The North Carolina Department of Health and Human Services has suspended admissions to Trails Carolina, a residential therapeutic camp in Transylvania County, after a 12 year boy died there Feb. 3, according to a letter DHHS sent the camp. The state also removed all attendees from the camp’s care on Feb. 16 and is still investigating the incident.
The program also faces a lawsuit from a former attendee who describes being sexually assaulted at the camp, claiming management failed to take action. The camp settled a 2023 lawsuit in which another past camper made similar claims.
Local social services staff were onsite the day after the camper’s death, but camp management prevented them from accessing the camp until Feb. 6, according to DHHS.
An autopsy conducted Feb. 6 showed the death appeared not to be natural, but a determination of how it happened remains pending, according to a press release from the Transylvania County Sheriff’s Office.
Another child in the camp’s care died in 2014 after trying to run away from the camp, according to the state health department’s investigation at that time.
Former attendees said it didn’t feel like the camp was well-regulated. While state regulators are supposed to conduct yearly surveys and investigate complaints at programs like Trails Carolina, located in the mountains north of Lake Toxaway, DHHS said it doesn’t have enough staff to keep up.
Advocates also pointed to difficulties in adequately regulating the camps.
Meanwhile, some former attendees want the camp shut down.
Lawsuits against Carolina Trails
Gertie Siegel thought she was just going to summer camp in North Carolina for a week, she said. Instead, her three months spent at Trails Carolina in 2016 felt like “a nightmare,” she said.
At the time, Siegel was 12 years old and struggling with depression. Her parents chose to send her to Trails Carolina in hopes she would receive help and therapy.
But Siegel told Carolina Public Press that she only spent around an hour with the therapist once a week. Much of her time was spent hiking, eating too-little amounts of food and sometimes drinking from broken water filters, the lawsuit said.
In her first week, Siegel said another attendee sexually assaulted her friend, but the alleged perpetrator was not separated from the others, according to the lawsuit.
The person went on to assault another attendee, who told Siegel and a staff member they were worried the assailant would target Siegel next, the lawsuit said. Siegel told numerous staff members that she was scared of the person who later assaulted her, according to the lawsuit.
Siegel said in the lawsuit that the staffers knew of the situation, but made her sleep next to that person, who then also sexually assaulted her. When Siegel told her therapist what happened, the therapist said she was equally at fault and made Siegel “take accountability” for not verbally saying “no.”
According to the lawsuit, the incident was never reported.
In an emailed statement, Trails Carolina said it is aware of Siegel’s lawsuit and will defend the program and staff against the allegations. “Trails is a place of healing for young people and their families and we are confident the facts will reveal the truth,” the statement said.
Another former attendee, Clara Mann, also filed a lawsuit against Trails Carolina in 2023 and settled. Like Siegel, Mann’s lawsuit said she was sexually assaulted by another attendee while she attended Trails at age 14. Mann was also sent to the camp to help her depression.
She recounted hiking several miles a day with 50-pound backpacks, drinking muddy water from streams and eating meals that often consisted of peanut butter on tortillas or cold soaked oats.
Mann told a staffer that she was assaulted, but she was then made to spend more time with the alleged perpetrator, according to the lawsuit. Her therapist asked her a list of “rude and blunt” questions about the experience, she said. Eventually, the alleged assailant was put in isolation. Mann’s lawsuit said the incident was never reported.
“The entire experience had a terrible impact on me,” she told CPP.
Mann’s lawyer, Jenkins Mann, is also her uncle. He said if Trails Carolina had reported the incident when it happened, it could have prevented further harm. He said that’s why following regulations matters.
The group’s capabilities determine the length of daily hikes and the individual’s ability determines how heavy their backpack is, Trails Carolina said in an emailed statement. The meals Mann described are included because they have carbohydrates and protein, and the program follows the National Outdoor Leadership School’s approach to nutrition, according to the Trails statement.
If water filters fail, the Trails statement said, each group has two backup methods for filtering water.
Deaths at camp
The 12-year old boy who died at Trails Carolina arrived a day before the incident, according to a press release from the Transylvania County Sheriff’s Office. Deputies were called the next morning and the child “appeared to be deceased for some time,” although camp staff said they tried CPR, the press release said.
Investigators were granted search warrants for two Trails Carolina locations in the county, according to the sheriff’s office. The medical examiner’s report is still pending, as well as computer forensics on the devices seized under warrants, the office said in a March 19 email to CPP.
