In a scathing new report, U.S. Senate investigators say that residential treatment facilities serving children with developmental disabilities and other behavioral needs are a hotbed of abuse and neglect.

A two-year investigation conducted by the Senate Committee on Finance found that children regularly experience physical, sexual and verbal abuse at such facilities. Inappropriate use of restraint and seclusion are rampant, there are unsafe and unsanitary conditions, staff are unqualified and inadequate and the behavioral health care that is supposed to be provided is often lacking, according to investigators.

The findings detailed in the 136-page report issued this month focus on four of the nation’s largest providers of residential treatment facilities — Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health and Vivant Behavioral Healthcare. The companies’ offerings include specialized programs aimed at children with intellectual and developmental disabilities and those with various other behavioral and mental health needs.

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Investigators reviewed more than 25,000 pages of company documents, media reports, conversations with dozens of experts and they conducted site visits. Their report describes a business model that’s built on maximizing profit at the expense of the children who need care.

“It’s clear that the operating model for these facilities is to warehouse as many kids as possible while keeping costs low in order to maximize profits. Too often, abuse and neglect is the norm at these facilities, and they’re set up to let this happen,” said Sen. Ron Wyden, D-Ore., who chairs the Senate Finance Committee.

Residential treatment facilities often fail to administer the behavioral treatment described in plans, instead leaving children to spend most of their time with unqualified general staff, investigators found. In addition, they said that facilities limit communication between children and their families, keep kids for extended periods, don’t involve guardians in the development of treatment plans and fail to provide quality discharge plans.

The report cites examples of a facility where 110 restraints and seclusions occurred in just 30 days and another where a staffer who was found to be routinely sexually assaulting a child was moved to a different wing instead of being fired. The staffer then came to the child’s window every night and planned to continue the abuse after the child left the facility, investigators said.

In other cases, children have died due to the actions of staffers or by suicide, the report found.

All the while, much of the care provided at residential treatment facilities is paid for with federal dollars, primarily from Medicaid or the child welfare system, Wyden noted. In some cases, he said, Medicaid pays more than $1,200 per child each day.

The report calls on state and local governments, federal agencies, accrediting bodies and residential treatment facilities to take steps to improve standards and oversight and prioritize community-based services. Wyden said he plans to introduce federal legislation to advance the recommendations.

Marc Miller, president and CEO of Universal Health Systems, was invited to testify before the Senate Finance Committee, but he declined. In a statement, the company pushed back against the findings of the investigation.

“The report attempts to extrapolate certain incidents and survey reports into a false narrative regarding the treatment provided, environment of care and regulatory compliance at our facilities. We vehemently dispute this characterization of our facilities,” the company said. “While even one incident of harm is one too many, we have provided information demonstrating the rates of such occurrences are extremely rare across the UHS spectrum and disproves this inaccurate portrayal.”

Officials with Acadia Healthcare responded to the report by saying that they are “committed to doing everything in our power to ensure that all patients in Acadia’s care receive the support and compassionate treatment they deserve” and noting that the incidents mentioned in the report occurred nearly five years ago or more.

Devereux Advanced Behavioral Health said “personal wellbeing, safety and individualized treatment success” are its top priorities and that as a nonprofit, the organization invests revenue and donations back into care.

Representatives of Vivant Behavioral Healthcare could not be reached.

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