A difficult kid in Alaska’s foster care system may soon find himself on a plane to Utah.

Parents in New Jersey with a rebellious teen may send her here.

A youth offender in Idaho may get sentenced to the Beehive State.

When the nation has kids it doesn’t know what to do with, it often looks to Utah, where a lucrative for-profit industry thrives with minimal regulation from state officials.

Utah is home to almost 100 youth residential treatment centers, and in the past five years, they have seen nearly 12,000 children come through their doors, with some of those young people bouncing from one facility to another. Utah is seen as an attractive place to seek such treatment in part because of the wholesome reputation of The Church of Jesus Christ of Latter-day Saints and, for some, the state’s iconic public lands create visions of dynamic, healing wilderness therapy.

They are kids sent by parents who pay upward of $30,000, believing their children are misbehaving and need help. Teens covered by Medicaid sent thousands of miles away after being hospitalized for depression or anxiety. Children who commit crimes. And they are students with disabilities sent to another state by their school districts.

They come from every state in the country, and even farther away, from places like Bermuda.

Utah’s “troubled teen” industry has brought in hundreds of millions of dollars in government money. That doesn’t include the parents who pay privately. A research brief from the University of Utah’s Kem C. Gardner Policy Institute estimated the industry pulled in $328 million in revenue in 2015 alone and accounted for 6,400 jobs.

[UPDATE: Explore the inspections and critical incident reports involving Utah’s troubled-teen treatment centers in this new database.]

A number of these children say they were helped by the therapy they received in places that run the gamut from campuses tucked into commercial areas to ranches on remote lands, from specialized facilities to huge centers that seek to treat many conditions and issues.

Others say they were tormented and abused.

A detailed analysis by The Salt Lake Tribune shows that the bigger facilities, often controlled by companies that own many treatment centers, have the most out-of-state contracts. And often they have more claims of sexual abuse and violence than Utah’s average treatment center.

The Tribune spoke with nearly a dozen young people who spent time in Utah facilities, many of whom detailed physical and mental abuse. The newspaper also scoured financial records, court documents, police logs and more to examine an industry that gets little scrutiny.

Because when something goes wrong, there’s often little known about it and few calls for change. One reason why: The kids neglected, mistreated or abused are not from here.

Why states send teens to Utah

The staff at Provo Canyon School often didn’t call them by their name. They were 309, the number given to identify laundry and other belongings.

The teen, who uses they/them pronouns, came to Utah in 2017 — one of 99 kids from Alaska sent here that year with Medicaid funding. They had tried to run away from a place in Alaska and then had been hospitalized. That hospital recommended the Springville treatment facility to their father and stepmother.

309, as they asked to be identified for this story, needed help to cope with post-traumatic stress disorder, anxiety and autism. But they said that didn’t really happen. Instead they were put in a place far away from home and family, where staff threatened the residents and said no one would believe them if they spoke out about abuse.

The residents were told to avert their eyes and look at the floor when staff restrained and held down another kid, 309 said. It happened frequently, sometimes because a resident tried to hurt themselves, or sometimes because they were being too loud.

Some residents were given injections of a sedative, they said, something that happened so often it was nicknamed “booty juice.”

“I consider my experience at Provo Canyon worse and more traumatic than my experience with child abuse when I lived with my biological mom,” said 309. “Sure, there were good moments, but I lived in fear and suffering. There’s no way out once you’re in, until the school decides they’re done with you.”

Now 19 years old, 309 has a hard time talking with their parents about what happened there, and asked to not be identified by name because of the ongoing anxiety they experience.

Alaska spent more than $31 million in Medicaid funding over six years sending 511 kids to Utah. And that’s hardly unique. Nevada spent even more — $35 million since 2014 — sending 761 youths here, according to its Medicaid data.

Officials in other states say they don’t have enough resources or specialized programming to care for these young people, or they’ve had trouble finding a facility that will take them.

