signed allowed the staff to "therapeutically hold, restrain, seclude, control and detain the Resident by the exercise of necessary techniques and holds when deemed necessary by The Institute."

Parents who send their children to residential treatment centers like Island View often hire independent contractors, colloquially known as "transporters," to forcibly ferry their kids to their new homes. When Emily Graeber was 13, her parents hired transporters who took her from her bed in the middle of the night. Aleks Jackowski, a 20-year-old former Island View resident, said he fell asleep on the couch watching television with his parents, only to wake up to two large men telling him to get ready as his mom stood sobbing.

"That's when I realized I was being taken away," Jackowski, who was 17 at the time, said. "My mom was saying, 'I love you, honey. We're sending you to this place to help you out.'"

Demands for compliance began the moment students arrived at Island View. Staff strip-searched new students.

"Other places would let you leave your shirt and boxers on," said Niazi, who had cycled in and out of troubled-teen programs since the age of 12 for his depression and anger issues. "Not here. They'd get you completely naked, make you spin around in front of them, squat and cough. As a kid, in front of grown men, it was degrading and humiliating and not a good feeling at all."

When Niazi was ordered to remove his piercings, he refused. So two staff members pinned him to the ground, he said. "They restrained me on my back and physically removed each one of my piercings, which tore my flesh open," Niazi said. "I still have scars from it."

Island View staff assigned each student to one of five ranks. A higher rank meant access to the foosball table or time outdoors, but its price was complete obedience. Kids couldn't move up in rank if staff felt they were "in denial about their issues that brought them to this point in their life," the Island View handbook — which HuffPost obtained — explains.

"You never got to go outside unless you had a certain rank, and I never got that rank, so never got to go outside," said Maximillian Silberman, a former student.

Kids at higher ranks were granted more time to talk to their parents on the phone. Those at the lowest rank would be lucky to have just one 10-minute conversation a week.

Any of these privileges could be gained or stripped away at a moment's notice, former students said.
"Long-term treatment facilities are like ... a jail without having done anything illegal," said 25-year-old Michelle Lemcke, who attended Island View in 2006. 

On Tuesday nights, the teens at Island View met for "problem-solving group," a block of time in which they were supposed to bring up issues they had with each other using "I feel" statements. The Island View handbook describes the ritual as a positive team-building exercise. "You have the opportunity to work together with other peers," the handbook reads. "Not to tear each other down, or try to get each other in trouble — but to help each other to live happier, more productive lives."

But tearing each other down seemed to be the primary focus of the problem-solving group, former students said. The teens were asked to drop slips of paper with a person's name and a complaint into a box to be read aloud during the meeting. On one occasion, Graeber remembered, the staff announced that not enough slips were being filled out. So going forward, each teen was required to drop five slips on five different people.

"Nobody was safe from getting a slip dropped on them," she said. "It would turn into such a frenzy — me calling someone out for something, and 20 other people jumping in about it."

The issues raised on the slips could be as benign as "eye rolling" or "acting like a drama queen," Graeber recalled. During his first week at Island View, Eli Rogers, who graduated from the center in 2011, had an emotional conversation with his mother on the phone — the one 10-minute call he was allowed to make that week, he said. He began yelling at her. Staff brought him into the problem-solving group to address his outburst.

"There were like 20 kids set up and four therapists just yelling at me," Rogers said. "I just got in defense mode, and it basically just became a shit-talking session."

Some kids took drastic measures to avoid the encounters entirely. One girl choked herself to induce fainting and another rubbed feces in her eyes to cause an infection, journalist Art Levine reported in a 2012 Salon story on Aspen Education.

At one problem-solving session, a girl went around the room giving everyone the middle finger, Graeber said. "She stormed off and got tackled because she left the group."

Island View staff regularly used physical restraint to control students, according to former residents.

"They'd take your arms, put them behind your back like you're being arrested," Graeber said. "Sometimes a staff member might crank it up, just to the point where your arm would almost break but not break."

Niazi recalled being held down by men twice his size, their knees in his back and shoulders, their weight pushing his head into the floor. Graeber once twisted and threw her glasses at a staff member she believed was trying to rile her up. She was restrained, too, she said.

Island View guards even broke a student's arm, a 2014 lawsuit alleged. "At Island View, mindless guards mangled [a student's] arm, causing severe and irreparable orthopedic and neurological damage," the parents of the 15-year-old girl, Terri and David Myers, claimed. A teacher pulled the student "off her bed, and called for help from three others to enforce his command," according to the suit. "In the melee that ensued, there was a loud 'pop' ... [Her] right (dominant) arm was badly and perhaps irreparably broken." The lawsuit was eventually dismissed after a court ruled that it should have been filed under the state's medical malpractice laws.



