National Association of Therapeutic Schools and Programs

OVERVIEW

The National Association of Therapeutic Schools and Programs (NATSAP) is a United States trade organization of therapeutic schools, residential treatment programs, wilderness programs, outdoor therapeutic programs, young adult programs, and home-based residential programs for adolescents and young adults with emotional and behavioral difficulties. It was formed in January 1999 for the purposes of serving as a national resource for professionals and programs designed to provide educational, therapeutic, and occupational assistance to young people experiencing complications due to neurodiversity, mental health issues, and educational challenges. Programs that are members include, "therapeutic schools, residential treatment centers, wilderness therapy programs, outdoor therapeutic programs, young adult programs, and home-based residential programs."

The mission of NATSAP is to “ensure that member programs have the highest quality service, cultivate collaboration, and educational opportunities, and to improve overall ethical standards and develop guidelines for best practices in the treatment of teens, young adults, and their families.

NATSAP is overseen by a rotating board of directors, which consists of a variety of professionals involved in the field, including program directors, seasoned clinicians and educators, and educational consultants. NATSAP also employs a small staff of its own to attend to its various functions, including organizing and running various conferences and educational events.

NATSAP is not an accrediting or licensing body for its members. Rather, it is an organization designed to encourage an exchange of information and ideas and to facilitate collaboration amongst members with the purpose of providing ethical guidelines for treatment and the development and advancement of best practice educational and treatment standards for the needs of the population being served.

The organization publishes a professional journal, the Journal of Therapeutic Schools and Programs, conducts conferences and workshops, and publishes a directory of its members.

NATSAP Clients

Families, teens, and young adults who seek help from the residential programs of NATSAP have typically tried other forms of at-home treatment previously, but had not been able to get the needed outcomes from those attempts. One study with over 13,000 respondents of NATSAP program participants revealed that 90% of them had tried outpatient therapy modalities before enrolling in a NATSAP program. Of those 90%, 43% had been hospitalized for psychiatric care.

Membership Requirements

Since its foundation, the membership requirements for NATSAP have intentionally evolved in order to continue to raise the collective bar for program quality and efficacy. Groups or individuals who wish to be members of NATSAP schools are required to commit to NATSAP's published Ethical Principles and Principles of Good Practice. However, NATSAP was not designed or intended to be a regulating or enforcing body of these principles and practices. The leadership of NATSAP recognizes and endorses the need for accountability to demonstrate compliance with these principles and practices and for enforcement when the principles and practices are not being followed.

As 2023, all NATSAP program members must achieve an appropriate accreditation in the State in which they operate from established regulatory organizations such as the Joint Commission. Whereas NATSAP is not equipped or intended to be an enforcing organization, these accrediting bodies are.

Ethical Principles

NATSAP has adopted the following guidelines as the common governing ethics for all member programs.

1. Be conscious of, and responsive to, the dignity, welfare, and worth of their program participants.
2. Honestly and accurately represent ownership, competence, experience, and scope of activities related to their program, and to not exploit potential clients’ fears and vulnerabilities.
3. Respect the privacy, confidentiality, and autonomy of program participants within the context of their facilities and programs.
4. Be aware and respectful of cultural, familial, and societal backgrounds of their program participants.
5. Avoid dual or multiple relationships that may impair professional judgment, increase the risk of harm to program participants, or lead to exploitation.
6. Take reasonable steps to ensure a safe environment that addresses the emotional, spiritual, educational, and physical needs of their program participants.
7. Maintain high standards of competence in areas of their expertise and to be mindful of their limitations.
8. Value continuous professional development, research, and scholarship.
9. Place primary emphasis on the welfare of their program participants in the development and implementation of their business practices.
10. Manage their finances to ensure that there are adequate resources to accomplish their mission.
11. Fully disclose to prospective candidates the nature of services, benefits, risks and costs.
12. Provide informed, professional referrals when appropriate or if we are unable to continue service.
13. NATSAP members agree to not facilitate or practice reparative therapy.

NATSAP does not consider it appropriate or ethical to attempt to use psychological treatment as a form of punishment. Nor does NATSAP consider punishment to be a valid form of psychological treatment. NATSAP holds the standard that all treatment methods should conform with respectful, humane, evidence-based practices. NATSAP believes that treatment programs that do not meet these standards should either reform or close down.