“We don’t have enough residential beds in Nevada for the size of our population,” said Megan Freeman, a psychologist with the state’s Division of Child and Family Services. “They would wait on a waiting list for a bed here, and for reasons related to the acuity of treatment or behavioral outbursts, that would not be an acceptable time to be waiting.”

[Tell The Tribune: What’s your experience with Utah’s ‘troubled teen’ industry?]

Marcia Lowry, executive director of A Better Childhood, said the problem is many states don’t develop in-state placements for children with serious behavioral issues, especially those in foster care. Her national nonprofit has sued several places over their foster care systems.

She said states will often send kids to any treatment center that will take them, even if the facility has a history of inadequate staffing or violence among youths or staff.

“Kids who are sent out of state are supposed to be visited regularly by a caseworker, and that doesn’t happen,” Lowry said. “They’re also separated from family. The kid doesn’t see anybody in the community or their parents. So the kid is often extremely isolated.”

The Tribune requested data from every state and almost every one of the 14 that provided detailed financial records contracts with the same handful of places.

Provo Canyon School, the facility where celebrity Paris Hilton alleges she was abused, netted more than $37 million in government funding during a five-year period from seven states, according to The Tribune’s analysis. It’s owned by Universal Health Services, which also owns two other Utah facilities that brought in significant money: Benchmark Behavioral Health received more than $29 million from eight states, while Copper Hills Youth Center got $26.3 million.

Another high-earner was Red Rock Canyon School, owned by Sequel Youth and Family Services, an Alabama-based company that focuses exclusively on youth facilities. The St. George school had received more than $13 million in government money from six states until it closed last year after a riot, allegations of child abuse and reports of sexual assault.

When police get involved

Police aren’t called every day, but those high-earning facilities are visited by officers more than others, according to an analysis of police dispatch records for 64 facilities across the state. The Tribune calculated a per-bed police call rate, so that small and large facilities — youth treatment centers can range from having fewer than a dozen beds to housing several hundred children — could be compared to one another.

Officers were called 29 times to Provo Canyon School’s boys campus to investigate sex crimes over a four-year period, a rate that’s more than four times the average at a youth residential treatment facility in Utah.

Copper Hills staffers reported sex crimes to police 21 times over a 5½-year period, which is 1.6 times higher than the average facility. Those alleged crimes involved youths acting out sexually with one another, as well as staffers accused of abusing a young person.

And at Red Rock Canyon School, staffers called police 69 times for violent crimes, such as assault or child abuse, in the same time period — twice the average number of calls for violent crimes.

A high number of police calls is a red flag that a treatment center doesn’t have the right programs and treatments in place, according to Lowry, with A Better Childhood. She believes undertrained staff don’t know how to deal with “troubled kids,” which can lead to fights or situations that get out of control.

“It’s a really dangerous place to put kids,” she said, “particularly dangerous when you have kids who already have problems. In the absence of good programming, the kids explode.”

Ken Foster, a former Copper Hills employee who worked there for three years until he quit in 2013, said he was often fearful to go to work. He didn’t have enough co-workers, and they weren’t able to give the kids the treatment they needed. As a result, employees regularly restrained children, though he said it wasn’t something they enjoyed.

Foster said it was also normal to give children sedative shots — a practice that is banned or extremely limited in some states.

“They were just warehousing kids,” he said. “It didn’t feel like we were doing any legitimate treatment.”

Adam Mclain and Ron Tuini, the CEOs of Provo Canyon School and Copper Hills Youth Center, did not address the high violence and sexual abuse rates in their facilities. But in a joint statement, they said their facilities promptly report alleged improper conduct to Utah’s child protective services, which triggers a police investigation, and the Department of Human Services’ Office of Licensing.

“The vast majority of the time,” they said, “it is determined through investigation that the allegations are unsubstantiated.”

The CEOs would not disclose how often their facilities use sedative shots or chemical restraints but said in their statement that medication is administered “in full compliance” with industry standards and state guidelines and is most often given orally.

