From the U.S. Government Accountability Office, www.gao.gov Transcript for: Preventing the Abuse of Youths Living in Residential Facilities Description: News media have reported several incidents of youth being mistreated, abused or neglected, and sometimes even killed by staff employed at residential facilities. We talk with GAO’s Kathy Larin about our new report that discusses the prevalence of this maltreatment and efforts to prevent it. Related GAO Work: GAO-22-104670, Child Welfare: HHS Should Facilitate Information Sharing Between States to Help Prevent and Address Maltreatment in Residential Facilities Released: February 2022 [Music] [Kathy Larin:] Children in the foster care system are already among the most vulnerable children in our nation. [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report—your source for news and information from the U.S. Government Accountability Office. I'm your host, Holly Hobbs. A brief warning to our listeners: This episode of our podcast discusses acts of violence and other abuses of children, which may not be appropriate for younger listeners and may be upsetting to some. News media have reported several incidents of youth being mistreated, abused or neglected, and sometimes even killed, by staff employed at residential facilities. Many of these youth are in the child welfare system because of abuse and neglect they experienced at home before being removed from their parents’ or guardians’ care. And so this new maltreatment may exacerbate their existing trauma. Today, we'll talk with Kathy Larin—an expert on child welfare programs and a director in our Education, Workforce and Income Security Team—about a new report that discusses the prevalence of this maltreatment and efforts to prevent it. Thanks for joining us. [Kathy Larin:] Thanks for having me. [Holly Hobbs:] So, Kathy, how many children are in residential facilities and why might they be staying there instead of foster homes? [Kathy Larin:] So the most recent data that we have on residential facilities is from 2019. And at that time, more than 43,000 youth, who were in the foster care system, lived in residential facilities. And the reasons that they can be in a facility really can vary. I mean, some need specialized care like special education or substance abuse treatment, behavioral health treatment. But others are placed in facilities because there just aren't enough traditional foster homes available. On average, youth stay in residential facilities for eight months. But some stay for a year or longer. [Holly Hobbs:] So do we know how prevalent abuse or maltreatment is at these residential facilities? [Kathy Larin:] You know, the short answer is no. HHS does collect data on maltreatment at residential facilities, but states aren't required to report that data. And we have found that even the data there that is reported is unreliable. And when we talk to officials in the states that we talk to, as well as experts in the field, they said that incidents are probably underreported for several reasons. Staff and residents may be afraid to report incidents out of fear of retaliation. Youth may worry that they won't be believed if the abuse takes place without eyewitnesses, for example, or some youth may not be aware of how to report maltreatment. [Holly Hobbs:] So given all that, what can you tell us about efforts to prevent abuse? [Kathy Larin:] So some states really have been taking steps to help prevent maltreatment. One example is through enhanced background checks for staff. Another is better training on how to manage behavioral issues. For example, appropriate boundaries for physical interactions, use of restraints. Other states have made it easier for staff and residents to report maltreatment without fear of retaliation. And another strategy is monitoring. So state agencies monitor facilities through regular visits. And through that monitoring, they can meet with youth, identify facilities where there are issues, and impose penalties if they discover violations. [Holly Hobbs:] And so for our report, we also talked to state officials and child advocacy groups about this issue. What do they think needs to be done? [Kathy Larin:] So what we really heard about was a need for more robust training, for example, on de-escalation techniques. We also heard about ways in which oversight of facilities, investigations, and mechanisms to hold providers accountable could all be strengthened. [Kathy Larin:] OK, so we've heard about the state role, and they run these residential facilities. What's the federal role in all of this? [Kathy Larin:] Well, the federal role is somewhat limited, in part because it is state agencies that are responsible for oversight of individual facilities. But federal agencies play a larger role in ensuring that children in the foster care system are well cared for, and they do provide technical assistance and guidance to states on these issues. {MUSIC} [Holly Hobbs:] So Kathy just told us that while states have taken steps to better protect children in residential facilities from abuse, some officials and child advocacy groups are looking for more—including more robust training for staff at facilities. So, Kathy, given our role here at GAO in looking for ways to improve federal efforts—did we make any recommendations for federal agencies to help protect these youth? [Kathy Larin:] Yes, we did make a recommendation in our report. As I mentioned, HHS is the lead federal agency that's responsible for addressing issues related to safety and well-being of youth, and also for overseeing foster care generally. So, we recommended that HHS do more to facilitate information sharing among states. You know, I mentioned some of the best practices and promising practices that states are using to help prevent and address maltreatment. But we thought HHS could do more to share these strategies so that more states are aware of promising practices for preventing and addressing maltreatment. [Holly Hobbs:] And last question, what's the bottom line of this report? [Kathy Larin:] Children in the foster care system are already among the most vulnerable children in our nation, and many have already suffered from abuse and neglect prior to entering foster care. Yet, maltreatment in residential facilities is an ongoing issue. States have taken steps to reduce its incidence, but more could be done to help prevent maltreatment from taking place. [Holly Hobbs:] That was Kathy Larin talking about GAO's recent review of maltreatment of youth in residential facilities. Thanks for your time, Kathy. [Kathy Larin:] Thank you. [Holly Hobbs:] And thank you for listening to the Watchdog Report. 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