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June 1, 2005
Congressman George Miller
2205 Rayburn House Office Building
Washington, DC 20115
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
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