Senate report: Children face abuse, mistreatment in residential behavioral facilities

Children are frequently harmed in residential treatment facilities, a report from the Senate Finance Committee alleged. 

The report is a result of investigations the committee opened into behavioral residential facilities operated by four providers — Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Healthand Vivant Behavioral Healthcare — in 2022. 

In the report, the committee alleged that sexual abuse, improper uses of seclusion and restraint and unsafe and unsanitary conditions persist in residential treatment facilities. The committee also found residential treatment facilities can cut off children from family and community connections and may not receive individualized treatment. 

The committee claimed harms are "endemic" to the operating model of residential treatment facilities. 

"The harms children in RTFs experienced are the direct, causal result of an operating model that incentivizes providers to optimize revenues and operating and profit margin," the committee wrote. "RTF providers offer minimal therapeutic treatment in deficient physical settings with lean staff composed of non-professionals, which maximizes per diem margins." 

The report suggests 10 actions to improve conditions and oversight of residential treatment facilities, including states prioritizing community treatment options over residential facilities and increasing state monitoring of facilities. The committee also urged Congress to increase legislative oversight of the facilities, including requiring evidence-based treatment in congregate facilities. 

At a hearing on June 12, Senate Finance Committee Chair Ron Wyden said he plans to introduce legislation to raise health and safety standards in residential facilities. 

"The buck stops here," Mr. Wyden said. "In order to get a dime from Medicaid or any other program in my jurisdiction, all of these facilities are going to have to start providing actual care." 

UHS CEO Marc Miller declined an invitation to speak at the hearing, Mr. Wyden said. 

Acadia Healthcare and UHS have faced large legal costs for alleged abuse at their facilities. In October, Acadia Healthcare paid $400 million to settle three cases alleging a nonprofit operated by a now-shuttered New Mexico facility placed children in a foster care setting where they were repeatedly sexually abused.  

In March, an Illinois jury ordered UHS to pay $535M to settle a case alleging a 13-year-old patient at an indirect subsidiary of UHS was raped by another patient. The system is appealing the decision. 

In a statement shared with Becker's, UHS said the system provided more than 12,000 pages of documents for the Senate Finance Committee's investigation and spent hundreds of hours responding to committee requests. 

"We regret that, despite our cooperation with the Committee throughout the course of a two-year investigation of RTFs, the report is incomplete and misleading and provides an inaccurate depiction of the care and treatment provided at UHS RTFs, as well as the safety of the residents at those facilities," the system said. "The report attempts to extrapolate certain incidents and survey reports into a false narrative regarding the treatment provided, environment of care and regulatory compliance at our facilities. We vehemently dispute this characterization of our facilities." 

A spokesperson for Franklin, Tenn.-based Acadia Healthcare said the report reviews historical incidents going back more than five years. All of the facilities referenced in the committee's reports are licensed, accredited and in good standing, the spokesperson said. 

"The patient stories highlighted in the committee's report are heartbreaking. Our industry can and must do better, especially given the critical role that residential youth treatment centers have in addressing our nation's behavioral health crisis," the spokesperson said. "At Acadia, we are committed to doing everything in our power to ensure that all patients in Acadia’s care receive the support and compassionate treatment they deserve. Thousands of youths have been successfully discharged from Acadia’s facilities with great outcomes." 

Vivant Behavioral Health told NBC News it provided records to the committee showing that it does not understaff its facilities and that it requires employees to be trained in patient safety.

A spokesperson for Devereux Advanced Behavioral Health, the fourth company investigated by the committee, told NBC News the company categorically denies that children in its programs are placed in abusive or unsanitary conditions.

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