Atlas›Domain XVI · Historical, discredited & harmful›Guide 102
Guide XVI-102

Boot camps for conduct disorder

1983United States
A 28 · L 60 · M 1221 interventions in the Trinity explorer
Client cardCompare
[source: …] where a claim comes from[uncertain] not confirmed in a primary source[synthesis] the writer's reconstruction

1. Introduction

Version followed: correctional and private boot camps for young people with conduct problems, as documented in the US Government Accountability Office testimony GAO-08-146T (2007), the Campbell systematic review by Wilson, MacKenzie and Mitchell (2005), the CrimeSolutions practice rating, NICE guideline CG158 (2013) and quality standard QS59, and major-news reporting of the 2006 death at a Florida juvenile boot camp. This guide covers the psychotherapist's own work with boot-camp history and its survivors; it does not teach how to run a boot camp.

Correctional boot camps are short-term residential programmes modelled on military basic training, used for adjudicated young people and adults; CrimeSolutions describes juvenile boot camps as "short-term residential programs that resemble military basic training facilities" and lists participants aged 13 to 18 [source: CrimeSolutions]. Boot camps opened in US adult prisons in 1983 and later spread to juvenile corrections [source: Wilson, MacKenzie and Mitchell 2005]. Private "boot camps" for so-called troubled teens also exist; GAO found no standard definition of the term "boot camp" [source: GAO-08-146T].

The core idea of change claimed for the model was that a militaristic regime of discipline, drill and confrontation would deter and reform young people with conduct problems. The Campbell review of 32 studies found that boot-camp participants reoffended at roughly the same rate as comparison groups (mean odds ratio 1.02) and concluded that the militaristic model itself does not appear effective [source: Wilson, MacKenzie and Mitchell 2005]. CrimeSolutions rates juvenile boot camps "Ineffective" for crime and delinquency [source: CrimeSolutions]. Lilienfeld (2007) placed "boot camps for conduct disorder" on his provisional list of potentially harmful therapies [source: Lilienfeld 2007, as reported by The Psychologist 2008]. GAO documented thousands of allegations of abuse, some involving death, in residential programmes including boot camps between 1990 and 2007 [source: GAO-08-146T]. The psychotherapist never recommends, provides, supervises or refers to a boot camp; the work is recognition, assessment, safeguarding, routing to supported care, and helping survivors and families. Cross-refer: Domain XV 025 (troubled-teen industry and wilderness programmes) and guides 082 (Straight, Incorporated) and 083 (Elan School) in this domain.

2. Framework

This is a framework for the clinician's work, not a therapy with a manual; phases are [synthesis] unless cited.

Historical phases of the practice (outline). (1) From 1983, adult correctional boot camps in the US; (2) spread to juvenile corrections, with state and county camps such as the Bay County, Florida, camp, which operated from 1994 [source: Wilson, MacKenzie and Mitchell 2005; CBS News 2007]; (3) a private-sector market of boot camps and related wilderness and behaviour-modification programmes, largely unregulated at federal level [source: GAO-08-146T]; (4) evaluation showing no reduction in reoffending [source: Wilson, MacKenzie and Mitchell 2005]; (5) deaths, investigations and closures, including Florida's closure of its juvenile boot camps in 2006 [source: Prison Legal News 2007; CBS News 2010]. Whether other states have closed all juvenile boot camps is [uncertain: not verified].

Phases of the psychotherapist's work [synthesis]:

  • Phase A, recognition and assessment. Goal: learn whether the client (or their child) was, is, or may be placed in a boot camp or similar programme; map trauma, medical, legal and family effects. Move on when current safety is known.
  • Phase B, safety and safeguarding. Goal: address any current risk (a minor still enrolled, suicide risk, untreated injury); report as law requires. Move on when immediate risk is managed and reports are made.
  • Phase C, routing to supported care. Goal: replace the boot-camp option with NICE-supported interventions for conduct problems (parent training, child-focused problem-solving programmes, multimodal interventions for 11 to 17-year-olds) [source: NICE CG158; NICE QS59]. Move on when the family has a concrete plan.
  • Phase D, processing and repair. Goal: trauma-focused and relational work with survivors and families, at the client's pace. Move on as symptoms and functioning improve.
  • Phase E, advocacy and follow-up. Goal: records, complaints, legal routes, and longer-term relapse planning. Session number and length follow the client's needs and the setting [synthesis].

