The warning signs have been flashing for a while now, but a new report from the Office of Inspector General (OIG) has made it impossible to ignore the troubling reality: children in residential behavioral health facilities are being failed by the very system designed to protect them. As the public continues to grapple with the complexity of child welfare systems, a clear pattern of neglect and abuse is emerging, with little accountability or oversight to stop it. This failure of monitoring has raised critical questions about how the U.S. handles vulnerable children in care, particularly in residential behavioral health facilities.
A System Failing Its Most Vulnerable
Reports of abuse and neglect in residential behavioral health facilities have continued to surface, but the OIG’s latest findings reveal just how deep the oversight issues run. According to the report, nearly one-third of states are not even collecting the information necessary to identify patterns of maltreatment among foster children in these residential behavioral health facilities. Without accurate data collection, these states are effectively flying blind when it comes to safeguarding children in care. They are unable to recognize the warning signs that would alert them to systemic abuse, making it easier for harmful practices to continue unchecked.
The remaining two-thirds of states, while able to report some data, fell short of demonstrating that they routinely monitor for patterns of maltreatment. This gap in tracking means that systemic issues can persist unchecked, and children’s well-being remains at risk. Even states that collect data often fail to analyze it in a way that would reveal patterns of abuse or neglect across the system. This lack of routine monitoring, even when data exists, suggests a critical failure in how these states approach child welfare.
Senate Finance Committee Chair Ron Wyden (D-Ore) did not mince words in his response to the OIG report, stressing the urgent need for systemic reform:
“This is the latest of several investigations – including my own – underscoring the failures of a system that is doing more harm than good. The rampant abuse and neglect at youth residential behavioral health facilities will only continue until meaningful action is taken to strengthen oversight, raise the floor for standards in these facilities, and refocus federal dollars into community-based services.”
Wyden’s statement underscores the growing concern that the current system, as it stands, is not only ineffective but actively exacerbates the issues at hand. The failure to consistently monitor and enforce proper care standards in residential behavioral health facilities means that children who are already in a vulnerable position are further harmed by a system that is supposed to offer them safety and support.
The Problem Goes Beyond State Lines
One of the more alarming revelations in the report is the issue of monitoring residential behavioral health facilities that operate across multiple states. Many of the larger chains that manage multiple facilities in different regions often fall through the cracks when it comes to proper oversight. Fourteen states admitted they could not provide data on maltreatment occurring within these chains, leaving a gaping hole in accountability. In essence, this lack of tracking across state lines means that problems in one facility can easily go unnoticed until it’s too late.
For those states that did track maltreatment across residential behavioral health facilities chains, the report highlighted some positive steps. Some states took actions such as:
- Increasing monitoring activities to ensure facilities are adhering to proper standards of care.
- Implementing corrective action plans when facilities were found to be negligent.
- Reducing or ceasing placements in facilities that demonstrated consistent problems with maltreatment.
- Terminating contracts with problematic parent companies, thus ending relationships with all facilities owned by that company.
These efforts, while commendable, are still reactive rather than proactive. The fact that some states needed to go to the lengths of severing ties with parent companies or ceasing placements shows just how badly the system is failing in its responsibility to provide consistent oversight and safeguard children from harm.
The case of one state terminating its contract with a parent company that owned several residential behavioral health facilities across the country is an example of the kind of bold action needed. This state recognized the systemic nature of the problem and acted to sever ties entirely, sending a strong message about the importance of accountability in the child welfare system. However, such actions should not be the exception but the rule. Until stronger, more consistent oversight mechanisms are in place, the same problems will continue to arise at residential behavioral health facilities across the country.
The Hidden Costs of Inadequate Oversight
The OIG’s findings are particularly concerning when viewed in the broader context of the U.S. child welfare system’s failure to prevent maltreatment in residential behavioral health facilities. These facilities, which are often used for children with behavioral health needs or those who have experienced trauma, are supposed to offer specialized care. Instead, many have been found to profit off the suffering of these vulnerable children.
While the OIG report’s data pertains to residential behavioral health facilities of all kinds, these facilities have been particularly notorious for taking advantage of foster children. Less than a year ago, Mother Jones published a groundbreaking investigation into Universal Health Services (UHS)-owned North Star Behavioral Health and other similar facilities. The article uncovered how these facilities, operating under the guise of providing necessary care, often kept foster children in their systems unnecessarily for months or even years. This prolonged confinement, in turn, generated millions of dollars for these for-profit facilities.
In fact, the investigation revealed that $611 million had been spent on the care of foster children at UHS psychiatric facilities alone. This staggering sum represents not only the financial cost but also the immense human toll of a system that puts profit above child welfare. Mother Jones reporter Julie Lurie identified several factors contributing to this lack of oversight, including insurers failing to closely surveil behavioral health services, allowing facilities to operate unchecked. The report painted a damning picture of a system more focused on financial gain than the well-being of the children it was supposed to protect.
This systemic failure highlights the need for stronger oversight, not only at the state level but also in terms of private sector involvement. Residential behavioral health facilities, particularly those run by large, for-profit companies, must be held to the highest standards of care and accountability. Without stringent regulations and more aggressive oversight, these facilities will continue to exploit the most vulnerable populations in society for financial gain.
A Call for Action: Improving Oversight and Accountability
The OIG report made several key recommendations aimed at improving oversight and protecting children in residential behavioral health facilities:
- The Administration for Children and Families (ACF) should provide guidance and technical assistance to states on how to monitor maltreatment in residential behavioral health facilities effectively. This would help ensure that states are better equipped to track and address any issues of abuse or neglect in real-time.
- The ACF should also work to improve monitoring of residential facility chains, particularly those operating across multiple states, and enhance inter-state communication. This would help ensure that children placed in out-of-state facilities are better protected from potential abuse, and any systemic issues can be addressed at a national level.
In addition to these recommendations, there must be a broader effort to reform the entire system that places foster children in residential behavioral health facilities. Instead of relying on institutional care, which often leads to neglect and abuse, we need to refocus federal dollars on community-based services. These services can provide more individualized and compassionate care for children in their own communities, reducing the need for lengthy placements in residential behavioral health facilities altogether.
Conclusion
The OIG’s report serves as a stark reminder of the critical gaps in the oversight of residential behavioral health facilities, particularly those serving foster children. Until meaningful changes are made to the way these facilities are monitored and regulated, children will continue to be at risk. It is clear that we cannot continue to allow profit-driven companies and under-resourced states to oversee the care of vulnerable children. The time for action is now—before more lives are needlessly damaged by a broken system.
