What GAO Found
Prior GAO reports have described allegations of youth being maltreated, and sometimes killed, by staff employed at residential facilities. Many of the youth placed in residential facilities are in foster care. Youth in foster care may be placed in residential facilities for a number of reasons. For example, youth are sometimes placed in residential facilities due to an insufficient number of family foster homes, especially homes that are equipped to provide care for youth with mental or behavioral health needs.
The use of residential facilities as placements for youth in foster care has declined over the course of 20 years, according to data from the Department of Health and Human Services (HHS). Residential facilities were listed as the most recent placement for about 101,000 youth in foster care in 2002. By 2022, the most recent year of available data, that number had dropped to about 34,000 youth.
GAO has previously reported on challenges to preventing harm to youth placed in residential facilities, which include:
- Monitoring youth in out-of-state placements. Youth are sometimes placed in out-of-state facilities if there are no available placements in their home state. Stakeholder groups and state agency officials said monitoring youth in out-of state facilities is difficult because of limited access to the youth or information regarding their care. To address this challenge, one state established an interagency committee that monitored youth placed in out-of-state residential facilities.
- Inappropriate use of psychotropic medications. Some youth placed in residential facilities are prescribed psychotropic medications, such as those used to treat depression and anxiety, among other conditions. However, health risks are associated with certain prescribing patterns—such as using multiple psychotropic medications. Some states have taken steps to curb inappropriate use of these medications among youth in foster care, such as requiring physicians to consult a child psychiatrist when prescribing certain medications.
- Harming youth through use of restraints. In some instances, staff injure youth while attempting to restrain them, which may result in maltreatment allegations and findings. To address this challenge, one state set up an interagency advisory committee on restraints that meets regularly to analyze restraint data and review feedback from program providers on the use of restraints in their facilities.
Various state agencies are responsible for monitoring residential facilities and working with them to prevent and address abuse or neglect. At the federal level, HHS is the lead agency for addressing issues related to the safety and well-being of youth, which includes youth in residential facilities. HHS officials reported that they primarily support states’ efforts by providing technical assistance and guidance. However, at the time of our 2022 report, some state officials told us they received little to no information from HHS.
Thank you for the opportunity to discuss our work on residential facilities that are responsible for the care of vulnerable youth in the child welfare system. Residential facilities may be an appropriate part of the continuum of care for some youth. However, for over 20 years, we have reported on youth in the foster care system who are placed in such facilities, including concerns with the physical, emotional, and sexual abuse of these youth. In multiple reports, we have called on the Department of Health and Human Services (HHS) to enhance the support it provides to states, which are primarily responsible for oversight of residential facilities.
My statement today will focus on (1) information about the youth who are placed in residential facilities, (2) potential challenges to preventing harm to youth placed in these facilities, and (3) state and federal oversight of residential facilities. My statement is based primarily on the findings from our 2022 report on maltreatment of youth in residential facilities, as well as findings from earlier reports.