Recently, the Associated Press published an article focusing on an investigation into adopted children and residential treatment centers, or RTCs, titled “Adopted and Locked Away; Kids Promised Forever Homes Instead Confined in For-profit Institutions.” Although this investigation raises legitimate concerns about safety, oversight, and the commercialization of behavioral health services for children that should not be minimized, it is important not to reduce this complex issue to a salacious headline. A public discussion concerning the industries serving troubled teenagers and the rampant institutional abuse that many youth experience is greatly needed, but in terms of adoption, we must look at the big picture.
Public conversations about residential treatment often become polarized. Current narratives cast facilities as inherently abusive and predatory and families who use them as overreactive, abandoning their children, or shirking their parental responsibilities. What this investigation does is reveal a deeper systemic crisis that cannot be reduced to a simple narrative of “for-profit facilities targeting adopted children and their families.” In reality, the AP investigation exposes a far broader crisis involving trauma, disrupted attachment, family isolation, our nation’s inadequate mental health infrastructure, and the inability of our existing systems to effectively support children with profound emotional and developmental wounds.
Are Residential Treatment Centers Really “Targeting” Adopted Children and Families?
One of the central allegations of the AP investigation is that residential treatment centers disproportionately and aggressively market to adoptive families. While those practices deserve examination and scrutiny, this framing dismisses a difficult reality: adopted children are statistically more likely to experience significant mental health and attachment-related challenges. This increased vulnerability is rooted in early adversity, developmental trauma, neglect, disrupted attachment, instability, and exposure to our nation’s foster care system, among other issues.
For many adopted children, these experiences manifest through severe emotional disturbance, aggression, self-harm, suicidality, running away, destruction of property, violence toward siblings, fire-setting, sexualized behaviors, and other behaviors that place themselves and others at risk. This is especially true for children with significant attachment issues (including reactive attachment disorder, or RAD), developmental trauma, or complex trauma. All across our country, behind closed doors, these are the struggles that many adoptive families face.
The reality is that many adoptive families are not seeking RTCs because they just prefer institutional care. They are often seeking help after exhausting outpatient therapy, in-home supports, school-based interventions, hospitalization, medication management, community mental health services, crisis intervention programs, and every other option possible.
Residential Treatment Is Often a Last Resort
One of the most important questions absent from much of the public discourse is this:
If not residential treatment, then what?
Families living with severe safety concerns often don’t have many options. We have an inconsistent, fragmented, underfunded mental health system that is lacking in infrastructure. In many communities:
- trauma-informed in-home services are not available or inaccessible,
- intensive and effective family programs often have lengthy waitlists,
- specialized attachment-focused clinicians are scarce,
- psychiatric beds are always running low,
- foster and adoptive parent supports can be inconsistent or inadequate,
- and insurance reimbursement structures can make long-term treatment inaccessible for many.
I know firsthand that parents are managing daily crises. I have sat with families who were making critical decisions concerning placing their children in RTCs. In my own work as a family crisis counselor, I sat with families whose private lives were defined by chronic fear, hypervigilance, and exhaustion. I worked with parents who had to lock away every kitchen knife in their home, install bolts on bedroom doors, sleep lightly at night, and constantly monitor younger siblings simply to maintain a basic sense of safety in their homes. These are realities most people never see. Behind closed doors, many families are living in constant survival mode while desperately trying to love and protect children who carry profound emotional pain.
Residential programs like Calo Programs were developed specifically to serve children and adolescents struggling with attachment disorders and developmental trauma. As we well know at the Attachment & Trauma Network, Calo Programs exists because of the reality that many families face. Many families need highly specialized interventions capable of addressing complex attachment issues that traditional outpatient systems are often ill-equipped to treat. For those families, residential treatment centers like Calo are a genuine lifeline when few alternatives exist.
To be clear, the need for RTCs does not excuse abusive practices within residential programs. The existence of abuse within some RTCs should force us to improve oversight, accountability, trauma-informed standards, workforce training, and regulation. But we simply cannot attack or eliminate treatment options without building realistic alternatives.
The Real Crisis: Systemic Failures Across Child Welfare and Mental Health
Rather than framing RTCs as the villains, we must examine the broader systemic conditions that contribute to poor outcomes for children and families.
The AP investigation indirectly exposes multiple systemic failures:
- inadequate adoption education and post-adoption support,
- chronic underfunding of children’s mental health,
- mental health workforce shortages,
- insurance barriers,
- lack of trauma-informed schools,
- poor foster care continuity,
- weak oversight of private behavioral health facilities,
- and the absence of coordinated long-term care for high-needs children.
In addition, many residential centers operate within impossible conditions:
- underpaid and undertrained staff,
- high turnover,
- inconsistent regulations across states,
- financial pressures from private equity ownership,
- insufficient trauma training,
- and reimbursement systems that reward stabilization over relational healing.
These conditions create environments where abuse is possible. Restraint-, control-, and compliance-based systems, as well as institutional practices, can flourish under these conditions.
Another uncomfortable truth is that this is a larger cultural problem. As a nation, we do not invest enough in the prevention of youth mental health and attachment disruptions. American society remains largely ignorant of or deeply uncomfortable with the reality of childhood trauma. We celebrate adoption as rescue, but often fail to invest in the long-term relational, neurological, and psychological support many families require afterward. We encourage families to seek help, yet provide few sustainable pathways once behaviors escalate beyond what our current youth mental health system is capable of.
In many ways, the demand for residential treatment has become a clear indicator that our system is already stretched beyond capacity.
The Conversation We Actually Need
What does truly trauma-informed, attachment-centered, developmentally appropriate care actually look like for children with profound relational wounds?
This is the conversation we need, and this conversation requires us to move beyond polarized thinking. Beyond the headlines.
We must be able to simultaneously acknowledge that some, but not all, residential programs cause enormous harm, that our youth mental health infrastructure is inadequate to support the relational healing at the core of this need, and that some families are navigating severe crises with dangerously limited support.
A trauma-informed perspective requires nuance.
Moving Forward
If we genuinely want better outcomes for adopted children and their families, the solution must involve large-scale systemic investment in prevention, relational and interpersonal healing, and long-term support for families.
That includes:
- expanded access to trauma-informed, attachment-focused family therapy,
- community-based services,
- culturally responsive care,
- respite programs for caregivers,
- post-adoption support systems,
- stronger oversight of residential facilities,
- evidence-based attachment interventions,
- workforce development,
- and policies that prioritize relational healing over behavioral compliance.
Residential treatment centers should not be painted with a broad stroke. Families in crisis need more than isolation, judgment, and headlines. They need real options, sustained support, and systems capable of holding both accountability and compassion simultaneously. Until society builds those systems, inadequate residential treatment will continue to exist not because families prefer institutionalization, but because too many families have nowhere else left to turn.