3. Guiding principles

[source: NICE CG158 and QS59 for supported care; GAO-08-146T for programme risks; otherwise synthesis]

  • Never refer, never endorse. Practical meaning: do not suggest, broker or soften a boot-camp placement, even "short-term"; name the evidence plainly.
  • The model does not reduce offending. Practical meaning: say so when a family asks; the Campbell review found no effect [source: Wilson, MacKenzie and Mitchell 2005].
  • Treatment focus, not militarism, is what helps. Practical meaning: route to programmes with a therapeutic content; programmes with a strong treatment focus did better than those without one [source: Wilson, MacKenzie and Mitchell 2005].
  • Safety first, then story. Practical meaning: establish current safety (enrolment, injuries, suicide risk) before trauma processing [synthesis].
  • Children are protected, not punished. Practical meaning: safeguarding and mandatory reporting override confidentiality where law requires; seek the young person's assent as well as parental consent [synthesis].
  • Restore control and choice. Practical meaning: survivors of coercive regimes often had no say; offer choices about pace, seating, topics and breaks [synthesis].
  • No physical management. Practical meaning: the psychotherapist never uses holding or restraint; any touch only with consent before and during, a right to stop, never sexual.
  • Believe the plausibility. Practical meaning: GAO documented untrained staff, dismissed illness and abuse allegations; treat accounts seriously while remembering that, as GAO says, allegations are not proof [source: GAO-08-146T].
  • Families acted on available information. Practical meaning: work with parents' guilt without blame; many were told programmes were safe [synthesis].
  • Assess what lies beneath conduct problems. Practical meaning: check for coexisting mental health problems, ADHD, autism, learning disability and substance misuse, as NICE advises [source: NICE CG158].
  • Non-moralising language. Practical meaning: describe what happened factually; let survivors choose their own words.
  • Know your duties when others use it. Practical meaning: concerns about a colleague or institution go to licensing boards, child-protection agencies and professional bodies [synthesis]; a financial or referral tie to a programme raises the multiple-relationship issues of APA Ethics Code Standard 3.05 (APA Ethics Code).

4. Intervention inventory

The interventions below are the psychotherapist's own work; steps not drawn from a cited source are marked [synthesis].

4.1 Historical and evidence literacy (for yourself and your team)

  • Purpose / when: Before working with families weighing "tough" options, or with survivors; so you can answer questions accurately.
  • Steps: Know the core facts: the Campbell review's null finding on reoffending [source: Wilson, MacKenzie and Mitchell 2005]; the CrimeSolutions "Ineffective" rating [source: CrimeSolutions]; Lilienfeld's listing of boot camps for conduct disorder as potentially harmful [source: Lilienfeld 2007]; GAO's findings on abuse, deaths and weak regulation [source: GAO-08-146T]. Keep a one-page summary with sources for team use [synthesis].
  • Example language (illustrative): "The research on boot camps is fairly clear: young people who go through them reoffend at about the same rate as those who don't."
  • Watch for: Overstating (e.g. claiming every programme is abusive) or understating; stick to what sources say. Working: colleagues cite evidence rather than anecdote.

4.2 Intake screening for residential-programme history

  • Purpose / when: At intake with adolescents, young adults and parents, since placements are often not volunteered [synthesis].
  • Steps: [synthesis] (1) Ask an open question about any time spent away from home in a residential, correctional, wilderness or "boot camp" programme; (2) ask whether it was state-run or private, and whether the young person chose it; (3) note dates and the programme's name for records; (4) if yes, schedule fuller assessment (4.3) rather than probing in detail at once.
  • Example language (illustrative): "Some young people have spent time in programmes away from home, like camps, residential schools or juvenile programmes. Has anything like that been part of your life?"
  • Watch for: Shame, minimising ("it was just a camp"), or a sudden shutdown. Working: the client can name the experience without distress escalating.

4.3 Trauma-informed assessment of a survivor

  • Purpose / when: When a client reports a boot-camp or similar placement.
  • Steps: [synthesis] (1) Explain the purpose and that the client controls how much detail to give; (2) assess current trauma symptoms with a validated measure you are trained in (intrusions, avoidance, hyperarousal, mood changes); (3) ask about specific harms GAO documented in such programmes in general terms (being denied food or medical care, being disbelieved when ill, physical force) without demanding narrative [source for harm categories: GAO-08-146T]; (4) assess institutional betrayal, trust in authority and helpers; (5) assess substance use, self-harm and suicide risk (4.5); (6) assess coexisting conditions that may have been missed, as NICE advises for conduct problems [source: NICE CG158].
  • Example language (illustrative): "You don't need to tell me everything that happened. It helps me to know broadly what kinds of things you went through, so we can look after you."
  • Watch for: Dissociation, anger at being questioned (echo of interrogation), compliance that hides distress. Working: a shared, client-owned picture of what happened and what still affects them.

