Psychiatric Residential Treatment Facilities (PRTFs) are designed to provide therapeutic services and programs for children and youth who struggle with psychiatric, behavioral, and emotional disorders and challenges.
The Sound of a “Safe Therapeutic Environment”
DRA’s monitoring and investigation team monitors and conducts complaint investigations at Arkansas’s psychiatric residential treatment facilities (PRTFs).
Video Now Available
View video clips of law enforcement responses to psychiatric residential treatment facilities (PRTF) through the lens of body worn cameras.
Documents Available for Search by Facility
What is a Psychiatric Residential Treatment Facility (PRTF)?
According to the Arkansas Department of Human Services, a PRTF is a “separate standalone entity providing a range of comprehensive services to treat the psychiatric condition of residents under the age of 21, on an inpatient basis under the direction of a physician. The purpose of such comprehensive services is to improve the resident’s condition or prevent further regression so that the services will no longer be needed.” In short, these facilities are designed to provide therapeutic services and programs for children and youth who struggle with psychiatric, behavioral, and emotional disorders and challenges. The services provided are less medically intensive than those you’d find in a psychiatric hospital or the psychiatric unit of a general hospital.
There are approximately 800 beds in PRTFs across the state. Most, but not all, of the 13 PRTFs in Arkansas are private for-profit entities. Their marketing materials boast the use of “empirically-validated, scientifically-sound treatment methods”…”individual, family, group, and recreational therapy”…”a highly structured” program in a “nurturing environment.” Treatment is said to be administered by multidisciplinary teams of highly trained professionals in a residential setting.
PRTF’s are only one kind of residential facility.
What is the PRTF Database?
Information from the various entities charged with oversight of these facilities is not coordinated or tracked, and is therefore not available in one place. This makes it impossible for guardians, judges, other states, and placement agencies to make informed decisions about the placement of youth.
DRA receives and reviews records and incident reports that are retrieved through our access authority and through Freedom of Information Act (FOIA) requests. The information on each facility compiled in this database is all information obtained through public information requests. This information is available to the public but has not previously been correlated and published or otherwise easily accessible to the public. By bringing different types of publicly available information together into one central location, it will also be easier for policymakers and concerned citizens to access information and focus reform efforts where they are most needed. By gathering and publishing the publicly available documents contained within the PRTF database, we are forcing transparency that will motivate programs to make improvements, either on their own or through external pressure, leading to safer, more therapeutic programs for youth.
What is included in the PRTF Database?
- Basic information about each facility, such as location, capacity, number of therapists, and use or restraint, seclusion, and chemical restraint, etc.;
- Complaint and Validation Surveys conducted by the Department of Human Services Office of Long-Term Care (OLTC);
- Licensing Compliance Records, Complaint Investigations, and Notice of Incidents created by the Department of Human Services Placement and Residential Licensing Unit (PRLU);
- Police Incident Reports for responses to PRTFs;
- Health Services Permit Agency reports based on their yearly survey of PRTFs;
- Child Welfare Agency Review Board meeting transcripts, available recordings, and copies of the only two actions ever taken to reprimand a facility; and
- Medicaid Inspection of Care reviews.
How do I use the PRTF Database?
You can access all documents for a facility by clicking on the facility name. You can search within each facility page to narrow results that show only reports that mention a keyword such as abuse or only a type of document such as only police reports. Documents are currently archived from 2019-present.
You can use the Database to:
- Access documentation from multiple agencies charged with oversight in one central location.
- Better understand the scale of abuse, neglect, and licensing violations in these facilities.
- Learn more about the disjointed regulatory system that dead ends at the Child Welfare Agency Review Board (CWARB).
- Understand the current state of under-regulation of the PRTFs and the need for reforms.
Who has oversight of the PRTFs?
Multiple divisions within the Arkansas Department of Human Services and outside agencies are responsible for aspects of oversight or investigations into these facilities.
Placement and Residential Licensing Unit (PRLU)
Placement and Residential Licensing Unit (PRLU) is a unit of the Division of Childcare and Early Childhood Education. They are responsible for enforcing the Arkansas Minimum Licensing Standards. This unit is responsible for monitoring the facilities and responding to and investigating complaints involving the Arkansas Licensing Standards.
