An Associated Press investigation has documented a sprawling system in which adopted children—representing an estimated 25 to 40 percent of young people in private residential treatment programs—are sent to for-profit facilities that promise to heal attachment-related behavioral problems but instead deliver physical restraints, psychological abuse, and environments that children and experts describe as destructive. The investigation, based on interviews with dozens of former attendees, their families, former employees, public officials, and hundreds of government and business records, found that the industry’s marketing to desperate adoptive parents relies on a disputed diagnosis of reactive attachment disorder and methods that lack empirical support.

Many of the children are placed in facilities that charge as much as $20,000 a month, promising to treat reactive attachment disorder, or RAD, a condition that the Diagnostic and Statistical Manual of Mental Disorders characterizes as extremely rare and applicable only to children under five who are so severely neglected that they fail to seek comfort when distressed. Brian Allen, a psychologist who runs the mental health program at Penn State’s Center for the Protection of Children, told the AP that the diagnosis has been “corrupted” and is routinely misapplied to teenagers with behavioral challenges. His clinic’s study of 100 adopted and foster children found that about 40 percent had been given a RAD diagnosis, yet “not a single one fit the criteria,” he said. Allen argued that the manual should remove the entry entirely because it demonizes adopted children and steers families toward harsh interventions. “We should absolutely not be doing those types of heavy-handed, obedience-focused, boot camp kinds of things,” Allen said. “There’s no empirical or theoretical basis for that.”

The AP traced how companies such as Family Help & Wellness and Embark Behavioral Health, often backed by private equity, have expanded a network of programs across the country while regulators rarely intervene until after fatalities or sexual assaults. The watchdog group Private Equity Stakeholder Project found that problematic facilities frequently reopen under new names after closures, making long-term accountability difficult. In North Carolina, for example, Family Help & Wellness rebranded Solstice East as Magnolia Mill in 2024 and later merged it with Asheville Academy, which had already been shut down after two student deaths by suicide. Two young people died at Family Help & Wellness facilities in the past two years, the AP noted, yet the company’s Uinta Academy in Utah remains open while facing a lawsuit that alleges “dehumanizing” punishments, including a staff member’s sexual assault of a teenage girl.

At Uinta, Kate—who asked the AP to withhold her surname because she had previously been sexually assaulted—said girls were required to scrub floors with a toothbrush for hours, pull weeds in 100-degree heat, or spend days baling moldy hay as punishment for any sign of emotion. “They’d strip away any sort of individuality,” she recalled. “They convince you that part of you is bad, that part is toxic, it’s unhealthy, it’s non-working and you have to get rid of it.” Kate cycled through four programs and was institutionalized for most of her adolescence, leaving at age 18. She described being thrown to the ground by staff members who held her face-first into the carpet for what felt like an hour, screaming that she was “out of instructional control,” because she panicked when a roommate turned off her night light.

At another facility, Zoie Albers, adopted from a Chinese orphanage, told the AP that within her first week she watched staff slam a boy onto the ground while other children told her that physical restraints were routine. Albers, who was 17 at the time, described “groups” in which children were forced to sit silently as peers berated them for such things as picking at self-harm scars. When she was the target, she said she cried for more than half an hour while the other girls called her “attention-seeking” and selfish, and she eventually agreed with them “to make it stop.” The facility, Three Points Center in Utah, closed in 2025 after state regulators found violations of a law prohibiting cruel, severe, unusual or unnecessary punishment.

The consequences extend to fatalities. Biruk Silvers, 17, died by suicide at Discovery Ranch in Utah in November 2024, just weeks after a therapist documented that he had expressed suicidal thoughts, according to a family lawsuit. The AP obtained licensing records showing the state cited Discovery Ranch for compromising child safety and fined it $10,300; the facility denied it had been warned of active suicidality and defended its practices as routine discipline. Investigators found that the program had started Biruk on a new antidepressant whose label warned of suicidal ideation in children. His friend Blaine Baily, who shared a bunk bed, said that after the death he slept for weeks in the same bed where Biruk had died, replaying the image every night. Discovery Ranch was temporarily barred from accepting new children but resumed normal operations after follow-up inspections.

A U.S. Senate inquiry led by Sen. Ron Wyden, titled “Warehouses of Neglect,” found that chronic understaffing, misuse of restraints, and inadequate mental health care are widespread across such facilities. The report concluded that the industry functions more like confinement for children in crisis than as therapeutic placements. Christy Nelson, a former special education teacher at Change Academy at Lake of the Ozarks in Missouri, told the AP she repeatedly reported dangerous conditions to regulators and legislators to no avail. “It was extremely dysfunctional, dangerous,” she said. The facility’s parent company, Embark Behavioral Health, said it investigated her concerns and addressed those it considered valid, but Nelson described no meaningful improvement.

Financial analysts told the AP that predictable public funding through Medicaid, school systems, and child welfare programs has made the industry attractive to investors seeking reliable returns, with profit margins approaching 20 percent. Because states rarely cap placement durations, facilities can extend children’s stays to maximize revenue, experts said. “All of that is kind of the predictable outcome when you pair this intensely profit-driven and untransparent business model with a service like residential behavioral health treatment,” said Eileen O’Grady, who studied the industry for the Private Equity Stakeholder Project.

Paris Hilton, who has testified about her own alleged abuse in similar institutions, has advocated through her nonprofit 11:11 Media Impact for tighter regulation. In 2021 the group estimated that roughly 200,000 children pass through the industry each year, with 50,000 placed by parents alone without any court oversight. The AP found at least 80 private facilities that specifically market adoption-related treatment, yet no federal agency tracks how many exist or how many children are inside them. While some companies have defended themselves by saying parents legally authorize the placements and that their programs operate under local licensing and evolving best practices, the investigation’s findings consistently show that children leave more traumatized than when they arrived—if they leave at all.