Island View Residential Treatment Center

Island View Residential Treatment Center was a Delaware limited liability company^[1] that operated a residential treatment facility in Utah and closed in 2014.^[2] Aspen and CRC Health determined the program no longer fit their strategic objectives and no longer wished to operate the program.^[3][4][3][5]

Background

The Syracuse campus opened in 1994 as the Island View Residential Treatment Center.^[6] Its founders were Lorin Broadbent, DSW, Jared Balmer, PhD, and W. Kimball DeLaMare, L.C.S.W.^[7]

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." ^[8]

In 2004, the residential treatment center was acquired by Aspen Education Group.^[7] CRC Health Group, a company owned by Bain Capital,^[9] purchased Aspen Education for $300 million in 2006.^[10] 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.^[11] As of April 2014, Island View no longer had a business license to practice in the city of Syracuse where their campus based.^[2]

Residential Treatment Program

Before its closure, Island View treatment center provided subacute care^[12] to troubled adolescents experiencing mood and behavioral dysregulation, substance abuse, and difficulties at home or school.^[13] The 90-bed lockdown facility^[14] provided care to students ranging in age from 13 - 17.6 years.^[13][15] Most of the students there come from an upper-middle-class background.^[16] The average length of stay at the treatment center was 8–10 months.^[13] Teenagers at the residential program were monitored 24 hours per day, seven days per week, by team directors and houseparent staff.^[17] While at the facility, students were generally only allowed to communicate with their parents.^[16] Island View was akin to a cross between a reform school and psychiatric security hospital.^[18] According to an Order by the state of Oregon, Island View "seems about as restrictive a placement as can humanely exist."^[18]

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.^[12] Residents typically received seven therapy sessions a week, in the form of five group, one individual, and one family therapy session.^[12] 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.^[19] 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.^[18]

At Island View, the majority of residents were organized into teams solely by gender.^[20] 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.^[20]

Restraints and seclusion

Parents were required to authorize the facility to use behavior modification such as therapeutic holds and restraints.^[21] 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.^[21] 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."^[22] 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." ^[22] 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." ^[22] 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." ^[22]

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.^[23] 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.^[23] 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." ^[23]

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." ^[23] 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." ^[23] 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."^[23]

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.^[24] 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." ^[24] 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."^[24] 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."^[24]

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.^[21] The complaints may have included allegations of abuse, neglect, punitive interventions, sexual harassment, etc.^[21] 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.^[21] Even then, the complaint would only be reviewed by the State of Utah, Department of Human Resources, and Office of Licensing.^[21]

Controversy

Lawsuits

Island View was at the center of several parental custody lawsuits, a couple of which played out on national daytime television.^[25][26][27]

In 2014, Miriam Blank, a mother from Houston, Texas, filed suit 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 (father) Jack Nuszen, and Norma Willcockson, the alleged child trafficker that transported the teenage girl from Houston, Texas to Syracuse, Utah, against her will to Aspen RTC. In 2015, sisters of the teen brought suit against Nuszen as well.^[25] The suits and appeals were dismissed as moot by the Texas Court of Appeals in August 2015.^[28] The status of the child who was at Island View is not known.

In 2014, another former student, Ben Hinman, sued Island View, along with the Provo Canyon School, for personal injuries related to his stays there during 2008 and 2009, respectively, demanding $800,000.^[26] The student claimed that Island View put him into a "private prison."^[29] United States District Judge David Nuffer ruled against Hinman on all counts and dismissed the case in 2015.^[30]

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.^[27]

Oversight Issues

Island View had an A+ Better Business Bureau ranking with zero complaints recorded in its final 3 years . The Salon's Art Levine visited Island View in 2011 posing as the father of a troubled girl.^[31] During that visit, director Laura Burt confirmed the skeptical stance toward potential medical emergencies.^[31] 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."^[31]

Psychological and corporal punishment

Before the program's closure, Island View, like many RTCs, used a "levels" model that grants privileges and freedoms as students follow the rules and imposes sanctions of varying severity on those who disobey.^[31] Communication restriction (CMR) was also used to restrict residents from speaking to one another when they misbehaved.^[19]

Another former resident reported in 2002 in an article in the SF Weekly that "she was traumatized by her time at Island View."^[32] The young woman says "she underwent therapy in which she was to say that she loved her father, and that her mother was crazy."^[32] 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?'"^[32] 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."^[32] 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.'" ^[32] 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.'" ^[33]

Deaths and bodily injuries

A 16-year-old Pennsylvania boy hanged himself in a bathroom at Island View in 2004 after he excused himself from a movie.^[34] The staff were unsuccessful in reviving him.^[35] Island View was cited for minor issues and required to submit a plan of "corrective action." ^[35] The death took place before Aspen owned the facility.^[35]

References

Coordinates: 41°04′34″N 112°04′35″W / 41.076003°N 112.076433°W / 41.076003; -112.076433