How do you know
which program to trust?
Understanding accreditation and affiliation facts

togetherly only lists programs that are accredited or programs that are members of standard-setting associations.

While there is no federal regulatory body setting standards for wilderness programs, residential treatment programs, and therapeutic boarding schools, there are a number of organizations that seek to ensure that programs treating children and adolescents work with a common set of standards based on research to provide the best possible treatment for their clients and ensure good outcomes. They seek to ensure that all children will be safe and treated with respect and work with licensed providers.

We currently list only programs that are accredited or are members of these organizations. Even so, affiliation with any or all of these organizations is no guarantee of services provided or results. It is, however, an indication that they are working with the organizations focused on helping teens struggling with mental health issues and have regular oversight.

The largest member associations creating standards for programs include the Outdoor Behavioral Healthcare Council (OBHC) and the National Association for Therapeutic Services. The Joint Commission and Cognia also work with some of these programs and a few additional associations are listed below. Each state has their own set of licensing standards and requirements. Our best advice to you is do your research. Visit, talk to the program, speak with parents, and always trust your instincts.

Important Associations to know

NATSAP

The National Association of Therapeutic Schools and Programs (NATSAP) is the largest non-profit member driven organization focused on wilderness and residential treatment programs as well as therapeutic boarding schools. NATSAP is not an accreditation body.

NATSAP provides research and tools for their members, including annual conferences around the country. NATSAP seeks to establish a set of standards for their members that will ensure that children and adolescents in NATSAP member programs receive the highest level of care, are treated with dignity, and that the focus is on the personal well-being of the children treated.

Outdoor Behavioral
Healthcare Council

The Outdoor Behavioral Healthcare Council (OBHC) is an organization of behavioral health providers who are committed to the utilization of outdoor modalities to assist young people and their families to make positive change.

They focus on wilderness programs and currently have 17 member programs. In 2013, they partnered with the Association of Experiential Education (AEE) to expand AEE’s “existing accreditation standards to better reflect the current practices of adventure and wilderness therapy.” This resulted in the creation of a detailed set of ethical, risk management, and treatment standards created by longstanding leaders in OBH, adventure therapy, and wilderness programming including OBH Center researchers and affiliates.

The Joint Commission

The Joint Commission is one of the best known organizations working specifically with organizations in the health care space.

They cover a wide variety of health care organizations including behavioral health programs like residential treatment programs treating children and adolescents. They believe that everyone deserves access to high quality health care. They work with programs to provide everything from tools and research around standards to accreditation.

AEE

The Association for Experiential Education (AEE) is a nonprofit, professional membership association dedicated to developing and promoting experiential education worldwide.

They are similar to NATSAP, but they focus exclusively on experiential programs like wilderness programs. Unlike NATSAP, they do provide accreditation for member organizations. The AEE is dedicated to ensuring the highest standards for experiential programs and their clients.

CARF

The Commission on Accreditation of Rehabilitation Facilities (CARF) is a non-profit accreditation group that works with a wide variety of programs including residential treatment and behavioral health programs.

They engage in a consultative process with a school or program seeking accreditation. CARF will do an assessment of the program under review and recommend areas for improvement. Every year thereafter, an accredited program must submit additional improvements made.

Cognia

Cognia is an accreditation and certification association. It is a national organization focused on providing schools with research and tools to help them identify ways to improve their programs and outcomes for the population they serve.

They take a holistic approach and will also provide expert assessment for programs to provide specific recommendations for improvement. In addition to tools, they also work with schools to provide accreditation.

Q & A

Accreditation

Does it matter if programs are accredited?

Yes. We believe strongly that it does matter. Accreditation is not a guarantee that it is the right program for your child though. Accreditations standards and regulations vary from state to state but there are a few organizations that accredit organizations nationally. The organizations that we have included in our Directory do not all accredit but are generally considered reliable organizations in the space: the National Association of Therapeutic Schools and Programs (NATSAP); the Outdoor Behavioral Health Council (OBHC); The Joint Commission; Council on Accreditation (COA); and Commission on Accreditation of Rehabilitation Facilities (CARF).

Because of the widely varying requirements from state to state, these accreditations and memberships are one tool to assess for safety and efficacy.

The National Association of Therapeutic Schools and Programs (NATSAP) does not accredit. NATSAP is a membership organization that provides resources, puts on conferences, and encourages advancement and best practices. NATSAP requires each member “to be licensed by the appropriate state agency authorized to set and oversee standards of therapeutic and/or behavioral health care for youth and adolescents or accredited by a nationally recognized behavioral health accreditation agency and to have therapeutic services with oversight by a qualified clinician.” (https://natsap.org)

For wilderness therapy, OBH joined with Association for Experiential Education (AEE) to outline standards, procedures, risk management, and ethical guidelines for programs to follow. To join OBH, the program must be accredited by AEE within 2 years of joining.

In addition, some accredited programs are members of the Sky’s The Limit scholarship program that can help fund wilderness programs.

How can I be sure the program has qualified people working there?

In general, these programs often have high turnover rates, as the work is challenging and often underpaid. Many of the folks working in this field do it because they care and have the drive to support youth despite the taxing nature of the work.

Another forefront part of discerning the quality of these programs are standards for safety.

Questions to ask to better understand the quality of program staff include:

-What is the staff-to-student ratio?

-How long have the therapists been employed at the program?

-How many of the therapists are licensed?

-What is the average length of stay for the residential counselors working at the program?

-What kind of training is provided and required of staff?

-What kind of evaluation process do you have for employees?

-Do you perform background checks?

-What would you say is the hardest part of working for this program?

-What is the best part of working for this program?

-What are your safety protocols?

-Who do you report to when safety is mismanaged?

-Would you recommend this program to your friends and family?

Will my child be safe?

This may be one of the most challenging questions to both ask and answer. Generally, yes, these programs are safe, and there are many guidelines and structures to maintain safety. That said, staff quality and experience vary. Most programs will physically restrain children if they believe it is necessary for the safety of the child or those around them. Be sure to ask what those practices are. Programs can choose not to accept a child they deem to be an undue risk or feel they are not equipped to monitor adequately, for example.

There has been increased media reporting around harm, and even deaths, at certain programs. It is worth noting that there is by far more coverage around traumatic experiences than positive experiences. This is part of the importance of committing to thorough assessments of any program you are considering. Ask about safety measures, surveillance, staff training, accreditations, and other elements. Although many of these injuries and deaths could have been prevented, keep in mind that for many youth making risky decisions, safety at home is not ensured either.

What’s the difference between regional and national accreditations?

It is honestly very confusing trying to figure out the various accreditations. Because there are no federal regulatory standards, the only national bodies provide guidelines (although NATSAP has recently announced that they will require all members to be accredited by 2025) for care. Regional accreditation generally provides more oversight and detailed guidelines for programs. That said, not all states or regions have regional accreditations which is why your search for programs may not only entail identifying programs with regional accreditations.

Here are a few links explaining accreditation in a little more detail.

https://www.edsmart.org/regional-vs-national-accreditation/

https://www.indeed.com/career-advice/career-development/national-vs-regional-accreditation

https://www.allkindsoftherapy.com/blog/accredited-vs-nonaccredited-oh-my

How do you know which program to trust?Understanding accreditation and affiliation facts