4.4 Medical routing

  • Purpose / when: Where a client reports injury, untreated illness, severe food restriction or exposure to extreme heat in a programme [source for harm types: GAO-08-146T].
  • Steps: [synthesis] (1) Ask about current physical symptoms and whether they were ever medically examined; (2) refer to a physician for assessment; (3) with consent, coordinate so medical records document programme-related injuries; (4) screen for disordered eating after food restriction and, where needed, refer to an eating-disorder service (support: the National Alliance for Eating Disorders).
  • Example language (illustrative): "It sounds like your body went through a lot there. I'd like you to see a doctor too, so nothing gets missed."
  • Watch for: Clients told they were "faking it" may distrust their own symptoms [source for the pattern: GAO-08-146T]. Working: a completed medical review.

4.5 Suicide-risk assessment and safety planning

  • Purpose / when: With any survivor of a coercive programme, and with young people facing placement; coercive programmes and abusive institutions are linked to suicide and suicide attempts.
  • Steps: [synthesis] (1) Ask directly about suicidal thoughts and past attempts; (2) assess intent, plans, history and protective factors using your service's standard approach; (3) build a written safety plan with warning signs, coping steps, people to contact and professional contacts; (4) discuss safe storage or removal of means without discussing methods; (5) give crisis lines: 988 (US) and Samaritans 116 123 (UK and Ireland); (6) escalate to emergency care where risk is imminent.
  • Example language (illustrative): "Sometimes after experiences like this, people think about ending their lives. Have you had thoughts like that?"
  • Watch for: GAO described a programme handing a suicidal teen back a knife after self-harm with no prevention plan [source: GAO-08-146T]; survivors may expect to be punished for disclosing. Working: an agreed plan the client can describe back.

4.6 Psychoeducation for parents considering a boot camp

  • Purpose / when: When a parent raises a boot camp or "tough love" programme for a child with conduct problems.
  • Steps: (1) Ask what has led them here and what they hope it will do [synthesis]; (2) share the evidence: no reduction in reoffending [source: Wilson, MacKenzie and Mitchell 2005]; (3) share GAO's findings that programmes have been linked to abuse and death, untrained staff and weak oversight, that there are no federal laws regulating these programmes and that state licensing varies or is absent [source: GAO-08-146T]; (4) offer the NICE-supported alternatives (4.10 to 4.12) [source: NICE CG158]; (5) if they still proceed, do not assist the placement; explain your concerns in writing and keep safeguarding open [synthesis].
  • Example language (illustrative): "I can see how exhausted and worried you are. I want to be honest: boot camps haven't been shown to help, and some have seriously hurt young people. There are approaches with much better evidence."
  • Watch for: Parents feeling judged; desperation after violence at home. Working: the family agrees to try a supported intervention.

4.7 Working with parents' guilt and the decision they made

  • Purpose / when: With parents who placed a child in a boot camp that harmed them.
  • Steps: [synthesis] (1) Explore what they were told and what they knew; (2) separate responsibility (the programme's conduct) from the parent's intention; (3) help them acknowledge the child's experience without defending the decision; (4) prepare for repair conversations (4.16).
  • Example language (illustrative): "You made the decision with the information you had and the fear you were carrying. Your child may still need you to hear how it was for them."
  • Watch for: Defensiveness, collapse into self-blame, or insisting it "worked". Working: the parent can listen to the child's account without counter-argument.

4.8 Responding to disclosure about a minor currently enrolled

  • Purpose / when: When a client, parent or sibling discloses current mistreatment of a young person in a programme.
  • Steps: [synthesis] (1) Listen and record the disclosure factually in the person's words; (2) do not investigate yourself; (3) report to the child-protection agency or police as mandatory-reporting law in your jurisdiction requires, and to the programme's licensing body where one exists [source for licensing variability: GAO-08-146T]; (4) where there is immediate danger, call emergency services; (5) inform the family of the report unless that would increase risk; (6) document what you reported, to whom and when.
  • Example language (illustrative): "What you're telling me means I need to contact child protection today. I'll tell you what I'm going to say."
  • Watch for: Pressure not to report; programmes that restrict communication with families. Working: a report made and a protective response under way.

