This article was published in partnership with The Marshall Project, a nonprofit news organization covering the U.S. criminal justice system.
Paitin Pahoundis jolted awake, a siren blaring in her ears. Her friend Samantha Primeau was in her room. It was time. The other girls, Samantha told her, were gone. They had jammed a sprinkler, triggering the fire alarm and filling the hallway outside with water.
Their escape plan was working. But there was a problem: Paitin didn’t have shoes.
The checkered Vans and the white Jordans with the bright orange stripes that her father had bought her before he went to prison, the ones she meticulously kept in mint condition, had been taken by staff and locked in another room, along with the rest of her possessions. She was on “no personals” status for not following the rules.
But, Paitin wanted out, and this was her chance.
As they walked out of the building and into a snowstorm, Paitin remembers a staff member standing in a doorway. She looked at Paitin and said, “If you want to go, just go.”
Both teens said they dreamed of escaping the staff members who forcibly held them down hard enough to leave bruises, the blood in the hallways from kids cutting themselves, the girls strangling themselves with bedsheets, the adults who insisted no family wanted to adopt them and who looked through them like they were already gone.
On that January night in 2022, the girls careened down the hill below the Fox Run Center for Children and Adolescents, their pumping adrenaline temporarily masking the frigid Ohio air. Not even Paitin’s soaking wet socks slipping off in the snow could deter her descent toward freedom.
Barefoot, Paitin crossed the highway that snakes along the back end of Fox Run’s grounds, dodging cars and climbing over medians. As they considered going to a nearby hotel, things started to fall apart.
Electric pain ripped through Paitin’s frozen feet. Samantha felt herself getting sleepy and slowed to a crawl, wishing she could pass out right there. They had nowhere to go. All they could do was turn back in failure.
At the top of the hill, police dragged Paitin into a squad car. She pounded the window, screaming in agony. Before she was hospitalized, Paitin recalls a staff member walking up and peering in. “I bet you will never do that again, will you?”
She would, she told herself. “I would rather be dead outside in the snow.”
Paitin and Samantha desperately wanted to escape what was supposed to be a therapeutic haven for kids with mental health and behavioral issues. Instead, they found themselves confined for months — in Paitin’s case, years — inside an institution where they witnessed kids routinely attacking and sexually assaulting each other, anarchic riots by children pushed to the breaking point, and suicide attempts using makeshift weapons fashioned from scraps of metal or bedsheets, according to police and state records and numerous interviews.
They endured violence from some of the adults charged with their care, medically unnecessary sedative injections and long, painful periods of being physically held down by staff. Many of those same episodes, some of which ended with children in handcuffs or ambulances, appear to be missing from the state’s own oversight records, according to an analysis by The Marshall Project. This leaves parents, caseworkers, regulators, and the judges deciding where to place kids in foster care with an incomplete picture of what was happening behind the facility’s locked doors.
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As the number of youth prisons dwindles in a nationwide push for rehabilitation over punishment, the juvenile justice system continues to place kids in residential treatment facilities like Fox Run. However, advocates say the facilities are “virtually indistinguishable from incarceration.” Some, like one in Pennsylvania with a record of child abuse, have secured contracts to house migrant children amid the Trump administration’s immigration crackdown.
Fox Run, one of Ohio’s largest youth residential treatment centers, is owned by Universal Health Services, a Pennsylvania-based Fortune 500 company. It’s a privately operated, 100-bed facility housing boys and girls as young as 5 from as far away as Alaska. Many of the youth are sent by their parents, foster care agencies, and juvenile courts. County governments across Ohio have paid Fox Run millions of dollars to house children who have complex mental health or behavioral needs, according to county contracts.
Kids were sent to Fox Run following suicide attempts or fights while in foster care. Others were placed by their parents at a doctor’s recommendation after a suicide attempt. Some, like Paitin, who lived at the facility for three years, found themselves at Fox Run because no foster parent would take them.
To understand what was happening inside Fox Run, The Marshall Project reviewed hundreds of pages of police and state inspection reports between 2020 and 2025, obtained through public records requests, and interviewed seven women previously housed in the facility. These records and interviews told stories of children desperate to escape, fleeing into cornfields, sprinting into traffic, and attempting to hitchhike. Former Fox Run staff members said the youth turned violent inside the facility because they were pushed to their limit. Many eventually ended up in juvenile detention as their behavior escalated. They thought ending up behind bars, like facing the frozen woods, would be an improvement over Fox Run.
