CARF International https://carf.org/ Commission on the Accreditation of Rehabilitation Facilities Fri, 13 Feb 2026 14:43:08 +0000 en-US hourly 1 https://wordpress.org/?v=6.9.4 https://carf.org/wp-content/uploads/2023/08/cropped-carf-favicon.png?w=32 CARF International https://carf.org/ 32 32 218515885 How PLEA’s Indigenous Matters Committee advances Truth and Reconciliation https://carf.org/blog/how-pleas-indigenous-matters-committee-advances-truth-and-reconciliation/ Tue, 03 Feb 2026 15:19:40 +0000 https://carf.org/?p=469336 Written by Penny Gagnon, MA, CARF Canada Chief Accreditation Advisor. Photo Caption:...

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Written by Penny Gagnon, MA, CARF Canada Chief Accreditation Advisor.

Photo Caption: Pictured above (L to R) are PLEA Knowledge Keepers Ernie Cardinal and Charles Lafferty.

For nearly two decades, PLEA Community Services, Vancouver, British Columbia, has been accredited by CARF Canada, continually demonstrating their commitment to quality and innovation in service delivery. PLEA’s vision is simple yet profound: a world where everyone has the opportunity for a good life, and everyone counts. This vision has guided the organization as it supports children, youth, adults, and families facing significant challenges, always striving to build lives of meaning and connection within their communities.

Among PLEA’s many achievements is the growth of the Indigenous Matters Committee. Recognized as a strength in PLEA’s last two CARF surveys, the committee exemplifies how reconciliation can move from symbolic gestures to meaningful change.

The committee’s journey from events to belonging started with recognizing and participating in cultural events such as National Indigenous Peoples Day, Orange Shirt Day (now known as National Day for Truth and Reconciliation), and other commemorations. Building on the important work, the committee has evolved into a powerful driver of organizational transformation, shaping policy, programs, and outcomes across the agency. “As a committee, we wanted to ask ourselves: What’s our intention? How are our values influencing what we do, and how do we tie our work directly to reconciliation?” said committee co-chair Sara Griffiths. That shift in focus marked the beginning of a deeper learning journey for the organization.

In 2021, PLEA adopted a five-year Indigenous Strategy that provided a roadmap for reconciliation. The top three priorities are: (1) to assist programs and personnel to improve knowledge, capacity, and competency in providing effective and culturally-sensitive services; (2) to develop connections and strengthen relationships with Indigenous agencies and communities; (3) to put forward recommendations and strategies for building and maintaining cultural connections for Indigenous participants. Around the same time, the organization welcomed Knowledge Keeper Charles Lafferty, who is Dene Métis with ties to the Łı́ı́dlı̨ı̨ Kų́ę́ First Nation and the NWT Métis, into a newly created role and as a committee co-chair. This role was designed with guidance from Elders and Knowledge Keepers, including Lafferty himself. “The foundation was already there when I arrived,” said Lafferty, “my role was to elevate the conversations, including looking at how colonial systems and Indigenous worldviews don’t always align, and how to navigate those differences with integrity.”

Since then, the committee has had a profound impact on operations across PLEA. The Board of Directors has been deeply engaged through attending events and learning alongside staff and participants. At one canoe awakening ceremony, a board member participated in her first smudge, guided gently by Lafferty. The ceremony involves washing the canoes in preparation for the upcoming season on the water. “She was nervous, but she trusted, and she was deeply moved,” said Griffiths. “It showed that leadership is willing to learn alongside everyone else.” Policies and procedures have also been reshaped to reflect cultural considerations, including updates to PLEA’s “Protocol in the Event of a Death” and the redesign of intake processes that involve extended family and cultural practices. Committee participation has even become a factor in staff performance reviews, reinforcing the principle that reconciliation is everyone’s responsibility.

The most visible changes can be seen in the delivery of services. PLEA’s canoe program has become a cultural centerpiece, with an annual wake-up ceremony in the spring and a putting-to-sleep ceremony in the fall. These events, rooted in Coast Salish traditions, include cedar brushing, spirit plate offerings, and shared meals. Over 100 people typically attend, including participants, staff, caregivers, board members, and community partners. For Lafferty, the meaning is clear, “The bottom line is belonging. Getting people out of their apartments, giving them a place in the community. That’s the gift of the canoe.”

Other initiatives reinforce this sense of belonging. Weekly on-the-land and outdoor programs connect participants with nature, a recognized element of healing. Cultural safety plans ensure that staff and caregivers learn about each participant’s specific traditions, languages, and foods, replacing generic “cultural goals” with individualized, meaningful supports. Caregivers and staff also receive education on the difference between cultural appreciation and appropriation, and those supporting participants from the Northwest Territories complete “Living Well Together,” a government-developed training program that builds cultural understanding.

The impact on participants has been profound. Youth who once stayed isolated in their rooms now take part in canoe journeys and on-the-land activities. Caregivers who had never before experienced traditional practices now cook side by side with participants. Residential school tours have also transformed understanding. Over 200 staff, board members, and caregivers have visited the former St. Mary’s Residential School in Mission, followed by structured debriefs to process the experience. “These moments are emotional and cathartic,” said Lafferty. “For many, it’s the first time they’ve heard the deep history. It changes how they show up every day.”

Looking ahead, PLEA’s next Indigenous Strategy will build on what has been learned over the past five years. Priorities include bringing every program to the same level of cultural integration, embedding outcomes measurement that tracks belonging and cultural safety, expanding mentorship to other organizations, and growing Indigenous staff and caregiver capacity.

“This work has to be 365 days a year,” said Griffiths, “not just around commemorative dates. And it has to be embedded in intakes, in policies, and in everyday practice.”

For organizations beginning their reconciliation journey, Lafferty offers two pieces of advice. The first is to start with the truth. “Go back to the Truth and Reconciliation Commission’s Calls to Action1. Use the free resources out there, like webinars, podcasts, and videos. And don’t rush the hard conversations,” he said. The second is to build the container. “Have a strategic plan, timelines, champions, and resources. This can’t be done off the side of a desk. It has to be resourced and intentional.”

Griffiths adds a reminder that allyship is essential and shares, “It’s not the responsibility of Indigenous peoples alone. Everyone in an agency must take responsibility, hold each other accountable, and commit to doing this in the right way.”

Both Lafferty and Griffiths say this work has changed them personally. Lafferty, whose family was deeply affected by the residential school system, says, “I’ve seen hopelessness up close. But this work gives me hope that systems can change. It’s a window to mentor, advocate, and move institutions toward reconciliation.”

For Griffiths, the pride comes from seeing strategy turn into action. “I see our strategic plan happening in real life. Staff are keen, participants feel they belong, and outcomes are improving. That makes me proud and hopeful for the future.”

The story of PLEA’s Indigenous Matters Committee represents how reconciliation is not an event or a checklist. Reconciliation is a journey of belonging, accountability, and continuous learning. As PLEA prepares its next five-year strategy, it offers a model for others, one that starts with truth, embeds reconciliation into the fabric of operations, measures what matters, and creates space where everyone belongs. In doing so, PLEA is living its vision: a world where everyone has the opportunity for a good life, and everyone counts.

Acknowledgements and contributions:

PLEA Community Services has operated throughout British Columbia for more than 40 years. It delivers community-based services and specialized homes to children, youth, adults, and families facing significant challenges in their lives. The organization offers the full spectrum of social services designed to support participants to avoid, overcome, and recover from the most complex circumstances.

It acknowledges that it is situated on the unceded traditional territories of the Coast Salish and Sto:lo Peoples, including ten local First Nations: q́ićəý̓ (Katzie), q́ʷɑ:ńƛ̓əń (Kwantlen), kʷikʷəƛ̓əm (Kwikwetlem), máthxwi (Matsqui), xʷməθkʷəy̓əm (Musqueam), qiqéyt (Qayqayt), se’mya’me (Semiahmoo), Sḵwx̱wú7mesh Úxwumixw (Squamish), scəẃaθən məsteyəxʷ (Tsawwassen), and səlilwətaɬ (Tsleil-Waututh).

CARF Canada gratefully acknowledges that its headquarters are located on Treaty 6 Territory, the traditional territories of many First Nations, including the Nehiyaw (Cree), Denesuliné (Dene), Nakota Sioux (Stoney), Anishinaabe (Saulteaux), and Niitsitapi (Blackfoot), and within the Métis homelands and Métis Nation of Alberta Region 4.

CARF Canada extends a special thanks to Charles Lafferty, Sara Griffiths, and PLEA Community Services. Their stories, knowledge, and insights made it possible to share this journey in a meaningful way.

Charles Lafferty, PLEA Knowledge Keeper, joined the organization in September 2021. He is from the Dehcho Region, located in Fort Simpson, Northwest Territories. He identifies as Dene Métis, with ties to the Łı́ı́dlı̨ı̨ Kų́ę́ (Liidlii Kue) First Nation and the Northwest Territories Métis. Today, Lafferty makes his home as a settler in Coast Salish Territory, specifically in the Musqueam, Squamish, and Tsleil-Waututh region known as Vancouver, British Columbia.

Sara Griffiths has been with PLEA for 19 years, beginning her journey with a federal FASD (Fetal Alcohol Spectrum Disorder) initiative before moving into a management role with PLEA’s specialized family care programs. As a third-generation Canadian, she has spent most of her life in New Westminster, British Columbia, where she lives with her husband. She is also a proud mother of two adult daughters who continue to inspire and motivate her every day.

  1. Truth and Reconciliation Commission of Canada, Calls to Action (Government of British Columbia, 2015), https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf. ↩︎

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]]> 469336 Impressively long-time organizations weigh in on accreditation https://carf.org/blog/impressively-long-time-organizations-weigh-in-on-accreditation/ Mon, 03 Nov 2025 16:27:04 +0000 https://carf.org/?p=462611 As CARF International approaches its 60th anniversary in 2026, there are several...

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As CARF International approaches its 60th anniversary in 2026, there are several organizations that have been and remain accredited since CARF’s early years. Established by two national organizations – the Association of Rehabilitation Centers (ARC) and the National Association of Sheltered Workshops and Homebound Programs (NASWHP) – the two organizations agreed to pool their interests and formed the Commission on Accreditation of Rehabilitation Facilities, now known as CARF International.

We have grown and changed in breadth and reach since 1966 from one standards manual for rehabilitation to accrediting more than 150 programs, services, and specialties in the fields of Aging Services, Behavioral Health, Child and Youth Services, Employment and Community Services, Medical Rehabilitation, Opioid Treatment Programs, and Vision Rehabilitation Services. What has not changed over the years is CARF’s value belief that all people have the right to be treated equitably with dignity, respect, and inclusion; should have access to needed services that achieve optimum outcomes; and should be empowered to exercise informed choice.

Accreditation is a comprehensive review to determine if a provider’s services meet international standards of quality. Achieving accreditation means the provider is committed to delivering safe and effective services and ongoing performance improvement.

We asked a few of our impressively long-time organizations to answer some questions about accreditation and why it is meaningful to them. Below are their answers:

Q: Why is accreditation important to you?

Accreditation is important for organizations because it provides assurance of quality, credibility, continuous improvement, accountability, and transparency. The standards set clear expectations of what is expected when you work in a CARF-accredited organization. It provides broad consistency and also improved outcomes with consistent assessment, stakeholder feedback, and service delivery. CARF accreditation offers external credibility of an agency’s competence. It creates public trust for individuals served, referral sources, future employees, and all stakeholders.

