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Resolution 605

Congregate Care, Collective Trauma

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Congregate Care Overview

Congregate Care, Collective Trauma

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Overview of Congregate Care

Congregate Care, Collective Trauma

The “troubled teen industry” is a term loosely applied to privately owned youth residential treatment centers located throughout the United States and abroad. This term may refer to group homes, therapeutic boarding schools, short term residential treatment centers and many other confusing terms. The facilities are inconsistently regulated, and may simultaneously house children placed by juvenile justice, child welfare, school districts, Medicaid and private insurance.

Authorities have known of the abuses for decades, with the Senate conducting investigations into youth treatment facilities as far back as 1974. Additional investigations from the Government Accountability Office followed in 2007, 2008, and 2022. Despite this awareness, little has been done to eliminate documented abuses including death, sexual assault, and human rights violations.

It is difficult to quantify the problem, though research indicates that between 120-200,000 children are impacted each year and over $23 billion in public money is used to fund placements in teen treatment centers, with fees as high as $800 per day. There is little consistent oversight between states and youth are often sent to out-of-state facilities.

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Pipelines into Congregate Care

120,000-200,000 youth are placed into Congregate Care facilities every year through a variety of pipelines, including:

Juvenile Justice
Child Welfare
Special Education
Mental Health
Disability Services
Office of Refugee Resettlement
Private Placements

At least $23 Billion in Taxpayer Funds are spent on these placements annually

Congregate Care, Collective Trauma

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Congregate Care

Facility Designations & Oversight

Qualified Residential Treatment Program (QRTP)

Psychiatric Residential Treatment Facility (PRTF)

...And Hundreds More

Wilderness Therapy Program

Therapeutic Boarding School

Residential Treatment Center

Group Home

Congregate Care, Collective Trauma

Question for audience . . . if you have sent a child from your court to a residential treatment program, why?

There is no universal definition for youth residential program types. These programs usually self-identify in order to qualify for specific funding streams or obtain licensure, certification or accreditation. A 2019 OJJDP Literature Review of residential facilities identified over 80 different program “types” noting that “the definitions of residential programs are fluid, and the characteristics may vary from state to state.”

Health and Human Services has likewise reported that there are no uniform definitions of residential facilities, and that there are over 70 different types of RTC. The challenges with nomenclature are more than just semantics–difference between states and different agencies can create significant jurisdictional loopholes and challenges for effective oversight.

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Increased reliance on out-of-state facilities
“Medicaid Arms Race”
Increased Jurisdictional Confusion
Difficulty in Overseeing Youth Safety
Lack of Interagency Data Sharing & Collaboration Creates Gaps in Reforms

Out-of-State Placements

Congregate Care, Collective Trauma

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Challenges to Reducing Placements into Congregate Care

Congregate Care, Collective Trauma

Lack of appropriate placement array
Lack of community-based services
Insufficient data collection and reporting
Lack of publicly-available information on facility safety
ICPC blanket approvals

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Institutional Child Abuse & Neglect in Congregate Care

Congregate Care, Collective Trauma

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Solitary Confinement
Physical, Chemical & Mechanical Restraint
Medical Neglect
Physical Abuse
Juvenile Strip Searches
Restricted Communication
Sexual Abuse
Restricted Food & Water

Institutional Child Abuse and Neglect in Congregate Care

Congregate Care, Collective Trauma

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Roughly 10% of all foster youth live in congregate care placements, with some state placement rates exceeding 30%
Nearly 5000 foster children under the age of 12 were placed into group homes and institutions in 2021
More than two-thirds (68%) of the young people in group placements are between the ages of 14 and 17
There were 822 substantiated instances of child abuse by group home and residential facility staff in 2021

Key Data Points

Congregate Care, Collective Trauma

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23,631 youth were placed into residential programs through the juvenile justice system in 2021
Roughly 17% of all youth placed into congregate care facilities through the juvenile justice system were held in privately operated programs
Black youth represent 13% of US youth under 18, yet are 23% of foster youth and 30% of congregate care population

Key Data Points

Congregate Care, Collective Trauma

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P&A investigations have uncovered abuse in for-profit congregate care facilities across the US, including:

broken bones and fight clubs
sexual abuse by trusted staff
forced isolation
shaming
inadequate food
vermin-infested living quarters
medical neglect
dangerous physical and chemical restraints
inadequate mental health treatment

For-profit congregate care facilities charge nearly double for the same services
The business model “banks on governments’ incapacity to create safe places for their most vulnerable children”

National Disability Rights Network - 2021

Data & Research

Congregate Care, Collective Trauma

Key Points

“Placing children in these facilities, especially once a state has notice of reported failures, is a violation of the states’ obligation to act in loco parentis (in the place of a parent), ensuring the safety of children in their care”

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Private equity firms are increasingly investing in behavioral services for children and adolescents
The private equity business model may prioritize profit over the well-being of children
Cost-cutting tactics at private-equity backed youth behavioral companies can lead to abuse, neglect and unsafe living conditions for youth
Private-equity backed congregate care facilities have faced criticism for:

Inadequate counseling or education services
Physical, sexual, and emotional abuse
Forced isolation
Use of physical and chemical restraints
Squalid living conditions

Private Equity Stakeholder Project - 2022

Data & Research

Congregate Care, Collective Trauma

Key Points

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Headlines

Congregate Care, Collective Trauma

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Headlines

Congregate Care, Collective Trauma

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Deaths in Congregate Care

Congregate Care, Collective Trauma

John Doe, February 2024

Age: 12

Trails Carolina

Alegend Jones, November 2023

Age: 17

Youth Villages

Angel Espinoza, May 2023

Age: 17

Gulf Coast Jewish Family and Community Services

Joshua Keith Beasley Jr, May 2023

Age: 16

Wayne Scott Unit

Isaiah Thomas, February 2023

Age: 13

BayCare