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Her roommate turned it off. She panicked. She ran and then curled into a ball, heaving, weeping. Three employees followed her — to comfort her, Kate thought.

Instead, they threw her face first into the carpet, she said, yelling that she was “OIC” — “out of instructional control.” For what seemed like an hour, they held her down, Kate said, one on each arm, the third holding her legs.

Kate would be institutionalized for most of her adolescence — until she could sign herself out as an adult. The Utah facility was her third stop in a sprawling network of loosely regulated, for-profit residential treatment centers, wilderness programs and boarding schools that’s become known as the

An finds that a business known for tough-love boarding schools for rebellious, rich teenagers has also set its sights on a Experts say adoptees, only 2% of American children, account for an estimated 25-40% of those in residential treatment.

Adoptees told the AP they believe they’ve been enmeshed in a shadow orphanage system where children end up with the very fate that adoption was supposed to spare them — but institutionalized instead, some for years, in oppressive and sometimes abusive facilities.

Charging as much as $20,000 a month, many of these facilities promise in their marketing pitches to treat adopted children for reactive attachment disorder, often called RAD. They offer a salve for desperate adoptive parents, claiming the child’s behavioral problems are caused by a pathological failure to connect with their caregivers, and they can learn to attach in faraway treatment.

But experts say most teenagers confined in these facilities almost certainly don’t have RAD, and that the treatment offered wouldn’t fix it even if they did.

The AP interviewed dozens of program attendees and their families, former employees, public officials, attorneys and experts, and obtained hundreds of government and business records to examine why and how adopted kids land in such facilities despite the companies’ disturbing track records.

Police reports reveal children as young as 9 self-harm and sexual abuse inside facilities. Adoptees and adoptive parents said children left more traumatized than when they arrived — if, that is, they ever left. Some have died inside the facilities that promised they would keep them safe.

Children are strip-searched, regularly restrained and punished with manual labor, the AP found. Communication with the outside world, including their parents, is limited and tightly monitored.

Many said it felt like prison, except they had not been convicted of any crime, they have no sentence and no judge monitors their confinement. Parents alone usually decide to send their children away and for how long.

The AP is using only Kate’s first name because it does not typically identify people who say they are victims of sexual assault. When she was 12, she says, she was assaulted by another girl in the middle of the night at her first residential center.

She finally checked herself out of treatment four years ago, when she was 18, but she cries even now as she recounts the night in 2017 when she says she was held to the ground, screaming “I can’t breathe” as snot poured from her nose. Eventually, she went silent, exhausted, she said, and she was released. She went to bed, without a night light.

She lived in that place for another two years.

“We were afraid all of the time,” she said.

A corrupted diagnosis

Adopted by a Kentucky couple, Kate longed to know her birth family, and resented their absence. She lashed out, sometimes violently. She was never in trouble with the law, she didn’t do drugs, but she knows she was a difficult child to parent.

She struggled with depression, anxiety and trichotillomania, a psychiatric condition that led her to pull out her hair.

Kate’s parents went looking for answers. Like many adoptive parents, they thought they found them when they learned about RAD.

The diagnosis is meant for young children who were so neglected in early life that they struggle to bond with caregivers, said Brian Allen, a psychologist who runs the mental health program at Penn State’s Center for the Protection of Children.

It originally described the effects of confinement in orphanages abroad that were so understaffed that babies were rarely held and received no affection, Allen said. Today, the Diagnostic and Statistical Manual of Mental Disorders — the catalog of mental illnesses known as the DSM — says it applies to children who’ve become so withdrawn, they seek no comfort when they are distressed or scared. The DSM specifies the diagnosis is extremely rare and applies to children under 5 — not older children who suffer neglect when small and misbehave years later.

Kate experienced no physical deprivation as a baby. Her adoptive mother was in the room when she was born and took her home right away, she said. But once she arrived in residential treatment, program therapists introduced her parents to reactive attachment disorder.

That’s a common misinterpretation, Allen said, to apply RAD to virtually any adopted preteen or teenager with behavioral challenges. Allen’s clinic studied 100 adopted and foster children brought in for treatment. Around 40% of them had been diagnosed with RAD, but not a single one fit the criteria, their study found.

Some proponents of the wider definition say it makes children manipulative and dangerous, and they must be corrected with obedience-based therapies. That, Allen said, is either a misunderstanding or an intentional bastardization of the diagnosis.

Allen argues the DSM should delete RAD from its listings. The diagnosis has been too “corrupted,” he said, and it is demonizing adopted children who could be better served by researched diagnoses like post-traumatic stress disorder or oppositional defiant disorder, for which there are studied treatments.

“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.”