–Laura Lamb, Chief Operating Officer, Vocational Guidance Services

Accreditation is a powerful tool that validates the quality, safety, and effectiveness of our programs and services. At Rancho Los Amigos, it serves as an external confirmation that we meet or exceed internationally recognized standards of care. More importantly, it reflects our ongoing commitment to continuous improvement, person-centered care, and achieving the best possible outcomes for our patients and families.

–Pattie Soltero Sanchez, DNP, RN, PHN, CPHQ, CPPS, Regulatory Compliance Officer,
 Clinical Nursing Director: Respiratory Care Services, Centralized Admissions &
 Referrals Office (CARO), Bed Control, and Patient Advocacy,
Rancho Los Amigos National Rehabilitation Center

CARF accreditation helps to validate the quality of care we provide. We share this information on our website and with those who consider utilizing our services or referring patients to our facilities.

–Marci Ruediger, Director of Regulatory Affairs, Jefferson Moss Magee Rehabilitation,
Magee Rehabilitation Hospital, Moss Rehab

Accreditation from CARF is a hallmark of quality and excellence for Henry Ford Wyandotte Hospital’s Inpatient Rehabilitation Unit. It signifies our commitment to meeting internationally recognized standards in health and human services, ensuring that our programs and services deliver safe, effective, and person-centered care since 1968. Accreditation from CARF enhances our credibility with patients, families, payers, and regulators, demonstrating that we prioritize continuous improvement, risk management, and optimal outcomes. This recognition not only validates our dedication to high-quality care but also positions us as a leader in the healthcare industry, capable of meeting the evolving needs of those we serve.

–Sarah Koppes, MSN, RN, CRRN, CNL, Administrative Director of
Rehabilitation Services, Henry Ford Wyandotte Hospital

CARF accreditation is important to us because it challenges us to monitor and raise the quality of the services we provide to individuals with intellectual and developmental disabilities. We re-evaluate whether to continue to pursue CARF accreditation periodically and always end up deciding it makes sense to continue making sure we are following the standards which come from best practices. These are things any high performing organization should be doing. We learn something with every survey and are able to apply what we learned to continually improve our services, processes, documentation, and engagement with each other, and the individuals and families we serve.

–Karen Craig, Director of Project Management and Compliance, Easterseals Arkansas

Q: What are the top business reasons for your organization to have accredited programs/services?

Quality, credibility, continuous improvement, accountability, and transparency for all levels of our organization including administratively, and especially programmatically. –Laura

  • Trust and credibility: Accreditation reassures patients, families, referral sources, and payers that Rancho meets rigorous quality standards.
  • Competitive advantage: It differentiates Rancho as a leader in rehabilitation care.
  • Operational excellence: Accreditation drives the use of best practices, resulting in improved efficiency, reduced risk, and better resource utilization.
  • Regulatory alignment: CARF standards help ensure compliance with local, state, and federal requirements. –Pattie

The increased focus on quality and safety helps to prevent costly adverse events and errors. Additionally, accreditation may help to drive referrals to our sites of service. U.S. News and World Report also recognizes that endorsements from organizations such as CARF are a strong indicator of high standards. –Marci

The business reasons for pursuing and maintaining CARF accreditation at Henry Ford Wyandotte Hospital include:

  1. Enhanced market position: CARF accreditation distinguishes our hospital as a provider of high-quality, standardized care, making us a preferred choice for patients, healthcare providers, and insurance companies. This strengthens our ability to negotiate favorable reimbursement rates with payers.
  2. Regulatory compliance and funding opportunities: Accreditation ensures compliance with state and federal regulations, often a prerequisite for maintaining licenses or securing funding. It demonstrates fiscal and operational accountability to our stakeholders.
  3. Risk management and operational efficiency: The accreditation process helps identify and mitigate risks through comprehensive safety protocols and streamlined processes, reducing liabilities and enhancing organizational resilience.
  4. Stakeholder confidence: Accreditation instills confidence in patients, donors, and community partners by showcasing our commitment to excellence, which can lead to increased referrals, partnerships, and community support.
  5. Continuous improvement: The consultative peer-review process provides actionable feedback, enabling us to refine our programs and maintain a competitive edge in delivering innovative, high-quality services. –Sarah

Other than continuing to perform at a high level with regard to quality and overall provision of services, the primary business reason for being CARF-accredited is that the governing regulations of most of our programs require accreditation either through CARF or The Council on Quality and Leadership (CQL). Despite this being a recommendation only for some of our programs, we choose to maintain CARF accreditation for multiple programs where there is no accreditation requirement due to the value we get from the triennial review of our programs and services. –Karen

Q: How have the CARF standards or the accreditation process been integrated into your daily operations? Please provide an illustrative example.

One example of how VGS has integrated CARF standards into our operations is the financial review of bills (1.F.7.). There is a systematic, quarterly review of bills for open receivables, accuracy, trends, and ways to improve if additional training is needed. –Laura

CARF standards are embedded into Rancho’s operational framework. For example, our patient admission and discharge planning processes were redesigned to align with CARF’s person-centered focus. This includes involving patients and families in goal setting from the very first day, documenting progress toward those goals in the care plan, and coordinating seamless transitions of care. This daily practice not only meets CARF’s criteria but also improves patient satisfaction and clinical outcomes. –Pattie

Many of the CARF standards have been integrated into our daily operations. One easy example is the incorporation of a thorough review of all durable medical equipment that is delivered to the hospital before it is released to the patient, to ensure that the equipment is exactly what was ordered and that it works properly. Other examples include the regular review of key program-specific metrics and the provision of written disclosures to patients related to the services that will be provided to them during their rehabilitation, their estimated length of stay and any responsibility for payment. –Marci

CARF standards are deeply integrated into Henry Ford Wyandotte Hospital’s daily operations, serving as a framework for our policies, procedures, and quality improvement initiatives. The standards guide our approach to patient care, staff training, and operational management, ensuring alignment with best practices. When we are making changes to processes within our department, we refer to the CARF standards manual to ensure it meets those standards before moving forward. –Sarah

As an organization we try to maintain a continued state of readiness instead of “getting ready” for the survey as it approaches. The work we do as an organization to maintain compliance with the CARF standards therefore has to be embedded in our daily operations. For example, to ensure regular review of policies and procedures we have a policy management software where we have loaded all organization-wide and department-specific policies and procedures. In this system we can set dates for documents to be reviewed with reminders sent to document owners. This way our document review processes are ongoing monthly instead of all right before the survey. Another example is development and management of our accessibility plan. We have a survey that is completed annually to help identify accessibility barriers. Once completed, the survey responses are shared with a specific organization-wide committee where we discuss what we think we can and cannot tackle in the upcoming year and assign owners to each task. We review progress monthly and update the plan throughout the year. –Karen

Q: How has accreditation had an impact on the quality of your organization’s programs/services?

VGS has been accredited with CARF since the 1960’s. We have embraced the standards and have built our programs, services, and administrative polices based on CARF. This accreditation covers all administrative and programmatic guidance that an organization needs to thrive. –Laura

Accreditation has elevated Rancho’s culture of accountability and continuous improvement. Through CARF’s requirements for outcome measurement and program evaluation, we have developed robust performance reporting structures to monitor patient outcomes, satisfaction, and access to care. As a result, we have been able to identify trends more quickly, address barriers proactively, and implement evidence-based changes that enhance quality and safety.
–Pattie

To maintain our accreditation, we track metrics such as whether patients who have had strokes have been taught how to prevent another stroke, and whether patients who have had spinal cord injuries have been able to return to productive activity, such as work, school, volunteering, parenting, household management, recreation, etc. These data help us to identify program-specific areas for improvement that we might not otherwise identify. The CARF focus on continuous improvement definitely helps to drive improvements in programs and services. –Marci

CARF accreditation has elevated the quality of Henry Ford Wyandotte Hospital’s Inpatient Rehabilitation program and services. The rigorous self-evaluation and peer-review process required for accreditation has driven us to critically assess and refine our practices, resulting in measurable improvements. By maintaining conformance to CARF’s evolving standards, we ensure that our programs remain at the forefront of quality and innovation, directly benefiting the patients and communities we serve. –Sarah

Being CARF accredited has helped improve the quality of our organization’s programs and services. Applying the standards across each program helps us take an in depth look at each program in terms of service delivery, outcomes for individuals served, communication with stakeholders, documentation, policies and procedures, and performance improvement. Our most recent survey was very thorough. Each of the recommendations and consultations identified opportunities to strengthen our programs operations and service delivery, which will ultimately result in improved outcomes for the individuals we support. –Karen

Q: What advice would you give to an organization considering accreditation for the first time?

While accreditation is an investment of time and financial resources it is worth it for quality services. There are many resources available to assist a new organization to be successfully accredited, you just need to lean into the process utilizing all expertise and resources. The CARF manual is a detailed guide of how to prepare, what should be considered, and what needs to be implemented in writing for documentation. –Laura

Approach accreditation as more than a compliance exercise—view it as an opportunity to strengthen your organization’s foundation for quality. Engage staff at all levels early in the process, and integrate CARF standards into your policies, procedures, and daily workflows rather than treating them as a separate checklist. Most importantly, foster a culture where feedback and continuous improvement are valued, so that the benefits of accreditation extend well beyond the survey. –Pattie

For an organization considering accreditation for the first time, we suggest communicating with CARF as well as other accredited entities to understand the benefits of CARF accreditation as well as the initial and ongoing work involved in preparing for a survey. Organizations often begin their accreditation journey by accrediting only one program. It is critical to identify people who can lead the preparation process and develop a gap analysis as well as a plan to close the gaps between current processes and what might be needed to come into conformance with the standards. CARF has many resources to help with preparation. It’s very important to understand the intent of the standards and to clarify what is required when questions arise in the preparation process. There are often many ways to meet the intent of the standards. –Marci

For organizations considering CARF accreditation for the first time, Henry Ford Wyandotte Hospital offers the following advice:

  • Start with a thorough self-assessment: Begin by conducting an internal evaluation to compare your current practices against CARF standards. This self-study, which may take 6–12 months, is critical for identifying gaps and preparing for the survey. Engage all levels of staff to foster buy-in and collaboration.
  • Leverage CARF resources: Work closely with your designated CARF resource specialist who provides guidance and access to tools like the Customer Connect portal. Consider attending CARF’s educational webinars and networking events to stay informed about standards and best practices.
  • Build a culture of continuous improvement: View accreditation as an ongoing commitment rather than a one-time event. Integrate CARF standards into daily operations to make survey preparation seamless and sustainable.
  • Engage stakeholders early: Involve patients, staff, and community partners in the accreditation process to ensure their perspectives shape your quality improvement efforts. This aligns with CARF’s emphasis on person-centered care and stakeholder input.
  • Plan for the long term: Accreditation is a multi-year journey. Develop a quality improvement plan (QIP) to address survey findings and maintain conformance through annual reporting. This proactive approach ensures sustained excellence and simplifies re-accreditation. –Sarah

Remember it is a consultative process, not a punitive process. It is an opportunity to showcase all the great things you are doing today while also creating a culture of continuous improvement. –Karen

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]]> 462611 New standards advocate for the highest palliative and end-of-life care for persons served https://carf.org/blog/new-standards-advocate-for-the-highest-palliative-and-end-of-life-care-for-persons-served/ Mon, 29 Sep 2025 21:05:16 +0000 https://carf.org/?p=460302 CARF International recently released a set of interdisciplinary, field-driven accreditation standards on...

