CARF International https://carf.org/ Commission on the Accreditation of Rehabilitation Facilities Wed, 28 Aug 2024 15:47:35 +0000 en-US hourly 1 https://wordpress.org/?v=6.7.1 https://carf.org/wp-content/uploads/2023/08/cropped-carf-favicon.png?w=32 CARF International https://carf.org/ 32 32 218515885 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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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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9,300+

Service providers

67,000+

Accredited programs and services

31,000+

Locations

13+ 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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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.

  • 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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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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Honoring nurses across health and human services https://carf.org/blog/honoring-nurses/ Thu, 06 May 2021 15:00:31 +0000 https://carf.org/?p=4134 May 6–12, 2021, is Nurses Week. CARF recognizes the profound impact the...

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May 6–12, 2021, is Nurses Week. CARF recognizes the profound impact the nursing field has across health and human services.

Now, as much as ever, it’s so important to honor the powerful, positive impact the nursing profession has had on health and human services. Nurses play a crucial role in delivering needed care across every area of CARF accreditation. We deeply value their courageous work. This Nurses Week, CARF wishes to recognize all the nurses in our surveyor cadre and those working in our accredited programs. We reached out to a number of nurses in our family of accredited organizations. Below are their insights on the nursing profession.

Q: Briefly describe your career in the nursing field. How did you get started? What motivated you?

I wanted to be a nurse from the time I was 8 years old. Hearing people’s stories and learning about them was a huge motivation for me. I started out working for the VA in The Bronx. My dad served in the Army, so that was important to me. I have been a civil servant my entire career. Serving the public provides meaning for me. 

Opioid Treatment Program Surveyor Anjanette DeVito, M.S.N., B.S.N., RN, Nurse Manager,
Santa Clara Valley Health and Hospital System, San Jose, CA

I knew I wanted to be a nurse when I was 5 years old after interacting with an ER nurse who was treating me for an injury. I began my career as a community health nurse after graduating from my undergraduate nursing program. I received a master’s degree in psychiatric/mental health nursing. I then was recruited to supervising nurse at my agency and eventually worked my way up with increasing responsibilities until I became president and CEO.

Employment and Community Services Surveyor Diane McCall, M.S., RN, President Emeritus, Wayne Center, Detroit, MI

I always wanted to be a nurse, even as a little girl! I started my career in a provincial hospital for mental health clients, as it was not possible to find a position in a general hospital in Ontario in 1974. Although I had an interest in working with patients seeking psychiatric care, it was not my original desire. I hoped to work in obstetrics, but my experience working in a psychiatric facility completely changed my focus. I loved the opportunity and refocused my practice on psychiatry. 

Surveyor Jill Bloom, RN, CPRP, Director of Mental Health and Addiction Services (retired), Langley, BC;
(Jill surveys for the Employment and Community Services, Behavioral Health,
and Child and Youth Services customer service units).

I had a family friend and family member who were nurses, and I thought their careers were so interesting and rewarding.

Medical Rehabilitation Surveyor Paula Martinkewiz, M.S., RN, CRRN, Senior Consultant,
Operations and Clinical Support Services, Integrated Rehab Solutions, Argyle, TX

I started as a staff nurse on a 45-bed inpatient rehabilitation facility, moved to manager of that unit, then to director of rehabilitation services, and now I do consulting. 

Medical Rehabilitation Surveyor Carolyn Walton, M.S., B.S.N., RN, CRRN, FACHE, Director, BRB Consulting, Media, PA

I have worked in various nursing fields from geriatrics, prison, youth services, and community health. I liked playing nurse/doctor when I was a child, and my motivation came from taking care of my brother while we were growing up. He was born with cerebral palsy.               

Opioid Treatment Program Surveyor Sara Mihlfeld, LPN, Vice President,
Medication Assisted Treatment Services, Meridian Behavioral Healthcare, Gainesville, FL

I was influenced by my mother, who was an RN. I started volunteering at my mother’s hospital at age 12; worked as a nursing assistant; went to school for my associate degree in nursing (ADN); and moved to Galveston, Texas, to work and get my bachelor’s (B.S.N) and then master’s degrees (M.S.N.) at University of Texas Medical Branch (UTMB). I started working as a case manager in acute rehabilitation, and then shifted to a nurse manager role. This year, I completed my doctorate of nursing practice (D.N.P.) at Grand Canyon University while working as a clinical educator at Kaiser Foundation Rehabilitation Center. I have been a program surveyor at CARF for the past 15 years. I have been blessed beyond measure throughout my nursing career.

Medical Rehabilitation Surveyor Gail Sims, D.N.P., M.S.N., RN, CRRN, Clinical Educator,
Kaiser Foundation Rehabilitation Center, Vallejo, CA

I began my nursing career as a licensed practical nurse (LPN) and worked my way through my ADN, B.S.N., and M.S.N. I have had a vast array of nursing experiences, working in medical; long-term care; residential rehabilitation; and inpatient, outpatient, and community-based mental health settings. My mother was a nursing assistant and inspired me to go into the field. 

Martha Wood, Associate Chief Nurse, Mental Health, Tuscaloosa VA Medical Center, Tuscaloosa, AL

I wanted to be a nurse when I was 5 years old. My goal was to work at Shriner’s. That didn’t happen, but I was introduced to rehabilitation when my dad worked at Rancho Los Amigos, when people were still in iron lungs. I started as a candy striper at the age of 15, and my first job in rehabilitation was at the Rancho spinal cord unit while I was still in school. I loved being involved with helping patients gain independence, working with them and their families. I worked in multiple settings, but when I returned to rehabilitation in 1976, I felt like I had come home.