4.9 When a colleague or institution recommends or uses a boot camp

  • Purpose / when: A colleague refers to a programme, a service contracts with one, or a programme claims clinical endorsement.
  • Steps: [synthesis] (1) Raise the concern directly with the colleague, citing the evidence; (2) if unresolved, take it to your clinical lead or safeguarding lead; (3) where children may be harmed, report to child protection and the programme's licensing body; (4) where a professional's conduct is concerned, use the relevant licensing board or professional body; (5) if you or a colleague has a financial or referral tie to a programme, consider APA Ethics Code Standard 3.05 on multiple relationships (APA Ethics Code).
  • Example language (illustrative): "I'm concerned about referring to this programme. The review evidence shows no benefit, and GAO documented serious harms in programmes like it."
  • Watch for: Being told "we have no alternatives"; retaliation. Working: the referral route is withdrawn or reviewed.

4.10 Routing to parent training (children aged 3 to 11)

  • Purpose / when: As the supported alternative for younger children at high risk of, or with, oppositional defiant disorder or conduct disorder, or in contact with the criminal justice system for antisocial behaviour [source: NICE CG158].
  • Steps: (1) Explain that NICE recommends group parent-training programmes for this age range [source: NICE CG158]; (2) identify a local programme that follows a developer's manual [source for manual fidelity in NICE quality standards: NICE QS59]; (3) address practical barriers (childcare, transport, timing) [synthesis]; (4) keep in touch with the family during the programme [synthesis].
  • Example language (illustrative): "The approach with the strongest evidence for this age is a parenting group, where you learn practical ways to handle the behaviour and strengthen your relationship with your child."
  • Watch for: Parents hearing "parent training" as blame. Working: attendance and reported change at home.

4.11 Routing to child-focused social and cognitive problem-solving programmes (ages 9 to 14)

  • Purpose / when: For children and young people aged 9 to 14 in the same risk groups [source: NICE CG158].
  • Steps: (1) Explain the purpose: building skills in solving social problems [source: NICE CG158, as summarised in the NICE and SCIE release]; (2) identify a group programme; (3) gain the young person's assent as well as parental consent [synthesis].
  • Example language (illustrative): "This is a group where young people your age practise ways of handling situations that usually end in trouble."
  • Watch for: Grouping a young person mainly with highly antisocial peers can raise concerns (see guide 095 in this domain, peer-group interventions for conduct disorder) [synthesis]. Working: the young person engages and uses skills.

4.12 Routing to multimodal interventions (ages 11 to 17)

  • Purpose / when: For young people aged 11 to 17 with conduct disorder, or in contact with the criminal justice system, or identified as high risk [source: NICE QS59].
  • Steps: (1) Explain that NICE quality standards say such young people and their parents or carers should be offered a referral for multimodal interventions [source: NICE QS59]; (2) describe them as NICE does: family-focused programmes based on social learning, delivered across individual, family, school, criminal-justice and community levels by trained case managers following a developer's manual, typically several meetings a week over several months (QS59 gives 3 to 4 a week over 3 to 5 months) [source: NICE QS59]; (3) make the referral and confirm parental involvement, which NICE treats as central [source: NICE QS59].
  • Example language (illustrative): "Instead of sending your son away, this approach brings help into your home, his school and the community, and works with you as a family."
  • Watch for: Families who want the young person removed from home; explore the safety reasons. Working: the family engages with the case manager.

4.13 Assessing coexisting conditions behind conduct problems

  • Purpose / when: Whenever conduct problems are the reason a boot camp is being considered, and with survivors whose difficulties were never assessed.
  • Steps: (1) Check for coexisting mental health problems, neurodevelopmental conditions (especially ADHD and autism), learning disabilities and, in young people, substance misuse, as NICE advises [source: NICE CG158]; (2) refer for specialist assessment where indicated [synthesis]; (3) never advise starting, stopping or changing a medicine; refer prescribing questions to the prescriber.
  • Example language (illustrative): "Before we decide anything, I'd like to understand what's driving the behaviour. Sometimes there's something underneath, like attention or learning difficulties, that changes what will help."
  • Watch for: Survivors who were labelled only as "bad". Working: a fuller formulation.

