Children in residential treatment facilities face multiple risks: Senate report

Children who are in residential treatment facilities are at risk for sexual and emotional abuse, physical restraint and overmedication, a new Senate report found.

The report, conducted by the Senate Committee on Finance and the Senate Committee on Health, Education, Labor, and Pensions, was created after an investigation examined allegations of abuse and neglect at residential treatment facilities (RTFs) operated by four companies.

The committees found that children are at harm because of the facilities’ operating model, which “incentivizes providers to optimize revenues” over proper treatment. The companies examined are Universal Health Services, Acadia Healthcare, Vivant Behavioral Healthcare and Devereux Advanced Behavioral Health.

In a statement, Senate Finance Committee Chair Ron Wyden (D-Ore.) criticized the facilities, arguing they are warehouses to store as many children as possible while keeping costs low.

“Too often, abuse and neglect is the norm at these facilities, and they’re set up to let this happen,” his statement said. “These findings demand bold action.”

The report earned bipartisan support, as ranking member Sen. Mike Crapo (R-Idaho) delivered remarks at Wednesday’s hearing urging his colleagues to intervene. He said work must be done so RTF placement is a “last resort” and efforts are made to reintroduce children to the community “as soon as possible.”

The children who are placed in RTFs often need mental and behavioral help, but the organizations fail to individualize treatment to adequately treat each child, the report found.

Additionally, the report found children “suffer routine harm” inside the facilities like sexual, physical and emotional abuse; unsafe and unsanitary conditions; and inadequate behavioral health treatment.

The report detailed one incident in Oklahoma, where a staff member admitted to molesting a girl, but the facility moved the staffer to another place after the misconduct was reported instead of terminating the employee. The staff member continued to stand outside the patient’s bedroom window each night, the report said.

Physical restraints and seclusion are often used as punishment and can injure children. It is often used without documentation, the report found. At one Arkansas treatment center, staff “routinely simultaneously chemically restrained and secluded children.”

The report noted that the facilities are short staffed and often staffed with unqualified people, and it said this has “led to tragic incidents” including child fatalities.

It also found that many facilities cut children off from their parents and outside community support instead of allowing them to maintain connection in an unfamiliar environment.

In a statement sent to The Hill, Universal Health Services said it cooperated with the two-year investigation and finds the report to be “incomplete and misleading.” The company also acknowledged there “have been incidents” but said the “rates of such occurrences” are rare and disproves the committee’s “inaccurate portrayal.”

The company’s CEO, Marc Miller, declined an invitation from Wyden to testify at Wednesday’s hearing in a letter. NBC News obtained the letter, which said the company provided more than 12,000 pages of documents and spent hundreds of hours answering questions.

In a statement to NBC, Acadia said the stories in the report “are heartbreaking.” The company said the industry “can and must do better” and said it was committed to ensuring all Acadia patients receive support and compassionate treatment.

Leah Yaw, a senior vice president at Devereux, said in a statement to The Hill that its been the nonprofit organization’s honor to work with the committee on the issue but said it’s “unfortunate” that its been lumped together with the three other for-profit companies. The company denied that children in its care are placed in abusive or unsanitary conditions.

Devereux said it is “extraordinarily careful” with its use of medication, and it helps fund college programs to address staffing shortages.

NBC reported that Vivant said in a statement that controlling staffing levels is a normal business concept and is not synonymous with understaffing, and the company complied with the committee.

The committee outlined several recommendations so as to recognize each child’s “dignity and worth” and to ensure that “federal dollars are spent as Congress intended.”

The senators said standards in the facilities must be raised across the board. Government funding should be prioritized on community-based solutions to decrease the number of children entering the facilities, and oversight mechanisms for the facilities must be implemented “at all levels.”

“At its core, the RTF model typically optimizes profit over the wellbeing and safety of children. The rampant civil rights violations that children experience in RTFs are a direct consequence of the industry’s model,” the report said.