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 www.natsap.org/overview/asp. 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.
Sincerely,
Jan Moss
NATSAP Executive Director
John Santa, Ph.D.
NATSAP Board President |