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Abuse within residential youth care settings remains under-recognized and inconsistently addressed in social work. While prior studies have documented individual-level impacts, less attention has been given to the institutional mechanisms that produce and reproduce harm. This study centers institutional betrayal as a mechanism-based framework for understanding how harm is generated through routine organizational procedures. It examines how practices such as coercive control, restricted communication, surveillance, and normalization of invasive procedures (e.g., strip searches, forced nudity) function as structurally embedded violations of trust and care. The purpose of this study was to (1) identify core mechanisms through which institutional betrayal operates in youth residential care and (2) examine how routine practices become system-level pathways of harm.
Methods
This study draws on a qualitative analysis of retrospective interviews with adults (n = 418) who were in residential congregate care, including therapeutic boarding schools and behavior modification programs, while under 18. A grounded theory approach was used to identify recurring patterns in how institutional practices were experienced and interpreted. Coding procedures focused on isolating mechanisms of institutional betrayal (e.g., coercion, deprivation of autonomy, institutional silencing, role-based authority misuse) and tracing how these operated across contexts. Findings were triangulated with interdisciplinary literature on institutional abuse, trauma, and organizational dynamics to strengthen conceptual coherence.
Results
Findings identify institutional betrayal as operating through a set of consistent and replicable mechanisms embedded in routine care practices. Four primary mechanisms emerged across participant accounts. First, coercive control functioned as a central mechanism in which behavioral systems, punishment structures, and compliance-based models enforced submission while framing control as treatment. Second, deprivation of autonomy operated through restriction of movement, communication, and decision-making, limiting participants’ ability to exercise agency or seek external support. Third, institutional silencing emerged as a mechanism through which disclosure was discouraged or punished, often through surveillance, monitoring of communication, or retaliation, reinforcing isolation and dependency on the institution. Fourth, normalization of invasive and degrading practices—including strip searches, forced nudity, and constant observation—functioned as a mechanism that redefined violations of bodily autonomy as routine or necessary. Across mechanisms, participants described not only discrete harms but also the cumulative impact of living within systems in which care and control were structurally intertwined. These mechanisms were linked to long-term outcomes, including impaired trust, altered help-seeking behavior, identity disruption, and relational difficulties.
Conclusions & Implications
Harm in youth residential care is often produced through normalized institutional procedures rather than isolated incidents or individual misconduct. Centering institutional betrayal shifts the analytic focus from individual events to the structural conditions that generate harm. The findings provide a framework that may support more precise evaluation of institutional practices, particularly in assessing whether routine interventions function as mechanisms of harm. Implications include the need for greater scrutiny of coercive and non-evidence-based practices, increased attention to environmental and organizational conditions in regulatory oversight, and more explicit consideration of institutional context in ethical decision-making. This study contributes a conceptual foundation that can inform future research, policy development, and practice frameworks aimed at addressing abuse in youth residential care.