When children repeatedly run away from a residential treatment center, the question should not end with how to stop them from leaving. Someone should also be asking why they are so desperate to get out.
A recent investigation by The Marshall Project raises that question about the Fox Run Center for Children and Adolescents, a 100-bed residential treatment facility in St. Clairsville, Ohio. Fox Run houses children as young as five, including children placed there by parents, foster care agencies, and juvenile courts.
The investigation describes children fleeing into fields, crossing a highway, attempting to hitchhike, and deliberately acting out in hopes that police would take them to juvenile detention. But the accounts of children running away were only part of what reporters found. Police and state records documented assaults, sexual assaults, suicide attempts, allegations of violence by staff, unsafe restraints, medical neglect, and concerns about understaffing.
Fox Run’s CEO told The Marshall Project that the facility serves children with complex behavioral health needs and that incidents involving aggression, self-harm, suicide, and attempts to leave are not uncommon among this population. He also said the facility investigates concerns and takes corrective action when warranted.
But the investigation raises a broader issue relevant to residential treatment facilities across the country: behavior that is attributed to a child’s psychiatric condition or behavioral history may also be communicating something important about the environment in which that child is living.
A Child’s Behavior Cannot Be Viewed in Isolation From the Facility
Children are generally placed in residential treatment because they already have significant needs. Some have histories of abuse or neglect. Others have experienced foster care disruption, psychiatric hospitalization, suicidal behavior, or involvement with the juvenile justice system.
Those histories can make it easy for adults to characterize what happens inside a facility as another manifestation of the child’s existing behavioral problems.
A child who runs away is “eloping.” A child who fights staff is “aggressive.” A child who screams during a restraint is “dysregulated.” A child who repeatedly calls home may be described as manipulative or resistant to treatment.
Those descriptions may capture part of what happened. They do not necessarily explain why it happened.
The Marshall Project found that some Fox Run residents described trying to escape conditions they considered intolerable. One former resident recalled that children would intentionally misbehave when police arrived because they hoped to be taken to juvenile detention instead. Police records reviewed by the reporters also documented children fleeing the facility and family members requesting wellness checks after children reported abuse.
When children living in a controlled environment repeatedly try to escape it, their behavior itself may warrant scrutiny.
What Was Happening Inside Fox Run?
The scale of the reported incidents is significant.
According to The Marshall Project’s review of five years of police records, law enforcement responded to Fox Run, on average, once every 21 days. Those records included responses involving 52 assaults and 17 sexual assaults. Some involved allegations of physical or sexual violence by staff.
The investigation also describes serious concerns about supervision. In one 2022 incident, an 11-year-old allegedly sexually assaulted a 9-year-old while other children barricaded a door. A nurse reportedly told police that understaffing sometimes resulted in children being left unattended.
The younger child was initially taken to a hospital, but did not receive the ordered forensic examination that day. According to the police records reviewed by The Marshall Project, the examination was delayed while staff sought permission from an out-of-state guardian.
State inspectors later found that Fox Run mishandled a different sexual misconduct complaint. After a male resident exposed himself and touched a girl, inspectors found that staff encouraged the girl to work on her “assertiveness skills” rather than adequately addressing the other resident’s conduct.
These examples illustrate why abuse in residential treatment centers is not limited to misconduct committed directly by an employee. Facilities responsible for children may also face serious questions when inadequate supervision permits resident-on-resident violence, staff fail to respond appropriately to reports of sexual abuse, or children do not receive necessary medical care after an assault.
Restraint Is a Safety Intervention, Not a Form of Discipline
Physical restraint presents another recurring concern in residential treatment.
Ohio regulations governing behavioral health providers permit restraint or seclusion only in response to a crisis involving an imminent risk of physical harm when no other safe and effective intervention is available. The regulations specifically prohibit using restraint or seclusion to compensate for inadequate staffing, as punishment or retaliation, as a substitute for treatment, or simply as a behavior-management technique.
Ohio also prohibits prone restraint and the use of mechanical restraints on people under 18.
The Marshall Project reported that Ohio inspectors had repeatedly cited Fox Run over restraints. In one case, a child younger than nine was reportedly restrained for an hour—twice the state maximum identified by the investigation. Inspectors also documented four children restrained for substantial periods even though records described them as calm, non-combative, and quiet.
A facility does not have unlimited authority to physically control a child merely because that child has a psychiatric diagnosis or difficult behavior. Whether a particular restraint was lawful or appropriate depends on the circumstances, including what prompted it, what alternatives were attempted, the technique used, its duration, the child’s condition during the restraint, and whether staff continued the restraint after the emergency had passed.