Physically restraining students and pitting them against each other weren't the only ways Island View staff had to enforce compliance.

Island View's resident handbook forbids "any form of sexual acting out … including note writing." So when Graeber passed a note to a boy in her class one day — and locked eyes with him — she was immediately sent to the Yellow Zone.

Students in the Yellow Zone had to sit silently in a white plastic lawn chair at a desk in a hallway for hours — or days. They could not go to class or see their peers. A staff member stood guard, making sure the children didn't speak. Time in the Yellow Zone could be doled out for misbehavior as minor as putting one's feet on furniture, talking without permission, physical contact with another student, "excessive eye contact" or showing skin, according to the Island View handbook. But the punishment should last at least 18 hours, though no more than 72,

the handbook said.

Sometimes, Island View residents felt like the staff were egging them on — daring them to misbehave. "The staff would treat you very disrespectfully. They'd make fun of you. You'd walk away and hear them talking shit about you, laughing about it," Lemcke said.

Melinda Rogers, whose son Eli attended Island View, said she saw firsthand how Island View staff humiliated children. In one incident, she said, a staff member openly antagonized a girl who had broken a minor rule.

"He embarrassed her in front of everybody to see how she would react," Rogers said. "If it were me and someone said that to me, I can remember thinking, 'Well, I wouldn't have acted how you wanted her to act.'"

Island View expected employees to be tough on kids. "The tougher you are and the harder you are on the kids, the more successful you were in Island View's eyes," Diaz, the former staff member, said. "Those [staff members] were the ones that would get special privileges to go out with the kids, go to movies or dinner."

Diaz "didn't see eye to eye" with his bosses, he said — so he didn't get those privileges.

There were more subtle humiliations in the Yellow Zone: Staff would put on Richard Simmons' "Sweatin' to the Oldies" for the kids' occasional exercise. And there was ongoing abuse: At night, staff pulled a thin mattress into the hallway. Yellow Zone inmates slept under the fluorescent lights. "This is not a time for the resident to check out of the program and relax … or catch up on their sleep," the handbook explains. "The resident is to remain in staff's line of vision at all times. This includes bedtime, where the resident will be situated in the hallway and monitored throughout the night by staff."

"It was really difficult to sleep," Graeber said. "They'd have night staff walk by every 20 minutes and shine a flashlight in your face to make sure you're still breathing."

Graeber and others said they were often given the maximum sentence: 72 hours of isolation and silence.

But the Yellow Zone wasn't even the worst punishment that Island View's residents had to endure.



When President Obama banned solitary confinement for juveniles in federal prison, he highlighted its ill effects — from depression and alienation to an increased risk of violent behavior. Still, many

private facilities force troubled kids to go into rooms that look a lot like cells.

Island View had three "time-out rooms" for isolating children. Kids were kept for hours in a small white chamber, approximately 4 by 4 feet, with a large metal door. Graeber was sent there after she threw her glasses to the ground. Niazi was sent there when he broke down in tears.

"Even if you're just getting really upset and crying, when you get to the bawling point of crying, that would be a catalyst for them to physically grab you and be like 'you're going to the time-out room,'" Niazi said. "And it's like, do I need to be in time-out — because I'm fucking sad and I'm in a dystopian fucking novel right now?"

There was no toilet. Graeber said she once urinated on herself because a staff member wouldn't let her out. The only window was a small opening in the door, so that employees could make sure the children weren't seriously hurting themselves.

"It made me feel like I was in an insane asylum," Lemcke said. "They locked you in there until you calmed down. That happened to me a lot."

When authorities in Iowa investigated what the Des Moines Register called a "tough-love school" earlier this year, they found similar concrete rooms, the walls of which were covered in urine and feces. Former students at the now-closed Midwest Academy said they were isolated in those rooms for a minimum of 24 hours.

The Utah Department of Human Services knew about Island View's isolation rooms and had some regulations for their use. "All time out or seclusion rooms shall … be equipped with a break resistant window, mirror or camera that allows for full observation of the room," states a 2013 DHS report. "Seclusion rooms shall have no hardware, equipment, or furnishings that obstruct observation of the child, or that present a physical hazard or suicide risk."

But the state didn't consider time in the rooms to be solitary confinement because — even though staff kept guard — the doors to the rooms remained unlocked, explained

John Ortiz, who has been a site inspector with the department for the last eight years.