Child Welfare Agency Review Board (CWARB)
The Child Welfare Agency Review Board (CWARB) publishes and has the authority to amend the rules setting minimum licensing standards for the operation of child welfare agencies. They govern the granting, revocation, refusal, conversion, and suspension of licenses. They also have the authority to impose civil penalties. Members of this board are appointed by the governor and with the exception of an appointed representative the Division of Children and Family Services (DCFS) are all representatives of licensed placement or residential agencies that are regulated by this board. To date, the board has taken no adverse action against any agency, including all of the classifications listed above, ever. That means:
- No agency has been fined;
- No agency’s license has been suspended or placed in a probationary status; and
- No license has ever been revoked, for any reason other than inactivity.
The CWARB meetings are public meetings. Prior meeting agendas, transcripts, and recordings are available here.
The Office of Long Term Care (OLTC)
The Office of Long Term Care (OLTC) implements the Centers for Medicare and Medicaid Services (CMS) regulations regarding restraint and seclusion. They review facilities once every 5 years and respond to complaints received regarding restraint and seclusion.
Health Services Permit Agency
The Health Services Permit Agency is responsible for issuing Permits of Approval (POAs) for several types of facilities including Residential Care Facilities and Psychiatric Residential Treatment Facilities. There has been a moratorium on the creation of additional PRTF beds in Arkansas since February 1, 2008. However, beds designated as exclusively for out-of-state residents have been exempted from the POA process and therefore have been able to proliferate in Arkansas despite the moratorium.
In furtherance of their objective to “evaluate the availability and adequacy of health facilities and health services” they have been tasked with surveying the PRTFs annually and publishing a report. Provider response to the survey has not been required and only between 4 and 8 providers have responded in the 5 reports published since 2013. At the time of the last report, 2019, there were 12 PRTFs. The providers that have chosen to respond each year has also not been consistent. A copy of the available reports can be viewed by clicking here.
Arkansas Child Abuse Hotline/Arkansas State Police Crimes Against Children Division (CACD)
Arkansas Child Abuse Hotline and the Crimes Against Children Division (CACD) of the Arkansas State Police Maltreatment allegations that are called into the Arkansas Child Abuse Hotline and then investigated by either the Crimes Against Children Division (CACD) of the Arkansas State Police or DHS are not reflected in the records provided here, other than a few referrals to local law enforcement agencies that are reflected in the reports of those agencies. Currently, substantiated maltreatment allegations originating in residential facilities are not being documented or tracked by facility by any agency or board. The abuse is almost exclusively attributed to the staff member or members involved and not to the facility.
Medicaid Inspection of Care
An Inspection of Care (IOC) must be performed at least once a year for every inpatient psychiatric provider, consistent with 42 CFR Part 456, Subpart I. The IOCs are to be performed by an independent contractor and they must include “personal contact and observation of each Medicaid recipient” and a “review of each beneficiary’s medical record.” At the end of 2019 it was determined that the contract for IOCs intended to cover PRTFs included language that limited its scope and excluded PRTFs. Only 2 PRTFs were reviewed in 2019 before the inspections were discontinued. A new contract was not put in place until May 1, 2021. The inspections that have resumed under the new contract have been limited to Medicaid Fee for Service clients and do not include clients that receive Medicaid benefits through a Provider-Led Arkansas Shared Savings Entity (PASSE). So far, all Arkansas Medicaid beneficiaries in PRTFs have been enrolled in a PASSE, therefore these inspections do not include client or guardian interviews, client record review, or medication pass observation. The IOCs can be viewed in our database.
Local Law Enforcement Agencies
Local Law Enforcement Agencies are often called to some facilities. Reasons for calls include elopements (runaway or missing youth), suicide attempts, overdoses, assault and battery, and agency assistance with controlling residents or maintaining order. Incidents investigated through the Child Abuse Hotline are also referred to local law enforcement for criminal investigation and prosecution.