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CARF International recently released a set of interdisciplinary, field-driven accreditation standards on July 1 for Palliative and End-of-Life Care (PELC). The accreditation standards demonstrate a person- and family-centered approach to providing holistic support to individuals who are experiencing life-limiting conditions and illness.

Early integration of palliative care allows a program to address the cultural, physical, emotional, psychosocial, religious, and spiritual needs and preferences of the persons served. The program seeks to understand the values, beliefs, wishes, and end-of-life choices of the person served through advanced care planning and implementation of individualized, interdisciplinary care plans.

New standards process

CARF’s process for creating new standards involves conversations with interested parties before convening an International Standards Advisory Committee (ISAC) to discuss and develop the standards. The committee size ranges from 10 to 15 and consists of CARF staff and surveyors, key stakeholders, and individuals or family members with lived experience.

One committee member, Sheryl Johnston, RN, has 25 years of hospice palliative care experience in community nursing, then at an acute care and complex care hospital, and now working for a hospice organization as Director of Clinical Services and Informatics at The Hospice of Windsor and Essex County Inc. in Windsor, Ontario, Canada.

“My education and professional experience have equipped me with the expertise to serve as a subject matter expert and the confidence to advocate for the highest possible standards,” said Johnston. “My background enabled me to identify potential limitations in applying certain standards statements and to determine which standards are most relevant across different contexts, ensuring they are practical and achievable for a diverse range of organizations.”

PELC specialty program

The PELC specialty program provides or arranges for grief and bereavement supports, resources, and end-of-life care. The program educates providers across the continuum of care and advocates for underserved populations. It utilizes current research and evidence-based practices to provide effective care and support to persons served and their families/support systems. The program demonstrates the commitment, capabilities, and resources to comprehensively address the complex needs of persons with life-limiting illness across a variety of settings.

“I was impressed with how smooth and organized the ISAC process was. These subject matter experts were from various sectors and disciplines, each bringing a unique perspective,” said Johnston. “The CARF ISAC team would ask questions and allow group discussions and healthy debate. It seemed as though overnight the team would magically turn them into standards for the group to review and edit as appropriate. Each person’s contribution was valued, respected, and appreciated.”

Standards developed

CARF developed these standards as a resource for aging services providers and community stakeholders. Key areas of the standards include:

  • Philosophy of palliative care
  • Early integration
  • Advance care planning for each person served
  • Education that meets the needs of persons served and families/support systems
  • Grief and bereavement supports and resources
  • Holistic end-of-life support
  • Competency-based training for personnel, including volunteers
  • Ethical concerns related to palliative and end-of-life care situations
  • Policy on medical assistance in dying

Seeking feedback

Once the ISAC has finished the standards creation, a review of the proposed standards and seeking expert insight from the International Advisory Council is completed, before conducting a public field review. The Palliative and End-of-Life Care ISAC and public field review involved 55 stakeholders, including individuals with lived experience and their family members.

“As the world’s population continues to age, we will see an increase in the need for these programs. CARF accreditation, led by peer surveyors, will assure the public that these accredited programs are held to the highest standards of quality and performance improvement in the specialty of PELC,” said Terrence Carolan, CARF managing director of Aging Services and Medical Rehabilitation.

The new standards are published in the 2025 standards manuals for Aging Services and Continuing Care Retirement Communities, and accreditation surveys using the standards began July 1, 2025. Accreditation for PELC demonstrates a program’s capability of addressing the diverse and potentially complex health needs of individuals with life-limiting illness and provides integrated, evidence-based, person-centered care.

“The field of PELC continues to evolve rapidly, and using CARF’s field-driven standards to achieve accreditation ensures that individuals with life-limiting illness are receiving evidence-based care from an interdisciplinary team at the time when it is needed most,” said Carolan.

Sparked interest in surveying

Involvement in the ISAC for Johnston, “gained new mentors and colleagues for me to reach out to with questions about what is happening in their organizations or region. It was through this advisory committee that I gained the connections and interest to become a CARF Surveyor. The training process was intensive, and I was able to practice the knowledge from the learning modules when I attended the in-person Survey Simulation Training at CARF’s headquarters.”

Johnston has been involved with three CARF surveys at her current employer, The Hospice of Windsor and Essex County. That knowledge, along with 25 years of hospice palliative care work, her continuous education, the ISAC experience, and becoming a CARF Surveyor, have all led to today, where she strives to improve early identification of anyone who would benefit from a palliative approach to care and improve early access to palliative care services for all populations, including underserved individuals and their families.

Standards share best practices

CARF’s standards introduce an established, international mechanism to share and adopt best practices to improve outcomes. Accreditation demonstrates to persons served, regulators, and payers that the organization offers a comprehensive array of services and supports designed to help persons served.

Devoted, dedicated professionals, CARF standards, services, and surveyors, as well as the more than 68,300 accredited programs and services supporting more than 13 million persons served annually, come together with a goal to enhance people’s lives.

Go to the CARF website if you are interested in learning more about becoming a CARF Surveyor, Aging Services accreditation, and the PELC standards.

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]]> 460302 Measurement-informed care is a collaborative process that advances service excellence https://carf.org/blog/measurement-informed-care-is-a-collaborative-process/ Tue, 27 May 2025 18:46:29 +0000 https://carf.org/?p=450352 CARF recently implemented a new standard to ensure behavioral health, child and...

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CARF recently implemented a new standard to ensure behavioral health, child and youth services, and opioid treatment programs use measurement-informed care (MIC) with persons served to advance service excellence.

Measurement-informed care is a practice that involves the systematic use of standardized tools/measures to track symptoms, outcomes, and functional status of persons served over time. It is a collaborative process that involves the patient and provider regularly monitoring progress to identify areas for improvement and make better-informed decisions about treatment plans and interventions.

The standard requires the program to implement written procedures for measurement-informed care that:

  1. Identify the tools to be used. The type of tool used should be appropriate to the person served and based on their needs and goals. Consideration should be given to cultural and linguistic backgrounds as well as reading level (when given to the person served to complete). Common examples of tools used in behavioral health include, but are not limited to: general mental health, substance use disorders, specific disorders, and quality of life.
  2. Prescribe intervals for administration of the tools. The effectiveness of measurement-informed care relies on regular administration of the identified tools. The optimal frequency of assessments can vary depending on the person’s condition, treatment phase, and individual needs. However, common intervals include:
    • Baseline Assessment: Before starting treatment to establish a baseline.
    • Regular Monitoring: At specific intervals during treatment, such as weekly, bi-weekly, or monthly.
    • Critical Transition Points: At key moments, like the end of a treatment phase or before transitioning to a new phase of care.
    • As-Needed Assessments: When there are concerns about a person’s condition or when significant life events occur.
  3. Specify how results will be shared with persons served. Sharing the results of screening/assessment tools with the persons served can have a significant treatment impact. Examples include: enhanced engagement, improved treatment adherence, enhanced therapeutic alliance, improved treatment outcomes, and increased satisfaction.
  4. Identify personnel training required. Considerations for personnel training may include reasons for implementation of MIC, training on the scoring and meaning of tools selected, expectations for frequency of administration, information technology or data requirements related to the administration of tools, and clinical training on responding to results.

Discussion with two of CARF’s Managing Directors about the new standard.

From Senior Managing Director of Behavioral Health Michael Johnson.

Q: Why did CARF decide to establish the Measurement-Informed Care Standard?

A: CARF has historically supported measurement-based care initiatives as part of performance measurement and management activities. As measurement-based care has become more widely adopted in the health and human services arena, we felt it was time to clearly define activities that support measuring the impact of services to persons served.

CARF uses the naming of “measurement-informed care” rather than “measurement-based care.” The reason is that in much of medicine, there are standard protocols for care based on the tests, labs, etc. Although there is still provider judgement in how to proceed, the results of the tests are what the protocols are based on. In behavioral health, often there are not clear protocols to implement in response to the results of the scale or instrument used to determine the impact of services for a person. So, the interventions implemented for persons served are informed by the results, not based on the results.

Q: What is the key factor of measurement-informed care and why is it worthwhile to implement?

A: The key factor to MIC is selection of the tool(s) an organization will use with their population served—and these tools should be standardized, reliable, and psychometrically sound.

There are a number of reasons to implement measurement-informed care. It is becoming a standard practice in healthcare and accredited organizations should utilize sound methods to be able to articulate the value of their care delivery systems using common tools. This helps the person served know what is and what isn’t working for them. It can signal early signs of decompensation or relapse and allow clinicians to intervene earlier in the process. This process of care enhances engagement in treatment because it informs the person served about their progress in an objective manner and supports them to more frequently monitor themselves—which often can lead to faster improvement of symptoms and functioning.

Q: What are the essential steps in implementing MIC?

A: Organizations will need to evaluate tools for their populations, select the one(s) they are going to use for their programs/services, update their EHR to capture the data collected, train staff, and review results. It could take an organization several months from start to initial data collection. Implementation (when effective) could take significant time, yet it is worth the overall investment.

From Managing Director of Child and Youth Services Theresa Lindberg.

Q. Why is MIC important and worthwhile?

A. MIC is important because it can be used in conjunction with qualitative and biometric information to inform treatment decisions and service planning. It is valuable and worthwhile because it can help to show clinical progress, efficiency of the care/services, and be an indicator of accountability to all stakeholders.

Q. What does MIC look like for a child and youth services organization?

A. MIC is similar to what would be used in adult serving programs, except the tools would likely be different or modified for child and youth populations. Family involvement and feedback should also be considered and collected, when appropriate.

Q. What kind of tools are used for MIC in child and youth services? How do you get the person served, family, and support system’s response?

A. There are tools that the child/youth can answer themselves, and there are also tools that incorporate both the child’s/youth’s feedback as well as from family and other significant support systems (school, child welfare, etc.). Organizations should consider the following when choosing tools: developmental stage, comprehension level, use of age-appropriate language, and the time it takes to complete the tool.

Advancing service excellence

The new MIC standard is in Section 2.A. of the 2025 Behavioral Health, Child and Youth Services, and Opioid Treatment Program Standards Manuals to enhance the clinical treatment process. CARF strives to continuously advance service excellence through a consultative peer-review survey process that affirms conformance to evolving, international consensus standards.

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]]> 450352 Disorders of Consciousness standards balance prognostic uncertainty and hope https://carf.org/blog/disorders-of-consciousness-standards-balance-prognostic-uncertainty-and-hope/ Thu, 01 May 2025 16:22:52 +0000 https://carf.org/?p=447915 CARF International convened an International Standards Advisory Committee (ISAC) to develop new...

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CARF International convened an International Standards Advisory Committee (ISAC) to develop new accreditation standards for the Disorders of Consciousness (DoC) Specialty Program as mounting evidence supported the need for persons with DoC to have better access to timely and progressive rehabilitation.

DoC encompasses a wide spectrum of clinical syndromes—which include persons presenting in a state of coma, vegetative or unresponsive wakefulness, minimally conscious, post-traumatic, or acute confusion—caused by traumatic brain injury (TBI) and other causes. According to the Journal of Head Trauma Rehabilitation, only 13% of persons with moderate and severe brain injury have access to inpatient rehabilitation during their recovery. 

