Residential treatment for children and youth is a service that has historically generated concerns. Some youth and families credit residential with having “saved their lives,” and the service is seen as needed to provide safety for youth when community services are insufficient or ineffective. Yet, practices in residential programs have often focused on coercion and control. In the worst-case scenarios, abuses, and even deaths, have occurred. Outcomes have often not been great, with young people having to return to out of home placement following discharge.