Yet many facilities advertise treatment for RAD.

“You have really fearful parents who are seeking rapid results and answers,” said Sloan Nova, a psychologist and director of a family therapy program at the University of California in San Francisco, who was in the 1980s and ended up in a treatment facility as a teenager.

“Often what sweeps in is this overpromise, a very seductive promise from residential treatment centers,” Nova said. “So it just sounds almost too good to be true.”

Life and death in one company’s facilities

Uinta Academy in Utah practices equine therapy, telling parents that if their daughters can learn to connect with animals, they can learn to connect with people. By the time Kate left there, she said, she felt like the horses they’d trained: broken.

“I had no feelings,” she said. “I was a robot.”

The girls there were required to do what they were told without question, with a neutral expression on their faces — no sighing, no frowning, no crying, she said. Break the rules and they had to scrub the floor on their knees with a toothbrush for hours or go outside in 100-degree heat, rake moldy hay or pull weeds all day, she said. The smell of freshly pulled weeds still makes her sick.

Uinta is one of more than a dozen facilities across the country operated by Family Help & Wellness, a company which faces multiple lawsuits alleging abuse. FHW has denied wrongdoing in connection to those claims.

FHW did not respond to a detailed list of questions outlining the allegations in this story, and Uinta’s administrators did not respond to requests for comment.

In a statement to the AP, the parent company said its programs are independently operated, and the company provides funding and support while the facilities determine “clinical models, admissions decisions and day-to-day care” and abide by local licensing laws and regulations. The company said it supports legislation to tighten industry regulations and is committed to strengthening oversight and improving quality of care that aligns with evolving best practices.

“The safety, well-being, and long-term success of every young person and family are our priority,” it wrote in a statement. “We recognize this is an area of increasing public attention and scrutiny, understandably so, given the real impact on young lives.”

The stakes are extraordinarily high: In the last two years, .

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EDITOR’S NOTE — This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at .

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Trails Carolina closed in 2024 after a 12-year-old boy suffocated and the state revoked its license. Asheville Academy, which Kate also attended, closed last year. North Carolina’s Department of Health and Human Services suspended admissions after two girls died by suicide, the agency said, and the facility surrendered its license days later.

FHW’s Uinta Academy remains open. A lawsuit filed against it last year by a 16-year-old girl’s parents alleged “dehumanizing” punishments: A girl was made to strap a hula hoop around her waist to create a barrier between her and other students. Staff threatened to shave girls’ heads.

The suit alleged Uinta’s punitive culture allowed a 24-year-old employee to groom and rape their daughter. She says in the lawsuit that she didn’t tell anyone because she’d seen other girls punished after expressing discomfort with what happened to them there. Years later, that staffer pleaded guilty to trying to meet a 12-year-old girl — in reality, a police officer who posed as a child online — for sex. The facility has not yet responded in court to the allegations.

Of the four programs Kate attended, Uinta was the one that scarred her the most, she said. It was where she learned not to think.

“They’d strip away any sort of individuality,” she said. “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.”

Eventually, she submitted. She became a model student — “brainwashed,” she said. She was selected to give tours to parents considering the program for the next wave of children.

She smiled and told them she was happy.

‘Profit-driven and untransparent’ programs

There’s a lot of money to be made from adopted children in distress. The AP found at least 80 private facilities that specifically advertise they treat adoption-related issues.

The broader industry was born in Utah and remains concentrated there, but facilities have opened in rural communities across the country.

There is no federal tracking, so no one knows the number of programs or how many children are housed within them. The advocacy nonprofit 11:11 Media Impact, led by hotel heiress Paris Hilton, who has and about abuse she experienced in such facilities, estimated in 2021 that the industry enrolls as many as 200,000 kids each year, including 50,000 placed privately at the sole discretion of their parents.

Many of these businesses started as small operations, with behavioral modification approaches historically rooted in Christian teachings, experts said. Today, public and private equity companies drawn to the promise of significant profits and an endless supply of struggling kids have been acquiring centers and commercializing treatment.

The industry no longer relies exclusively on the checkbooks of wealthy parents. The COVID-19 pandemic prompted more bipartisan political support for youth mental health funding, bolstering programs that tap public taxpayer dollars via healthcare, child welfare, juvenile justice and school systems.

That reliable money flow allows investors to go “into these markets risk free,” said Raj Kumar, an analyst at the financial services firm Stephens who tracks healthcare.

Promising a healthy 20% in profit margins, residential treatment centers make money based on minimizing staffing costs and maximizing how long kids are in care, Kumar said. That’s easier to do, experts said, because there are so few regulations compared to other inpatient healthcare settings such as nursing homes.