According to a DHHS statement, all children were removed from the camp and put in temporary care with the local social services. Parents were also notified, the statement said.
DHHS “threatened and intimidated parents” by demanding they travel to pick up their children or the department would take them into custody, Trails Carolina said in an emailed statement to CPP.
Locating alternative placements would normally take several weeks, the statement said, and “this negligent and reckless move by the State denied parents the opportunity to continue to care for their children in the appropriate manner.”
Trails also said the state made “reckless decisions based on false and misleading information” from the Transylvania County Sheriff’s Office that was contrary to local social workers who said the camp was safe.
The state’s actions were an attempt to avoid fair due process because they likely didn’t have evidence to close the program through judicial review, the Trails statement said.
In an emailed response to CPP about these claims, a DHHS spokesperson said local social services and the health department jointly ensure patient’s safety in a licensed health care facility. Local DSS agents can remove children from a facility, while the state division of health service regulation can impose penalties, suspend admissions and suspend or revoke a facility’s license, the spokesperson wrote.
“While we cannot comment on the specifics of the investigation, (DHHS) determined that action needed to be taken to ensure the health and safety of the children,” the spokesperson wrote.
The recent death is not the first tied to Carolina Trails. A 17-year-old boy died a decade earlier after attempting to flee the camp, multiple news media reported at the time.
He was found in nearby Jackson County in a creek at the bottom of a gorge with clothes frozen to his body. X-rays revealed his left hip was fractured, consistent with a fall from a height. The cause of death was determined to be hypothermia secondary to the hip fracture.
A DHHS investigation at the time stated that Trails Carolina staffers subjected the client to “neglect and harm” by not following supervision protocol.
What is wilderness therapy?
Trails Carolina’s website describes wilderness therapy as a program that combines residential treatment with “natural healing benefits of outdoor behavioral health care.”
Adolescents and teenagers go to wilderness therapy camps for reasons including mental health issues, risk behaviors and substance use disorders. Wilderness therapy has been reported as feeling like “abuse” to some partly because of a lack of oversight.
Meg Appelgate, founder of the nonprofit Unsilenced, experienced wilderness therapy as a teenager and now raises awareness about issues in the industry. She said red flags include restricting a child’s communication with family and removing their autonomy under the guise of therapy, as well as longer term stays.
While youth who are a danger to themselves or others may benefit from short-term crisis intervention, that sort of residential treatment is usually no longer than a month, Applegate said. Those patients are under medical supervision and can usually contact their parents, she said.
While at Trails, Siegel said her parents were told to write her a “harsh” letter detailing why they sent her to the camp. She had to read the letter aloud to other campers and they gave her “feedback” on her behavior, such as snapping at her mother.
Looking back, Siegel said a lot of the behaviors she and other attendees were shamed for were normal for teenagers, such as skipping school because of bullying.
In an emailed statement, Trails Carolina wrote that students are not required to read their parents’ letters in front of the group and the letters are not encouraged to be “harsh.”
“We ask parents to be clear and direct about the impact of a student’s actions and why they decided to have them come to Trails. Our goal is to remove any confusion or mystery about why they are here,” the Trails statement said.
Behaviors like self-harming and suicidal ideation aren’t “normal,” the statement said, and the program asks what needs participants are trying to meet through their behavior. Parents try many alternatives before wilderness therapy, the Trails statement said.
Looking at the science
Experiencing nature and learning survival skills can be beneficial for everyone, but many of the children sent to the camps have diverse, complex needs, said Corye Dunn, public policy director at Disability Rights NC. A standard treatment for everyone often doesn’t help, she said.
Kate Nooner, a psychology professor at UNC Wilmington, researches how trauma and abuse impact children. She said the “tough love” model that some wilderness therapy programs use isn’t backed by science. Providing structure and setting limits is different than forcing kids to live in harsh conditions, Nooner said.
Consistency and consent are vital in trauma informed care, she said. While involuntary commitment is a part of the treatment system, that’s typically only if a patient is suicidal and needs acute hospitalization, Nooner said. The patient’s stay in the facility is also usually short-term, she said.
Patients should engage in evidence-based therapeutic activities for most of the day, Nooner said, rather than forcing them to do a physically challenging activity in a harsh environment.
Trails Carolina said in a statement it provides therapy from licensed professionals and that nature-based activities are therapeutic. Having a patient in therapy eight hours a day would be “exhausting and counterproductive,” the statement said, so this approach helps attendees learn to apply their new skills in a physical environment.