In a statement, Fox Run CEO Randy MacKendrick said the facility serves children with “complex behavioral health needs” and that incidents involving aggression, self-harm, suicide and attempts to leave the facility are “unfortunately not uncommon among this high-acuity population.”
“Fox Run cooperates with state regulators and other oversight agencies, investigates concerns, and implements corrective actions whenever warranted,” MacKendrick added. “When concerns arise, they are reviewed promptly and, when appropriate, reported to the appropriate regulatory and law enforcement authorities.”
While officials from the Belmont County Sheriff’s Office diligently documented desperate attempts by children to get out of Fox Run, often through violence, many of those incidents were absent from a database maintained by the Department of Behavioral Health, the state agency charged with licensing and inspecting the facility. The Ohio Department of Behavioral Health and Belmont County Sheriff’s Office did not respond to multiple requests for comment.
What they’re running from
Two years after Paitin and Samantha briefly considered seeking help at the nearby hotel, a 12-year-old trans boy walked into its lobby.
He fled Fox Run after a girl entered his room while he was sleeping, pressed a pillow over his head and wrapped her hands around his neck, according to a sheriff’s office report. Another youth stole a staff member’s keys and let the boy out.
He ran down the hill, crossed the highway and reached the hotel, where he told workers he was a runaway. They called the police. He was returned to Fox Run and arrested for theft. He had taken the keys with him when he fled.
Over the five years of police records reviewed by The Marshall Project, law enforcement officials visited the facility, on average, once every 21 days. They went for 52 assaults and 17 sexual assaults; some of those cases involved allegations of physical and sexual violence by staff. Police also responded to calls for unruly behavior or kids running away, or went to the facility after family members called for wellness checks because they couldn’t reach their children, or because their children reported abuses.
In March 2022, a staff member reported to police that an 11-year-old “forcibly sodomized” a 9-year-old boy while several other youths barricaded the door with a mattress. A Fox Run nurse told a detective that understaffing meant staff frequently left the floor “leaving the juveniles unattended.” Others said workers might have been out on smoke breaks.
The child was initially taken to a nearby hospital, but the facility lacked anyone certified to conduct a forensic examination. A nurse ordered a transfer to a hospital with trained personnel, but the child was instead returned to Fox Run without receiving a forensic exam.
The next day, when the nurse realized the child had missed the appointment, she contacted the police, reporting significant bruising to the face and rectal area. She said Fox Run staff delayed the child’s exam while waiting for permission from an out-of-state guardian and expressed serious concern for the child’s well-being, according to a sheriff’s office report.
When an officer returned to Fox Run, they found staff members were unclear on procedures for handling sexual assault allegations. It was only when the officer ultimately contacted the child’s out-of-state caseworker for verbal consent that the process of securing the necessary exam moved forward — a day later than the nurse’s order.
Two years later, state inspectors found Fox Run mishandled a separate sexual misconduct complaint — with staff encouraging a girl to work on her “assertiveness skills” after a male resident exposed himself and touched her, instead of addressing the boy’s actions.
Police also documented cases of staff directly causing harm to children.
In 2022, a staff member “violently” kicked an 11-year-old and after she was fired, she admitted to police that “she had done wrong.” She pleaded guilty to assault and was sentenced to 180 days in jail. In 2024, another staffer was terminated when he shoved his elbow into a boy’s mouth, leaving a visible red mark, after the boy hit him with a broom and called him a racial obscenity.
Last year, state inspectors discovered a child with a chipped tooth was not taken to a dentist for more than two months, nor were they given their prescribed antibiotics. Fox Run management subsequently reported a staff nurse to the state nursing board over the incident. State records indicate several suspected abuse cases in which MacKendrick, or another manager, personally called police, fired employees or notified other authorities.
Abigail, who was placed at Fox Run in late 2020 after a suicide attempt and asked to be identified only by her first name, remembers hearing other girls, including Paitin, screaming while being physically restrained by staff.