The publicly traded company Acadia Healthcare has been scrutinized as it has come to dominate the business. Lesser known entities like FHW and Embark Behavioral Health are often backed by private equity firms, which aren’t required to disclose their inner workings publicly. Those investor groups didn’t respond for comment.

Private equity’s focus on fast profits is especially troublesome, said Eileen O’Grady, who for the watchdog organization Private Equity Stakeholder Project. She found problematic facilities often reopen under new names, which makes them harder to track and less accountable to litigation.

Aspen Education Group, for example, was once a leading player in residential treatment while backed by Bain Capital, one of the world’s largest private investment firms, which has declined to comment. Aspen sold off many properties following allegations of abuse and lawsuits. Acadia Healthcare, which didn’t respond to interview requests, and FHW picked some of them up.

In 2014, FHW rebranded Aspen’s Island View Residential Treatment Center in Syracuse, Utah, as Elevations, which lists “adoption and attachment issues” as a specialty.

Trouble followed. The AP obtained police data for the property: There were 167 Syracuse Police Department cases for Elevations in 2025 alone — more than the total during Island View’s ownership between 2005 and 2014.

O’Grady said ongoing problems at facilities like that show that the business model and treatment philosophy are “fundamentally at odds.”

“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,” O’Grady said.

In North Carolina, FHW has shifted the facades of its troubled sites, including a facility called Solstice East. That facility was rebranded as Magnolia Mill in 2024, and then merged with Asheville Academy the same year that center was shut down, according to a lawsuit filed in December by four former program attendees.

They sued the company alleging “systematic abuse, neglect, exploitation and forced labor” at Solstice East and Trails Carolina. The lawsuit claimed there was a web of LLCs that shielded the investors and owners involved, alleging such residential programs “operate as cash machines for private equity firms and investors who operate the facilities through layers of management companies.”

The company in March sought to dismiss the case, arguing that the plaintiffs were legally sent there by their parents. The company said it was “offering structured program environments governed by rules, supervision, and behavioral expectations,” court documents show.

It defended what it described as “routine program discipline and behavioral accountability mechanisms” — inherent, it said, in residential treatment settings.

“Warehouses of Neglect”

Christy Nelson, a special-education teacher, said she tried to report her concerns about the Missouri treatment facility where she worked to everyone she could think of: its corporate owner, state regulators, legislators. Nothing ever came of it, she said.

There were too few workers to keep the kids safe, she said, and kids bullied and abused each other. It was so chaotic, they could barely teach, she said. Kids spent most of their time with young, low-paid front-line employees with dismal training in mental healthcare.

The facility, Change Academy at Lake of the Ozarks, or Calo Programs, which is owned by Embark Behavioral Health, advertises as “the nation’s first adoption-specific family treatment center.”

“I started to feel like improvements were never happening and that real change wasn’t ever going to happen,” Nelson told AP. “It was extremely dysfunctional, dangerous.”

Calo sent AP statements, saying that it upholds a high standard of accountability and takes seriously its responsibilities to report any allegation of abuse. Additionally, it wrote that all new staff complete at least 40 hours of orientation before working directly with children, and said their “program completion rates and outcomes reflect the strength and effectiveness” of their approach.

“Our students arrive in crisis — many presenting with self-harm, suicidality, and aggression … Calo serves the students and families that other programs and providers have given up on,” the company said in a statement. “Calo operates under rigorous, continuous external oversight given the complexity of our population and the breadth of our funding sources — which span Medicaid, commercial insurance, adoption subsidy, school district funding, and private pay.”

Calo also said that it investigated and addressed “directly and in good faith” the concerns raised by Nelson and a second teacher that company officials “thought were valid.”

Nelson said she quit and brought her accusations to a congressional investigation into the industry, led by U.S. Sen. Ron Wyden of Oregon. The report was entitled,

It described how in facilities across the country, chronic understaffing led to improper physical restraints, a lack of mental healthcare and rampant physical, sexual and emotional abuse.

The industry, the report found, functions more like confinement for kids in trouble, rather than places where vulnerable children find healing.

Zoie Albers had never been in trouble. She was never defiant.

Adopted from a Chinese orphanage at nearly 2 years old, her parents brought her home to Tennessee. By 9, she was tormented by thoughts about how she had been given up for adoption.

Zoie started harming herself. Her parents tried doctors, different schools, sports, church, medication, hospitals — and finally, a residential treatment center in Utah called Three Points Center, which was exclusively for adoptees and operated a second facility in North Carolina.

“We wanted some place that was nurturing and caring and that would help her and respect her and just help her accept herself,” said her mother, Leslie, “and that was what they purported to do.”

