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Posted June 21, 2005 

NATSAP Letter To Congressman Miller

June 1, 2005

Congressman George Miller
2205 Rayburn House Office Building
Washington, DC 20515

Reference: Legislation to Curb Child Abuse in Residential Treatment Programs

We appreciate the intent of the introduction of this legislation, but are concerned the excellent work being done by a large number of residential treatment programs will be impacted negatively if their interests are not considered.

The National Association of Therapeutic Schools and Programs ("NATSAP") was established in 1999 as a trade organization with a mission to serve as an advocate and resource for innovative schools and programs, which devote themselves to society's need for the effective care and education of struggling young people. NATSAP is now a thriving and growing organization with 142 member programs serving nearly 10,000 youth annually. Our programs are located in 31 states throughout the country and employ more than 5,000 adult staff, many with professional backgrounds and degrees, and all trained to care for troubled youth in ethical and responsible ways.

One of the primary reasons our programs came together to form NATSAP was to exchange ideas and come to agreement on reasonable and necessary standards of operation that would allow diversity of approach and yet provide the basic ethical position and framework of operation that would protect children and their families. Since NATSAP programs are located throughout the country and serve primarily private paying families, they fall under diverse licensure laws and regulation.

Our organization felt the need to establish a national consensus of ethics and standards that would define programs that offer quality care for children. To this end we have established Ethical Principles, Principles of Good Practice, Supplemental Principles of Good Practice for Therapeutic Schools, and Standards for Behavior Support Management. We have enclosed a copy of each of these principles and standards. They can also be reviewed on our website All NATSAP programs are required to subscribe to these principles and standards as a condition of membership, and we provide ongoing discussion and education about ethics and operations at our national and regional conferences.

In addition to membership in NATSAP, the majority of our members are licensed or accredited either by a state licensing board or by a national or regional accrediting agency. The national accrediting agencies include the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA). We have found that there is great diversity in the structure and operations of programs throughout the country, and so it is important to allow for a variety of methods to assure that programs comply with high standards of care.

We also recognize that there are programs that are unaware or chose to ignore basic ethical standards and practice principles. We feel that such programs represent a minority of the many fine programs who serve troubled youth. However, such programs are, of course, a risk to families, children, and to all of us who operate quality programs. NATSAP hopes to raise awareness for such programs, and try to include and educate such operators to improve their program quality and safety.

NATSAP programs, however, have legitimate concern that it would be very dangerous for either the federal or any state government to create prescriptive regulations without input and representation from our member programs. For example, our organization is quite concerned about your proposed legislation in SECTION. 303. Eligibility (b) (3) that states "In the case of each child who is a resident of the facility and whose domicile is another State, the facility meets the standards of such other State for the operation of such a facility, including any licensing standards". Given the vast array of administrative rules in different states such a clause would create an unreasonable administrative nightmare, and in effect allow the most restrictive rules in all states to dictate treatment standards for every state. We urge you to omit SECTION 303 (b) (3), and furthermore ask that you meet with representatives from our organization to discuss a variety of issues with your proposed legislation.

Programs that serve the private market are, of course, in need of clear operational standards, but such standards are in many cases quite different from those required for publicly funded programs in which the state has a fiduciary responsibility for both the expenditure of funds and often for the care and guardianship of the affected children. In the private pay market, parents retain the ultimate control to authorize, pay for, and select the type of treatment they feel most appropriate for their child. Both parents and children in such situations still need assurance that the programs they choose and work with represent themselves honestly, and have practice standards that are within the range considered safe and appropriate by the profession. It is in this spirit that NATSAP members have worked to create our Ethical Principles and Practice Standards.

NATSAP would like to offer our resources to work with you on ways to approach the problem of defining the proper role of government and regulation for the private pay market. We support an approach that does not suppress the diversity of legitimate methods in our profession and yet protects the interest and concerns of parents and children enrolled in our programs. We would like to open a dialogue with your office in order to assure that any laws or regulations that you sponsor are crafted in a way that protects the legitimate interest of ethical programs as well as safeguarding the interest of the children and families we serve.

Thank you for your consideration.


Jan Moss
NATSAP Executive Director

John Santa, Ph.D.
NATSAP Board President

Copyright © 2005, Woodbury Reports, Inc. All Rights Reserved.
(This article may not be reproduced without written approval of the publisher.)

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