Unlicensed Residential Programs: The Next Challenge in Protecting Youth – Over the past decade in the United States, the number of private residential facilities for youth has grown exponentially, and many are neither licensed as mental health programs by states, nor accredited by respected national accrediting organizations. Unregulated residential programs have been linked with reports of youth mistreatment, abuse, and death, as well as exploitation of families. In the fall of 2004, a multi-disciplinary group of mental health and child-serving professionals was formed through a collaboration between the Florida Mental Health Institute and the Bazelon Center for Mental Health Law, in response to rising concerns about reports from youth, families and journalists describing mistreatment in unregulated programs. This review is a summary of the information gathered by this group, the Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment (A START). It provides an overview of common program features, marketing strategies and transportation options that seem to characterize many of the unregulated programs. It describes the range of mistreatment and abuse experienced by youth and families in such programs, including harsh discipline, inappropriate seclusion and restraint, substandard psychotherapeutic interventions conducted by unqualified staff, medical and nutritional neglect, and rights violations. It reviews the licensing, regulatory and accrediting mechanisms associated with the protection of youth in residential programs, or the lack thereof. Finally, it outlines policy implications and provides recommendations for the protection of youth and families who select residential treatment options.