NATSAP 2020: The State of Therapeutic Schools and Programs

Introduction

The common mission of NATSAP members is to promote the healthy growth, learning, motivation, and personal well-being of program participants. The objective of member therapeutic and educational programs is to provide excellent treatment rooted in deep-seated concern for client’s well-being and growth, respect for them as human beings, and sensitivity to their individual needs and integrity. In conjunction with this mission, NATSAP has taken numerous actions to improve overall ethical standards and therapeutic practices within the field. Below is an outline of the improvements to practice, principles, and standards NATSAP has achieved.

Who is NATSAP?

Therapeutic schools and programs are part of an ever changing and evolving industry, and like the industry, NATSAP has changed with the times. The National Association of Therapeutic Schools and Programs (NATSAP) is the largest not-for-profit membership association in the U.S. dedicated to residential treatment centers, therapeutic boarding schools, and wilderness therapy programs. We serve as an advocate and resource for innovative organizations that devote themselves to society’s need for the effective care and education of struggling young people and their families. Our vision is a nation of healthy children. We are the voice inspiring, nurturing, and advancing the courageous work of our schools and programs.

Our member programs are devoted to providing effective care to thousands of individuals experiencing a wide range of mental and behavioral difficulties. That care is given under the watchful eye of state licensing departments and national accrediting bodies. Beginning in 2023, all NATSAP Member Programs must be accredited by an approved national therapeutic accrediting body. NATSAP is not a licensing or accrediting body, or authorized or established to monitor schools or programs.

Becoming a NATSAP member

NATSAP’s stringent membership requirements have evolved, just as the therapeutic field has evolved. In order to become a NATSAP member, applications are reviewed in a three step process by the Membership Director, the Membership Committee- a group of therapeutic program members with clinical and business backgrounds- and our Board of Directors.

During the application process, programs provide information on their enrollment policies, testing procedures, and facilities. We ask how the school or program conducts background checks and provides professional development for their employees. We may question the program or the state licensing organization to obtain clarity about how the program operates.

When a program wishes to renew its membership, we require them to provide us with new copies of their licensure and lead clinician’s certification. If this information is not provided, the program is dropped from membership. We prefer to see a decline in members rather than a decline in standards.

Community Collaboration

Before: Little to none. There was hardly any organized and purposeful industry-wide collaboration with the intent to share ideas, information, etc. among professionals within the therapeutic field.

Now: NATSAP offers frequent opportunities for collaboration between members through National Annual Conference, the annual Leadership Summit and Academic Conference, various Regional Conferences, numerous webinars, etc.

  • In NATSAP’s first year, NATSAP founders launched annual National Conferences as an initiative to share industry principles, best practices, ethics, studies, etc. This collaboration point has been essential in uniting high-standing therapists, educational consultants, schools, and programs. It has been crucial in creating baseline best practices, ethical standards, and therapeutic standards with the safety and healing of the students remaining at the forefront.
  • Additionally, NATSAP hosts numerous Regional Conferences, a Leadership Summit and Academic Conference, and webinars. All events encourage and provide opportunities for education, information sharing, networking, etc.

Overarching Ethical Standards

Before: Many of the ethical standards that existed within the therapeutic field before NATSAP was created were only outlined by individual programs/schools. Unified ethical standards did not exist or were not enforced by the associations that wrote them.

Now: Standards for ethical practice were at the forefront of priorities at the initiation of NATSAP. The Ethics and Standards Committee (since retired) and the original NATSAP Board of Directors composed 13 ethical principles which have since been instilled in the threads of membership at NATSAP.

  • These standards and principles are reviewed and added to on a regular basis. NATSAP’s Best Practices Committee fields ethical complaints. If a program is engaging in unethical behavior, this committee can ask for a suspension of membership (until the issue is corrected or for a specified length of time), or they can recommend that the program be removed from membership.

Licensed Therapists and Treatment Plans

Before: No requirement for licensed therapists or clinicians to oversee treatment in therapeutic schools/programs.

Now: Therapeutic services are required to be overseen by a qualified clinician.

  • All clinicians and therapists employed at NATSAP programs must be licensed. A program who employs non-licensed therapists/clinicians is not eligible to become a NATSAP member.
  • Each student within a NATSAP Program must have a written treatment plan overseen by the licensed clinician.
  • This requirement has elevated the therapeutic field as a whole. As the desire of programs to become a member of the association grows, so does the desire of programs to increase their own standards to match the high standards of the association.

Required Licensure/Accreditation for Programs and Schools

Before: No requirement for therapeutic schools or programs to be licensed or accredited.

Now: Currently, all NATSAP program members are required to be either state licensed or nationally accredited.

  • NATSAP has called for state and local licensing boards and legislative bodies to develop, implement, and enforce standards of care to guide programs toward excellence and to protect our youth in treatment
  • To maintain state licensure or national accreditation, a program is required to meet approved standards of care, report incidents, and be subject to periodic (often unannounced) on-site reviews and audits. 
  • This is a high standard to which all NATSAP members are held. As the therapeutic field grows closer to the desired ethical and credential oversight as the standard practice, more programs are seeking this additional oversight.
  • NATSAP is not a licensing or accrediting body, but an advocate for programs to adhere to these standards. By January 2023, all NATSAP programs must be accredited.

A Data-Driven Approach

  • Before: Therapeutic treatment was largely not science-based or data-driven

    Now: Since NATSAP was founded, we have been committed to demonstrating effective treatment through outcome studies.

  • To this end, more than 65 NATSAP members contribute annually to the University of New Hampshire Therapeutic Schools and Programs study.In addition to the UNH study, some member programs have worked with Cornell and Stanford; others have long-running research collaborations with their local universities.
  • To further our data-driven approach to demonstrating positive outcomes, NATSAP has launched the Research Designated Program (RDP). The RDP status recognizes programs that supply data to evaluate a school or program’s effectiveness and increases understanding of the positive impact of schools and programs.
  • Additionally, NATSAP helped fund the Golden Thread, a software package that allows members to follow a client through treatment. As a secondary benefit, the software allows educational consultants, who refer families to schools and programs, to collect data on those who initially seek services, but ultimately, choose not to attend a therapeutic program.
  • The therapeutic program community faces a challenge in facilitating randomized controlled studies of treatment outcomes, both RDP and the Golden Thread research initiatives provide valuable data in the face of this challenge.

State and Federal Legislation

  • NATSAP is continuously advocating with state and federal representatives on bills that can improve oversight and protection to individuals with disabilities- specifically those with mental health issues- therapeutic programs, school regulation for students with mental health issues, funding, etc.
  • NATSAP continuously monitors legislation, engages in conversation with public offices and organizes advocacy days sponsored by NATSAP in which parents, alumni, program administrators, and therapists meet face-to-face with legislators to advocate for relevant legislation.
  • NATSAP also provides various resources for members to monitor relevant legislation in their state, including information on the bills themselves, representatives backing the bills, and how to contact respective elected officials.
  • Recently, NATSAP petitioned for the Utah State Department of Education to increase its oversight of private residential treatment centers. This regulation became law in late 2019.

Conclusion

NATSAP members provide treatment that is rooted in deep-seated concern for the students’ well-being and growth; respect for them as human beings; and sensitivity to their individual needs and integrity. As the field of therapeutic programs evolves, NATSAP will be there to guide the way, to change with the times, and to ensure that we continue to be the voice inspiring, nurturing, and advancing the courageous work of our schools and programs.