This report summarizes a 3-year review of reports of child abuse and neglect in New York State's mental hygiene facilities. The study determined that greater efforts are required to ensure protection of those children who were "repeat" alleged victims and who, as a group, were involved in 400 of the 850 reports to the State Central Register. The report also identified unstructured activity times on residential units, limited presence of clinical staff, and the use of physical interventions and restraints as the major risk factors leading to child abuse and neglect allegations. In over two-thirds of the reports, there was no reported physical injury, and an additional 25 percent required only first aid. Adult to child sexual abuse was alleged in 15 percent of the reports, and supervision neglect resulting in child to child sexual activity was alleged in 14 percent. Twenty-four percent of the reports from 143 facilities across the state were sustained as child abuse or neglect upon investigation. Figures and text detail the findings. Recommendations address confusion over reporting, underreporting in some programs, prevention for "high risk" children, high risk behaviors and circumstances, and accountability. Appendices present statutory definitions, reporting rates, and agency responses to the report. (DB)