Utah increased its oversight of its troubled-teen industry. Has it worked?

Editor’s Note: This story was produced as part of “Sent Away,” an investigative podcast from The Salt Lake Tribune, KUER and APM Reports that examines Utah’s teen treatment industry. You can listen to the final installment, Episode 7, here.

It’s been a year since Utah legislators enacted more regulations of Utah’s massive teen treatment industry — the first increased oversight in more than a decade.

The legislation placed limits on use of restraints, drugs and isolation rooms in youth treatment programs. It earmarked more money to hire more regulators who now go into youth treatment programs more often. And it required programs to report when a staff member uses a physical restraint on a young person or puts them in seclusion.

These new regulations came in response to increased scrutiny in recent years of youth treatment programs amid allegations of mistreatment and abuse, including accounts from high-profile celebrities like Paris Hilton.

State regulators now have a clearer picture of what goes on in Utah’s more than 100 teen treatment programs. But did the reform efforts work?

What the data shows

The new reform increased what critical incidents need to be reported to state regulators.

These critical incident reports are generated after a kid’s health or safety is jeopardized while they are in a program — and can come from facilities, parents or other staff. The reports range from runaways to a teen spraining their ankle playing sports to more serious allegations of abuse or misconduct, offering insight on what goes on behind the closed doors of troubled-teen facilities.

A new data analysis of these reports shows that state regulators are finding more rule violations after these critical incidents are reported than ever before.

The Office of Licensing, which is the government agency that oversees these types of treatment programs, cited programs more than 200 times last year. That’s twice as often as the year before, prior to the reform. And it’s a huge increase from six years prior when, in 2016, regulators found just four violations.

As a part of the new law, the Office of Licensing expanded the types of incidents that facilities are required to report to the state. Programs must now report to officials, for instance, any time a child is held in a restraint, whether they are injured or not.

These new reports make up a sizable percentage of rule violations in 2021, the data shows. In that year, one out of every five rule violations were found after programs reported that staff had held a child in a restraint without injuring them. Before 2021, those incidents would not have been investigated.

‘We need to hold these programs accountable’

Amanda Slater was the top regulator of teen treatment programs for three years before she recently moved to a new job within the Department of Health and Human Services. She said the new law is making a difference in Utah.

“I think that it’s giving us a better picture of what’s happening in these programs and then the availability to act sooner,” she said, “not wait until something bad happens.”

Before the new law, state inspectors typically only visited treatment programs once a year. And those visits usually were scheduled ahead of time.

“If we’re only going in there once a year, and it’s announced, you know, most people would clean up their house before you show up,” she said. “You don’t always find the problems.”

Now inspectors stop by four times a year, and the state has more staff so they can show up unannounced. Being in treatment centers more often has allowed regulators to identify problems sooner, Slater said.

It’s also clear the government has gone through a philosophical shift about its role in overseeing the treatment programs. Previously, Slater and other licensing directors described their regulatory role as “technical assistance,” with the goal of working with the programs — rather than being punitive.

Slater noted that last year, her office took more punitive measures against teen treatment programs than in years past.

“I have realized,” Slater said, “that we need to hold these programs accountable.”

Is it enough?

Still, even the bill’s sponsor, Sen. Mike McKell, R-Spanish Fork, has questioned whether the increased oversight is enough.

“I think we need to enhance the tools,” McKell said. “Straight up, I think our tools are not strong enough today.”

Two months after the implementation of McKell’s reforms, a 9-year-old boy died after being left in a hot car at a day-treatment facility called Roost Services. Eight months later, in January, a girl died at Maple Lake Academy, a teen treatment facility just six miles from McKell’s home. State regulators say she died after not receiving “necessary medical care.”

“We need to acknowledge that a kid, post Senate Bill 127, is no longer with us,” McKell said, referring to the oversight reform measure. “And that’s extremely, extremely troubling to me.”

McKell didn’t bring a bill to further strengthen state oversight during the most recent legislative session. But he said he hopes to debate whether more regulation is needed during an interim session.

“I think we are seeing some improvement across the board,” he said, “but there are certain violations that absolutely merit a facility being shut down. ... I think there are violations that are too egregious to remedy.”