JOHN YANG: Every year, more than 50,000 children in foster care across the country are sent to residential treatment facilities, some for mental health services, but some simply because the foster care system is out of room.

A Senate investigation looked into four of the largest operators of these facilities and found that children in their care are sometimes subjected to abuse and neglect.

Here's Ali Rogin.

ALI ROGIN: Children in the care of residential treatment facilities are at risk for sexual physical and emotional abuse as states failed to track mistreatment in centers run by some of the country's largest behavioral health companies.

These places house children and teens who need specialized care and mental health treatment as well as young people from foster care and the juvenile justice system.

A recent Senate investigation revealed that despite receiving payments from Medicaid and taxpayer funded programs, many of them have put profit before safety.

We spoke to a handful of people who lived in these types of facilities when they were younger.

AMAL KHAROUFI: There was no like immediate need for me to be in a treatment facility.

It was just my foster parents didn't want to deal with me anymore.

And there was nowhere else to place me so it was just easiest place to put me in.

ANDREA MILLER: My sister and I abruptly removed to a residential treatment facility.

We were placed in this high level facility not because of any behavioral concerns, but because there was a lack of any other placement options.

MIRIAH PAYNE: My mom was working three jobs at the time and was really trying her best to, you know, give us what we needed.

And she looked at a treatment facility because my sister was not coming home, she was running away with her friends and you know, she wanted better for her.

So she had admitted her into one of these facilities.

STORMY LUKASAVAGE: My first night in that group home, one of the staff ended up fine the next day, just sleeping with a bunch of youth in the bathtub.

That was just day one.

JULIA STUMLER: Staff was monitoring you 24/7.

They check on you every 15 minutes at night.

You know during the day, you're not allowed to just like walk outside.

ANDREA MILLER: Going in with someone that you have a very close bond with we weren't allowed to touch so there was no hugging allowed, you know, even in moments of discomfort for us to fall in line or just stay well behaved.

A lot of times they would threaten to separate us.

AMAL KHAROUFI: I don't understand why certain people are hired into these facilities, but it's very obvious that they shouldn't be.

I was forced put on drugs and overly medicated at eight years old having to wean myself off of it was hard to.

JULIA STUMLER: But the staff just really aren't sure what to do or how to handle a situation and it seems immediate, like they'll resort results to like giving someone a shot.

ANDREA MILLER: They will threaten you that they're going to put you in a hold or physically restrain you for not doing something that they want you to do.

MIRIAH PAYNE: She wasn't provided what she was actually needed she was more reprimanded and that's not what facilities should be.

STORMY LUKASAVAGE: My group home experience is something that I still carry with me to this day, my body is covered in scars from some of those fights.

JULIA STUMLER: It was really, really hard time to go through just because like as a child, it's like, who do you tell in these facilities, everyone's so interconnected.

AMAL KHAROUFI: People need to really get down in there and figure out what's going on in these facilities and what's not working, because obviously, something's not working.

STORMY LUKASAVAGE: These are going to be the citizens of tomorrow, that go through this system.

They could be anyone's kids.

That's how easy it is to be forgotten about.

MIRIAH PAYNE: These are people that may need extra help and extra care.

And we have to make sure we're paying attention to that.

ALI ROGIN: For more on the conditions that some young people face in these residential treatment facilities I'm joined by Sixto Cancel founder and CEO of Think of Us, a nonprofit aimed at improving conditions for youth in child welfare systems.

Thank you so much for being here.

I want to ask you first, what problems were these sorts of residential treatment facilities created for?

And is there agreement that these types of facilities are the best way to address these problems?

SIXTO CANCEL, CEO, Think of Us: You know, there are young people who experienced foster care and at no fault of their own, they have been removed and placed in foster care because of extreme physical abuse, sexual abuse, emotional abuse.

And there are times where we need to address that trauma and short term quality residential treatment is needed.

But that's not what we're seeing today.

What we're seeing today is that there are states and young people being put in facilities where it is as a housing option.

ALI ROGIN: Many of the people that we spoke to said that these facilities are like prisons, what are the conditions there?

SIXTO CANCEL: There are research that shows that when young people aged out of foster care, but they are two times more likely to experience PTSD than an Iraq war veteran.

Our young people told us stories about how when they woke up, they were subjected to a strict schedule, make forced to eat things restrained, sedated, that the rules were so strict that they couldn't actually live life.

ALI ROGIN: And this Senate investigation used many of the findings from your own report, which featured firsthand accounts from people who have been through this system.

Why is it so important to focus on the voices of the people that went through the system?

SIXTO CANCEL: For decades, there has been this argument about whether children need to be raised in families or whether they can be raised in facilities responsibly.

But when we heard the stories of every single one of those young people, whether it's our report or other reports from other sectors of young people living in these facilities, what we heard was a great injustice, that they were maltreated that they were beaten on by staff that they were sexually abused by others in those facilities.

ALI ROGIN: Why is it so difficult to gather the evidence required to really show the conditions in these facilities?

SIXTO CANCEL: We have to be believed, even when I was 13.

And I was trying to speak out about the abuse that I was experiencing in a foster home, I had to literally tape a recorder to my chest, to be able to get the evidence, the system is broken, there's no way that we can fundamentally say, hey, this is happening to me.

And I need you to investigate.

And this is why we need Congress to make sure that they're putting in the levers for us to be able to have a voice that is obligated to be heard.

ALI ROGIN: The issue here seems to be endemic to the business model, where are these facilities are turning massive profits is that part of the issue?

SIXTO CANCEL: Facilities get paid for how many beds are filled per night, these facilities on average are making $1,000 per night per kid.

So if there's not a kid sleeping in that bed, they don't get to be there.

One facility takes $30 million to run.

And yet they're bringing in over $200 million a year.

ALI ROGIN: Part of the issue also seems to be that states are not doing a good job of monitoring abuses at these facilities, what needs to change there?

SIXTO CANCEL: States need to hold residentials accountable.

But most importantly, states need to use the option that works.

The option that works is placing children with their family members.

It shows that they have less behavioral health issues, it shows that it's much more productive to society.

ALI ROGIN: It really sounds like part of the issue is relieving the pipeline of children that are sent to these facilities.

If you remove some of the stress on the system, you get the children who really need that care into the facilities and others, as you've been saying into foster situations where they're being looked after by a member of their own families or other kin.

SIXTO CANCEL: Faiths are struggling to find enough foster parents.

But the reality is, is that these children have actual family members who can step up for them.

So if we place those children with the right supports the nonprofit's who can come out and support those families, then we won't see many of them go into these facilities.

In fact, the federal agency over Child Welfare said that over 40 percent of these children don't actually need to be in a residential treatment center.

ALI ROGIN: We heard back from two of the companies investigated by the Senate, one of them Universal Health Services said the Senate report is quote, incomplete and misleading and provides an inaccurate depiction of the care and treatment provided.

Another group Devereaux claims The report's findings do not apply to them saying the facts disprove any suggestion of unmediated or systemic abuse or neglect at Devereaux.

What do you make of those responses do you think these organizations are being held accountable?

SIXTO CANCEL: What I would tell Congress and what I would tell the American public is to believe the people who have been sexually abused, believe the people who have been physically abused.

This is not a one off case.

There is a systemic issues within these companies and there are records and human beings who will tell you what they have experienced.

ALI ROGIN: Sixto Cancel founder and CEO of Think of Us, thank you so much for being here.

SIXTO CANCEL: Pleasure is mine.