4.14 Working with a client drawn to militaristic or "tough love" approaches

  • Purpose / when: A parent, a young person or a former participant who believes harsh discipline is what is needed or what "fixed" them.
  • Steps: [synthesis] (1) Explore the appeal (order, structure, belonging, respect) without arguing; (2) acknowledge what structure and adult attention can offer; (3) separate structure from humiliation and force; (4) share the evidence on outcomes [source: Wilson, MacKenzie and Mitchell 2005] and that programmes with stronger treatment content did better [same source]; (5) build structure through supported routes (4.10 to 4.12).
  • Example language (illustrative): "It makes sense to want clear rules and consequences. The research suggests structure helps when it comes with skills and support, not when it relies on fear."
  • Watch for: A survivor's identification with the regime as a way of coping with what happened. Working: the client can hold both what they valued and what harmed them.

4.15 Restoring trust and control in the therapeutic frame

  • Purpose / when: Early and throughout work with survivors of coercive programmes.
  • Steps: [synthesis] (1) Explain confidentiality and its limits clearly at the start; (2) offer explicit choices (pace, topics, breaks, seating, door open or closed); (3) avoid commanding language, raised voices and anything resembling drill; (4) agree a stop signal; (5) never use physical management or holding; any touch only with consent before and during, a right to stop, and never sexual.
  • Example language (illustrative): "You're in charge of what we talk about and when we stop. If anything I do reminds you of the programme, tell me and we'll change it."
  • Watch for: Automatic compliance ("yes, sir" responses), startle, freezing. Working: the client starts to disagree with you safely.

4.16 Trauma-focused processing

  • Purpose / when: When the client has current trauma symptoms and enough stability.
  • Steps: [synthesis] (1) Choose an established trauma-focused therapy you are trained in and that fits current guidelines for the client's age and diagnosis; (2) prepare with stabilisation and the safety plan (4.5); (3) obtain informed consent (and assent for minors), including the right to pause; (4) process the experience at the client's pace; (5) review symptoms regularly.
  • Example language (illustrative): "When you feel ready, we can work on the memories that still feel raw, in a way that keeps you in control."
  • Watch for: Overwhelm, dissociation, increased risk; slow down. Working: falling symptom scores and better functioning.

4.17 Processing shame and the "I deserved it" narrative

  • Purpose / when: Survivors who were told the regime was what they deserved for their behaviour.
  • Steps: [synthesis] (1) Elicit the beliefs about self the programme taught; (2) examine them against the facts, including the evidence that the model does not work [source: Wilson, MacKenzie and Mitchell 2005]; (3) separate responsibility for past behaviour from the treatment received; (4) develop a self-account that includes both.
  • Example language (illustrative): "You may have done things that needed addressing. None of that meant you deserved to be hurt."
  • Watch for: Self-blame that protects attachment to parents. Working: the client can describe the harm without minimising it.

4.18 Family repair conversations

  • Purpose / when: When a survivor and the parents who placed them want to repair the relationship.
  • Steps: [synthesis] (1) Prepare each side separately (4.7 for parents); (2) agree ground rules and the survivor's right to stop; (3) let the survivor say what happened and what they need; (4) support the parent to acknowledge without defending; (5) plan next steps and review.
  • Example language (illustrative): "Today is about you hearing each other, not about deciding who was right."
  • Watch for: Re-enactment of power (the parent controlling the conversation). Working: an acknowledgment the survivor experiences as genuine.

4.19 Advocacy, records and legal routes

  • Purpose / when: When a survivor or family wants accountability or information.
  • Steps: [synthesis] (1) Help the client request their records from the programme and any placing agency; (2) explain that complaints can go to the state licensing body where one exists, child-protection agencies and police [source for licensing gaps: GAO-08-146T]; (3) suggest independent legal advice; civil claims have been brought after deaths, as in the 2006 Florida case [source: CBS News 2010]; (4) write factual clinical reports only within your competence and with consent.
  • Example language (illustrative): "If you want to take this further, there are a few routes. A lawyer can tell you which ones fit your situation."
  • Watch for: Re-traumatisation through legal processes; prepare the client. Working: the client feels they chose what to pursue.

