Investigations in 18 States Find Serious Abuse at For-profit Youth Facilities

"A disturbing new report by the National Disability Rights Network (NDRN) reveals widespread abuse and neglect at for-profit youth residential treatment facilities. The report, Desperation without Dignity, provides a comprehensive review of investigations by the nation’s Protection and Advocacy agencies and others in 18 states. It examines the history of the for-profit residential treatment industry, the private funding structure that fuels it, and discusses alternatives to residential placement that are both nurturing and provide the treatment that children and youth need.

“Our investigators, along with other powerful advocates, have been inside these facilities,” said NDRN Executive Director Curt Decker. “In some, children quite literally do not receive enough food to grow normally, are given powerful drugs they do not need, and are housed in vermin infested buildings. It is critical that officials at the federal, state and local level take action to protect these children.”

The report outlines the most common problems children experience while residing in residential treatment facilities, including:

Physical abuse

Physical abuse, often masked as punishment or a control tactic. Children report incidents such as dragging, punching, and throwing or “slamming” them against walls or the floor.

Emotional abuse

Children at some RFs report being subjected to a near-constant barrage of verbal abuse from staff. Staff curse, yell, make demeaning and derogatory comments, insult and make fun of the children.

Sexual abuse

Children in RFs report sexual violence committed by both facility staff and their peers.

Restraint and Seclusion

Residential treatment facilities have been investigated for the improper use of restraint and seclusion resulting in injury and even death. In May 2020, sixteen-year-old Cornelius Frederick was killed by staff during a restraint.

Overuse and Misuse of Medication

P&As have found instances of overuse and misuse of psychiatric medication during monitoring visits. Despite the potentially life-threatening risks associated with taking psychotropic medication without appropriate health and medication information and monitoring, children in some for-profit RFs do not receive such care.

Facility Conditions

P&As discovered for-profit RFs that do not maintain adequate living conditions, including a lack of adequate access to clean water, proper sanitation and bedding.

Despite this abysmal track record, thousands of children continue to be sent away to for-profit residential treatment facilities. Many facilities employ misleading advertising practices, including statements about their level of oversight, to attract new customers.

“Parents see the marketing and believe they are sending their children to state-of-the-art facilities where they will receive high quality care,” said Curt Decker, executive director of the National Disability Rights Network. “It’s a fairy tale designed to lure parents and governments who desperately want safe placements for children.”

According to the Residential Treatment Center, there are 1,591 or more such facilities currently in operation in the United States. Services are provided within an institutional setting, and the amount and type of mental health and educational services provided depend on the facility due to a lack of consistent government oversight

“The abuses and failures to provide adequate care are not isolated incidents but are nationwide and systemic, as shown in this report,” continued Decker.

The report outlines policy changes that must occur to address the conditions of the facilities, their treatment models for children, and the lack of educational opportunities offered.


  • First and foremost, there needs to be a consistent and effective system of government oversight of these facilities to ensure that children are safe and receive the treatment they need.
  • State and county governments must immediately stop placing children in residential facilities that have a record of violations and/or do not provide the services they agree to provide.
  • Community-based systems of support must provide a continuum of services to meet the needs of children and youth with disabilities so that out-of-state residential treatment and over-use of residential treatment is not necessary. Effective alternatives to residential treatment exist.
  • Congress should pass legislation to ensure sufficient financing for community- based placements for youth in the Medicaid program.
  • The federal government should create a dedicated funding stream to allow all P&A agencies to address the need for independent, knowledgeable, and thorough monitoring and investigations of the care and treatment provided by for-profit facilities.

NDRN wishes to acknowledge the tremendous contributions to this report by members of the Protection and Advocacy (P&A) network and especially the staff who monitor these facilities, investigate reports of abuse, and represent the youth placed in them."

Source: National Disability Rights Network (NDRN)