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On June 12, the United States Senate Committee on Finance held a hearing about youth psychiatric residential treatment facilities (PRTFs). The hearing coincided with the release of this report: Warehouses Of Neglect: How Taxpayers Are Funding Systemic Abuse In Youth Residential Treatment Facilities.

The report and hearings describe alleged abuse and neglect at youth PRTFs operated across the country by four providers: Universal Health Services (UHS), Acadia Healthcare (Acadia), Devereux Advanced Behavioral Health (Devereux), and Vivant Behavioral Healthcare (Vivant).

Two of these providers operate residential treatment facilities in Mississippi: Universal Health Services runs Diamond Grove, Brentwood and Alliance, and Acadia runs Millcreek of Pontotoc and Millcreek of Magee. We do not know if authorities specifically investigated any Mississippi facilities, and we also do not know if these findings would apply to PRTFs not operated by these providers.

These are the key findings of the investigators (paraphrased for clarity):

• Congress needs to pass laws to improve the conditions in PRTFs and mental health care in general.
• Children are routinely harmed inside PRTFs (both by other children and employees).
• The primary way companies operate PRTFs creates risks for children.
• Children inside PRTFs often do not get the mental and behavioral health treatment they need, even though Medicaid, insurance companies, state agencies and families pay money for children to get this help.
• Horrific instances of sexual abuse keep happening inside PRTFs without anything happening to stop them.
• The use of restraint and seclusion in PRTFs leads to abuse that no one is watching or monitoring.
• PRTF staff sometimes ignore federal restraint and seclusion rules and laws.
• PRTFs often hire unqualified or inadequately trained staff who routinely fail to do their jobs properly.
• PRTFs are often not homelike and have unsafe and unsanitary conditions for children.
• PRTFs often don’t help children stay connected to their families and communities or make discharge plans that include ongoing care in the community.
• PRTFs often use safety and surveillance equipment that is similar to what jails use, creating environments that feel more like detention facilities than therapeutic settings.
• State and federal authorities do not adequately identify risks to children in these facilities. When authorities require PRTFs to address problems, they usually require them to address single events, not fix company-wide issues.
• Companies that own PRTFs sometimes use business strategies to avoid taking responsibility for bad things that happen in PRTFs. For example, a company might sell part of the company to another company, change the name and then rehire the people who caused problems in the past.

The report goes on to list these recommendations to address the key findings (quoted verbatim):

• Congress must legislate to improve the conditions in RTFs and the broader behavioral health landscape. It should focus its attention on the following categories: (i) raising the floor for congregate care standards (including standards that reflect active treatment and require use of evidence-based treatments), (ii) investing in community-based alternatives for care, and (iii) strengthening the oversight of congregate care facilities.
• The companies under investigation in this report must raise standards across facilities.
• States should use their existing authority to prioritize the availability and utilization of community-based services for children with behavioral health needs. States have historically inappropriately overused PRTF placements as a “solution” for children with complex behavioral health needs or nowhere else to go.
• States should improve PRTF oversight activities in order to compel providers to raise the bar on standards within PRTFs.
• CMS (Medicaid) and ACF (child welfare) should work together to clarify and streamline federal oversight requirements for PRTFs.
• CMS and ACF can work collaboratively to center perspectives of youth with lived experience.
• ACF should increase awareness for judges on the risks of improper placements in PRTFs, the full continuum of care, and clinical best practices for treating children with behavioral health needs, particularly for children in foster care. The Committee found that a significant portion of foster children placed at PRTFs have no demonstrated behavioral health needs, so family court judges should be dissuaded from placing children in PRTFs, particularly if those facilities have a record of abuse, neglect, or overuse of restraint or seclusion.
• CMS and ACF can and should do more to prioritize spending on community-based behavioral health services as an alternative to placement in PRTFs if possible and safe.
• The Department of Justice (DOJ) should assess PRTF placements for potential Olmstead (unlawful segregation) violations. DOJ should require that state and local governments meet their obligation under Title II of the ADA to exhaust least-restrictive, in-community treatment before leveraging congregate care.
• Accrediting bodies, such as the Joint Commission, should closely monitor facilities following the discovery of noncompliance with requirements or elements.

These senators led the hearing:

1.  Ron Wyden (D – OR)
   •  Download Statement
2.  Mike Crapo (R – ID)
   •  Download Statement

These people testified or were invited to testify at the hearing. We encourage you to read or listen to their testimony:

1. Marc Miller (Invited to Testify), President And Chief Executive Officer, Universal Health Systems, King of Prussia, PA
2. Reagan Stanford, JD, Abuse And Neglect Managing Attorney, Disability Rights Arkansas, Little Rock, Ark. (Download Testimony)
3. Elizabeth Manley, Faculty And Senior Advisor For Health And Behavioral Health Policy, Innovations Institute, University of Connecticut School of Social Work, Hartford , CT (Download Testimony)
4. Kathryn Larin, Director, Education, Workforce And Income Security, United States Government Accountability Office, Washington, DC (Download Testimony)

You can still give input into this hearing. We encourage families and youth with experience with PRTFs to let the committee know how PRTFs worked in your situation and any specific recommendations you have about PRTFs. The committee posted these instructions for giving feedback:

Any individual or organization wanting to present their views for inclusion in the hearing record should submit in a Word document, a single-spaced statement, not exceeding 10 pages in length. No other file type will be accepted for inclusion. Title and date of the hearing, and the full name and address of the individual or organization must appear on the first page of the statement. Statements must be received no later than two weeks following the conclusion of the hearing.

Statements can be emailed to:
Statementsfortherecord@finance.senate.gov

Statements should be mailed (not faxed) to:
Senate Committee on Finance
Attn. Editorial and Document Section
Rm. SD-219
Dirksen Senate Office Bldg.
Washington, DC 20510-6200

Families as Allies is happy to help families submit feedback on policies. We will assist you with the process, not try to influence what you send. You can contact us at 601-355-0915 or info@faams.org.