Best Practices

While still recognizing that there will be diversity in the philosophies and practices of its member programs, NATSAP has continued to develop guidelines governing common best practices. These guidelines cover the areas of:

1. Safety for all participants and employees.
2. Adherence to state and federal laws.
3. Administrative practices and procedures.
4. Employee practices.
5. Admission/discharge policies.
6. Behavior management plans.
7. Participant rights and responsibilities.
8. Health care access.
9. Incident reporting.
10. Physical facilities.
11. Educational services.

While the specifics of these guidelines are too lengthy to be included in their entirety in this entry, some salient points include:

• Guidelines for providing an appropriate and effective education.
• A prohibition against kickbacks, benefits, or payments for referrals.
• Accuracy in marketing materials.
• Screening of potential program employees.
• Training and supervision for program employees.
• Management of behavioral problems that is respectful of the rights and dignity of program participants.

Outcomes Research for NATSAP Programs

The scope and mission of NATSAP has expanded and evolved in a variety of ways since its formation. The leadership of NATSAP recognized the need for process and outcome research to evaluate the effectiveness of the methods being used by the various programs within NATSAP and to empower them to continue to refine their practices to better serve the needs of those who come to them seeking help. As a result, in 2008 NATSAP began to collaborate with Michael Gass, Ph.D. from the University of New Hampshire to create research protocols with established, scientifically validated psychosocial measures such as the youth and parent report versions of the Youth Outcome Questionnaire (YOQ 2.0), the Patient Health Questionnaire (PHQ-9), and so forth. These measures help to monitor and establish both the emotional safety of program participants and the effectiveness of the treatments being utilized.

To continue to encourage a scientist-practitioner model for NATSAP programs, in 2006 NATSAP also launched a scientific journal, the Journal of Therapeutic Schools and Programs (JTSP). This is a peer reviewed journal edited by a Ph.D. level university professor. The role of editor is currently held by Ellen Behrens, Ph.D., from Westminster College.

In an effort to encourage NATSAP programs to engage in this process and outcome research, NATSAP has created the Research Designated Program (RDP) status for programs that are consistently employing these research protocols . In 2018, 47 NATSAP programs had received full Research Designated Program status. NATSAP is continuing to develop tools, processes, and resources designed to expand that number until all NATSAP programs are fully utilizing the research protocols.

While NATSAP programs are continuing to conduct ongoing research, there is now a solid research base of large scale, multi-site, longitudinal studies conducted by nationally recognized university researchers and overseen by federally recognized internal review boards to ensure that the studies are ethical, unbiased, and valid. The combined data of these studies indicate that participants at NATSAP RDP programs tend to improve significantly through the course of their treatment and that they tend to maintain these improvements after they return home, with 85% of participants demonstrating continued improvement twelve months after discharge from their treatment program.

Origins of NATSAP

The idea for NATSAP was first proposed by John Reddan, who had a background working in the admissions department of a private school in Hawaii and had experience with the National Association for Independent Schools. He was observing the rapid formation of many therapeutic schools and programs in the United States in the mid-to-late 1990s, and noted that many of them were essentially operating in a vacuum, with little to no interaction with other programs that were trying to address the same psychosocial needs of similar populations. While some of these programs had personnel who were members of other professional organizations, such as the American Psychological Association or the American Association for Marriage and Family Therapy, the focus of these organizations tended to be on private practice and medical settings, and therefore mostly left unexplored and unaddressed the practical needs of residential treatment centers and therapeutic schools.

Mr. Reddan felt there was wisdom in establishing some sort of national association to help these new residential treatment programs develop and establish themselves, with opportunities to share what they learned and what they were finding to be most effective in their efforts to attend to the needs of those who came to them for help. Mr. Reddan visited with the directors of several therapeutic programs to seek funding, and launched NATSAP with the financial backing and initial membership of Hidden Lake, Cascade School, Spring Ridge Academy, Montana Academy, Aspen Youth Services, Three Springs, and Crater Lake.

The initial set of board members and officers worked to establish a set of guidelines for ethical practices that “would tolerate a diversity of approaches while still insisting that all programs address basic safety, structural, and process issues necessary for any responsible program.”

When the first NATSAP directory was published in 2000, there were 66 member programs. That number grew to nearly 150 by 2005, and now in 2021 has over 300 member entities.

