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Monday, June 17, 2024

Residential Treatment Facilities

In The Politics of Autism, I discuss the civil rights of people with autism and other disabilities

The Senate Finance Committee has issued a staff report titled Warehouses Of Neglect: How Taxpayers Are Funding Systemic Abuse In Youth Residential Treatment Facilities

 In July 2022, the Senate Committee on Finance (the Committee) and Senate Committee on Health, Education, Labor, and Pensions launched an investigation into allegations of abuse and neglect at Residential Treatment Facilities (RTFs) operated by four providers – Universal Health Services (UHS), Acadia Healthcare (Acadia), Devereux Advanced Behavioral Health (Devereux), and Vivant Behavioral Healthcare (Vivant). Since then, the Committee has engaged in a sweeping inquiry, reviewing over 25,000 pages of company productions, holding dozens of conversations with behavioral health stakeholders, and visiting RTFs on the ground.
Children should receive high-quality mental health services in the least-restrictive environment that meets their needs. Children are sent to RTFs by private and public actors, including parents and guardians, psychiatrists, child welfare agencies, the juvenile justice systems, and educational systems. The Committee has jurisdiction over many RTF placements funded through the Medicaid program and the Social Security Act’s child welfare provisions, through which RTF providers are paid per diems for the children in their care.
The RTF providers optimize per diems by filling large facilities to capacity and maximize profit by concurrently reducing the number and quality of staff in facilities. The Committee’s investigation found that children at RTFs suffer harms such as the risk of physical, sexual, and emotional abuse at the hands of staff and peers, improperly executed and overused restraint and seclusion, inadequate treatment and supervision, and non-homelike environments. These harms amount to acute safety concerns and have long-term effects, including suffering, trauma and even death. Taken together, the Committee finds that these harms are endemic to the RTF operating model.


 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. RTFs employ substandard labor practices and avoid investments in physical maintenance. So long as providers are allowed to proceed with business as usual, children will continue to suffer.

Last week, the committee held a hearing on the subject.