"Oftentimes, my experience has been that these young men and women are struggling, and need a space to process and talk to somebody," Ortiz said. "This time-out room is a place where they can do that — they can take a time-out. Many of the kids will say, 'I need a time-out,' and they'll go to the time-out room to sit down, cool off, and once they're back on track, these kids are transitioned back into the program."

Isolation rooms aren't used as punishment, Ortiz said. Former Island View students disagree.

Graeber said she hated walking by the rooms and seeing her friends trapped in there. "I'm still really haunted by the screams," she said. "Sometimes I have nightmares just from the screaming."

Although the state set the maximum time for isolating teens at four hours, Island View often kept them there longer, former residents said. An inspector with Utah's Office of Licensing had to remind the facility of the time limit in a 2009 on-site review.

Once, after four hours in isolation, Graeber began to panic. She began to cry. Then she started slamming her head against the wall. 

When parents signed over guardianship of their children to Island View, they also signed over the power to decide which medicines their children would take — voluntarily or involuntarily. Some kids took all

the medicine that staff therapists prescribed. Others refused and were

forced to comply.

"They didn't have that choice," Diaz, the former employee, said. "They would have gotten in trouble for not taking their pills."

Nearly a dozen former Island View students said they were prescribed more drugs, at higher dosages, than they had been taking before entering the facility. They claim Island View staff required them to take medicines they didn't need, including antipsychotics, in order to keep them sedated.

"The assertion that our medical staff were 'tranquilizing' clients to keep them under control is a preposterous idea," Jared Balmer, a former executive director at Island View who left in 2010, told HuffPost. (Asked about other allegations regarding Island View, Balmer said only that "anybody can accuse anybody of anything.")

Antipsychotics can cause rapid weight gain, increase the risk of diabetes and metabolic problems, and haven't been proven effective in treating teen depression and emotional issues. But on its website, CRC Health — Aspen and Island View's parent company — lists antipsychotics such as Zyprexa, Risperdal and Seroquel as one option for combating teen depression. And all of the former Island View students who spoke to HuffPost said they were forced to take antipsychotics, some for problems including bipolar disorder, which is now thought to be dramatically overdiagnosed in children.

It's legal and common for doctors to prescribe drugs at higher doses and for different conditions than those approved by the Food and Drug Administration. But they should be especially careful when prescribing antipsychotics to children,

experts say.

"A lot of these kids come in feeling broken, traumatized and damaged," said Robert Foltz, associate professor of clinical psychology at the Chicago School of Professional Psychology, and mental health professionals have "made some major mistakes in diagnosing" them. "Tons of kids come into residential with tremendous trauma exposure," he explained, "but they're called bipolar and as a result put on a ton of medications and inappropriately treated, rather than treating the trauma effectively."

Doctors shouldn't "routinely prescribe antipsychotic medications as a first-line intervention for children and adolescents for any diagnosis other than psychotic disorders," the American Psychiatric Association warns on its website. It's not clear these drugs are even effective in treating bipolar depression in teens. A 2014 study examining bipolar depression in about 150 adolescents found that the extended release version of Seroquel, for example, did not outperform a placebo. AstraZeneca, the makers of Seroquel, note in the drug package's insert that the "safety and effectiveness of Seroquel in pediatric patients less than 18 years of age with bipolar depression have not been established."

"So, as our field is guided by 'evidence-based practice,' the evidence actually supports that Seroquel does not effectively treat bipolar depression in youth," Foltz said.

Before Graeber landed at Island View, a therapist at another Aspen facility, Second Nature, put her on Seroquel to deal with anxiety and sleepless nights, she said. At Island View, she said, nurses increased her dosage to 800 milligrams a day — the maximum dosage that AstraZeneca recommends. She wasn't alone.

"My whole list of meds changed from two pills to five," said Eli Rogers.

Silberman, who attended Island View for eight months in 2007, received daily doses of Abilify, another antipsychotic.

Niazi, who said he was on both Seroquel and the antidepressant Trazodone, believes he was put on the medications because they would "turn you into a person the next day that doesn't have the energy to fight." He said, "I often would do everything I could to not take those medications."

Many of the former students remember feeling over-sedated. "I was a zombie 24 hours a day," Graeber said. "I feel like they kept us sedated for ease of control so people wouldn't have as many outbursts."

The fact that a child calms down after taking an antipsychotic doesn't prove that the child is, in fact, bipolar — or that the drug will fix the child's behavior problems, Foltz emphasized. "The reality is all of us would calm down on any of those medications," he said.

