Child Welfare

Abuse of Youth Placed in Residential Facilities (GAO 2024)

Read the full report here.

Triggers: mentions of physical, sexual, and psychological child abuse; child death; medical neglect; chemical restraint; physical restraint; foster care trauma; suicide

Published June 12, 2024

GAO has published several reports about child abuse in residential facilities

The first GAO report on this topic was published in 2007.

The GAO reports on this topic focus on children who are in the foster care system.

This report is testimony from Kathryn A Larin

This report is mostly a summary of past GAO reports on this topic

GAO’s 2022 report recommended that HHS should set up a system for states to communicate with each other about child abuse in residential treatment

HHS agrees that they should set up the communication system but they have not done it

Past GAO reports on this topic described child abuse at these facilities in detail

Sometimes child abuse and neglect at residential facilities results in death

2002: 101,000 children in the foster care system were in residential facilities
2022: 34,000 children in the foster care system were in residential facilities

Threats to child safety at residential facilities
It is hard to monitor children in residential facilities once they leave their home state
Recommendation: form a state “interagency committee” to be in charge of monitoring
Children at residential facilities are often prescribed the wrong medications
Recommendation: require physicians to talk to child psychiatrists before they prescribe some medications
Children at residential facilities are often prescribed too many medications
Staff sometimes injure children during restraints
Recommendation: set up a state “interagency advisory committee” to have meetings about use of restraints in residential facilities

In 2007, GAO found thousands of allegations of child abuse at residential facilities

In 2006 at least one child died in a residential facility in most US states

News stories describe child abuse and death at residential facilities

TRIGGER WARNING: examples of physical abuse and neglect p. 2

HHS collects data about child abuse from states through the National Child Abuse and Neglect Data System

Some states do not submit child abuse data to HHS

Child abuse data probably undercounts instances of abuse and neglect

Many children end up in foster care because they have been abused or neglected

Being abused in residential treatment makes foster care children’s trauma worse

Some children in the foster care system end up in residential treatment because they have behavior or mental health problems

Some children in the foster care system end up in residential treatment because there isn’t room for them anywhere else

There are not enough foster family homes to take care of all the children in the foster care system

States don’t have enough time to recruit and train new foster care families

Older children are placed in residential facilities more often than younger children

LGBTQ+ children are placed in residential facilities more often than other children

Kids placed in foster homes or kinship care usually have better results than kids who are placed in residential facilities

State child welfare agencies have been trying to put less foster care kids in residential facilities for the past 10 years

In 2002, 19% of kids in foster care were placed in residential facilities
In 2022, 9% of kids in foster care were placed in residential facilities

Family First Prevention Services Act (FFPSA) became law in 2018

FFPSA puts more restrictions on when federal foster care funds can be used to pay for residential facilities

Sometimes children are sent to facilities out-of-state because there aren’t places for them to go in their home state

Child welfare officials can’t visit children in other states frequently

Some states have developed “prescription guidelines” to help decrease children being prescribed the wrong medications and/or too many medications

It is against federal law to to use restraint or seclusion for “coercion, discipline, convenience, or retaliation”

Seclusion is psychologically damaging for children

States pay for-profit and nonprofit companies to run residential facilities

HHS is federally responsible for overseeing child safety and welfare

States reported receiving “little to no information from HHS”

HHS agrees that they should facilitate information sharing between states but they have not done anything about it yet