U.S. Policy Finally Addresses Institutional Child Abuse in the Troubled Teen Industry

For the first time in U.S. policy, a bipartisan bill, the Stop Institutional Child Abuse Act (SICA) was passed into law at the very end of 2024. This legislation aims to provide oversight and collect data to ideally assist in improvements by better understanding the landscape and practices of residential treatment programs for “troubled teens” comprehensively across the country. Child abuse is defined as the physical, sexual, or emotional abuse or neglect of a child (an individual 17 years old or younger). This bill was championed by celebrity Paris Hilton, who was sent involuntarily by her parents to multiple troubled teen industry (TTI) programs as a young adult in the mid to late 1990s. After struggling with insomnia and post-traumatic stress disorder (PTSD), a condition of persistent mental and emotional stress occurring as a result of psychological shock, Paris disclosed her experience in the TTI for the first time in her documentary, “This is Paris” released in 2020. Since then, she has advocated for years for legislation in several states and subsequently at the federal level, seeking legal protections to help youth caught in these generally coercive organizations, groups of people whose membership is primarily forced and must abide by strict rules and regulations.  

The Troubled Teen Industry  

For decades, journalists, scholars, politicians, survivors, and other advocates have raised ethical concerns regarding the TTI, such as lack of recipient rights, involuntary treatment, “attack” therapy, the use of seclusion, restraints, neglect, and a variety other concerns that vary by program. The American troubled teen industry consists of mostly private, previously federally unregulated total institutions, isolated groups with strict rules and regulations aiming to control every aspect of members’ lives. Similar models exist in other countries, like Canada or Australia, but to a much lesser extent due to stronger child protection laws, more government oversight and regulation, less for-profit treatment, and far more focus on therapeutic approaches involving family and community-based supports. The U.S. remains internationally notorious for its TTI due to the scale of the industry, profit-driven focus, emphasis on behavioral modification, and marketing to parents of “troubled teens.” Troubled teens are typically labeled as such if they display any deviance, violation of social norms, and/or struggles with mental/physical health, LGBTQ+, neurodivergence, or any outlier status in society. Examples of these institutions include residential treatment centers, wilderness therapy, teen ranches, therapeutic boarding schools, and boot camps or military schools. While all of these programs are total institutions, their frequent use of more intrusive features like degradation ceremonies, an event, ceremony, or rite of passage used to break down people and make them more accepting of a total institution, leads them to be classified as “totalistic” teen treatment by Dr. Mark Chatfield. This classification includes seven characteristics:  

1. strict communication controls, 
2. peer surveillance and policing, 
3. the need to change the whole person, 
4. a series of prescribed phases of progress and privileges, 
5. regular participation in group sessions involving confrontation or confession rituals, 
6. strict system of rules with inflexible punishments and 
7. a central authority structure that governs all aspects of life.

 

All the while beneficiaries of the industry, including organizations like the National Association of Therapeutic Schools and Programs (NATSAP), made up of TTI programs, continue to promote involuntary treatment, and produce research embroiled with conflicts of interest or short-term outcomes to prove that their programs work. More longitudinal research (past two years), as well as research conducted by those not embedded or heavily connected to the TTI is desperately needed to provide better insight into long-term outcomes of these programs.  

U.S. Policy is Not Enough  

While the ”Stop Institutional Child Abuse Act“ is a long-awaited first step in the right direction to protect youth by providing a myriad of improvements — such as    

• comprehensive data collection,  

• promotion of evidence-based best practices,  

• better oversight,  

• reporting and interagency collaboration,  

• risk assessment tools,  

• training resources for trauma-informed care and de-escalation techniques,  

• promotion of community-based care, and  

• movement to standardize care across the states —  

many outstanding concerns remain for a still largely unregulated, mostly privatized, troubled teen industry. Tragically, youth continue to regularly die in these programs. Only a few months ago, two young women completed suicide, leading to the shutdown of Asheville Academy after their deaths in the spring of 2025. A year prior, in North Carolina, a young man died in Trails Carolina, a wilderness therapy program. These cases are not isolated; time and again, stories emerge in the news reporting deaths of young adults in the TTI. What goes unreported is the number of individuals who die after attending these programs, frequently from overdoses or suicide. In my research on a therapeutic boarding school in the TTI, I found that for every individual interviewed as an adult about their experiences as a troubled youth in the TTI, they knew at least two others who died well before middle age (average interviewee was nearly 30). Within months of graduating from my program in 2000, a peer completed suicide, since then I’ve lost another half dozen peers and those are only the ones that I know of.  

A Call for Youth Rights  

TTI programs continue to operate, nearly the same as before SICA, sometimes shapeshifting, and/or changing states to evade consequences, as U.S. policy pushes involuntary institutionalizations as care. This replicates the for-profit healthcare industrial complex and focuses on pumping out “pills and programs“ to enforce social control, the informal and formal regulation of members of society to gain conformity and compliance. Many have emphasized, even those working in the industry, that we need stricter regulations, increased enforcement, and safe, affordable, community-based alternatives to total institutions. We must continue to push for youth rights that address the deleterious systemic issues immediately within total institutions for troubled youth. By amplifying the voices of survivors, the U.S. ratifying the UN Convention on the Rights of the Child, and making programs accountable, we can create a future where youth are respected, supported, and given the autonomy they deserve, free from the dangers of coercive confinement.  

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Mooney is a guest blogger at UITAC Publishing. UITAC’s mission is to provide high-quality, affordable, and socially responsible online course materials.    

Images used in this blog:

1. “Teenager, Hoodie, Hand No Gesture” by ottawagraphics (Ana Krach) is licensed by Pixabay under Creative Commons CC0 1.0. This image has not been altered.
2. “Steve Cohen and Paris Hilton outside the US Capitol” by Office of Congressman Steve Cohen is licensed by Wikimedia Commons under the public domain. This image has not been altered.
3. “Shackles, Conclusion, Arrested Woman” by lechenie-narkomanii is licensed by Pixabay under Creative Commons CC0 1.0. This image has not been altered.