In a first of its kind hearing, the U.S. Senate Finance Committee heard testimony on Wednesday from experts across the country highlighting widespread, ongoing abuse inside psychiatric residential treatment facilities for children and youth, including some of the 13 facilities that operate in Arkansas.
Reagan Stanford, abuse and neglect managing attorney with Disability Rights Arkansas, was one of three witnesses who testified in Washington, D.C., Wednesday morning. The Little Rock-based advocacy organization has investigated child maltreatment in Arkansas facilities for half a decade and has created an online database that documents instances of abuse and general living conditions in youth treatment facilities across the state.
“The word that most comes to mind when I think of the time I have spent monitoring these facilities is ‘chaos,’” Stanford told lawmakers. “The added trauma children experience within these facilities follows them through life and is compounded by society’s refusal to acknowledge the detrimental effects these placements can have. All of this occurs without meaningful oversight at any level.”
Psychiatric residential treatment facilities, or PRTFs, are secure, inpatient facilities that admit children with sometimes severe emotional and behavioral problems. Many of the children in such facilities are in state foster care systems. Many are also from disadvantaged families, requiring Medicaid to pay for treatment. Experts say that some states, including Arkansas, warehouse children in PRTFs because there are no other available placement options. As of Feb. 26, the 13 facilities in Arkansas contained 599 children, many of which originally came from other states.
While there have been piecemeal efforts in a handful of states to address the mistreatment of children in PRTFs, Wednesday’s hearing may be the first time federal lawmakers have addressed head-on an industry that some experts argue offers almost no therapeutic benefits while often further traumatizing already traumatized children.
“The failures of the treatment facilities to provide a safe and therapeutic environment, individualized, intensive services and meaningful discharge planning and follow through are imputed to the child,” Stanford said. “The child is often seen as the failure, not the treatment facility — and because they are viewed as the failure, all too often the child is cycled back into residential placement.”
The industry, which rakes in billions in revenue annually, is funded almost exclusively by taxpayer dollars via Medicaid and state child welfare money.
Residential treatment facilities “often leave [children] harmed and more traumatized,” Sen. Ron Wyden (D-Oregon), chair of the Senate Finance Committee, said during the 90-minute hearing. “It seems more often than not abuse and neglect are the norm at these facilities. The system is failing except for the providers running these treatment facilities who have figured out how to turn big profits off of taxpayer funded child abuse.”
Survivors who endured maltreatment in residential treatment attended the hearing. The committee played a video with testimony from parents and children who described experiences of the violent use of restraints or sexual abuse at the hands of employees. The video also featured testimony from celebrity Paris Hilton, who described being sexually assaulted as a teenager in a treatment facility when she was a child.
The committee also released a report titled “Warehouses of Neglect: How Taxpayers Are Funding Systemic Abuse in Youth Residential Treatment Facilities.” The 136-page report centers on allegations of abuse and neglect at treatment facilities operated by four providers, including Tennessee-based Acadia Healthcare, which operates three PRTFs in Arkansas and dozens of others across the U.S.
The report says staff at Piney Ridge Treatment Center, an Acadia-owned PRTF in Fayetteville, “routinely simultaneously chemically restrained and secluded children, in violation of federal regulation.”
“At that same facility, staff conducted 110 restraints and seclusions in a 30-day period,” it says.
The report documented numerous problems at Millcreek Behavioral Health in Fordyce, another Acadia-owned PRTF. One child, for example, was regularly strip-searched, and, at least, twice subjected to a vaginal cavity search by staff. “During the restraint, a staffer touched her breast and made her squat naked in the shower for a forced vaginal cavity search,” the report said.
Acadia recorded $768 million in revenue for the first quarter of this year, a 9% increase from the same period in 2023. The company projects that 2024 revenue could reach $3.25 billion.
“It’s clear the operating model with these facilities is to warehouse as many kids as possible to keep costs low in order to maximize profits,” Wyden said.
“The findings in this report are beyond appalling,” Sen. Bob Casey (D-Pennsylvania) said. “I am not sure we have enough words in the dictionary to describe how disturbing this is to the American people; how taxpayers are funding systemic abuse in youth residential treatment facilities.”
Elizabeth Manley, a behavioral health policy expert at the University of Connecticut School of Social Work, said residential treatment can provide “a significant benefit to young people” in some cases. But, she added, there must be reform at the federal, state and local levels.
“We need the care to be delivered in trauma-responsive environments that embrace patient and caregiver engagement,” she said.
Other witnesses said PRTFs cut costs at the expense of evidence-based, individualized treatment for children, instead offering cookie-cutter programs that provide few if any measurable benefits.
“What is clear is that often these facilities are operating as placements and not service alternatives,” Stanford said. “States are so reliant on residential placements that they are hesitant or outright unwilling to hold the facilities accountable, instead considering them partners with the state.”
“You cannot effectively regulate something that you are in partnership with,” Stanford said.
The Arkansas Department of Human Services monitors PRTFs, as does the Child Welfare Agency Review Board, a governor-appointed panel that includes members who have direct or indirect business ties to the youth residential treatment industry.
As of mid-March, the Division of Children and Family Services, the section of DHS responsible for foster placements, counted 90 children in state custody occupying Arkansas PRTF beds.
“We know that these problems are not specific to Arkansas,” Stanford said. “This is a national problem that demands congressional action.”
Stanford and others who testified Wednesday said more community-based solutions are needed to curtail states’ reliance on residential treatment for children. Some speakers highlighted pilot programs in states where community health clinics are incorporating teams of behavioral health experts to respond to families with children in crisis. Such efforts aim to keep children at home instead of being institutionalized.
Kathryn Larin, the director of education, workforce and income security with the U.S. Government Accountability Office said her agency had recommended in 2022 that the U.S. Department of Health and Human Services facilitate information sharing between states on best practices “for preventing and addressing maltreatment in residential facilities.” HHS agreed with the recommendation but has not yet implemented it, she said.
Wyden said the Senate committee is working on a bipartisan plan that could be introduced as early as this fall. It would bolster more home and community based services while “beefing up health and safety for vulnerable kids and vulnerable families,” he said.
Lara Farrar is the recipient of a University of Southern California Annenberg Center for Health Journalism Data Fellowship focusing on psychiatric residential treatment facilities in Arkansas. Her ongoing coverage will be published in collaboration with the Arkansas Times.