Utah’s ‘Troubled-Teen’ Centers Use So-Called ‘Booty Juice’ To Sedate Kids, A Treatment Outlawed In Other States
When social workers in Oregon’s foster care system sent a 14-year-old to Utah, they were trying to find a place that could help. But instead the girl, who has an intellectual and developmental disability, endured an increasingly difficult stay at Provo Canyon School.
Over roughly three months, employees pinned down her arms and legs down nearly 30 times, some restraints lasting as long as a half hour.
Fellow students beat her up at least four times, including once when she was punched in the face while she was asleep.
Staff injected the girl with sedatives 17 times — a number so alarming that child welfare officials from Oregon flew in to investigate. Those officials got her on a plane and took her back to Oregon in March 2019.
“The whole idea of sending her to Provo Canyon School was supposed to be that her needs were so great, that this was the only place that could help her,” said Oregon state Sen. Sara Gelser, who has investigated allegations of abuse at youth facilities. “And what they sent back to us was a broken, injured, frightened child with more trauma than she went there with.”
Gelser shared with The Salt Lake Tribune heavily-redacted, public documents outlining this girl’s stay in Utah. They don’t reveal who she is, but they do offer a look at her treatment via emails exchanged between Oregon child welfare workers and Provo Canyon School, contracts for her stay, and documentation of every time she was restrained or put into seclusion.
The records show troubling treatment methods that would either be outlawed or severely curtailed under a legislative proposal championed by a Utah Republican who said the largely for-profit industry needs more government oversight.
Provo Canyon School said it’s open to these new regulations. It is one of Utah’s oldest youth residential treatment facilities, and can house more than 250 kids at a time between its two campuses in Provo and Springville. It’s owned by the for-profit company Universal Health Services, one of the largest hospital providers in the nation.
The facility has faced scrutiny in the past year over accusations of poor and abusive treatment of kids. The most high-profile account comes from celebrity Paris Hilton, who said she was abused at the school in the 1990s.
Others have come forward since and there’s a pattern to the stories these former residents tell. They often involve being physically held down, being left in seclusion rooms for hours and being overmedicated or sedated.
A Reform Effort In Utah
If the girl had remained in Oregon, she never would have been injected with sedatives.
That type of restraint is outlawed there and in a number of other states — but it is permitted in Utah, where the troubled-teen industry has thrived under light regulations. Almost 100 facilities dot the state, and in the past five years, nearly 12,000 children have come through their doors.
Some of the youths are sent by their parents, while others are ordered into treatment by a judge after committing a crime. Then there are children in foster care, like the 14-year-old from Oregon, who are brought here because no place in their home state will take them.
Gelser was a driving force to get Oregon officials to bring all of their foster children home in 2020, cutting ties to treatment centers in Utah and elsewhere. Her campaign began after Oregon Public Media published a report about the number of foster children who were being sent to other states. Gelser responded by holding legislative hearings demanding child welfare officials explain why their kids were receiving treatment in places like Red Rock Canyon School, a Utah center where a riot had broken out and violence had been escalating.
She also began filing public records requests for information about the Oregon kids sent elsewhere. That’s how she received the documents about the 14-year-old at Provo Canyon School. She said in a recent interview that she was “shocked and heartbroken” when she read the hundreds of pages.
“We have worked so hard, just as a Legislature and a community, to really try to wrap supports and protections around kids,” she said. “And the idea that just a plane ride can strip those rights and protections from them is incredibly frustrating.”
Change could be coming to Utah, driven by a partnership between two unlikely allies: Gelser, a liberal Democrat from Corvallis, and Utah Sen. Mike McKell, a conservative Republican from Spanish Fork.
McKell has sponsored legislation that would limit the use of restraints and isolation rooms at Utah youth treatment centers. It would also ban the sedatives, referred to as chemical restraints, unless a facility gets special permission from state regulators.
It’s the first time Utah lawmakers will consider new regulations on youth residential treatment facilities in the past 15 years.
Restraints, Seclusion And ‘Booty Juice’
When Oregon officials arrived at Provo Canyon School in February 2019, the 14-year-old girl told them she was getting into fights and was often getting in trouble.
Staff would hold her down, she told them, and sometimes the adults bit her or pulled her hair. Records show there were times when staff held her down three times in a single day and often gave her a shot of Haldol, an antipsychotic.
“Typically, in a restraint, [the girl] stated she received ‘booty juice,’ which she described as a liquid that makes someone fall asleep and calms you down,” an Oregon worker later wrote in a report. “After receiving booty juice, [she] would then spend time in the calming room, staff would shut the door and hold the door while they stand there.”
The public records show the girl was frequently restrained for trying to intervene when her peers were being held down by staff. Sometimes she acted out at the encouragement of her classmates.
“Peers have always been one of her biggest struggles,” a Provo Canyon School worker wrote in an email to the girl’s social worker. “She wants friends so badly, but has never had one.”
The records show the girl’s social worker became worried in December 2018 about the medication Provo Canyon School was giving her and reached out to a state-contracted nurse for advice. That nurse expressed concern about Haldol, saying it could have irreversible side effects in children like long-term muscle spasms or “tics.”