“In fall 2024, the American College of Surgeons collaborated with the American Congress of Rehabilitation Medicine to publish the updated clinical practice guidelines for the treatment of TBI with important information for the field,” said Terrence Carolan, Managing Director of Medical Rehabilitation and Aging Services, CARF International. “For example, the guidelines acknowledge that recommending withdrawal of life-saving treatment within 72 hours of a TBI diagnosis is arbitrary, and that a longer period of observation and treatment is needed to assess a person’s potential for recovery.”

Rationale

There are 153 self-identified DoC programs in the world and CARF accredits 35 organizations with this program. These programs deliver services that focus on the assessment, treatment, and care of individuals with DoC and may be located in a hospital, skilled nursing facility, or long-term care hospital in the U.S.; acute hospital or hospital with transitional rehabilitation beds in Canada; or, in other countries, a setting that is comparably licensed.

“We anticipate and are already seeing an increase in the number of individuals with DoC. This will increase with time as more healthcare systems in the United States, Canada, and around the world improve the identification, treatment and medical management of those with DoC.”

Before deciding to create the DoC Specialty Program standards, CARF collected information that included 12 months of interviews with stakeholders (individuals and family members) which were recorded and analyzed for themes; related efforts across the field of rehabilitation; and recently published literature and resources. This groundwork showed strong signals supporting the creation of standards to be used in the peer-led accreditation survey of DoC programs.

ISAC Process

In January 2025, CARF convened a three-day in-person ISAC meeting that involved a wide variety of medical rehabilitation disciplines and had virtual participation of an individual with lived experience and a family member. The ISAC used a consensus process to create draft standards.

The standards address the essential components of a DoC specialty program, including:

  • An efficient pre-admission process that facilitates entry to the DoC program by collaboration with acute care providers for appropriate referrals and informed communications with the families/support systems of the person served.
  • Admission decisions based on the clinical status of the person served and independent of social, psychological, or demographic characteristics.
  • Use of a transdisciplinary approach to provide a complete and clear understanding of a person’s condition. Where the team works together to assess consciousness using trusted tools that fit the specific population and setting. They also use treatments that help the person wake up, manage medical issues, and improve function. This approach supports accurate diagnosis and guides effective, evidence-based care for people with complex medical and rehabilitation needs.
  • Families/support systems are partners in decision-making and receive education and support to effectively care and advocate for their loved ones, navigate fluctuations in the clinical status of the persons served, and balance prognostic uncertainty and hope.
  • Personnel receive competency-based training on the unique aspects of persons with DoC.
  • Personnel also receive ongoing support for their own well-being.
  • Advocates for the needs of persons served and their families/support systems.
  • Demonstrates the commitment, capabilities, and resources to comprehensively address the needs of persons with DoC.

Field reviews

CARF’s standards development process includes two rounds of online open feedback periods called field reviews. Proposed standards are first reviewed by the International Advisory Council—which represents a broad spectrum of stakeholders, including persons served, providers, and professionals in the health and human services field. Then there is a public field review where service providers, consumers, caregivers, payers/regulators, insurers, and other interested individuals are invited to provide anonymous feedback on the standards through an online survey.

There was a robust response to the recent DoC field reviews with feedback and comments from 139 respondents.

Final steps

Carolan and the ISAC members will use the input from the reviews to finalize the standards that will be published in the 2026 Medical Rehabilitation Standards Manual, which goes into effect July 1, 2026.

An organization seeking accreditation for a Disorders of Consciousness Specialty Program will also need to meet the applicable standards in Sections 1., 2., and 3.A. of the standards manual.

“This is about awareness, access, and advocacy,” said Carolan. “We’re at a point where healthcare providers are not always able to identify individuals that have DoC. There’s still a need for improved awareness of what DoC is—not just by the public, but by healthcare providers at all levels of care. This is a very specific part of brain injury rehabilitation and there is a profound lack of access to specialized care. We are going to call on every CARF Surveyor to be vigilant and identify how they can advocate for this group of individuals because there is a tremendous need to support access to specialized care for these individuals.”

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]]> 447915 CARF Surveyors share their experiences and how this work enriches their lives https://carf.org/blog/carf-surveyors-share-their-experiences-and-how-this-work-enriches-their-lives/ Tue, 21 Jan 2025 20:42:38 +0000 https://carf.org/?p=441481 Regulators, payers, and the public all continue to increase the demand for...

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Regulators, payers, and the public all continue to increase the demand for quality and accountability in the operations of health and human services providers and their delivery of services to persons served. This trend aligns with CARF’s mission to promote the quality, value, and optimal outcomes of services through a consultative accreditation process and continuous improvement services that center on enhancing the lives of the persons served.

As the cornerstone of CARF’s peer review accreditation process, surveyors promote CARF’s mission, vision, values, goals, and objectives by conducting on-site reviews of health and human service organizations. In applying standards from the respective CARF standards manual, surveyors interview personnel, persons served, and other stakeholders; observe organizational processes and service delivery; and review documents, including records of persons served, plans, policies, and procedures to determine conformance to the standards.

Surveyors also offer relevant, experience-based consultation to organizations regarding conformance to the standards and performance improvement. Part-time, intermittent surveyors are professionals in their fields with full-time responsibilities independent of CARF.

There are rich benefits to individuals who become CARF Surveyors:

  • Professional growth and development of leadership skills
  • Influence industry performance and improve service quality
  • Connection to international peer groups and professional networks
  • Access to emerging best practices and insights from industry thought leaders
  • Annual continuing education conferences to learn about new topics and field trends
  • Access to complimentary training and education, standards manuals, publications, and other tools and resources

Interested in learning more about what surveyors’ experience? Please read the Question & Answer section below.

Q: Why did you become a CARF surveyor?

I became a CARF surveyor for several reasons. Primarily, it offered an opportunity to help my organization improve its services by learning from the best practices of other organizations across the nation and internationally. Additionally, our organization previously had an onsite CARF surveyor, and leadership wanted to fill that gap. Another reason came after a survey, we received multiple recommendations and consultations to enhance our focus on performance management, making my role essential. Finally, I saw this as a valuable avenue for professional growth and development.

–Dawn Jones, Director of Performance Management and Quality, Cleveland Sight Center, became
a surveyor in 2022 for Employment & Community Services, and Vision Rehabilitation.

To expand my first-hand knowledge of how rehab is developing outside of my own organization.

–Steven Mandley, PT, CBIS, Physical Therapist, Program Director, Rehab & Community
Integration, PLLC, became a surveyor in 2009 for Medical Rehabilitation.

I worked closely with a co-worker who was a CARF surveyor for many years, and she kept encouraging me to consider it. I blew it off until I was in the position of having to help prepare our programs for a survey and realized the benefits of becoming a surveyor. I got to understand I would gain a deeper knowledge of the standards as well as being able to give back to the field. I believe in and practice, that it is very important to bring others along, and becoming a surveyor is the perfect way to do that. I finally got to a place in my job where the opportunity presented itself and decided to go for it.

–Jeannie Lewis-Whitaker, LMHC, CADC, MAC, VP of Accreditation & Clinical Integrity, WestCare
Foundation, became a surveyor in 2018 for Behavioral Health, and Child & Youth Services.

I strongly believe that sometimes we choose our path, and other times, a path is chosen for us. My sister’s birth with down syndrome played a significant role in shaping my initial decision to pursue a career in healthcare. After many years in rehabilitation medicine as both a clinician and director, I developed a deep interest in analyzing and improving the quality of healthcare delivery. Serving as a CARF surveyor perfectly aligns with my values of helping others, being a lifelong learner, enhancing healthcare models on both individual and organizational levels, and giving back. This combination of learning, contribution, and meaningful impact makes being a CARF surveyor incredibly rewarding.

–Pawan Galhotra, Program Director, Polytrauma System of Care, Veterans Affairs Palo Alto
Health Care System, became a CARF surveyor in 2003 in Medical Rehabilitation.
The opinions expressed are not those of the Veterans Affairs or any other governmental agency.

Surveys can directly impact important decisions within a company, leading to significant and clear improvements in patient care. I became a CARF surveyor because I wanted to join a dedicated team that offers valuable insights to organizations helping them refine their strategies and enhance operational effectiveness. As a surveyor, you can directly contribute to development and growth of person-served care.

–Angela Bonaguidi, Director, University of Colorado, Addiction Research and Treatment Services,
became a CARF surveyor in 2017 for Opioid Treatment Programs.

At the time I believed becoming a surveyor would enhance my knowledge in coordinating surveys at our organization. Additionally, our organization has a high degree of commitment to supporting activities which enhance our field of service.

–Jim Bernardo, Special Advisor, Presbyterian Senior Living, became a CARF surveyor in 1988
for Aging Services and Continuing Care Retirement Communities.

Q: What is a unique benefit of working as a surveyor?

A unique benefit of working as a surveyor is the continuous learning and leadership development it provides. This role allows me to stay current with evolving standards and practices, and it also enables me to bring valuable insights back to my own organization. –Dawn

The benefit to me is the transparency of colleagues and peers to collaborate and share challenges and breakthroughs, especially within the working environment. It is so different from conference or professional networking. –Steven

Always getting exposed to a clearer understanding of what the standards are really about (quality); becoming aware that there is not one way to achieve conformance, there are multiple ways; becoming exposed to other organizations and the work they do in real time; and of course, the travel – the opportunity to go to locations you might never ever have reached without this opportunity. –Jeannie

One unique benefit of working as a surveyor is the opportunity to suggest enhancements of service delivery for an organization which positively impact not only the persons served today but also may have a lasting impact for those served in the future. Another unique benefit of being a surveyor is the continual growth of my cultural competence as I expand my understanding of how cultural, social, and economic factors influence the delivery of rehabilitation services both nationally and internationally. This deepens my appreciation for the value society places on rehabilitation and the profound impact it has on those who contribute to the community. –Pawan

The fast-paced nature of surveying demands that we stay continuously updated on the latest industry trends and innovations while actively seeking to acquire new knowledge and skills. Collaborating with various organizations not only enhances technical expertise but also helps to build a broader and more diverse professional network. –Angela

There are several benefits: the opportunity to advance quality, learning best practices, and creating meaningful relationships with fellow surveyors. –Jim

Q: What do you think has been your most impactful moment as a surveyor so far?