For a child who has already experienced trauma, improper restraint can become another source of harm inside a facility that was supposed to provide treatment.
Oversight Depends on Regulators Knowing What Is Happening
Perhaps one of the most concerning findings in The Marshall Project’s investigation involves information that may never have reached state regulators.
Reporters compared police records with state incident data and identified at least 40 incidents involving police that did not appear in the state records they reviewed. The missing incidents included arrests or transfers to juvenile detention, assaults, and hospitalizations or emergency medical evaluations.
Fox Run’s CEO told The Marshall Project that a state review determined some incidents were not reportable and others were appropriately reported, although he did not specify which incidents fell into each category. He also noted that Fox Run had not been cited for violating reporting law in connection with the incidents identified by the reporters.
The larger problem extends beyond a single facility. A regulatory system cannot identify patterns it cannot see.
Ohio law gives the Department of Behavioral Health authority to inspect licensed residential facilities, including in response to complaints. The Department may review facility records, interview residents and staff, require correction of deficiencies, suspend admissions, and, in specified circumstances, refuse to renew or revoke a facility’s license.
But oversight mechanisms depend on accurate information reaching the people responsible for oversight.
When serious incidents are missing from regulatory records, families, caseworkers, courts, and agencies making placement decisions may be working with an incomplete history of the facility.
Children in Residential Treatment Retain Legal Rights
Placement in a residential treatment facility does not erase a child’s rights.
Ohio’s behavioral health regulations recognize rights that include protection from physical, sexual, and emotional abuse, neglect, inhumane treatment, and sexual exploitation. Residents also have rights concerning dignity and privacy, treatment in the least restrictive feasible environment, and freedom from restraint or seclusion except under specified circumstances.
Facilities are also subject to grievance requirements.
These protections are particularly important for children who cannot simply leave. A child placed through foster care or a juvenile court may have little control over where they live. Even children placed voluntarily by parents may be geographically distant from their families and dependent on staff for communication, transportation, medical treatment, and access to the outside world.
That dependence makes meaningful outside oversight essential.
A Facility’s Records May Tell Only Part of the Story
For families and former residents trying to understand what happened inside a residential treatment center, the facility’s own records are an important starting point—but they may not be the only source of evidence.
The Fox Run investigation is a striking example. Reporters compared state inspection records, facility incident data, police reports, interviews, and other public records. The picture that emerged was more complete than any one source could provide.
A legal investigation may similarly involve records maintained outside the facility: police reports, emergency medical records, hospital records, state inspection findings, licensing records, child welfare records, court records, communications with caseworkers, and documentation from outside medical or mental health providers.
For children placed through foster care, records concerning who selected the facility and what information was available when placement decisions were made may also become relevant.
The chronology is often critical. It can show whether similar incidents occurred before a particular child was harmed, whether regulators or facility leadership had identified deficiencies, what corrective measures were required, and whether those problems continued.
Abuse in Residential Treatment Can Raise More Than One Legal Issue
There is no single “residential treatment center abuse” claim that applies to every case.
Depending on the jurisdiction and facts, abuse or neglect in a facility can implicate state tort law, licensing and regulatory requirements, disability discrimination laws, constitutional protections, or other federal and state law. Claims may involve the conduct of individual staff members, the facility itself, a corporate operator, or, in some circumstances, government entities responsible for a child’s placement or care.
The legal analysis also changes depending on how the child entered the facility. A privately placed child, a child in state custody, and a young person placed through the juvenile justice system may have different potential claims.
For that reason, identifying what happened is only part of evaluating a case. It is also necessary to determine who had responsibility for the child, what legal duties applied to those individuals and entities, what they knew about conditions at the facility, and what they did with that information.
When Children Are Desperate to Leave, We Should Pay Attention
One of the most powerful aspects of The Marshall Project’s reporting is that it reframes conduct that institutions can too easily dismiss as misbehavior.
Children ran away from Fox Run. They fought. They harmed themselves. Some reportedly tried to get arrested because juvenile detention seemed preferable to returning to treatment.
Those behaviors do not, by themselves, prove that a facility is abusive. But neither should they automatically be treated as proof that the problem lies solely with the child.
A residential treatment center has enormous control over a young person’s daily life. When children repeatedly report abuse, flee the facility, suffer injuries during restraints, experience violence from other residents, or require emergency intervention, those events deserve careful examination—particularly when the children involved have limited ability to advocate for themselves.
ALM Law represents children and survivors harmed in foster care, residential treatment, and other youth-serving systems. When there are concerns about abuse, neglect, unsafe restraint, sexual violence, or systemic failures inside a residential facility, a legal investigation can help reconstruct what happened inside the facility and determine whether there are viable claims against the individuals or entities responsible.