The Role of Residential Care
Understanding the Role of Residential Treatment
Psychiatric residential treatment facilities (PRTFs) play a vital role in the behavioral health care continuum for youth with special, and often complex, emotional, behavioral and psychiatric needs.
The National Association for Behavioral Healthcare (NABH) explains: [t]he goal of psychiatric residential treatment is to provide care to children and adolescents with significant social and emotional needs in a non-hospital, highly structured, and therapeutic environment. These settings provide a safe place where individuals can gain stability, support, and treatment for mental diagnoses, substance abuse, intellectual / developmental disabilities, sexual conduct disorders and other disabilities that require stabilization.[i]
UHS PRTFs, such as Provo Canyon School, are designed to provide 24-hour, structured therapeutic intervention services to meet the individual needs of each youth, with a special emphasis on learning necessary skills with the goal towards reintegration back to their community through the support of outpatient services.
A recent Manhattan Institute report, penned by a former Provo Canyon School student, outlines the critical role of psychiatric residential treatment facilities and the regulatory oversight in place to safeguard patients (and staff). The report also provides context and industry data to debunk recent allegations of systemic abuse and ineffective treatments at PRTFs:
“Youth in PRTFs often face severe emotional and behavioral challenges.[ii] Many pose a danger to themselves or others, engage in self-harm, or exhibit psychotic symptoms or aggressive behaviors. Some are at risk of or are already engaging in criminal behavior, making residential treatment a necessary intervention. Admission to these facilities is reserved for individuals deemed medically necessary and is typically considered a last resort when less intensive options, such as outpatient or community-based services, have proved insufficient.[iii]”
“Federal data find that youth PRTFs are as safe as general hospitals, a conclusion supported by data collected through rigorous random and complaint-based surveys.[iv]
These surveys, conducted by state agencies and accreditation organizations, are reported to the Centers for Medicare & Medicaid Services (CMS) and detailed on the QCOR website, ensuring that safety and quality standards are consistently met.[v]”
“Deaths resulting from improper restraint or suicides due to inadequate supervision represent tragic failures for those entrusted with the care of vulnerable children. Current data suggest that deaths in treatment are extremely rare. Government bodies, such as the U.S. Department of Justice, monitor the safety and quality of residential treatment centers for criminal-justice-involved youth. According to a recent biennial report on juvenile offenders, residential treatment centers reported four deaths in 2020: three suicides and one death of unknown cause. This equates to a rate of 5.1 deaths per 10,000 youth, or approximately 0.051%.[vi]”
“A report from the HHS Office of Inspector General suggested that one-third of states may not collect sufficient data to effectively identify maltreatment in residential treatment programs. It further alleged that, even in states where such data are collected, monitoring practices might be inadequate.[vii] While further improvements may be necessary, it is inaccurate to characterize the entire industry as unregulated, particularly given the federal and state frameworks governing many facilities.”
[i] National Association for Behavioral Healthcare (NABH), Residential Treatment, A Vital Component of the Behavioral Health Continuum (April 2021)
[ii] Amy Baker et al., “Mental Health and Behavioral Problems of Youth in the Child Welfare System: Residential Treatment Centers Compared to Therapeutic Foster Care in the Odyssey Project Population,” Child Welfare (2007): 97–123.
[iii] National Association for Behavioral Healthcare (NABH), “Residential Treatment: A Vital Component of the Behavioral Healthcare Continuum,” April 2021; American Academy of Child and Adolescent Psychiatry (AACAP), “Residential Treatment Programs,” September 2023.
[iv] Scott Dziengelski, “Deinstitutionalization Redux: The Decline in Residential Mental Health Treatment for Youth,” Manhattan Institute, May 16, 2024
[v] Centers for Medicare & Medicaid Services (CMS), “Quality, Certification and Oversight Reports (QCOR),” Jan. 15, 2025.
[vi] Sarah Hockenberry and Anthony Sladky, “Juvenile Residential Facility Census 2020,” U.S. Dept. of Justice, OJJDP, January 2024.
[vii] Ann Maxwell, “Many States Lack Information to Monitor Maltreatment in Residential Facilities for Children in Foster Care,” HHS, Office of Inspector General, June 2024.