Legally, residential treatment staff can physically restrain a child by holding them to stop them from moving, typically because they believe the child is a danger to themselves or others. Sometimes staff will hold kids on the ground, against a wall or bend them over from behind. The use of mechanical devices — like belts, straps or harnesses — to restrain anyone under the age of 18 is prohibited in the state of Ohio and The Marshall Project’s review of state oversight reports and police records did not uncover evidence of these kinds of mechanical restraints being used.
“You just hear [her] screaming like, ‘I can’t breathe. You’re hurting me,’” Abigail said. “You’re listening to this, and there’s nothing anybody can do, and we’re all just like, in the room. I was sobbing. There were a lot of other people crying. People are trying to comfort other people … You’re just exposed constantly to violence from staff, violence from kids.”
Isabella Ramirez, who also lived in Fox Run with Paitin, said that kids would regularly misbehave in the hopes of being sent to juvenile detention. “At Fox Run, we begged the officers. We’d be bad in front of the officers just so they’d take us.” Isabella, who also had traumatizing experiences at several other residential treatment centers throughout her teens, recalled. “But they couldn’t take no more because the cells were full.”
Recalling when she was held down by Fox Run workers, Isabella said, “[My skin] was purple. And I could get gasps of air out, saying I could not breathe.” Memories of the younger children at Fox Run, ages 5 to 6, who were held in what she said was called the “Dreams Unit,” still haunt her.
“Grown men would throw them like ragdolls,” she said of the children. “They’re just so little. They’re scared.”
Last July, a 15-year-old girl told a staff member, “I will do whatever I can to get the fuck out of this place,” after using metal brackets from the ceiling to cut her arm and threatening to cut staff members, according to a sheriff’s office report.
In 2021, a teenager who was denied the use of crutches by Fox Run staff, “immediately begged not to be taken back to the facility” after a police officer called for an ambulance to treat her injured leg and self-harm injuries.
If you spent time in a youth residential treatment center, you are legally entitled to request official records about what happened to you. Learn about how to do that here.
Fox Run reported 126 suicide attempts to state inspectors from January 2022 to June 2025, a number that Marissa C. Nardi, lead counsel at youth advocacy nonprofit Children’s Rights, said “is not normal” and should “deeply alarm the state and prompt a thorough investigation.”
Children who attempted suicide at Fox Run sometimes found themselves behind bars with criminal charges because they threatened or attacked staff after wrapping bedsheets around their necks, cutting themselves or trying to swallow screws.
“If kids locked in a treatment facility are being traumatized instead of treated, to the point of regularly attempting suicide, fleeing into the woods, or seeking incarceration as a safer option, there is no acceptable justification for the state to keep placing children there,” Nardi said.
Using detention as a response to youth acting out in distress is a system failure, said Jeffrey Shook, a professor of social work, law and sociology at the University of Pittsburgh. Once children are in these systems, behavior gets criminalized, leading to deeper justice involvement rather than meaningful help. Mobile crisis teams or outside social workers, he said, should respond to calls involving youth crises while in psychiatric care.
“Taking that sheet and attempting to hang yourself. You’re saying something right there,” Shook said. ”Are we listening to that?”
An industry under scrutiny
Since the 1950s, youth residential treatment centers, often rooted in religious-based behavior modification methods, have evolved into substance use or mental health treatment centers, boarding schools or wilderness camps. (Fox Run and its parent company are not religiously affiliated). The industry remains loosely regulated due to weak federal oversight and insufficient tracking of abuses, experts say.
The number of youth involved in the juvenile justice system who were placed in residential treatment facilities was around 29,300 in 2023, a jump of 4,400 from just two years earlier, figures from the Department of Justice show. At the beginning of this year, roughly 1,000 children were living in around 140 facilities in Ohio, according to state data.
Universal Health Services has faced two federal probes into its care of children, including one that led to a $122 million settlement with the federal government in 2020 after allegations that the company billed taxpayers for medically unnecessary services while failing to provide adequate care to patients. UHS was also the subject of a $553 million verdict in a negligence lawsuit in 2024, which the company settled out of court last year.
The U.S. Senate Finance Committee investigated UHS in 2024, alongside three other residential treatment providers. The committee found evidence of systemic abuse in different facilities across the four companies.
The committee’s report included two UHS facilities in Ohio — Belmont Pines Hospital in Youngstown and Foundations for Living in Mansfield — where records documented children being assaulted, improperly restrained and inappropriately medicated. Routine inspections by Ohio regulators have documented similar conditions at Fox Run.
