This is a very realistic view of private residences for disabled youth. They are created to serve children with physical and or psychological and mental challenges and quickly become cash cows for unscrupulous investors and greedy, lazy doctors. I saw this first hand almost 40 years ago when I worked in a similar institution which employed "milieu therapy," which means no therapy.
Susan Nussbaum, the author, has the advantage of being born able and later on, being hit by a bus. She is able to breathe life into the character of Joanne who also was hit by a bus. Ms. Nussbaum used her experiences working with others who belong to the special club, "crips," to people Good King, Bad King. The young people become "awards of the state," because their parents, physically, financially and emotionally are unable to care for them. These teens are fierce and frail having survived the School of Hard Knocks. Their academic deficits are rarely addressed in their especially bad education. The State is deaf and blind to the needs of a community which no one wants to see.
That being said, many of these down and out children are resilient . For every scheming predator, there is an underpaid overworked houseparent, teacher, Legal Aid lawyer to offer support and guidance.
Parts, but not all, of this very realistic novel are grim. It is truly the story of man against himself (kids fighting their own bodies) and man against society (kids fighting to be seen , heard and respected). Nussbaum is inspired by her characters and hopes to give hope to those who fight.