June 12,2024

Wyden Investigation Exposes Systemic Taxpayer-Funded Child Abuse and Neglect in Youth Residential Treatment Facilities

Two-year investigation of four major companies reveals RTFs receive billions of dollars in federal funding - including Medicaid and child welfare dollars - and provide substandard care and subject kids to abuse and neglect Report calls for Congress, industry, federal government agencies, and states to raise standards for congregate care, strengthen oversight, and invest more in community-based alternatives

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., today released the findings of a two-year investigation exposing systemic taxpayer-funded child abuse and neglect in youth residential treatment facilities (RTFs) across the United States. 

The Committee’s investigation into four major RTF operators revealed that children in these facilities are regularly subjected to physical, sexual, and verbal abuse; inappropriate restraints and seclusions; unsafe and unsanitary conditions; and lack of necessary behavioral health care. The report, which examined conditions at RTFs run by Universal Health Services (UHS), Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare, found that these harms are not isolated exceptions, but inherent to a model that incentivizes maximizing profits at the expense of providing high-quality care to children – and often paid for with taxpayer dollars, including Medicaid and child welfare funding.

“It’s clear that the operating model for these facilities is to warehouse as many kids as possible while keeping costs low in order to maximize profits. Too often, abuse and neglect is the norm at these facilities, and they’re set up to let this happen,” Wyden said. “These findings demand bold action. In addition to recommendations in the report that facilities, states, and federal agencies can implement now, I’ll be introducing legislation in this Committee’s jurisdiction in the coming months to raise health and safety standards, require real oversight and enforcement, and invest in the community-based services that are proven to actually help kids.”

RTFs are intended to provide temporary, stabilizing care for children with acute behavioral health needs. Yet, for decades, journalists and government oversight agencies have found that the RTF industry attracts profit-motivated actors who abandon their duty to provide children with high-quality care. Children that enter these facilities often leave even more traumatized than when they arrived. In the most extreme cases, some children have died, including by suicide, because of the harms they experience in these facilities and the lack of care they have been provided for their intensive needs. 

Due to the patchwork system of oversight and accountability, RTF providers have evaded enforcement and accountability for years. The current system fails to effectively identify and address the harms, allowing deficiencies to persist for years. 

The full report, “Warehouses of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities” is available here, and key findings are listed below. The committee held a hearing to discuss the report, more information including video, testimony, and supporting documents for the report can be found here.

  • Children suffer routine harm inside RTFs. The risk of harm to children in RTFs is endemic to the operating model. 

  • Children inside RTFs often do not get the treatment they need for mental and behavioral health needs, despite RTFs being reimbursed with federal dollars to provide intensive services. 

  • Horrific instances of sexual abuse persist unremediated inside RTFs. 

  • The use of restraint and seclusion in RTFs allows for unchecked abuse. RTF staff have too often ignored federal restraint and seclusion regulations, resulting in daily use of restraint and seclusion in some instances.  

  • RTFs often employ unqualified or inadequately trained staff and that staff routinely fail to discharge their duties. RTF staffing failures have led to tragic incidents, including child fatalities, and childrens’ repeated exposure to risk. 

  • RTFs are often non-homelike environments, exposing children to unsafe and unsanitary conditions. 

  • RTFs often fail to effectively maintain connections between children and their communities and to plan for childrens’ discharge to the community for ongoing care. 

  • RTFs often employ carceral technology to monitor children, creating environments that feel more like detention facilities than therapeutic settings. 

  • State and federal oversight authorities fail to effectively identify and address harm to children in RTFs. When RTFs correct deficiencies, their efforts are remedial rather than company-wide.

  • Exploiting corporate structures can enable RTF operators to evade oversight. 

In addition, in the report, the Committee recommends state and local governments, federal agencies, accrediting bodies, and RTF providers immediately take the following actions:

  1. Congress must legislate to improve the conditions in RTFs and the broader behavioral health landscape. It should focus its attention on the following categories: (i) raising the floor for congregate care standards (including standards that reflect active treatment and require use of evidence-based treatments), (ii) investing in community-based alternatives for care, and (iii) strengthening the oversight of congregate care facilities.

  2. The companies under investigation in this report must raise standards across facilities.

  3. States should use their existing authority to prioritize the availability and utilization of community-based services for children with behavioral health needs.

  4. States should improve RTF oversight activities in order to compel providers to raise the bar on standards within RTFs.

  5. CMS and ACF should work together to clarify and streamline federal oversight requirements for RTFs.

  6. CMS and ACF can work collaboratively to center perspectives of youth with lived experience.

  7. ACF should increase awareness for judges on the risks of improper placements in RTFs, the full continuum of care, and clinical best practices for treating children with behavioral health needs, particularly for children in foster care.

  8. CMS and ACF can and should do more to prioritize spending on community-based behavioral health services as an alternative to placement in RTFs if possible and safe.

  9. DOJ should assess RTF placements for potential Olmstead violations.

  10. Accrediting bodies, such as the Joint Commission, should closely monitor facilities following the discovery of noncompliance with requirements or elements.