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The youth treatment industry booms in Utah, but has skirted reform for years


Utah is the epicenter of America's teen treatment industry. Over one hundred operators there cater to youth from around the country, employing thousands of people and pumping hundreds of millions of dollars into the state's economy. And as Jessica Miller explains in the new podcast "Sent Away," Utah regulators have historically been hesitant to clamp down on the industry there, despite some tragic failures. Miller is also a reporter for the Salt Lake Tribune, and she joins us now from Salt Lake City. Thanks for being with us.

JESSICA MILLER: Thanks so much.

RASCOE: Tell us about the youth treatment industry in Utah and - how many kids are there, and what are they there for?

MILLER: So it's hard to tell how many kids are currently in programs in Utah. What we do know - we have federal data that's showed since 2015, there's been some 20,000 kids from other states who have come to Utah to these teen treatment programs. And the kind of kids that are being sent here - it's really a wide range of things. They might be depressed. They might be suicidal. Some of them are foster kids, and the state has placed them in facilities here. You know, some are sent by their parents. And then there's some who are in the juvenile justice system that get here after a judge ordered them to get treatment at one of these programs.

RASCOE: Why Utah? Like, how did this state come to have such a high concentration of these centers?

MILLER: You know, a lot of people who don't live in Utah see the state as having this kind of squeaky-clean reputation because it's - the Church of Jesus Christ of Latter Day Saints is headquartered here, and 60% of people who live here are Mormons. And so there's that. And to be clear, the treatment programs aren't associated with the church. They're not owned by the Mormon church. But there is this reputation that companies have used to their advantage when catering to parents from other states. And then on top of that, we have this regulatory system that historically has been really lax and very friendly towards this industry as a whole.

RASCOE: You and your team went through years and years of public records on all of these facilities in the state. Would you talk to us about some of what you found?

MILLER: Sure. Yeah. You know, at one facility, we found a report of a girl who had been zip-tied and put into a horse trough as a form of punishment. That was in a police report in the facility. You even acknowledged that this was something that happened. At another facility, there's video of an employee slamming a teen to the floor and causing that teen to have a concussion. The boy's mother says he didn't get treatment for about a week. And then, you know, there's another case where court records show that a boy had his wrist bent by a staffer in what's called a gooseneck hold. And in this case, the boy's wrist was broken. And his mother has filed a lawsuit alleging that he didn't get medical care until days later. And then, more holistically, we found more than a dozen cases in a three and a half year period where staff members either fired or quit after they were accused of acting sexually inappropriate towards children.

RASCOE: It seems like a part of the issue that this investigation that you guys have done has brought to the surface is not just what is happening at these facilities but the way regulators are responding or the lack of response. Can you tell us more about that?

MILLER: Yes. You know, in looking through all of these, you know, hundreds of documents, there's one theme that emerged for us, and it's that regulators here give these places chance after chance after chance. And regulators do have the authority to shut down the place if they need to or they wanted to, and they can take punitive action where they demand, you know, certain things be done or, if not, the facility will have their license revoked. But what we've seen in recent history is there's been a real hesitation to actually do that.

RASCOE: There was a bill passed in early 2021 in Utah that looked to bring some reforms to this industry, you know, for the first time in 15 years. Has it solved the problem?

MILLER: Yeah. So we're about a year out from this reform taking place now. And what the reform did - you know, it's straight outlawed some things. You know, kids can't be chemically sedated anymore. They can't be put into isolation. It's increased the number of times regulators are going into facilities. The question of whether this has solved the problem or whether - you know, that's something that we're still trying to figure out ourselves. And one metric that we're looking at is looking at what's called a critical incident report. It's whenever the state finds a facility didn't respond correctly after a kid's health or safety was jeopardized. And looking at those reports, we've seen a huge increase in those between 2020, before the reform, and 2021, after the reform.

So these facilities are reporting these incidents more often, and the state is holding them more accountable than in years past. But just a couple months ago, in January, there was a girl who died in one of these facilities in Utah after regulators say she didn't receive necessary medical care. The lawyer with the facility disagreed with the state's assertion, and there's an ongoing investigation. But this death has led the bill's sponsor himself to question whether more reform is needed in Utah.

RASCOE: That's Jessica Miller of the Salt Lake Tribune. Her podcast, reported in partnership with KUER and APM Reports, is called "Sent Away." Jessica Miller, thanks for speaking with us.

MILLER: Thank you so much. Transcript provided by NPR, Copyright NPR.

Ayesha Rascoe is a White House correspondent for NPR. She is currently covering her third presidential administration. Rascoe's White House coverage has included a number of high profile foreign trips, including President Trump's 2019 summit with North Korean leader Kim Jong Un in Hanoi, Vietnam, and President Obama's final NATO summit in Warsaw, Poland in 2016. As a part of the White House team, she's also a regular on the NPR Politics Podcast.