My most impactful moment as a CARF surveyor was when Dr. Baxter, a well-respected surveyor, trainer, and longtime partner of CARF, took the time to guide me through the Performance Measurement and Management Standards. His patience, depth of knowledge, and critical insights challenged me to think more deeply about the standards and how to apply them effectively. Dr. Baxter’s mentorship in developing a solid performance measurement plan left a lasting impression on me, as he encouraged me to refine my approach and elevate my understanding of quality management. I am still in awe of the time and care he invested in helping me as a new surveyor, ensuring I was equipped to produce a high-quality performance measurement plan. In the end, our organization received no recommendations in this area, which I attribute to his invaluable guidance. I am immensely grateful for his mentorship, which continues to influence my work to this day. –Dawn

When a rehab director smiles and realizes that the CARF standards genuinely can help them promote their local/branch mission, versus being a chore just to please their corporate reports. –Steven

Oh wow – what a great but hard to answer question. I have two answers. 1. My most impactful moment for me was when I stood my ground as an intern on my first survey as a Program Surveyor. I felt confident in my knowledge of the standard and did not respond to pressure from the organization to change my decision. It was one of those, very few, black and white standards which made it easier. But the fact that I was confronted with it on my first survey was initially challenging. 2. My most impactful moment while with an organization was as I was explaining different ways to conform to the standard, I could see the lightbulb go on. As we further discussed options during consultation, it turned into a brief creative process for the person that I had the privilege of witnessing. It was very cool. –Jeannie

Many years ago, after conducting a survey, I received an email from a member of the executive leadership team of an organization we had assessed. The email highlighted the results of a consultation we provided during the survey, along with a television news story showcasing the positive impact of that consultation on the community. It’s always incredibly rewarding to witness the tremendous success of an organization you’ve surveyed. –Pawan

As a surveyor, my most impactful experience occurred during a return survey. The survey team discovered significant gaps in the documentation of patient care which could lead to misunderstandings about treatment quality. After discussing findings with leadership and staff, we worked together to improve their record-keeping practices. This collaboration not only enhanced the facility’s conformance to standards but also directly benefited persons served by ensuring they received appropriate care. Witnessing the positive changes reinforced my belief in the importance of thorough surveying in promoting better health outcomes. –Angela

Meeting with a group of Continuing Care Retirement Communities (CCRC) residents who told me that the CARF Accreditation process affirmed their choice of their CCRC. –Jim

Q: What has been your favorite survey experience and why?

My favorite survey experience was a luncheon with the surveyed organization’s leadership, staff, and individuals they served. This informal setting allowed for genuine conversations, and I was impressed by the open, welcoming culture of the organization. It was a memorable and impactful experience that demonstrated the organization’s commitment to inclusivity. –Dawn

A Canadian survey where I first saw how rehab professionals were dedicated to doing rehab right was my favorite survey experience. They were able to influence government funders to do the right thing, especially when it involved returning injured workers back to a productive and meaningful life, safely. –Steven

My favorite survey was my first one. It was such an experience. –Jeannie

My most memorable survey experiences are those that challenge me clinically and operationally. Over the years, I’ve encountered numerous organizations that have developed innovative processes, procedures, and programs tailored to meet the individualized needs of the people they serve, all while adhering to CARF quality standards. For instance, one survey of a brain injury specialty program stood out due to its exceptional focus on community inclusion, where the community was intricately connected to the program, offering unparalleled opportunities for employment, education, housing, and independence. –Pawan

I really enjoy surveying organizations in small communities because it offers unique cultural experiences. In these settings local values and traditions may have more influence in the way organizations operate. Each organization has its own story reflecting the community’s history and identity. Connections to culture and identity make my work more meaningful and enjoyable. –Angela

When conducting a survey at a Ukrainian organization in Canada, I had the opportunity to experience the cultural infusion of traditions and the impact they had on the lives of the persons served. –Jim

Q: How has being a surveyor challenged you the most?

One of my most challenging experiences was a Digitally Enabled Site Survey for an organization in another country. This survey required me to adapt to different cultural expectations, interpret standards in unique ways, and manage time zone differences—all while maintaining professionalism and focus. –Dawn

Learning what is possible outside of my own organization and posing new opportunities to those who have never seen alternative rehab programming outside of their own organization. –Steven

When I first began doing surveys, I was anxious, nervous, and questioning my knowledge base, and really agonizing on how to not let how we do it at my organization influence how I reviewed and rated another organization’s work product. It took me a few surveys to be able to remove that potentially irrelevant judgement. Now, I am able to take what is presented and look at each document as unique and with fresh untainted eyes. Now, it is about what I see that is in conformance and where could they improve (if relevant) vs “we don’t do it like this.” This has allowed me to see opportunities to improve our documents. –Jeannie

Being a surveyor has constantly challenged me to maintain an open mind and value diverse perspectives on service delivery. –Pawan

Surveyors have to comprehend various regulations and standards that oversee person-served care. This understanding is essential to guarantee that organizations deliver appropriate care and comply with legal obligations. Furthermore, surveyors might encounter pushback from employees who may feel uneasy about the audit process. Finding the right balance between providing meaningful guidance and keeping good relationships can be difficult but essential for impacting improvements in an organization. –Angela

Conducting a survey of one location of a multifacility organization which did not support the corporate mandate for survey accreditation and being inserted in the middle of an organizational conflict. –Jim

Q: What advice would you give to future or aspiring surveyors?

Network with other surveyors and find mentors in both administrative and program areas. This support will help you refine your skillset. I also recommend attending the CARF Continuing Education Conference and Performance Management workshop for additional insights and connections. –Dawn

Be humble and expect to learn things you have never seen implemented before. Go into a survey to learn and be blown away. Don’t go in to be the hero and save or correct them. –Steven

Always be yourself. As you go through the training and are then actually conducting surveys, it is important to not forget who you are and let your work and interactions reflect that. If you are funny, be funny but also be about the work and the purpose of your time with them. Being yourself helps to reduce their anxiety and allows your knowledge, your love for “the work and the clients” and helping others show. –Jeannie

Embrace new adventures and opportunities for discovery—there is always so much to learn and share. –Pawan

As aspiring surveyors, it is important to approach your work with both diligence and empathy. Understand the unique challenges that organizations face in delivering care. Thoroughly review documentation and ensure conformance but also recognize the human element behind the standards. Engaging with providers can foster better relationships and enhance the survey process. Finally, always stay updated on field and standards changes to improve your effectiveness as a surveyor in this vital field. –Angela

Be open to learning new and different experiences. –Jim

Q: Can you give an example of how the peer model allowed you to both share and develop your own experience in the field?

The peer model has been essential to my growth as a CARF surveyor. Collaborating with experienced surveyors has exposed me to diverse perspectives, which has broadened my approach and refined my methods. After each survey, we receive feedback not only from peers but also from the organization and editors, providing a well-rounded evaluation that drives continuous improvement. This multi-layered feedback process has strengthened my analytical skills and increased my confidence in delivering actionable insights. The collaborative peer model has deepened my understanding of CARF standards and empowered me to develop effective quality improvement strategies for my organization. –Dawn

Once I learned how to earn peer trust in another organization, the transparency allows fast and effective learning on both sides when you are collaborating with those who share your passion in a specialty area. I learn so much more during a survey than I ever could in an onsite course or conference. –Steven

As an admin and program surveyor, I get to experience both sides of the coin when I work with other peers. When I function as a program surveyor, I love to see how the administrative person presents guidance in the pre-survey calls about what needs to be provided for us to review and experiencing different ways of presenting the entrance and exit conference. One of the things I learned from the peer model is also humility. We are coming in, in a way, as the “authority,” but during the survey process, watching my peers has helped me to go back to my roots of listening keenly and being open. Because I do both types of surveys, when I am with peers, I always will be the program surveyor because I get a chance to be really clearly reminded why we do what we do. –Jeannie

As a surveyor, I have had the privilege of integrating best practices to enhance efficiencies while maintaining exceptional quality and recognizing the invaluable contributions of all stakeholders. The CARF surveyor cadre offers guidance not only to the organizations we survey but also to one another. I hold the utmost respect for my fellow surveyors and their unwavering dedication to advancing the field of rehabilitation medicine. –Pawan

After finishing a survey, CARF surveyors go back to their main jobs. It’s not unusual for a surveyor to have recently taken part in a CARF survey, but from the opposite side. Because we are in the field, we can look at a survey not just as someone checking the work but as someone who is invested in person-served care. As such, there is a deeper level of mutual understanding and respect. –Angela

My example is more general. The peer model allowed me to calibrate how I evaluate the relative quality of my own program and eliminate pride. –Jim

Q: How has being a surveyor impacted your professional development?

Being a surveyor has greatly improved my skills in coaching, public speaking, and training. I used to feel nervous about public speaking, but this role has helped me build confidence and ease in presenting and leading discussions. –Dawn

It has allowed me to speak with confidence and with real plan/objectives to leadership about the importance of implementing best practices and the ability to do what is right. –Steven

Every year when the new manuals are released, I develop a “new manual changes” document for my organization. I review the changes document, compare it to the old manual, and write a brief summary with examples that are relevant to my organization including a “what does this mean for you” explanation that is shared during our accreditation call. This process alone helps me with my understanding of the changes/standards and gives me a better grasp for when I am helping my organization to prepare for its survey. –Jeannie

Professionally, I have greatly benefited from the opportunity to implement many of the excellent processes I’ve observed over the years. My expanded knowledge of quality standards, coupled with a deeper understanding of how the ASPIRE standards and program standards work together, has been instrumental in my professional development. –Pawan

Being a surveyor contributes to professional development as there is an inherent responsibility to remain informed and keep up with the latest trends in healthcare services. As a surveyor, you’re held accountable and have to demonstrate standards and field knowledge. Sure, the general field has annual expectations, but it’s on a different level when you’re a CARF surveyor. You have a duty to CARF and the surveyed organization to be knowledgeable, communicate well, and provide a meaningful survey experience. –Angela

By providing the skills and exposure to identify components of success and incorporate them in our own services and being able to offer better consultation as a surveyor. –Jim

Q: Has your reason for being a CARF surveyor changed from when you first started?

While my primary motivation remains the same, my interest in professional development has deepened. I now see ongoing growth and learning as essential to my role as a surveyor and as a quality improvement specialist. –Dawn

Yes. I now want to spread best practices and show American practitioner’s how rehab can be provided to help catastrophically injured people regain function with dignity in a way that is not pressured by profit. Other countries with very different payer schemes are doing it, and so can we. –Steven

Not really, I still practice bringing others along, having integrity in my work and sharing experience, strength, and hope. The only thing that has changed is my commitment to continue to do this work for as long as I can as a CARF surveyor. –Jeannie

Each survey has been an opportunity for growth and learning. Over the years, I have significantly expanded my knowledge base, enabling me to share best practices with organizations. At its core, my motivation for being a CARF surveyor remains unchanged since I began: to listen, learn, and share. –Pawan

At first, I remember becoming a surveyor to better understand the process and CARF standards. At some point the original reason evolved into a desire to continue surveying because of the strong connections and teamwork with others in the field. There are many reasons why I keep doing surveys but one of the main ones is that I get to be part of a team that really makes care better. –Angela

Not really. –Jim

If interested in learning more or completing an application go to this section of the website: https://carf.org/surveyor/.

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]]> 441481 ASAM Level of Care Certification by CARF: From concepts to practice https://carf.org/blog/asam-level-of-care-certification-by-carf-from-concepts-to-practice/ Wed, 07 Aug 2024 17:34:56 +0000 https://carf.org/?p=429040 In the spring of 2020, CARF International and the American Society of...

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In the spring of 2020, CARF International and the American Society of Addiction Medicine (ASAM) launched a partnership to exclusively provide Level of Care (LOC) certification through CARF’s consultative survey process. This put into motion CARF’s independent assessment, verification, and certification of residential substance use disorder treatment services demonstrating fidelity with The ASAM Criteria®.

“It was not the most opportune time to begin [due to the global pandemic], but people in the industry knew it was coming, and many organizations were interested in starting the certification survey process,” said Michael Johnson, Senior Managing Director of Behavioral Health for CARF International. “Now, with it being a 3-year certification, we have many organizations in the midst of recertifying which is a testament to some of its value.”