They noted their facilities treat youths with “special, often complex, mental health and behavioral needs,” and added that 99% of young people have reported when they are discharged that they “feel better.”

Sequel, the company that owned Red Rock Canyon School, declined to comment.

How Utah became the place for residential treatment

Sienah Pablo was one of the lucky ones. She went to a Utah facility for more than a year and said it helped with her depression and anxiety.

But she knew that not everyone at the Heritage Community Schools had the same experience. She saw kids held in restraints — sometimes they were needed, she said, other times it felt like too much. She knew some of the kids in other parts of the Provo campus didn’t do well after leaving. But for her, she said, it worked.

“If I hadn’t gone, I don’t think I would be alive right now,” she said. “We had the perfect balance in my area of love and also directness. We felt like we were treated like humans. But the others weren’t really.”

The California girl was 16 when she was sent to Utah, paid for by her school district as part of a program that funds specialized education for kids with disabilities.

Pablo said she struggled at first, feeling numb and hurt that her parents sent her away. But she thrived once she started participating.

She was one of nearly 1,000 California kids who came to Utah in 2017 to stay at a youth residential treatment center, according to data generated from the Interstate Compact for the Placement of Children, a national system.

That compact shows just how popular Utah has become as a destination for teens needing treatment, a legacy that goes back more than 50 years. All of this started in the 1960s, when a Brigham Young University student named Larry Dean Olsen started leading wilderness outings with his classmates.

BYU deans noticed that students who went were doing better in school and were well-mannered at home. So school officials developed a course that offered failing BYU students a shot at readmission if they learned survival skills and went on a monthlong backpacking trip through the Utah desert.

The lucrative wilderness therapy industry was born.

There’s no central database that shows how many youth treatment centers are operating throughout the country, but the director of the National Association of Therapeutic School and Programs said Utah likely has the most. About 30% of the association’s members are based in Utah.

Executive Director Megan Stokes said the industry continues to morph, and now it’s not just so-called troubled teens hiking in the desert heat. The programs have expanded into communal-living facilities in urban areas.

Utah’s popularity is based in part on its squeaky-clean reputation as the headquarters of The Church of Jesus Christ of Latter-day Saints, according to Ken Stettler, former director of Utah’s Office of Licensing, the government body that oversees these facilities.

Stettler said that during the two decades he was director, he often fielded calls from parents or education consultants telling him they wanted to send their kids to Utah because of the church’s influence.

“There’s a connotation, with the LDS faith, that there’s a wholesome environment that Utah sets forth,” he said. “That this was a good place to send kids.”

Critics say the industry has flourished here for other reasons, too. The land is affordable, workers don’t demand high wages and state regulators are stretched thin and reluctant to punish violations.

The Office of Licensing conducts yearly inspections to make sure facilities are following the rules, such as having the proper number of staff and ensuring residents are being fed proper meals.

The 30-member inspection team provides oversight to more than 3,000 licensed facilities, everything from treatment centers for both kids and adults to foster care facilities.

Director Amanda Slater described the licensing role as not being punitive, but as “technical assistance” for various agencies through yearly inspections and occasional random visits. Even if a series of serious issues are found, it’s unlikely a facility would be shut down or face significant punishments.

In the past five years, the licensing agency has revoked just two licenses — neither of which was a youth treatment facility.

“It’s very rare,” Slater said of revoking a license. “It would have to be pretty severe.”

Unlike nursing homes or even restaurant inspections, the Office of Licensing doesn’t make its inspections or incident reports public — unless someone files a formal public records request.

When asked why, Slater said the agency is interested in working with the facilities and oftentimes the allegations aren’t substantiated. The Tribune filed records requests for inspections and incident reports for a five-year period and was told it would cost more than $6,000 to receive them. The newspaper declined to pay those costs.

An outcry from another state

Caleb La Chance had a panic attack in a courtroom when he found out he was coming to Utah.

