On Wednesday, June 12, 2024, the Senate Finance Committee held a hearing, “Youth Residential Treatment Facilities: Examining Failures and Evaluating Solutions.” Chairman Ron Wyden (D-OR) opened the hearing by announcing the publication of a report, Warehouses of Neglect: How Taxpayers are Funding Systemic Abuse in Youth Residential Treatment Facilities. The Senate Finance Committee and Senate Health, Education, Labor and Pensions (HELP) Committee conducted a two year investigation into four residential treatment providers. The report includes recommendations for Congress, the Administration, and state Medicaid and child welfare systems, as well as the companies operating the Residential Treatment Facilities (RTFs).
Chairman Wyden highlighted several key themes in his opening remarks: the use of restraint and seclusion, workforce concerns of untrained and ill-equipped staff, and the need for more community-based alternatives to reduce the use of residential care. Ranking Member Mike Crapo (R-ID) noted that there needs to be more support for preventative services and that residential care should be the placement of last resort; residential treatment should be held to the highest standards of care and have rigorous oversight. Chairman Wyden stated that he is interested in bipartisan solutions to the problems outlined in the report.
There was no lived experience voice on the witness panel, though a video was played that shared individual stories of people who had experienced abuse in RTFs.
Reagan Stanford, JD, Abuse and Neglect Managing Attorney for Disability Rights Arkansas, focused on the lack of a therapeutic environment in the RTFs and the need for meaningful oversight from the Centers for Medicare and Medicaid Services (CMS).
Elizabeth Manley, Faculty And Senior Advisor For Health and Behavioral Health Policy at the Innovations Institute, University of Connecticut School of Social Work, spoke to the value of high quality, trauma-sensitive residential treatment for some youth and young people who are unsafe in the community, but stated that all children and youth must have access to the most appropriate, least restrictive, individualized, strengths based and culturally appropriate care – the right services at the right time for the right duration. Ms. Manley emphasized the need for increased access to community-based and family-centered care such as mobile crisis and in-home services.
Finally, Kathryn Larin, Director of Education, Workforce And Income Security for the Government Accountability Office (GAO), notes that in multiple reports, the GAO has asked the Department of Health and Human Services (HHS) to provide additional support and instruction for states regarding residential care. She noted that reporting abuse is voluntary and not all states do it, and called attention to the difficulties of monitoring out-of-state placements, the use of restraint and seclusion, and the over-reliance on psychotropic medications. She recommended better training for staff, stronger penalties and oversight, and best practice guidance from HHS.
During questions, Chairman Wyden elicited further examples of abuse and neglect from Ms. Stanford and Ms. Larin. Ranking Member Crapo asked for further clarification from Ms. Stanford and Ms. Manley about the benefits of community-based services, both as alternatives to residential care and as prevention services. Ms. Manley noted that each child should have intensive care coordination to work with the family to determine the best treatment option available.
Senator Stabenow (D-MI) noted that President Kennedy’s Community Mental Health Act of 1963 still has not been fully realized; it largely eliminated asylums but never provided comprehensive community mental health care. Senator Casey (D-PA) asked Ms. Stanford if RTFs are meeting the needs of the youth, to which she gave a resounding negative, and he noted that restraint and seclusion are traumatizing practices.
Senator Hassan (D-NH) focused her questions on how to better provide oversight, particularly for out-of-state placements, and the need to invest in community-based services to meet the mental health needs of youth. Senator Cortez Masto (D-NV) also focused on the oversight, calling out the need for technical assistance and coaching and to hold Medicaid accountable. She noted the challenges of not enough funding and the limited options of services available.
Senator Wyden wrapped up the hearing with additional questions about New Jersey’s single point of entry to access care, which Ms. Manley explained helps parents to know all their options from the beginning.