4.20 Supporting families bereaved by a programme death

  • Purpose / when: With parents, siblings or friends of a young person who died in a programme.
  • Steps: [synthesis] (1) Offer grief support that allows anger and guilt; (2) prepare for long legal and investigative processes, which can include disputed autopsies and acquittals (as in the Florida case) [source: Prison Legal News 2007; CBS News 2010]; (3) assess complicated grief and suicide risk (4.5); (4) support siblings' needs separately.
  • Example language (illustrative): "There's no right way to grieve something like this, especially while the questions about what happened are still open."
  • Watch for: Media attention, retraumatisation by footage; help the family set limits. Working: the family can function and grieve alongside the legal process.

4.21 Working with former staff

  • Purpose / when: A client who worked in a boot camp and is troubled by what they did or saw.
  • Steps: [synthesis] (1) Assess moral injury, trauma and guilt; (2) clarify any ongoing safeguarding duty (knowledge of current abuse must be reported); (3) support honest accountability without condemnation; (4) refer for legal advice where relevant.
  • Example language (illustrative): "It took courage to bring this here. Let's look at what happened and what you want to do about it now."
  • Watch for: Justification ("it was training") or overwhelming guilt. Working: the client can acknowledge harm and take constructive action.

5. Handling problems

Most guidance here is [synthesis]; sourced points are tagged.

  • A parent insists on a boot camp after you have shared the evidence. Restate your concern in writing, offer the NICE-supported routes again [source: NICE CG158; NICE QS59], share GAO's practical cautions (check licensing, staff training, medical and suicide procedures, and owners' regulatory and court histories) [source: GAO-08-146T], and do not help arrange the placement. Keep the door open and agree how the family can contact you. If there are signs the placement itself would expose the child to abuse, consult your safeguarding lead [synthesis].
  • A parent says the home is unsafe because of the young person's violence. Take the safety concern seriously: make a safety plan for the household, involve social care and, where indicated, crisis services; refer urgently for multimodal intervention [source for multimodal routing: NICE QS59; rest synthesis].
  • The survivor will not talk about the programme. Do not push. Work on present-day symptoms and stability; return to the topic only when the client chooses [synthesis].
  • Overwhelm or dissociation in session. Stop, ground the client in the present room, check what triggered it (a tone, a command, a sound), and adjust the frame (4.15). Review risk before the client leaves [synthesis].
  • Compliance that hides distress. Survivors may agree with everything. Invite disagreement explicitly and notice when "yes" does not match body language [synthesis].
  • Rupture: the client experiences you as another controlling adult. Name it, apologise for your part, and give back control over the next step [synthesis].
  • Non-attendance or dropping out. Follow up without penalty; survivors may expect punishment for missing sessions. Offer flexible formats [synthesis].
  • The survivor defends the programme ("it straightened me out"). Do not argue. Explore both what they value and any harms (4.14). Note that the evidence does not show boot camps reduce reoffending [source: Wilson, MacKenzie and Mitchell 2005].
  • Suicidal crisis. Follow 4.5; give 988 (US) or Samaritans 116 123 (UK and Ireland); arrange emergency care where risk is imminent. Avoid discussing methods; do not dramatise deaths in programmes [synthesis].
  • Disclosure of current abuse of another young person. Report as mandatory-reporting law requires (4.8). Your duty does not depend on the client's agreement where a child is at risk [synthesis].
  • Legal proceedings stall or fail. In the Florida case, guards and a nurse were acquitted by a state jury in 2007 and federal authorities declined to bring charges in 2010 [source: CBS News 2010]. Help clients and families prepare for outcomes that do not match their sense of justice, and look at other forms of acknowledgment [synthesis].
  • Colleague or service pressure to use a programme. Follow 4.9 and document your concerns [synthesis].
  • Your own reactions. Footage and accounts can be distressing; use supervision and avoid viewing graphic material unless clinically necessary [synthesis].

Harm account

What was actually done

Boot camps placed young people, usually adjudicated or sent by courts, probation or parents, in short-term, paramilitary-style residential regimes resembling military basic training, run in correctional settings by state and county authorities or by private operators [source: CrimeSolutions; Wilson, MacKenzie and Mitchell 2005; CBS News 2007; GAO-08-146T]. In 2007 GAO reviewed ten closed cases in which teenagers died in private residential programmes between 1990 and 2004, including boot camps and wilderness programmes, and described practices such as severe restriction of food, ill teenagers being dismissed as "faking it" and left without treatment for days, punishment through forced exposure to extreme heat, a death after a restraint incident ruled a homicide, and possible alteration of programme records during an investigation [source: GAO-08-146T]. GAO linked these deaths to untrained staff who failed to recognise medical emergencies, inadequate nourishment under "tough love" philosophies taken to extremes, reckless or negligent operating practices, and ineffective management [source: GAO-08-146T].