Independent assessment by CARF (carf.org/loccertification/) ensures providers demonstrate capacity to deliver one or more residential Levels of Care that is in alignment with the nationally-recognized standards found in The ASAM Criteria—thereby distinguishing themselves to payers, regulators, referral sources, and persons served.

“I believe that going through the certification process takes the criteria from abstraction to operationalization. Organizations have familiarity with the criteria, but translating it into specific actions they should take is a way to create accountability. When you become certified, then you are demonstrating your fidelity to The ASAM Criteria, to the individuals you are serving, to payers in the marketplace, and regulators,” said Johnson.

“For the certification survey, organization staff members have to prepare, think through and articulate the criteria, as well as adapt processes even though they might have felt they were aligned with the criteria before that. Actually implementing the elements in their organization has strengthened the overall quality and commitment to the criteria.”

Certification is available for adult Levels of Care 3.1, 3.5, and 3.7 (www.asam.org/asam-criteria/about-the-asam-criteria). ASAM and CARF International have continued the collaborative partnership by working together on revising the fourth edition of the ASAM Level of Care Certification Manual.

To date 326 organizations have received ASAM LOC certification by CARF and 125 of those have completed the recertification process.

“It is gratifying to work with organizations committed to enhancing quality and fidelity to The ASAM Criteria,” said Dr. Susan Johnson, one of the ASAM LOC surveyors for CARF and Principal, SMJ Associates, LLC. “Providers consistently report a positive experience with the process. It is exciting to witness providers’ dedication to persons served and continuous quality improvement.”

We asked ASAM LOC certified organizations to answer a few questions about the CARF certification process and their experience. Below are their answers:

Q: Briefly can you describe your experience with the process for ASAM LOC certification by CARF?

My organization received its ASAM certification for our Orlando, Florida program (detox/residential program), in fall 2021. The program received a three-year certification. Then in the next 12 months, my organization got the remaining 11 detox and residential programs ASAM certified, all receiving 3-year certifications. Next in 2024, the program in Orlando was recertified for another three years. Each of the certification surveys lasted one day, and it was very easy to navigate through the survey. The entire process has been very collaborative, educational, and insightful for all our staff members who have been involved with ASAM and CARF. The surveyor that we have had for our surveys in 2022 and then again in 2024, Dr. Susan Johnson, has been delightful; she is extremely knowledgeable and supportive throughout the surveys.

–Joe Baldassarre, Director of Licensing and Compliance, Praesum Healthcare
Corporate Office located in Lake Worth Beach, Florida with Sunrise Detox and Evolve Recovery
locations in Georgia, Florida, Massachusetts, New Jersey, and New York.

Unlike other surveys that feel punitive, our experience with CARF was entirely different. The certification process was simple and straightforward, from submitting the application through completion of the survey. The ASAM manual and workbook provided all the necessary elements for a successful outcome. The surveyor’s professionalism, positivity, and expertise in substance abuse treatment combined with her background in quality assurance and compliance made the survey process both enjoyable and educational. It was a true collaborative, peer-to-peer approach, and the surveyor played a key role in helping us improve the quality of care and treatment services by recommending revisions to our organization’s policies, procedures, and practices. The consistent presence of the same surveyor across all our facilities allowed for a comprehensive understanding of our entire organization. It also made it easier to anticipate her expectations and prepare to meet the rating element requirements.

–Alisha Spring, Director of Quality Assurance, Haven Health Management
Corporate Office located in West Palm Beach, Florida with facilities in Arizona, Arkansas, Florida,
Indiana, Massachusetts, New Jersey, and New York.

In preparing for our certification survey, I worked for several months on researching best evidence-based practices for each of our levels of care. This was a great opportunity to familiarize myself with current advancements in addiction treatment. This process allowed us to identify practices that were aligned with our mission and vision. During the actual survey, our surveyor was very helpful and encouraging. She was incredibly complimentary of our policies and procedures which reinforced our commitment to providing appropriate person-centered services.

–Kristi Bierbaum, LPC-S, Chief Operating Officer, Uprising Addiction Center, Shreveport, Louisiana

I believe I can speak for all Chrysalis House staff who were involved in the CARF ASAM LOC certification process that the overall experience was very positive. The surveyors have been thoughtful and eager to engage in meaningful conversations with staff regarding ASAM elements of care. As a provider of LOC 3.5 and 3.1 there was a sense of ease knowing that patient care was at the center of the certification process.

–Kama L. Orr, Executive Director, Chrysalis House, Lexington, Kentucky

We had a fantastic experience at the time of our initial certification and with our triennial recertification. The surveyors at both visits, while focused on the document review for alignment of our procedures and practices to prescribed requirements, were willing to take time to provide consult about best practices happening across the country. Both showed a genuine interest in our staff, clients, and programs. They recognized our programs’ challenges and strengths, conveying feedback and recommendations in a strength-based way that left us feeling inspired and encouraged.

–Jennie Hulette, LCSW, Vice President of Quality, Seven Counties Services, Inc., Louisville, Kentucky

Q: What was your organization’s motivation for getting certification?

My organization has always placed a heavy emphasis on this process, in what we seek for our day-to-day operations, our written policies and procedures, and overall business practices to align with the latest standards as set forth by the entities that license, certify and accredit our programs. We strive to ensure that our patients receive the best quality care possible and that our staff are always providing those services to patients when they need them the most. ASAM certification has further solidified our operations in that it provides a well-defined outline for detox and residential practices that can be practiced throughout all our locations. –Joe

The ASAM Level of Care Certification provides documented evidence of our organization’s adherence to the criteria. Through an on-site peer-review process, we’ve demonstrated our commitment to delivering evidence-based addiction treatment. As more payers adopt The ASAM Criteria, certification has become invaluable in ensuring clients receive the treatment they need and families can have confidence that their loved one is receiving safe, quality care.–Alisha

We wanted to make sure that our program was aligned with ASAM expectations and that services were being provided using evidence-based practices. Becoming certified demonstrates our commitment to the delivery of services consistent with The ASAM Criteria. –Kristi

Chrysalis House is a national model for integrated care in a residential setting for pregnant and postpartum women. As Chrysalis House evolves, it is important that nationally recognized standards are met to the highest level of compliance. Achieving and maintaining ASAMLOC certification ensures that Chrysalis House administers a high degree of care aimed to improve the overall quality of treatment. By adhering to The ASAM Criteria, Chrysalis House can implement evidence-based practices and treatment protocols that are proven to be effective. This can lead to better treatment outcomes for patients, including higher rates of sobriety and improved mental health. By pursuing ASAM certification, Chrysalis House can better serve its patients, enhance its treatment programs, and ensure sustainable operations in the competitive field of addiction treatment. –Kama

Q: What kind of value does certification bring to your organization?

The value in which this certification brings to our organization has been paramount. Not only have there been several occasions in which insurance carriers have deemed it necessary for my organization to maintain this certification, but the feedback that my colleagues and I have received with each inspection has been tremendously valuable with our written policies and procedures, electronic medical record system documentation, and staff development and education. We look forward to every opportunity that we have with each survey to further push us to be an even better treatment provider. –Joe

The ASAM Level of Care Certification plays a crucial role in ensuring patients receive appropriate treatment and families can trust the quality of care provided. Certification assures that our organization’s policies, procedures, and practices have undergone a rigorous evaluation and adhere to The ASAM Criteria. Through certification we are able to show our commitment to evidence-based practices, safety, and continuous improvement. Our organization has leveraged the ASAM Level of Care Criteria for quality assurance chart audits and we have been able to proactively identify potential placement issues and address them promptly. By using The ASAM Criteria, we are ensuring that charts consistently meet medical necessity for each level of care. –Alisha

Certification has opened credentialing doors with several managed care organizations. We had some difficulty getting credentialed with a particular organization as they wanted assurance that services were ASAM aligned. Once we obtained certification, we were able to become credentialed. –Kristi

Certification has meant enhanced quality of care, increased credibility and trust, regulatory compliance, comprehensive care continuum, supporting staff development, and positively impacting the community. –Kama

Q: Did going through the certification process help you understand the criteria better?

Yes, with every inspection that my colleagues and I have undertaken, it has provided us with more knowledge of criteria as set forth by ASAM. My organization can truly see how we have improved our operations and service deliveries in the time that we have gotten all our programs certified with ASAM. –Joe

The certification process significantly enhanced my understanding of The ASAM Criteria. Our organization relied on the ASAM Level of Care Certification Manual and the preparation workbook during our survey preparations. I was able to move beyond mere recitation of the rating elements and truly grasp their meaning. The workbook facilitated a comprehensive review of our existing processes, covering everything from training requirements to staff supervision and policies. By utilizing the checklists and recommendations within the workbook, we ensured that any necessary policy adjustments aligned with The ASAM Criteria for each level of care. Based on our initial survey experiences, we developed a compliance tool for each level of care that now helps us maintain sustained adherence to the ASAM rating elements.
–Alisha

Absolutely, going through the certification process allowed me to learn more about the criteria and become the ASAM point of contact when managing and developing new programs. –Kristi

Yes, it definitely did, by going through the certification process we were able to apply each aspect of The ASAM Criteria to our program and make modifications as needed. –Kama

The ASAM Level of Care Certification Manual is a highly effective and beneficial programming resource. The manual was our ‘playbook’ to guide the development and operations of running our ASAM 3.7, 3.5, and 3.1 residential programs. Preparation for certification was a diligent process but one that improved our entire program because it created an intentional structure to comprehensively review and align our procedures to the specifications of the standards and rating elements. In doing so, we know that we are best positioned to deliver life-changing addiction treatment services in our community. –Jennie

Q: What improvements or impact has certification had on your care delivery?

We have made significant improvements with our electronic medical record system, as well as our written policies and procedures which has equated to better patient care and a more educated workforce since obtaining ASAM certification. The standards, which are dictated by ASAM and CARF, are well written and easy to understand (as told to me by my colleagues) and have had an incredibly positive impact on our enterprise. –Joe

The certification process drives continuous improvement across all areas of the organization. We have been able to streamline operations and ensure consistency through standardized processes throughout the organization, implementation of industry best practices, and adoption of a common language irrespective of the program location. These improvements have primarily manifested in changes to our policies and procedures, and an enhanced staff training program – directly impacting the quality of care and our ability to provide effective treatment services. Since the rating elements and ASAM manual are consistently updated to comply with industry changes, certification has also helped us to remain current with industry standards and best practices. –Alisha

The biggest impact has been in staffing. Our state regulations regarding staffing are primarily left up to the facility. However, we decided to move into team staffing to reasonably improve the delivery of services. This ensures that each client has an assigned therapist, nurse and behavioral health technician. –Kristi

ASAM certification has impacted our care delivery by being able to provide individualized services for our patients. They are receiving the appropriate levels of support as they progress through different stages of recovery, facilitating smoother transitions and continuous care. The certification process includes regular reviews and updates, ensuring that Chrysalis House continues to improve its services and stays current with best practices. –Kama

Thank you to all who contributed to this article. We are grateful for your commitment to continuous improvement and demonstrating fidelity with The ASAM Criteria®.

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]]> 429040 Accreditation – Enhancing people’s lives https://carf.org/blog/accreditation-enhancing-peoples-lives/ Fri, 05 Apr 2024 17:37:16 +0000 https://carf.org/?p=416047 Since 1966, the CARF accreditation seal has been the hallmark of quality...

