	Background

Since the early 1990s, hundreds of residential treatment programs and  facilities have been established in the United States by state agencies and  private companies. In addition, the programs provide a range of services,  either on-site or through links with community programs, including  educational, medical, psychiatric, and clinical/mental health services. In addition to the lack of a standard, commonly recognized definition for  residential treatment programs, there are no standard definitions for  specific types of programs—wilderness therapy programs, boot camps,  and boarding schools, for instance. Widespread Allegations of Abuse and Death at Residential Treatment Programs

We found thousands of allegations of abuse, some of which involved  death, at public and private residential treatment programs across the  country between the years 1990 and 2007. We are unable to identify a more  concrete number of allegations because we could not locate a single Web  site, federal agency, or other entity that collects comprehensive  nationwide data related to this issue. According to the  most recent NCANDS data, during 2005 alone 33 states reported 1,619 staff  members involved in incidents of abuse in residential programs. Because  of limited data collection and reporting, we could not determine the  numbers of incidents of abuse and death associated with private  programs. For example:    We identified claims of abuse and death in pending and closed civil or  criminal proceedings with dozens of plaintiffs alleging abuse. Cases of Death at Selected Residential Treatment Programs

We selected 10 closed cases from private programs to examine in greater  detail. Specifically, these cases were focused on the death of a teenager in  a private residential treatment program that occurred between 1990 and  2004. We found significant evidence of ineffective management in most of  these 10 cases, with many examples of how program leaders neglected the  needs of program participants and staff. These ineffective management techniques  compounded the negative consequences of (and sometimes directly  resulted in) the hiring of untrained staff; a lack of adequate nourishment;  and reckless or negligent operating practices, including a lack of adequate  equipment. These specific factors played a significant role in most of the  deaths we examined. The program closed in 2001.
Why GAO Did This Study

Residential treatment programs provide a range of services, including drug and alcohol treatment, confidence building, military-style discipline, and psychological counseling for troubled boys and girls with a variety of addiction, behavioral, and emotional problems. This testimony concerns programs across the country referring to themselves as wilderness therapy programs, boot camps, and academies, among other names. Many cite positive outcomes associated with specific types of residential treatment. There are also allegations regarding the abuse and death of youth enrolled in residential treatment programs. Given concerns about these allegations, particularly in reference to private programs, the Committee asked the General Accountability Office (GAO) to (1) verify whether allegations of abuse and death at residential treatment programs are widespread and (2) examine the facts and circumstances surrounding selected closed cases where a teenager died while enrolled in a private program. To achieve these objectives, GAO conducted numerous interviews and examined documents from closed cases dating as far back as 1990, including police reports, autopsy reports, and state agency oversight reviews and investigations. GAO did not attempt to evaluate the benefits of residential treatment programs or verify the facts regarding the thousands of allegations it reviewed.

What GAO Found

GAO found thousands of allegations of abuse, some of which involved death, at residential treatment programs across the country and in American-owned and American-operated facilities abroad between the years 1990 and 2007. Allegations included reports of abuse and death recorded by state agencies and the Department of Health and Human Services, allegations detailed in pending civil and criminal trials with hundreds of plaintiffs, and claims of abuse and death that were posted on the Internet. For example, during 2005 alone, 33 states reported 1,619 staff members involved in incidents of abuse in residential programs. GAO could not identify a more concrete number of allegations because it could not locate a single Web site, federal agency, or other entity that collects comprehensive nationwide data. GAO also examined, in greater detail, 10 closed civil or criminal cases from 1990 through 2004 where a teenager died while enrolled in a private program. GAO found significant evidence of ineffective management in most of the 10 cases, with program leaders neglecting the needs of program participants and staff. This ineffective management compounded the negative consequences of (and sometimes directly resulted in) the hiring of untrained staff; a lack of adequate nourishment; and reckless or negligent operating practices, including a lack of adequate equipment. These factors played a significant role in the deaths GAO examined.