Diaz, the former employee, was disgusted by his colleagues' eagerness to heavily medicate the students. "These kids were being used as damn lab rats," he said. "Poor kids are falling asleep in class, getting in trouble, and they're always so thirsty — mouths super dry. ... All they did was pass pills. [But] if a kid was sick or throwing up [from the medication], they wouldn't do much else but give you a Sprite and watch you."

No Island View student ever formally complained about his or her medication, Ortiz, the state site inspector, told HuffPost. But even if there were complaints, the Department of Human Services wouldn't have investigated. "We're not doctors," he said. "We're looking at the basic safety of the facility."
All of the former Island View students who said they were treated with antipsychotics at Island View now say they are no longer taking the drugs. 

After her parents sent Emily Graeber back to Island View, she was forced to apologize to all the other residents for running away. "The way she was talking was not like how a normal person talks," recalled Silberman, who was also at the facility at that time. "It was scripted. ... It was completely humiliating."

Then she was placed in a Yellow Zone variation called "Individual Focus" — which included sleeping in a brightly lit hallway — for more than two weeks. As an additional punishment, Graeber said she was not allowed to speak for 58 days.

"A staff member sits ... in the hallway during the day," she said. "They'd observe, monitor, make sure you weren't speaking."

To use the bathroom, Graeber said she had to write a note and hope a staff member would see it and respond. Occasionally, she'd catch glimpses of her classmates. "The girls were worried when I ran away, so they were happy to see me," Graeber said. "They'd go behind a wall and just peer at me and make faces just to make me smile, which was nice."

Her mandatory one-on-one therapy sessions weren't going well, either. The day after Graeber had returned to her parents, her grandmother — the relative she got along with best — died. But when Graeber tried expressing her grief to her therapist, she said the therapist scoffed.

"The therapist would come in, I'd be crying hysterically about my grandma, and the therapist would say, 'Why are you crying? You're upset that you got caught,'" Graeber recalled. "They basically told me it was my fault that she died, that if I hadn't run away, none of this would have happened."

Diaz, the former Island View employee, said the therapists sometimes seemed more concerned with appearances than with the best interests of the children.

Silberman remembers one weekend when parents were invited to Island View to see the progress their children had made. His birthday was coming up, and he desperately wanted to go home for the occasion. His therapist said that if he wanted to leave, he'd have to "make it believable" that Island View was helping him, Silberman said. So in front of a small crowd of parents, including his own, he began to cry as he talked about the strides he'd been making.

"The therapist congratulated me, but it was such a ruse because the parents were there," Silberman said. "It was completely smoke and mirrors. I remember fake crying just to go home, because that's what I was told to do."

Parents were manipulated, too, Melinda Rogers said. The day she and her husband arrived at Island View,

they joined other parents for a conference with the staff, who she said immediately started blaming the parents for their children's behavioral problems.

"They bring you into a room, and basically they tell you that you're a helicopter parent, which I really wasn't," Rogers said. "They tell you that your child is very manipulative and you have to stop falling into those patterns of manipulation. So when they say, 'We want to go home' or whatever, you just say no."

In a 2005 letter, the father of another resident lambasted Island View for its failure to truly help his son. "No one seemed to have any form of treatment plan specifically for our son," he wrote. "This was after he had been there for six months or more. I feel the Island View staff would have let him stay forever, or until the money ran out."

But even if one parent lost faith in the system, there were always more with needy kids and open checkbooks.


In April 2014, the month Island View was formally closed, Elevations RTC opened on the same site. Its parent company, Family Help & Wellness, was founded and is run by Tim Dupell, who was the executive vice president and

CFO of Aspen from 1999 until 2004. And many Elevations employees, including Elevations executive director Judi Jaques, had worked for Island View.

Aside from a shiny new website and an "Elevations" sign outside the facility, the operation mirrors its predecessor.

"They took the same exact product and put a new label on it," said Aleks Jackowski, who attended Island View for seven months up to the change over and then spent another two months at what was now Elevations. "It was the same handbook, the same rules — everything stayed the same."

On Elevations' website, the student dress code and employee applications still included the names "Island View" and "Aspen Education" in August 2016, more than two years after Island View closed. Elevations continued to use the Yellow Zone and isolate students in time-out rooms, Jackowski said. It also continued to treat kids with high-dose antipsychotics, according to Jackowski, who said he has never been diagnosed with psychosis or bipolar disorder but was given 800 mg of Seroquel a night "to help him sleep."