He was then 16 years old and had been in Oregon’s foster care system nearly his entire life. By that point, he said, he had bounced around more than 50 homes, some shelters and a few lockdown facilities.

But he had always been able to stay in Oregon, until late 2018, when he started getting in trouble for running away and smoking weed. There weren’t any places in his home state that would take him, so his social worker looked elsewhere. Red Rock Canyon School was the first place to respond. He was told that December he was being sent to Utah, a place he had never been.

“Oregon is my network,” he said. “I know a lot of people in this state. In Utah, I don’t know anybody.”

La Chance spent six months here. He said he was frequently held in restraints, sometimes eight to 10 staffers piling on top of him. Two staffers were charged with child abuse for harming him, including one man who shoved La Chance after the teen told him he couldn’t take away another resident’s therapy time for not having his shirt tucked in. La Chance looked on as his friends were assaulted by staff and other students during a riot last April.

Despite his pleas to be moved somewhere else, he didn’t leave Utah until Red Rock closed last July.

“I felt relieved and happy,” he said. “All of us in there kind of have a trauma bond, so we were all real close. So I was like, ‘Damn, I have to leave them in this. But I’ve got to get out of here.’”

When things go wrong at these facilities and children are hurt, there’s little outcry from public officials in Utah. After kids like La Chance were assaulted at Red Rock Canyon School, no one here called for change. State licensers eventually threatened to pull Red Rock’s license, but the facility remained operational until it made the choice to shut down.

One of the most vocal advocates for more regulation in Utah facilities doesn’t live here — she’s a legislator in Oregon.

State Sen. Sara Gelser said she tried to speak with Utah licensing officials as Oregon pulled its kids from Red Rock and other facilities because of concerns for their safety. She left feeling as if they were “annoyed that I would question what they were doing.”

“When it comes to Utah, there’s a conflict of interest,” she said. “It is such a revenue generator for that state, that there is a disinterest in actively monitoring these organizations.”

Slater, with Utah’s Office of Licensing, pushed back on that allegation, saying her office impartially follows the rules and statutes approved by “public input, industry standard and the Legislature.”

Gelser sponsored legislation earlier this year that would require out-of-state facilities that house Oregon foster kids to follow Oregon’s rules. That would mean facilities would be prohibited from using chemical restraints, and they would have to report child abuse or other licensing violations directly to Oregon officials, even those that involve children who aren’t from that state.

By the time the bill passed, Oregon had brought home all of its foster children. Gelser hopes her legislation will be replicated elsewhere, and that other states will do a better job of communicating when problematic facilities are taking their kids.

It’s a patchwork system, Gelser said, where Oregon authorities might send their kids one place, not knowing that Idaho officials pulled their kids after deciding that facility was dangerous.

And these young people aren’t often believed when they report abuse, Gelser said. Instead, they are dismissed as lying or exaggerating.

But when they are believed, things can change. La Chance shared his experience with Oregon legislators considering changing the law. A report from a 9-year-old Oregon girl in foster care led to the shutdown of a Montana facility after she told her lawyer she was chemically sedated frequently with what they also called “booty juice.”

Gelser told that girl in June that all of Oregon’s kids in foster care who were sent away were back now. The lawmaker told her that she had helped bring them home by speaking up.

The girl was excited, Gelser recalled, and bounced around in conversation about everything from how it felt to be put in a restraint to the name she picked for her pet guinea pig. It was a reminder to the legislator that these were just kids — that this now-11-year-old who experienced so much trauma was still just a girl who loved to twirl around in a skirt.

“She’s back, but there’s all these kids that aren’t,” the Oregon senator said. “And we’ll shut down [facilities], but they’re just going to come back unless we fundamentally change the way that we look at kids and look at trauma and we look at who gets to profit from these kids’ lives. Because, right now, it’s not these kids. They aren’t getting any benefit from it.”

This article was produced as a project for the Data Fellowship, a program of the USC Annenberg Center for Health Journalism.