The Pathways Children Take Into These Facilities
Thousands of American children live inside locked residential treatment centers, and they can be as young as five, according to reporting published by The Marshall Project.
They arrive through three main routes. Some are placed by child welfare agencies while in foster care. Some are sent by court order. And some are placed by parents who were told their child would finally get help, often after exhausting what their community offers.
Once placed, many are sent hundreds of miles across state lines, away from family, school, and every person they know. That detail is easy to skim past and hard to overstate. A child in behavioral health crisis is separated not only from a difficult home situation but from siblings, familiar clinicians, and anyone who can visit on a weekday.
The reporting centers on Fox Run in St. Clairsville, Ohio, owned by Universal Health Services, a Fortune 500 health care company. The outlet's underlying investigation drew on hundreds of pages of police and state inspection records covering 2020 through 2025, obtained through public records requests, as well as interviews with seven women previously housed at the facility. Those records describe children fleeing into cornfields, darting across highways and trying to hitch rides from strangers. Former staff members described unaddressed trauma and neglect.
Reporters also found that at least 40 incidents reported by sheriff's deputies do not appear in the state database meant to track what happens inside residential treatment facilities, leaving parents, caseworkers, regulators, and placing judges working from an incomplete record. In a statement to The Marshall Project, Fox Run rejected the allegations made against it.
A Federal Investigation Reached the Same Conclusion
These accounts are not isolated to one company or one state, and they are not new to federal oversight bodies.
A two-year investigation by the Senate Finance Committee examined four major operators of youth residential treatment facilities: Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare. The resulting report found that children "suffer routine harm inside RTFs" and described the risk as endemic to an operating model that rewards keeping costs low, according to the committee's published findings.
The committee documented physical, sexual, and verbal abuse, inappropriate use of restraint and seclusion, unqualified or inadequately trained staff, unsafe and unsanitary conditions, and a failure to maintain children's connections to their home communities or to plan for their discharge. In the most extreme cases described, children died, including by suicide. The report also found that a patchwork of state and federal oversight allowed deficiencies to persist for years without enforcement.
The financing detail is central to why this is a health policy story rather than only a criminal justice one. These facilities receive billions of dollars in federal funding, including Medicaid and child welfare dollars. The full report and supporting exhibits remain public, and the committee held a hearing on its findings.
Distance Is Itself a Clinical Problem
Interstate placement is often described as a logistical fact. In behavioral health, it functions as a clinical variable.
Family involvement is a component of effective treatment for most childhood mental health conditions, and it is difficult to deliver when a parent lives eight hours away. Discharge planning depends on connecting a child to services in the community they will return to, which is harder when the treating facility is in a different state with different providers and different Medicaid rules. And oversight weakens with distance, because the agency that placed a child and the agency that licenses the facility may sit in different states with no shared enforcement authority.
The children most affected are those with the least ability to advocate for themselves: young children, children in foster care without a consistent adult, children with developmental disabilities, and children whose families cannot afford travel. Families with resources can visit, hire attorneys, and move a child. Families without them often cannot. The result is that the children with the fewest advocates tend to be placed farthest away and stay longest, which inverts what a clinical system would do if distance were being assigned by need.
The underlying pressure is a shortage of community-based care. Parents frequently reach these facilities after months of waiting lists for child psychiatry, intensive outpatient programs, or in-home crisis services that do not exist where they live. The Senate report recommended expanding exactly those alternatives, raising standards for congregate care, and strengthening oversight.
Questions Families Can Ask Before a Placement
No family in this situation should be made to feel that seeking intensive help for a child was a mistake. Some children do need a level of care that cannot be delivered at home, and residential treatment is not uniformly harmful.
What the reporting supports is asking harder questions before agreeing to a placement. Families can ask how far the facility is and what the visitation policy actually permits. They can ask about the licensed staffing ratio, how often a child sees a licensed therapist rather than a technician, and the facility's policies on restraint and seclusion. They can ask to see state licensing inspection reports, which are public records in most states, and to review any recent complaint findings. They can ask what the discharge plan looks like and who will provide care afterward.
Families who believe a child has been harmed in a facility can contact their state's licensing agency, the state child protection hotline, and the federally funded protection and advocacy organization that exists in every state to represent people with disabilities, including children in institutional settings.
Families in immediate crisis with a child can reach the 988 Suicide and Crisis Lifeline by call or text at any hour. Many states also operate mobile crisis response teams that can come to a home, which is often a better first step than an emergency department.
Several questions remain unresolved. No federal licensing standard governs these facilities. The Senate report recommended that the Justice Department assess residential placements for potential violations of the right to receive services in the least restrictive setting, and whether that review occurred has not been publicly reported. There is also no national public database showing how many children are placed out of state, which is itself part of the accountability gap. MedicalDaily will report on federal or state action affecting oversight of these facilities.
Key Questions Answered
How young are children in these facilities? Reporting by The Marshall Project found children in locked residential treatment centers can be as young as five years old.
How do children end up there? Through foster care placements, court orders, or parents who sought intensive help after exhausting available community options.
Why does out-of-state placement matter? It separates children from family involvement in treatment, complicates discharge planning into their home community, and weakens oversight when the placing and licensing agencies are in different states.
Has the federal government investigated? Yes. A two-year Senate Finance Committee investigation of four large operators found routine harm to children and oversight failures, and recommended stronger standards and more community-based alternatives.
Who pays for these placements? Medicaid, child welfare funding, and private insurance are the main sources, which is why the committee framed the issue as a use of taxpayer money.
What should a family ask before agreeing to a placement? Distance and visitation policy, licensed staffing ratios, how often a child sees a licensed therapist, restraint and seclusion policies, licensing inspection findings, and the discharge plan.
Where can a family in crisis get help now? The 988 Suicide and Crisis Lifeline is available by call or text at any hour. Many states also operate mobile crisis teams that respond in the home.