In January 2006 a 14-year-old boy died at the Bay County Sheriff's Office juvenile boot camp in Panama City, Florida, a day after an incident captured on surveillance video. He had been sent there for a probation violation. Reports state that after he collapsed during compulsory physical training, guards struck him and physically restrained him, with a nurse present who did not appear to intervene [source: Prison Legal News 2007; CBS News 2010]. A first autopsy attributed the death to complications of sickle cell trait; a second autopsy, after exhumation, found that the guards' actions caused his death by depriving him of oxygen [source: Prison Legal News 2007; CBS News 2010]. Defence lawyers said the guards' actions reflected their training; a jury acquitted the guards and the nurse of aggravated manslaughter in October 2007, and the Justice Department declined federal charges in 2010; the family received about $7.4 million in settlements [source: CBS News 2007; CBS News 2010; Prison Legal News 2007].

How it caused harm

  • Death and injury: deaths in custody linked by investigators and courts to force, medical neglect and deprivation [source: GAO-08-146T; CBS News 2010].
  • Medical neglect: untrained staff misread emergencies; in GAO's words, staff "only realized that a teen was in distress when it was already too late" [source: GAO-08-146T].
  • No benefit to set against the harm: the militaristic model did not reduce reoffending [source: Wilson, MacKenzie and Mitchell 2005]; CrimeSolutions rates it ineffective [source: CrimeSolutions].
  • Weak oversight: no federal law defines or regulates residential treatment programmes; some states do not license private programmes at all [source: GAO-08-146T].
  • Psychological harm: fear, humiliation, distrust of authority and helpers, trauma symptoms and shame are plausible consequences for survivors [synthesis] [uncertain].
  • Missed treatment: time spent in a boot camp is time not spent in effective care for conduct problems and any coexisting conditions [synthesis].

Recognising it today

  • Programme marketing: "boot camp", "military-style", "tough love", "discipline academy" or similar language for children and teenagers; GAO noted there is no standard definition of the term, so names vary [source: GAO-08-146T].
  • Warning signs GAO identified: unlicensed or out-of-state unlicensed operation; staff without verifiable training or credentials; unclear procedures for medical emergencies and suicidal behaviour; accreditation that does not cover all parts of the programme; owners or staff with prior regulatory or court histories; promises of a "perfect fit" or an unmatched safety record [source: GAO-08-146T].
  • In a young person's account: being denied food, water or medical care; being told they were faking illness; physical force by staff; restricted contact with family; punishments that are physical ordeals [source for categories: GAO-08-146T].
  • In clinical presentation: trauma symptoms linked to a placement, fear of authority, automatic compliance, shame about "being sent away" [synthesis].
  • Legacy: state-run juvenile boot camps were closed in Florida in 2006 after the Bay County death, under a law signed by Governor Jeb Bush that banned certain physical tactics used by guards [source: Tampa Bay Times 2006; Prison Legal News 2007]. The current number and regulation of private programmes elsewhere is [uncertain: not verified].

What to do instead and how to help those harmed

  • Supported care for conduct problems: group parent training for children aged 3 to 11; group social and cognitive problem-solving programmes for 9 to 14-year-olds; assessment of coexisting conditions [source: NICE CG158]; multimodal family-focused interventions for 11 to 17-year-olds [source: NICE QS59]. See 4.10 to 4.13.
  • Survivors: trauma-informed assessment, medical review, suicide-risk assessment, and trauma-focused therapy at the client's pace (4.3 to 4.5, 4.15 to 4.17).
  • Families: psychoeducation, work with guilt, repair conversations, and bereavement support (4.6, 4.7, 4.18, 4.20).
  • Reporting duties and legal routes: mandatory reporting to child protection or police; complaints to licensing bodies; independent legal advice; civil claims have been brought after deaths [source: CBS News 2010; rest synthesis].
  • Crisis resources: 988 (US); Samaritans 116 123 (UK and Ireland).
  • Survivor organisations: check that any organisation's own published self-description and current status fit the client before suggesting it [uncertain: not verified].

Sources

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