By February 2019, Oregon child welfare workers were sounding the alarm again.
“For the last two months or so, they have been using medical restraints at least once a week, on top of physical restraints,” an email reads. “These medical restraints are the use of an intramuscular injection.”
Oregon workers visited the Utah campus later that month, and pulled the girl from the school a few weeks after that when they located an Oregon facility that agreed to take her.
In a statement, Provo Canyon School administrators said they couldn’t comment on an individual's treatment, but they did address the use of chemical restraints and solitary confinement.
The administrators said they “eliminated the use of seclusion or isolation some time ago.” The records, however, show that Provo Canyon was using seclusion as recently as 2019, when the 14-year-old girl’s paperwork was labeled as “Seclusion/Restraint Order.” There were nine times where staff wrote the girl had been secluded in a three-month period because they felt she was a safety risk.
Tim Marshall, an administrator at the school, said in a follow-up email that Provo Canyon School started to phase out seclusion in 2018, and eliminated its use at its Provo campus in June 2019 and in Springville, where the Oregon girl stayed, in February 2020.
“We have currently been free of the use of seclusion at either site for the past 12 months,” he wrote.
Provo Canyon School further said their physicians do not prescribe medication as a means of discipline.
“The infrequent use of medications to assist a patient in gaining control is within the standard of care or the requirements in Utah code,” they said. “We do not use medication to sedate, render a patient immobile or restrict them in their ability to continue to engage actively in their care.”
Utah Is An Outlier
Chemical restraints in these care facilities are prohibited not just in Oregon, but also in Colorado, Illinois, Michigan and Montana. Some states like California and Arizona allow it, but require facilities to document each time they are used. Others, like Wisconsin, allow it only if the Department of Children and Families approve it.
Utah law is silent on the use of chemical restraints, and there’s no reporting requirements unless a child is injured. The state can investigate if they believe chemical restraints are being abused. It does require intermediate secure care facilities, like Provo Canyon School, to have a plan for “the use of involuntary medicine,” but doesn’t mandate anything further.
This means it’s impossible to know how frequently this sort of sedation is used on kids at youth facilities in Utah.
In a review of laws in 14 states that have a significant number of youth residential treatment centers, Utah is one of three that has no clear written policy for chemical restraints on children. The others are North Carolina and Connecticut.
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.
McKell said he wants to limit the use of sedatives like Haldol and said he’s heard of some scenarios where it has “clearly been overused.”
“If we pass this legislation, and if we see chemical restraints are [still] being used on a regular basis, we will be back to the Legislature to rein that in,” he said. “There may be an appropriate place for chemical restraint, but it better be extremely rare.”
McKell said his concerns about the industry stem from cases he has seen as a personal injury attorney. He added recent reporting, including ongoing coverage in The Salt Lake Tribune, and public advocacy has raised his interest.
McKell’s bill would require treatment centers to document any instance in which staff used physical restraints and seclusion and submit monthly reports to the Office of Licensing, which is the industry’s primary regulator in Utah. It would also prohibit programs from sedating residents or using mechanical restraints, like a straightjacket, without the office’s prior authorization.
‘A Monumental Piece Of Legislation’
The troubled-teen industry has been supportive of the legislation so far.
Provo Canyon School administrators said they back McKell’s bill and the transparency it will bring. The National Association of Therapeutic Schools and Programs, which many of these facilities belong to, is also on board, though its leaders say they’d like a few clarifying amendments made. There’s been little public opposition of the bill, but it hasn’t been heard in a committee yet.
McKell said when drafting it, he consulted with Breaking Code Silence, an activist group of former students who say they were abused at troubled-teen facilities, and Gelser, the Oregon senator.
McKell called Gelser a “trailblazer,” and said he sought her out because of her expertise in navigating the industry.
Gelser said the Utah senator was her “new hero” after she saw the extensive nature of his proposal.
“That’s a monumental piece of legislation that will reverberate far beyond the boundaries of Utah,” she said. “Because almost every state in the country has kids that are coming to Utah. And they’re not safe when they get there right now.”
Gelser said that at a time when the country is so divided, she feels like she has a partner in McKell, a politician from the other major party.
McKell said, for him, it’s not about political lines.
“How we treat participants in these programs is certainly more important than political party,” he said. “This is an issue that, I think we can all agree, there needs to be some reform.”
That 14-year-old girl was taken back to Oregon in March 2019. The contract Oregon officials signed — agreeing to pay $102,425 for her care — was supposed to expire in June 2019.
Emails show Oregon officials pushed to have her leave Provo Canyon early. And when she got back to Oregon, her case worker wrote a summary of the visit she had with the girl in her new treatment center. She noted the girl had deep cuts in her arms from harming herself while at Provo Canyon and she noticed something else too.
“I was worried about the child I might find when she arrived,” the case worker wrote. “I was relieved to see that she still has her spark.”
KUER News reporter David Fuchs contributed to this article.
Editor’s note: KUER and The Salt Lake Tribune are collaborating on a reporting project about Utah’s youth residential treatment centers.