Documents from Utah authorities back up Jackowski's claims of isolation, restraint and psychological abuse of students under Elevations' control. In August 2014, a state inspector admonished Elevations for its mistreatment of children. "Youth don't feel like they have a voice," the inspector noted in her audit. "They don't complete the grievance [forms] because they have ... had staff laugh at it and throw it in the trash."

Students complained that restraint was being used too often on physically smaller children whose behavior didn't "warrant takedowns," the inspector found. They said staff "talk shit" to kids, telling them to "stop being a crybaby" and wasting their time, according to the report. In one incident, a student told the inspector that a staff member broke confidentiality by walking into the child's classroom and saying aloud, "How's that drug problem of yours going?"

"All youth often feel 'belittled' by the staff thinking they are right and the youth are wrong and threaten them with the time-out room. Staff are shaking their car keys implying 'I get to go home and you don't,'" the inspector noted.

Elevations students still struggle to avoid the time-out room. In April of this year, a student was taken to the emergency room for an injury to his wrist. The incident began after the boy, who had been sick, resisted going to a time-out room, according to a report by facility nurse Jan Sewell.

"Milieu [staff] took him by the arm in the escort position and began walking towards the time-out room," Sewell's report reads. "[Redacted] tried to get away from milieu staff and while doing so he lost his footing and began to fall to the ground. Milieu staff felt a pop in his right wrist."

The facility's new owners insist they don't use isolation rooms. "But we do utilize what we call a de-escalation or time-out room for students who are overstimulated and need to emotionally regulate with time away from the student community," Kristen Hayes, who worked for Aspen Education until 2014 and now works for Family Help & Wellness, said in a statement. "The door to this room is always open and staffed when a student is in the room."

Over the past 18 months alone, the local police department has responded to calls at Elevations for runaways, unconscious students, a seizure and a "traumatic injury." In a July 2015 incident, a teen tried to hang himself in the shower and "ingested a great amount of shampoo." He began to spit up blood as an officer questioned him. "I attempted to talk to [redacted] and ask him questions, but he did not want to talk to me and he kept yelling he wanted to die," the police report states.

A month earlier, two teens bolted into a field of tall grass just outside the compound. When an officer and staff members found them, one of the boys came quietly. Another refused to let staff touch him, so they took him to the ground.

Afterward, the officer went to speak with the first boy. "I asked what his plan was for running away," the report reads. "[He] stated that he had no plan, he just wanted to be outside without supervision and feel free."


Parents sometimes forget that "troubled teen is not a diagnosis," said Szalavitz, the journalist who wrote the book on the industry. "If your kid has behavior issues, generally the first thing to do is get a psychiatric evaluation 

— somebody who is independent, not an educational consultant, no affiliation with any industry — and figure out what the heck is going on."

Residential treatment centers such as Island View and Elevations were never great ideas in the first place, said Burnim, the Bazelon mental health law expert. "It's not a good model to bring people with behavior problems [together] ..." he said. "The task of managing kids who are there because they have behavior problems overwhelms the facility. … You get a lot of abuses even in places where they're well intentioned."

Moreover, the rote compliance these places demand is not a useful coping strategy for life outside an institution, Burnim said. "You can teach them to be compliant in an institution because they get the reward of ... getting out," he explained, "but once they get out, it's the same old problem, and they haven't learned how to better manage their condition."

One alternative to residential treatment centers is therapeutic foster care, in which children with emotional or mental problems are placed with trained foster parents. It allows the children to continue living in a home-based environment, attending public school and interacting with people they know.

But the gold standard for treating most disturbed children is giving parents the support and services they need to keep their kids with them. There is a "virtual national consensus among people in the mental health field that children with mental health difficulties and behavioral problems should be treated at home," Burnim said.

In fact, Burnim argues that if the country invested enough in home-based services, the problem of residential treatment centers would start to resolve itself. "I don't think you need to legislate against RTCs," he said. "You just need to create an alternative that sells itself."

Emily Graeber is doing better now. She stopped using heroin four years ago. She has a boyfriend, a dog and an associate degree in veterinary technology. But finding employment has proved difficult. Sometimes her decision to run away from Island View is all she's asked about in job interviews. So Graeber is scraping by with money from dog sitting. Her boyfriend runs a landscaping company, which helps pay the rent.


"I do try to be normal and carry myself in a way where if people were to hear these things about me, they'd be like 'No, not Emily,' but it does affect me," she said. "Often my boyfriend wakes me up because I'm having nightmares and thrashing around. One night I knocked him straight in the face because I was so wrapped up in a nightmare."

"I thought he was trying to take me to Island View."


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