“Tough love” models are no longer used, the statement read. “That online search results and news media reports fail to accurately reflect the safe, outcome-proven treatment options available for children struggling with mental health is reckless and unfair,” the statement said.
The statement pointed to sources including a youth outcome questionnaire from the Outdoor Behavioral Council, in which parents said their kids improved after wilderness therapy.
The council accredits wilderness therapy programs and aims to create best practices in the industry. Trails Carolina is an accredited member.
“We believe Trails Carolina deserves an objective and thorough investigation of the tragic incident that occurred,” the council said in an email. “Trails has been cooperative and they remain a valued member of the OBH Council at this time.”
Michael Glass, director of the Outdoor Behavioral Healthcare Center, wrote in an email to CPP that effective treatment for teens with behavioral health issues is deeply needed, and wilderness therapy can provide “effective and trauma informed care” if adhering to best practices.
The OBH Council supported creating the center and is one of its funders, although the website said the research is independent of funders.
Glass pointed to two randomized controlled treatment wilderness therapy studies in Canada as recent examples with statistical significance.
In response to whether it’s useful for wilderness therapy programs to isolate attendees from their families, Glass wrote: “Any program that removes youth from their caregivers without the primary focus of having them return when they reach their treatment goals, is not following appropriate mental health practices.”
As to standardized treatment, Glass wrote that accredited wilderness therapy programs continuously assess a client’s treatment plan and can tailor them as appropriate, but practitioners also need to consider “logistical, safety, environmental, and group dynamics” factors.
Inadequate camp regulation
Laws governing wilderness therapy camps vary state to state, Appelgate said.
In North Carolina, the programs are licensed as mental health treatment facilities, so state health inspectors are supposed to conduct annual surveys and investigate complaints, according to a DHHS spokesperson.
If they find deficiencies, the facility must submit a plan of correction to address it within ten days. If the plan is accepted, surveyors are supposed to follow up to make sure the facility is in compliance again, the spokesperson wrote over email.
But there’s not enough staff to complete all these surveys on time, according to the spokesperson, partly because of staff vacancies and turnover. The mental health licensure section has 33 surveyors, while there are over 1,900 licensed residential and almost 1,600 non-residential mental health facilities in the state, the spokesperson said.
The division’s workload has “increased dramatically” in the past few years, yet there’s insufficient staffing and uncompetitive salaries, the spokesperson wrote.
Gov. Roy Cooper included additional staff for the division in each of his last recommended budgets, but only in the past session did the General Assembly enact four new positions for mental health facilities, according to DHHS.
Surveyors have difficulty seeing the full scope of activities in these programs, Appelgate said, as much of the attendees’ time is spent far from the base facility. For example, it would be difficult to see when water filters break during long hikes, she said.
If participants are at base camp when the inspectors come, they likely would not see all the children, she said.
State health inspectors interview clients and counselors both at base camp and remote camps sites, according to DHHS.
Another issue is that many wilderness programs don’t have staff with significant behavioral health training, Dunn said.
North Carolina laws require facilities to have a program director with a minimum of two years’ experience in child or adolescent services specific to the campers’ needs, as well as “educational preparation in administrative, education, social work, nursing, psychology or a related field.”
Facilities must also have at least two staff members on duty for every eight or fewer campers. Staff must be trained to “manage the children or adolescents individually and as a group,” and on alternatives to restrictive interventions. Only staff who have been trained in seclusion, physical restraint and isolation time-out may use those procedures.
Dunn said that level of experience “feels like a low bar.”
Solutions for care
The mental and behavioral health system for children and adolescents has gaps, which Dunn said can lead parents to wilderness therapy. That’s why building up the community-based care system is important, she said.
“Fewer people would feel that sense of desperation to try something that requires sending their child away with strangers,” she said.
Appelgate said she recommends professionally assessing the child to discover the root cause of their risk behaviors, such as an underlying element of trauma.
Over the past few years, Appelgate said she’s seen a “steep decline” in wilderness therapy. Many programs that used to be long-term are shifting to shorter-term models to escape scrutiny, she said.
Mann said knowing children are still in these camps makes her “angry.”
“As long as these camps are up, America’s youth are going to be hurt,” she said.
This article first appeared on Carolina Public Press and is republished here under a Creative Commons license.
Just an absolute tragedy that this “camp” was allowed to operate as it did for so long. The North Carolina Department of Health and Human Services [DHHS] dropped the ball repeatedly here …as bureaucrats are wont to do when their precious pensions are always their top priority. sigh.