In a response to the committee’s 2024 report, the company called the findings “incomplete and misleading.” UHS maintained that it took action when appropriate and thoroughly investigated allegations made by individuals and inspectors.
The Senate report “fails to recognize the thousands of children helped by our facilities over the years; children whose lives have been greatly enhanced as a result of their stay and the treatment they received,” UHS’ response read.
The conditions at residential facilities have even attracted celebrity attention. In 2024, Paris Hilton testified before Congress that she experienced physical and sexual abuse as a teenager at a residential treatment center in Utah and has pushed for reform.
Even so, a 2024 report from the U.S. Department of Health and Human Services Office of Inspector General found that nearly a third of states cannot identify patterns of maltreatment in residential facilities because they do not consistently track where abuse occurs.
Enough people have been traumatized by going through the system that a community on Reddit for “survivors and advocates who oppose the abusive Troubled Teen Industry” has swelled to tens of thousands of users over the past 15 years.
Organizations like Breaking Code Silence and Unsilenced gather testimony from people who experienced mistreatment. They also collect government documents — including inspections, investigations and citations of facilities across the country. Each website also offers templates and instructions for former residents to request their records from facilities.
‘No child should be in there’
Six months before her escape in the snow, Paitin ran away with her friend Isabella. They were a part of a group of 10 girls, one of whom was hospitalized after she threatened to run into traffic. They made it about 10 miles down the road to Wheeling, West Virginia.
Police picked them up after the pair contacted their parents, who turned them in. The girls told Fox Run staff they’d hitchhiked with a local man who bought them clothes at Target and gave them money. Isabella said the man had a brother who had been placed in Fox Run. He understood their desire for freedom.
In bodycam footage obtained by The Marshall Project, an officer searching for the girls expresses his frustration on a phone call. “That fucking place needs [to be] shut down. I’m tired of it … I said this is ridiculous … Fucking shit hole,” the officer says.
“They’re just going to run again later,” he added, referring to the girls.
Several other adults connected to Fox Run shared the officer’s frustrations. In interviews, five former Fox Run employees told The Marshall Project that children lived in a constant state of crisis. One worker, Julie Lipscomb, was left with bruises, nerve damage from a bite wound and stress so severe she said her hair began falling out. “That place could turn the nicest person into what they feel like is a monster,” she said.
Sydney Smith, who worked at Fox Run for about four months last year after graduating high school nearby, underwent training on physically restraining kids before stepping out on the floor at Fox Run. But she said she wasn’t prepared for the reality of what she was asked to do.
“You were pinning children to the floor, usually one person on each arm and a person like laying perpendicular over their body,” Smith said. “And then somebody holding their head where they couldn’t bite you.”
State inspectors cited Fox Run multiple times for its use of restraints, inspection records show. One child under age 9 was held down for a full hour, double the state’s maximum time limit. Four other children were restrained for “substantial” periods despite being described as “calm, non-combative and quiet.” In 2022, inspectors found Fox Run injected children with sedatives without a clear link to a psychiatric condition.
Wendy Opic, who worked at Fox Run when Isabella and Paitin were there, said she still prays for the children inside the facility. She remembers a manager thanking her for de-escalating children through conversation instead of restraining them. “Isn’t this what you’re supposed to do?” Opic thought to herself. “Be nice to these children?”
“I kept thinking, how do you get this place shut down? Because I don’t know how to do anything like that. No child should be in there,” she said.
As she cried, she added: “They were just treated like animals.”
What regulators can’t see
The Marshall Project obtained inspection reports from the Department of Behavioral Health — the state agency regulating residential facilities for kids with significant behavioral health needs, like Fox Run — from September 2021 to February 2025. Inspectors cited Fox Run for unsafe restraints, medical neglect, understaffing and deteriorating facility conditions. However, inspection records do not show state follow-up investigations tied to those incidents.
Additionally, it seems that many incidents may have never reached regulators’ attention. An analysis of Fox Run’s self-reported incident data from January 2022 through June of 2025 found that at least 40 incidents involving police did not appear in state documents. An Ohio statute requires residential treatment facilities to report suicide attempts, arrests, assaults and child hospitalizations to the state within 24 hours of the occurrence.