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9,600+

Service providers

68,300+

Accredited programs and services

31,900+

Locations

12 million

Persons served annually

Our reach

Countries, states, territories, and provinces on five continents recognize one or more of our areas of accreditation, and many mandate CARF accreditation exclusively.

Since 1966, the CARF accreditation seal has been the hallmark of quality in human services. CARF’s reputation for advancing excellence in the industry is founded on its unique consultative peer-review survey model, conformance focus, and evolving field-driven standards.

Accreditation positively impacts organizations’ business and services in many ways. These benefits combined with the strength of our international standards and consultative peer-review model, are distinguishing factors that make CARF the accreditor of choice for health and human service providers.

We asked accredited organizations across the continuum of care to answer a few questions about CARF accreditation and their experience with CARF. Below are their answers:

Q: What does CARF accreditation mean to your organization?

In 2016, accreditation became a mandatory prerequisite for agencies to maintain their foster care and residential licenses issued by the California Department of Social Services. However, the true significance for Koinonia lies in its pivotal role in streamlining our strategic planning processes and refining numerous policies. This accreditation has notably contributed to elevating safety practices across all our facilities and establishing a systematic approach to measuring and enhancing the quality of our programs.

–Laura Richardson, Compliance Manager, Koinonia Family Services, Loomis, California
Child and Youth Services
Accredited since October 2016.

CARF accreditation is confirmation that Hillel Lodge has met or exceeded a comprehensive set of standards encompassing all our activities. Accreditation also underscores our commitment to continuous quality improvement and commitment to evolve our service offering to meet the needs of the persons served.

–Ted Cohen, CEO, The Bess and Moe Greenberg Family Hillel Lodge of Ottawa,
Ottawa, Ontario,
Aging Services
Hillel Lodge has always been an accredited home, but recently switched to CARF,
and is in its first accreditation cycle.

CARF guidelines are the foundation for our program and service areas. When looking to grow into a new service area, the CARF guidelines are integral as a tool for expansion. This ensures we provide the highest quality of services and keep our focus on continuous improvement.

–Stacy Freed, Director of Programs, Pioneer Resources, Muskegon, Michigan
Employment and Community Services
Employed by CARF-accredited organizations for 18 years,
and a CARF surveyor for three years.
Pioneer Resources has been accredited for 22 years.

On With Life feels that being CARF accredited distinguishes us as an organization that strives to set ourselves apart, challenges us to be better, and holds ourselves accountable to provide high quality care and service. The consultative approach that CARF has provides us with the opportunity to be accountable to what we do, but also see how we can strive to be better!

–Tammy Miller, Director of Outpatient Services, On With Life, Ankeny, Iowa
Medical Rehabilitation
Personally involved with CARF accreditation since 2004 while
On With Life’s has been accredited since 1994.

CARF accreditation signals a strong commitment to providing high-quality services. It demonstrates that our agency is willing to undergo a rigorous evaluation process to ensure that our programs and services meet or exceed industry standards. Accreditation by CARF enhances an agency’s credibility. It provides external validation of CODAC’s commitment to excellence, which can be reassuring to members, families, funders, and the community. Many stakeholders, including government agencies, health plans, and members, may prioritize or require services from accredited organizations, giving accredited agencies a competitive edge.

–Amy Munoz, Chief Compliance Officer, CODAC Health, Recovery & Wellness, Inc., Tucson, Arizona
Behavioral Health
CODAC has been accredited by CARF since 2002.

At Centerstone, our noble purpose is “To deliver care that changes people’s lives.” Our noble purpose is critical to the development and provision of quality treatment to individuals that trust us with their care. We feel strongly that the mission of CARF aligns with our noble purpose. In fact, accreditation is not required in all the states wherein Centerstone provides service; instead, we proactively choose accreditation. The CARF standards provide guidance for best practices for service delivery as well as expectations for administrative functions. The application and integration of the CARF standards into our day-to-day functions supplements our organizational structure and enhances our quality of care. To internal and external stakeholders, accreditation is evidence of the organization’s commitment to the highest standards of care. The CARF standards have provided a common set of language for our organization as we moved through the merger process and has provided opportunity for standardization of functions and tasks.

–David Guth, CEO, Centerstone, Nashville, Tennessee
Behavioral Health
Centerstone has been CARF accredited since 2010. The earliest accreditation
for various legacy organizations, prior to the merger(s), was achieved in 1996.

Accreditation is a requirement for reimbursement for many of our funders; however, we would seek accreditation even if not required. It provides us a guideline of organizational best practices; it keeps us current in the field; and it provides a system of planning and documenting administrative and clinical issues. It is a great indicator of the quality of services we provide. We have added programs since the time of our original survey to now including five Behavioral Health programs and one Employment and Community Services program; and have also included the Governance standards.

–Brad Farmer, Executive Director, Acadiana Area Human Services District, Lafayette, Louisiana
Behavioral Health and Employment and Community Services
CARF surveyor for 26 years. The organization has participated in four surveys
and has received a three-year accreditation each time.

CARF accreditation is the Gold Seal of approval. It is the highest standard an organization can achieve. CARF accreditation is the recognition of the work we put in every day to meet the needs of our clients, community and stakeholders by providing the highest quality care at the highest industry standards. CARF accreditation sends a message to insurance companies, contractors and payers that our organization is able to achieve the triple aim of healthcare: access, quality, and cost.

–Laureen Pagel, CEO, Starting Point Behavioral Healthcare, Yulee, Florida
Behavioral Health
Involved with CARF accreditation for 24 years,
and our first accreditation was in 2000.

CARF accreditation has been an excellent way to demonstrate how our agency provides quality services in all areas of the organization. Continuing to receive a three-year accreditation has assisted us when applying for grants and in expanding our programs.

–Sue Evans, Chief Operating Officer, Walden Family Services, San Diego, California
Child and Youth Services
Been accredited nine years, and just completed our fourth survey.

Q: What did preparing for CARF survey accreditation do for your organization?

Primarily, gearing up for our CARF survey accreditation fostered a sense of camaraderie among our staff, as we collectively pursued the substantial achievement of international accreditation. The preparation process also facilitated a thorough examination of our organizational processes, leading to the establishment of consistency across our accredited programs. –Laura

Preparation for CARF survey accreditation helped our organization formally come together to perform a comprehensive review of how our organization conforms to the CARF standards. This review provides us with an excellent opportunity to examine our organization’s strengths and weaknesses which not only helps us plan for future quality improvement activities, but also provides valuable information that will inform our ongoing strategic planning activities. –Ted

Continuous improvement is always the goal and by preparing for our accreditation, it keeps everything fresh on our radar. It requires a lot of intentional preparation, which in turn helps us to ensure we are in conformance with quality standards. –Stacy

As a CARF accredited facility, the preparation for the surveys does not place undue stress upon us because, as an organization, our daily function is very much aligned with the CARF standards. For us the preparation is a good check and balance of where we are, what we need to continue to do better, and where we can strive to go in the future. –Tammy

Accreditation involves a thorough review of operations, policies, and procedures. This process was meaningful in identifying areas of potential risk and developing an opportunity for us to address and mitigate these risks, ultimately enhancing overall organizational resilience. Our CARF survey required collaboration among different departments and teams. Staff appreciated the teamwork involved and the chance to work together towards a common goal. –Amy

The CARF standards have provided a common set of language for our organization as we moved through the merger process and has provided opportunity for standardization of functions and tasks. The continuous quality improvement process that is built into CARF accreditation has provided significant value to our organization in that it has ensured continuous improvement and afforded us opportunities for growth. –David

It helped us organize our policies/procedures and all supporting documentation. It provided a common language internally and focused our efforts as a team. It assisted us in ensuring a thorough review of our plans, mission, strategy, implementation, and the mechanisms to ensure ongoing review and monitoring of all of those items. –Brad

Preparing for CARF helped all staff focus on the same common goal. It ensured we all spoke the same language and it provided consistency across all program areas and locations. CARF preparation “raises the bar” for the entire organization. It is an opportunity for supervisors and directors to identify gaps in care, training deficiencies, communication breakdowns, and possibly even rogue staff who decided not to follow agency policy. As well as those who exemplify the CARF standards every day in their work. CARF preparation is not something that occurs six months before a site visit…it is something we do every day. –Laureen

CARF accreditation has led to our organization continuing to improve our standards by building frameworks to continually review our systems and services, and looking at ways we can improve to provide relevant services. CARF has been a valuable tool as our agency has grown and developed new programs. The standards have assisted us in ensuring that our services are client centered and continuing to develop based on the feedback of our youth and families. –Sue

Q: What was your staff members’ general impressions and feelings about the survey process?

Initially, our staff members felt a significant amount of anxiety and stress leading up to the survey process. However, the actual experience of the survey proved to be quite uplifting and affirming. The presence of surveyors who demonstrated a clear understanding of our work and their capacity to offer supportive feedback was immensely beneficial. –Laura

Once our staff members became familiar with the accreditation process they really appreciated how the CARF standards added structure to their departmental quality improvement initiatives. CARF outlines what is expected for our home to achieve conformance to the standards and also provides documentation requirements and review cycles as well as education requirements. This structure helps to support our quality improvement program. –Ted

Staff who are new to the organization can be intimidated by the process. However, we do try to focus on the peer-consultation process of the surveyors, ensuring that staff understand they are there to support and offer suggestions on ways we can make our programming even better. –Stacy

There is always trepidation when the word “survey” comes up, especially when a majority of “surveys” that come to our buildings are much more tied to deficiencies or punitive in nature. Our staff has really begun to appreciate the CARF survey opportunities in which they can share the incredible things that we are doing as an organization and ask questions of the surveyors of how they can be better—what they have seen others do. They enjoy the consultative experience that has come with doing the CARF surveys. –Tammy

Many staff members expressed a sense of pride and validation during the CARF survey process. Achieving accreditation can be seen as a collective accomplishment, reflecting our hard work and CODAC’s commitment to high standards and quality services. Specifically, staff members appreciated the chance to showcase their knowledge, skills, and dedication to quality care during the survey process. The overall pressure associated with the survey was seen as a motivator for maintaining excellence. –Amy

As an organization, we approach accreditation less about a required activity, but rather, activities that enhance service delivery and business functioning. As such, generally speaking, staff are well aware of the organization’s commitment to accreditation and all levels of the organization participate in the accreditation processes. On an ongoing basis, the effort is to effectively integrate standards in such a way that they are relevant to staff and meaningfully contribute to quality of care for persons served. –David

Our original survey was intimidating to many of the staff as it seemed to be a huge project. Now that we have been accredited for a number of years, the staff looks forward to the surveys as a way to hear feedback from peer surveyors, to learn new trends and information, to be recognized for their efforts. We have designated a “CARF team” to help us maintain our efforts in between surveys and those team members take pride in their efforts and appreciate working with the surveyors when they are on site. –Brad

Our QI Director found the survey process to be simple and straightforward. We know what to prepare for and what to expect. The surveyors are always professional, courteous and helpful. They have a vested interest in helping organizations maintain the CARF standards and it shows. –Laureen

Although initially preparing for our first survey was a lot of work for many staff, once the structure was in place the staff have found it beneficial and helpful as the agency continues to grow and develop our programs. Our staff have found the survey process beneficial in discussing best practices and how other accredited agencies have met standards. –Sue

Q: Do the persons you serve notice or make comments about your CARF accreditation?