Evolutions of Practices within NATSAP Programs

As previously mentioned, NATSAP was formed at a time when many new residential treatment centers, therapeutic schools, and wilderness programs were being opened across the United States. Some of these treatment programs were built upon certain ideas that were popular in the 1990s, such as behavioral modification approaches based on the works of behaviorists like B. F. Skinner and John Watson, the therapeutic community modality which had gained significant notoriety in the 1960s and has since been discredited as pseudo-science, military style boot camps, and various “tough love” approaches. It should be noted that these kinds of structures and strategies were also found in psychiatric hospitals and other mental health treatment settings at the time. However, other treatment programs that sprung up in this time period were based on very different philosophies and practices, with a focus on attachment and creating emotional safety as a basis for psychological treatment. Many of these programs specifically worked to create methods that were an alternative to the more behavioral, consequence-based approaches of that era.

As a result, in the early years of NATSAP, programs from a wide variety of approaches and philosophies became members, including some programs that utilized some of these more behavioral and punitive practices that have since been discredited. As the larger field of psychology continued to develop, researchers recognized the shortcomings of these behaviorally-focused, control-driven approaches–especially ones that were experimental in nature and not based on scientific research–psychological treatment across the country evolved, including in residential treatment. Programs with membership in NATSAP that historically had employed some of these practices have either evolved and adopted new approaches in harmony with the continued developments in the field of psychology, or they have shut down.

NATSAP programs strive to be in harmony with scientific developments in the field of psychology, and as such any treatment program that still utilizes these out-of-date models is not conforming to the ethical principles and established best practices of NATSAP and is not considered a valid candidate for NATSAP membership.

FEDERAL REGULATION AND REFORM OF PROGRAMS

Not all treatment programs are created equal. Some programs have utilized models that have excluded licensed mental health clinicians and have relied on discipline, punishment, confrontation, and restrictions as methods of intervention for a wide variety of diagnoses and presenting issues. Conversely, there are many other programs that utilize coordinated, collaborative treatment teams with social workers, psychologists, psychiatrists, marriage and family therapists, and auxiliary team members such as recreation therapists, yoga instructors, nutritionists, nurses, and a variety of other licensed health and wellness professionals. These programs are versed in sophisticated models such as the biopsychosocial model, family systems theory, and trauma informed care. They employ research-tested modalities such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Eye Movement Desensitization and Reprocessing therapy (EMDR), biofeedback, neurofeedback, Acceptance Commitment Therapy (ACT), and various diagnosis-specific specialized interventions and approaches applied as indicated by the specific needs of individual participants.

As a result of these disparities in program design and operation, there is a significant divide in the experiences that participants of these various programs have. There are many families and program participants who report positive experiences and outcomes from a wide variety of existing facilities . At the same time, there are other families and participants who describe disappointing and even disturbing and harmful experiences with other programs. At a consumer level, it can be difficult for prospective participants and families to discern between programs based on good science and best practices from programs with non-scientific approaches and problematic treatment models.

Part of NATSAP’s current mission is to be a hub for a wide variety of facilities that operate in harmony with science, regulations, and best practices so that families, teens, and young adults in need of intensive psychosocial help can have a reliable way to recognize high-quality, ethical programs. NATSAP is an advocate for the proper care and treatment of teens and young adults with mental health needs.

NATSAP supports the idea of Federal legislation designed to provide uniform standards, regulation, and oversight for all therapeutic boarding schools, residential treatment centers, wilderness therapy programs, and other mental health treatment centers.

News articles

• Terry Sellers: Limits on ‘troubled youth’ programs can leave some without needed treatment
• Efforts Are Underway to Reform Teen Behavioral Programs
• A parent’s perspective on the ‘troubled teen industry’
• 'A mirror image': Paris Hilton, Drew Barrymore Bond Over Solitary Confinement as Teens
• Drew Barrymore Recalls Her Tough Teen Years While Empathizing With Britney Spears and Paris Hilton
• DESPERATE MEASURES -- A special report.; Embattled Parents Seek Help, at Any Cost.
• I went into the woods as a teenage drug addict and came out sober. Was it worth it?
• Troubled US teens left traumatised by tough love camps.
• Kids Get Hurt at Residential Schools While States Look On.
• A Business Built on the Troubles of Teenagers.
• Deep in the Wilderness, a Growth Industry Is Blooming.

External links

• NATSAP official website