Within Zoie’s first week there she watched the staff slam a boy to the ground, screaming, she said. She told the AP that the other kids tried to comfort her. Don’t worry, they’d said: This happens all the time, this is normal here.

“I don’t think this is normal, I don’t think this is OK,” she remembers thinking.

For the next nine months, Zoie said, she was careful to be as quiet and compliant as possible. Children were restrained all around her, she said. There was constant chaos. Everyone was yelling all the time.

Any child could “call a group” on someone else, which meant that person had to sit quietly as the other children told them what they don’t like, Zoie said. At the end, she claimed that the targeted child had to “take accountability.”

One girl was simultaneously restrained and shamed, she said. The girl had tried to run away and a male employee twisted her arms behind her back and pulled her to the ground, Zoie said, holding her straddled between his legs for 45 minutes while the other girls berated her for being stupid enough to run away.

Once, Zoie was unconsciously picking at scabs from self-harming. Someone called “a group” on her, she said. For more than a half hour, she said, she cried as the other girls told her she was “attention-seeking” and selfish.

She had to agree, she said, to make it stop.

Not long after Zoie left, in 2022, Three Points Center’s license was put on conditional status for, among other things, violating a Utah law that prohibits “cruel, severe, unusual or unnecessary” punishment.

The facility shuttered last year. Its founder, Norm Thibault, declined to comment for this story. He moved on to another program that treats adoption issues in young adults.

A hard life — then punishment, suicide

Some facilities shut down after children die there. Some don’t.

Biruk Silvers was 17 years old.

He and his older brother, Yabi, had had a hard childhood in Ethiopia. This is the story Yabi tells: an abusive, alcoholic father and a mother who fled. Life on the streets. A new beginning — Biruk was 7 and Yabi 11 when they were brought to the Chicago suburbs by their new parents.

Yabi said Biruk was curious, he read everything: novels, history, the Guinness Book of World Records. He cared about all creatures, including ants. He liked to watch them march along in their lines and got upset when their parents called the exterminator.

Biruk arrived at Discovery Ranch in Utah in April 2024 to be treated for depression, suicidal tendencies and trauma.

Blaine Baily and Biruk shared a bunk bed, Biruk on top and Blaine on the bottom, and they became as close as brothers, said Blaine, who is also adopted.

Blaine said Biruk was positive and outgoing, but routinely punished. He told his parents he was tackled and put in a choke hold, according to a lawsuit his family filed. The facility denied that in court. They took his books away as punishment, the lawsuit alleged. He lost his privilege to sit on furniture and had to sit on the floor.

On Nov. 5, 2024, Biruk was found dead hanging from a belt, tied to a post on the bunk bed.

The family lawsuit says that the facility started Biruk on a new medication for depression on Oct. 18 that came with the caution: “WARNING: SUICIDAL THOUGHTS AND BEHAVIORS” in kids and young adults.

On Nov. 1, he met with his therapist again and said he wanted to kill himself, the family wrote in their lawsuit. Discovery Ranch denied in court documents that it had been warned Biruk was actively suicidal. The school did not respond to requests for comment, sent via email and voice message left for its director; attorneys representing the school in litigation also did not reply.

The Utah Department of Health and Human Services conducted an investigation into Biruk’s death. It cited Discovery Ranch for compromising the safety of its children, failing to supervise him and not following its own suicide prevention policy. Discovery Ranch was fined $10,300.

The state temporarily barred the facility from taking any more children, which lasted just a few months.

Biruk’s death wasn’t the facility’s only infraction. Licensing records obtained by the AP show the state repeatedly issued the facility warnings: There was the employee who admitted punching a child in the stomach. There was the incident where two employees took hold of a child on the campus where the students raised calves. A third staffer stuck two fingers into the child’s mouth.

“How does that cows--- taste?” the staffer allegedly demanded.

Discovery Ranch was allowed to resume normal operations after passing two follow-up inspections.

Biruk’s adoptive parents recently settled their lawsuit, signed a non-disparagement agreement and said they could not talk about what happened to their son. Discovery Ranch has defended its reputation: It filed a lawsuit in January against a mother who reported to the state of California and posted online that her son was abused there, demanding $5 million because the facility claims her allegations were false or misleading.

Blaine, Biruk’s friend, remained at Discovery Ranch for several weeks after the death of the boy everyone called “B.” Until he left, he slept in the same bed where his friend died.

“Every night,” he said, “all I could envision was him hanging from that bed post.”

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Galofaro reported from Kentucky and Tennessee. Ho reported from California, Missouri and Washington.

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The Associated Press receives support from the Public Welfare Foundation for reporting focused on juvenile justice. The AP is solely responsible for all content.