The incidents for which the state had no record included: a child being arrested or taken to a juvenile detention center (21 incidents), assaults (15 incidents), and hospitalizations or evaluations by emergency medical services (9 incidents). The story of the trans boy who was arrested after being assaulted and escaping to the hotel did not appear in these official records.
The Department of Behavioral Health did not respond to multiple requests for comment.
Of the 40 incidents that did not appear in state records, MacKendrick, the Fox Run CEO, said that a state review showed that some “were not reportable” while others “were appropriately reported,” but did not indicate which, or how many, of the dozens of incidents fell into each category.
MacKendrick noted that the facility had not been cited for violating the law for its handling of the reporting of any of the incidents The Marshall Project identified as not being in the state’s database.
Lax government oversight has largely been the norm for Ohio’s youth residential treatment industry. While several of the state’s residential treatment centers have voluntarily surrendered their licenses to operate following pressure from media or investigative agencies, only a few have actually had their licenses revoked. Most companies instead reach settlements with the state.
A watchdog group, Disability Rights Ohio, has the right under the Americans with Disabilities Act and the Rehabilitation Act of 1973 to investigate residential treatment facilities, usually triggered by complaints from children and parents. The group’s investigations in recent years led to voluntary license suspensions by Sequel Pomegranate Health Systems in Columbus and Youth Intensive Services in Youngstown.
However, some state lawmakers want to force regulators into more aggressive responses when facilities harm children. A bill recently introduced in the Ohio House of Representatives by Rep. Crystal Lett would require the Department of Behavioral Health to take measures against youth treatment facilities with incidents of violence and other serious violations. That could mean even shutting them down rather than leaving the agency with discretion over what sanctions to impose, if any.
Lett said she introduced the measure in response to The Marshall Project’s investigation in November 2025 that revealed escalating violence, staff injuries and campus-wide fights at Mohican Young Star Academy, Ohio’s largest youth treatment facility. The report also led to the state suspending admissions to the facility and a license revocation hearing that began this June.
“With respect to the revocation hearing, we are unable to comment on pending litigation. We look forward to vindicating our rights through the appropriate legal process and do not believe there is merit to the alleged violations,” Mohican owner Zach Logan wrote in an email.
Mohican, which rebranded as Empowering to Elevate Academy in late 2025, has previously withstood at least two state efforts to shut it down. In 2021, former Ohio Attorney General Dave Yost sued to remove the facility’s then-operator, Olga Strasser, over allegations of improper restraints, but a judge dismissed the case for lack of evidence. Yost vowed to move forward with revoking the facility’s license, but the state’s ongoing effort hasn’t been successful.
“Just the fact that it’s continuing in real time. It was our proof that this isn’t a hypothetical situation that we’re legislating for. It’s a real situation unfolding,” Lett said in April of this year. “I can’t help thinking: If my kid were in there right now, what am I doing to help that kid?”
For the children who have come out the other side of living in residential treatment, the healing process is often a slow one.
Years after her escape and discharge, Paitin still has the shoes staff members took from her, but she never put them on after getting out. She’s kept them pristine, a cherished object from her dad. “It hurts me to see them dirty,” she said. When he visited her at her new apartment, he immediately noticed the shoes. “He looked happy,” Paitin said.
Paitin, Samantha and Isabella have a collection of various items from their stays in Fox Run and other residential treatment facilities: clothes with their initials still written on the tags, journals, drawings, and, for some of them, medical records detailing psychiatric treatment.
When Paitin requested her records, Fox Run administrators told her she’d have to return to the facility to get her paper documents. She said she had a panic attack in the parking lot and couldn’t set foot in the building.
It’s just one way the facility’s impact lingers.
“I’m more quiet, reserved now, and it’s just not who I remember me being,” Paitin said. “Like, it makes me want to cry. I remember being so bubbly and everything. Now I just feel like I’m stuck in the same mindset ... It’s kind of like I’m numb.”
She still dreams of running. Sometimes she wakes up and forgets she’s no longer locked inside Fox Run. Other days, she dreams of what life is like outside of Ohio and its expanse of cornfields. For now, she leans on her friends. They Snapchat, call and text each other. They gather evidence and give it to a journalist. They hope for change.
“I just feel bad for the kids that are still there,” Paitin said.
Additional reporting by Rachel Dissell.