Disability Rights NC Says Abuses Are Ongoing

October 14, 2021

A disturbing new report by the National Disability Rights Network (NDRN) reveals widespread abuse and neglect at for-profit youth residential treatment facilities in 18 states across the country, including North Carolina. Disability Rights NC staff know that the examples cited in the report are not isolated, as we regularly hear about abuses in these facilities from children and their guardians.

“Children are routinely treated as though they are expendable, and it must stop,” said Virginia Knowlton Marcus, CEO of Disability Rights NC (DRNC). “Our children are hurting and need care but are not getting the help and support they need to grow and thrive. Instead, they are being neglected and abused.”

At any given time, approximately 700 North Carolina children are locked away in Psychiatric Residential Treatment Facilities (PRTFs). About half of these children are in the foster care system. About a third are sent to out-of-state PRTFs, as far away as Arkansas and Utah.

North Carolina pays more than $100 million a year for these institutions, $400 to $800 per day per child, where kids often cycle in and out, because the care they need in the community is not available. Rather than building services that keep kids in their homes and communities with people they love and who love them, NC sends them to expensive psychiatric institutions that purport to be “therapeutic” but often are essentially holding tanks and cause damage.

DRNC staff who monitor in these PRTFs regularly see and report abuse and neglect to NC’s regulatory agency, NC Department of Health and Human Services Division of Health Service Regulation (DHSR). Regulators cite facilities and require corrective actions, but corrections are slow, inconsistent, and violations repeatedly occur. Litigious facilities are often allowed to continue operating at the expense of the children placed in their care.

In addition to the examples listed in the report, consider these examples from DHSR findings, all from different PRTFs:

  • While a PRTF was short-staffed, a sleeping child was attacked, resulting in a concussion. “I have headaches and migraines, they are constant…I sleep with one eye open (now).”
  • Another PRTF failed to report a suicide attempt to the state, saying, “The treatment team viewed (the child’s) behavior of tying an electric cord around her neck as self-injurious and not a suicide attempt.”
  • Staff and children reported to regulators at one PRTF that the children had not received required therapy for weeks.
  • Two staff members at another PRTF “have called the clients ‘dogs’ and referred to their rooms as ‘dog kennels.’ Staff referred to the clients as ‘gay’ and made negative comments about their families.”
  • Kids at another facility told regulators that the way staff use physical restraints hurts. “Staff took me outside and pressed me up against the brick wall because there were no cameras. They pulled my arms behind my back and punched me.” These illegal restraints were reported by several children. Another child said, “They could talk to us more. They could allow us to talk to our mom when we’re upset. It hurts my feelings when they just restrain me cause I’m upset.”
  • Regulators cited that facility for failing to get a child to the doctor after a staff member assaulted him, resulting in a fracture of his orbital bone. Equally shocking, public records show that staff member had recently8 been released from prison after serving nearly 20 years for murder.

These are just a few examples from many NC regulatory findings at NC’s PRTFs. There are 10 for-profit PRTF providers in NC.  Another four providers are non-profits. The state operates one PRTF. Some NC providers have multiple PRTF licenses.

“North Carolina is shamefully failing the children who need help the most,” Knowlton Marcus said.  “These are not ‘bad kids.’ They are children who are being treated badly.”

DRNC calls for the State to:

  • Develop a community-based care system for kids.
  • Stop sending children to out-of-state institutions as a matter of course. Provide effective monitoring and oversight of facilities if we must send children out of state.
  • Stop spending money on services with poor outcomes and high rates of readmission.
  • Ensure accountability for managed care entities for failing to cultivate adequate provider networks.
  • Ensure zero tolerance for repeated failures of institutional service providers at the expense of our kids.

DRNC is part of the national Protection and Advocacy (P&A) system. P&As are empowered under federal law to conduct monitoring activities and investigations where people with disabilities receive services, such as in Psychiatric Residential Treatment Facilities (PRTFs). DRNC’s investigators and attorneys have been monitoring and conducting investigations in PRTFs for more than a decade, ever since DRNC became NC’s designated P&A.

Two DRNC attorneys, Joonu-Noel Andrews Coste, and Kristine Sullivan, supervising attorney for DRNC’s Investigations and Monitoring team, worked with NDRN and 17 other P&As on the report.  Coste, Sullivan, and Senior Investigator Kishona Mimms currently lead DRNC’s monitoring and investigative efforts at NC’s PRTFs.

DRNC launched an initiative earlier this year, Bring NC Kids Home, in an effort to bring to light the injustices our children endure in these facilities.


About Disability Rights North Carolina

Disability Rights North Carolina (DRNC) is the federally mandated protection and advocacy system in North Carolina, dedicated to advancing the rights of all people with disabilities, of all ages, statewide. DRNC is an independent, 501(c)(3) nonprofit organization and a member of the National Disability Rights Network. Learn more about Disability Rights North Carolina at disabilityrightsnc.org.


Virginia Knowlton Marcus, CEO

Corye Dunn, Director of Public Policy

Joonu-Noel Andrews Coste, Attorney
919-856-2195 ext. 223