Many individuals and families we serve have actively participated in interviews during our survey process and found it to be a positive experience. While I believe that most of the individuals we serve value the improvements implemented as a result of CARF accreditation, they may not be fully aware of all the specific changes attributed to CARF. The counties we serve and our donors, however, highly appreciate the assurance that comes with partnering with an internationally accredited provider. The recognition of our CARF accreditation instills confidence in the quality and standards of our services. –Laura

Our persons served are very aware and proud that we are CARF accredited. They experience the benefits of the accreditation process daily through improved services and outcomes. Each quality improvement project is ultimately focused on helping Hillel Lodge evolve to better serve the needs of the persons served. –Ted

Families understand that CARF accreditation is the gold standard for service organizations. They know that the organization is focused on continuous improvement and satisfaction of services. –Stacy

Because we place signage around our facility and on our website, we are often asked about it from our persons served and families. When we talk about it and share with them what it means, they are impressed with our desire to constantly be holding ourselves accountable, seeking growth, and striving to be a top provider offering quality services. –Tammy

Members voiced appreciation for the opportunity to be involved in the accreditation process. The members interviewed during CODAC’s survey felt empowered knowing that their feedback contributes to the evaluation of services. –Amy

While clients are involved in the actual survey, I believe that the accreditation process and outcome is often invisible to them. What they do see and experience is our commitment to delivering care that changes people’s lives which aligns with CARF standards. –David

Not so much in those direct words, but we do hear positive feedback about things that we do as a part of our efforts to meet the standards. For example, as part of maintaining a warm, safe, and welcoming environment for services, clients make comments about the cleanliness of the facilities, or the artwork in the clinics, and the opportunity to directly provide feedback about concerns they may have. Clients also appreciate the customer service focus offered and the opportunity to actively participate and provide input into services provided. –Brad

The families and youth have been very willing to talk with surveyors and share their experiences of the services provided and how they have been able to give their feedback into how services are offered. –Sue

Thank you to all who contributed to this article. We are grateful for your commitment to continuous improvement and enhancing the lives of persons served!

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]]> 416047 Substance use disorder treatment programs and the value-based contract of the future https://carf.org/blog/substance-use-future-value-based-treatments/ Tue, 22 Nov 2022 15:00:21 +0000 https://carf.org/?p=4088 By 2030, it is anticipated all Medicaid payments will be on a...

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By 2030, it is anticipated all Medicaid payments will be on a value-based model, rewarding providers for their quality of care rather than patient volume.

“Value-based programs reward healthcare providers with incentive payments for the quality of care they provide to people with Medicaid.” That’s according to how the Centers for Medicare & Medicaid Services (CMS) defines the relatively new paradigm. Value-based programs support CMS’ three-part aim: to provide better care for individuals, improve health for diverse populations, and to lower the cost of healthcare services.

The transition toward value-based payment models isn’t optional. All traditional Medicaid beneficiaries will be treated by a provider in a value-based care model by 2030. CMS made that expectation clear on September 15, 2020, when it guided state Medicaid directors to advance the adoption of value-based care strategies across their healthcare systems.

Aligning provider incentives across payers is one of the goals. Their ability to improve quality of care in a cost-effective manner or lower costs while maintaining standards of care is how healthcare providers are reimbursed under value-based care.

This is in contrast to traditional Medicaid reimbursement models that reward volume of care. And, in the spirit of better health for all populations, value-based healthcare for serving Medicaid patients is also designed to address social determinants of health and healthcare disparities.

Caring for individuals with a substance use disorder

So, what does value-based care look like when behavioral healthcare providers are caring for individuals with a substance use disorder?

CenterPointe, based in Lincoln, Nebraska, is a CARF-accredited provider of Medicaid behavioral healthcare services, including substance use disorder treatment. CenterPointe has had several value-based contracts with payers in recent years. The majority of persons served at CenterPointe are experiencing cases of mental illness and addictions. Nearly all of these persons have minimal or no income when they enter CenterPointe programs.

With the right value-based contracts, excellence is rewarded

According to CenterPointe Vice President/Director of Quality Improvement & Data Management Center Isaac French, M.A., LSSBB, given the right value-based contracts, excellent providers are often rewarded for practices and outcomes that are commonplace in their patient-centric organizations.

His advice for behavioral healthcare providers considering the necessary pursuit of value-based contracts is to ”be prepared with reports and data. That’s huge.” It’s the source of “negotiation power.”

 “You have to start measuring in advance, showing evidence-based improvements over a period of time, even years,” French continued. He said, for substance use disorder treatment providers, it all makes sense when you have “shared” goals with the payer, like reduced hospitalizations; reduced jail time; and reduced returns to emergency rooms, crisis centers, and residential treatment centers.

Participation in outpatient therapy, psychiatric appointments, medicine management, and peer support services, as well as showing evidence of recovery and treatment plans, has led to welcome bonuses for CenterPointe from payer Nebraska Total Care, a Nebraska-focused managed care organization (MCO), according to French.

Michelle Nelson, CARF International’s new managing director of substance use disorders, is well versed in CenterPointe’s success with value-based contracts. A Licensed Alcohol and Drug Clinician (LADC), a Licensed Independent Mental Health Practitioner (LIMHP), and a Professional Counselor, Nelson recently joined CARF after 28 years with CenterPointe, where she most recently held the position of chief clinical officer/clinical director. She was previously director of the Drug Crisis Center and served in many other positions throughout her career at CenterPointe.

“There are lots of people in America who aren’t receiving quality behavioral healthcare, if they are receiving care at all,” Nelson said. “Most Americans understand that the cost of behavioral health is too high and there are too few providers.” So how does one find high quality behavioral healthcare providers specializing in substance use disorders and what does high quality addiction treatment look like?

Finding high quality substance use disorder treatment providers

Nelson highly recommended selecting a behavioral healthcare provider specializing in substance use disorder services that are accredited by CARF. She emphasized that accreditation is an important tool in assessing the quality of services. It demonstrates a healthcare provider’s commitment to enhancing performance, managing risk, and distinguishing service delivery. And payers recognize accreditation as a demonstration of superior performance due to clearly defined and internationally accepted standards.

Since 1966, CARF’s field-driven, international-consensus standards have evolved and been refined with input from global stakeholders, including healthcare providers, consumers, and industry experts. All have demonstrated a commitment to continuously improving services, encouraging feedback and serving the community.

As a longtime CARF client at CenterPointe, Nelson is passionate about the opportunity to engage with more providers. She is charged with expanding CARF’s reach in behavioral healthcare, especially to substance use disorder treatment providers.

Nelson is well qualified and recognizes firsthand the challenges substance use disorder treatment providers are facing, including a diminished workforce, overwhelmed administrators, a lack of infrastructure and electronic health records (EHR), and a lack of integration between the silos of behavioral health and primary care. Furthermore, value-based payment models haven’t always been well explained to substance use disorder treatment providers.

Evidence-based research influences clinical practice

Research shows that addiction can be treated using certain clinical practices, but there are no quality standards that require addiction treatment facilities to deliver these practices. As a result, the quality of care varies and it’s unclear whether facilities are consistently utilizing helpful practices. This can add challenges for people looking for high-quality addiction treatment programs for themselves or their loved ones.

Atlas (Addiction Treatment Locator, Assessment and Standards Platform) is a tool recommended by CARF. It was created by the nonprofit addiction treatment advocacy organization Shatterproof “to help people search for, and compare, addiction treatment facilities to find care for themselves or their loved ones.”

Atlas follows Shatterproof’s National Principles of Care©, the key elements of high quality addiction treatment. According to Shatterproof, evidence has shown and continues to show these principles improve the health of persons with addiction.

Shatterproof National Principles of Care:

  • Fast access to treatment
    You should be able to get treatment as soon as you’re ready.
  • Personalized evaluation and treatment plan
    Treatment should consider your unique needs. One-size treatment does not fit all.
  • Access to medications for opioid or alcohol use disorders
    Treatment providers should work with you to find out if a medication, which is approved by the Food and Drug Administration (FDA), may be the best choice for treating your substance use disorder.
  • Effective behavioral therapies for addiction
    Certain behavioral health therapies—such as cognitive behavioral therapy and family behavior therapy—are proven to help manage and treat addiction effectively.
  • Long-term treatment and follow-up
    Addiction treatment should include long-term management and follow-up, not just one-time treatment.
  • Coordinated care for mental and physical health
    Your treatment plan should include treatment for other illnesses you may have, including mental health (such as depression or anxiety) and physical health conditions (such as diabetes or hepatitis).
  • Additional services to support recovery
    Treatment is more successful when other circumstances also are addressed, such as housing, employment, and personal relationships.

Nelson said there is a growing national movement to integrate behavioral healthcare and primary care, which she sees as critical as all Medicaid healthcare providers, not just those treating substance use disorders, move to value-based contracts with payers by 2030.   

Although the importance of integrating behavioral healthcare and primary care has been recognized, Nelson would like to see more action in practice. Of course, Nelson would also like all substance use disorder treatment providers to be worthy of CARF accreditation and available everywhere through search on Atlas. If this were the case, she would know their patients are being well cared for and that primary care and behavioral healthcare are being integrated. They are also likely to be on the road to being ready for those value-based contracts with payers that are rapidly approaching. The year 2030 is less than eight short years away.

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]]> 4088 CARF celebrates Recovery Month https://carf.org/blog/carf-celebrates-recovery-month/ Tue, 31 Aug 2021 15:00:20 +0000 https://carf.org/?p=4138 Formerly hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA),...

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Formerly hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA), and now supported by Faces and Voices of Recovery, the theme for National Recovery Month 2021 is “Recovery is for Everyone: Every Person, Every Family, Every Community.” Recovery Month celebrates the millions who have found recovery from mental health and substance use disorders and serves as an opportunity for education on the benefits of mental health and substance use treatment. SAMHSA defines recovery as “a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.”

According to SAMHSA, there are four major dimensions that support recovery:

  1. Health: overcoming or managing one’s diseases or symptoms and making informed, healthy choices that support physical and emotional well-being.
  2. Home: having a safe and stable place to live.
  3. Purpose: conducting meaningful daily activities and having the independence, income, and resources to participate in society.
  4. Community: having relationships and social networks that provide support, friendship, love, and hope.

Recovery does not look the same for everyone and is not necessarily defined by abstinence or cessation of symptoms, but rather through a holistic look at a person’s wellness. This year’s theme highlights the fact that everyone’s journey is different but we “are all in this together,” and recovery is possible, especially with support. To CARF, this theme highlights the importance of community in recovery, made even more apparent throughout the course of the COVID-19 pandemic, which has disrupted support services and increased social isolation. While recovery should be celebrated all throughout each year, it is especially important to recognize those in recovery, given the prolonged grief and anxiety caused by the pandemic and the accompanying loss of life and economic and family stresses, which have increased the risk of substance use disorders and relapse.

CARF International commends all providers for their courageous work in continuing to provide quality services to persons with substance use disorders during this challenging time. A great deal of recognition is due to providers and professionals in the addiction treatment field continuing to support those in recovery. With our surveyors, staff, and partners, CARF celebrates all those in recovery along with their families/support systems and communities.

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