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Toward the overall goal of interrogating systems that contribute to racial inequity in child and adolescent psychology, we examine the role and function of Residential Treatment Centers (RTCs) in creating or exacerbating race and gender inequities using the language of mental health and the logic that treatment intentions justify children’s confinement. In Study 1, we conduct a scoping review to investigate the legal consequences of RTC placement, attending to race and gender in 18 peer-reviewed articles, encompassing data for 27,947 youth. In Study 2, we use a multimethod design focusing on RTCs in one large mixed-geographic county to examine which youth are formally charged with a crime while in RTCs, and the circumstances under which these charges occur, attending to race and gender ( N  = 318, 95% Black, Latine, Indigenous youth, mean age = 14, range = 8–16). Across studies, we find evidence for a potential treatment-to-prison pipeline through which youth in RTCs incur new arrests and are charged with crimes during and following treatment. This pattern is pronounced for Black and Latine youth and especially girls, for whom use of physical restraint and boundary violations are recurring challenges. We argue that the role and function of RTCs via the alliance between mental health and juvenile legal systems, however passive or unintentional, provides a critical exemplar of structural racism; and thus invite a different approach that implicates our field to publicly advocate to end violent policies and practices and recommend actions to address these inequities.

A Treatment-To-Prison-Pipeline? Scoping Review and Multimethod Examination of Legal Consequences of Residential Treatment Among Adolescents