Medical Rehabilitation Surveyor Donna Williams, M.S.N., RN, CRRN, Rehabilitation Nurse Case Manager,
Kaiser Foundation Rehabilitation Center, Vallejo, CA

Q: What was it like to be a nurse when you began your career?

Nursing 30 years ago was hard! Preceptors expected that new grads knew everything! They were not at all patient or kind. These experiences provided direction as to what kind of preceptor and manager I wanted to be. Anjanette

It was very hands on. There were no computers or electronic thermometers or blood pressure equipment. Carolyn

I started out working in geriatrics. Nursing seemed more personal in the 1970s. I developed relationships with my patients and their families.Sara

Nursing was both an art and a science in the 1970s, although we did things without examining the evidence in the literature. We based our practice on what was taught in nursing school, which was based on a few textbooks. We did not challenge the instructors, our managers, or the physicians. Looking back, we did things that were later proven to be ineffective, but we did not know a better way. Without much technology, we worked very hard to carry out the plan of care. We carried our paper “cheat sheets” on clipboards or in our pockets and stayed after to document the events on our shift. Most nurses worked full time, and many picked up overtime or had second jobs. In some ways, we had better continuity because we worked full time. Gail

We stood when the doctor came into the room. Patients were on bedrest in hard casts for months after spinal surgery. Fractures were immobilized with traction. Strokes were for the older population. We did a lot of bedside care. The philosophy of mobilization for better outcomes was just starting. Donna

As nurses, we were very poorly paid and expected to blindly follow orders, but that all changed within the first five years of my career, as the government and unions recognized the need to pay nurses a living wage for the work that we did. The practice of nursing became more valued as a profession. Jill

When I began my career in an intensive care unit (ICU) at a very busy county hospital, we didn’t even have 24-hour coverage by ER physicians. Our attending physicians worked and were on call 24 hours a day. This practice empowered nurses to be top notch and ready to address any and all issues with the help of attending physicians who were often on the phone. It wasn’t too long after I started that we got our first 24-hour ER physician who would cover the ICU and any emergency that was happening on the hospital. Times have certainly changed.Paula

Q: How has the COVID-19 pandemic changed your job or your role/responsibilities?

The pandemic has made things challenging, but working for a public institution has allowed my organization to continue to provide services, with small modifications; e.g., testing, masks. Anjanette

I’ve had a lot of telehealth meetings, and much less person-to-person contact. Sara

We had to adapt. As a clinical educator, I cross-trained medical/surgery and telemetry nurses to work in the ICU, rehabilitation nurses were refreshed on medical/surgery, and non-clinical nurses in quality and management were oriented to tasks that could be conducted on the units during the surge in admissions. I assumed the role of my direct supervisor, as he was working in the command center. During this period, I was completing my D.N.P.. I continued with school throughout the pandemic. Gail

While this pandemic rages, people are still sustaining spinal cord injuries, strokes, traumatic brain injuries, and other illnesses. The challenge has been getting services for these patients as well as those post-COVID while dealing with diminished capacity and other hospitals transferring their patients to our unit. The pandemic has increased the need to work as a team, both within our own facility as well as the facilities that refer to us. Donna

The COVID-19 pandemic has been unlike anything I have experienced in my nursing career of more than 35 years. It has been a challenge, but it has also shown me that nurses are courageous and able to adjust/adapt to just about any situation. The use of telehealth has been invaluable during this time. Martha

Q: How has nursing changed over your time in the field?

In so many ways…from how medications are delivered and dispensed both in hospital and in clinic to how we document. Anjanette

The profession has grown to be highly respected and specialized. As a new RN in the 1970s, we were “Jills of all trades,” wearing many hats, but that changed with the introduction of aides and other valued members of the team such as restorative nursing assistants (RNAs) and licensed practical nurses (LPNs) in the field. Jill

Nursing is less hands on and more task oriented by electronic methods. There is more knowledge to attain. Carolyn

There have been many advancements with medication assisted treatment, which gives patients more options. Sara

Nursing tasks are much easier to complete due to technology. The equipment talks you through each step. Nursing ratios have made it incredibly easier. In the 1970s, we cared for a telemetry unit of 24 patients with 1 RN, 1 licensed vocational nurse, and 2 nursing assistants. In California, the ratio is 5 patients for each RN with nursing assistants and unit assistants. Charting is much simpler in an electronic medical record. Evidence-informed practice helps us learn from the research and build on previous studies. Whenever there are new procedures, equipment, and techniques for providing patient care, we search the literature at our fingertips to ensure that we are providing care with the most up-to-date practices. Gail

Nursing has changed a lot in the past 35 years. One important change is the use of technology to provide care. The use of telemedicine has allowed care to be provided to patients that would have never been able to receive it. Martha

Nurses have become more independent, more valued as part of a team. We are speaking up more and taking on more roles. When I started, nurses were mostly in the hospital or in home health. Now we are everywhere, owners of our own businesses, directors, educators, and researchers. PhD nurses were rare. Now advanced degrees are encouraged. Rehabilitation nursing as a specialty was a very new concept. Now, we are involved in encouraging rehabilitation nursing worldwide. Donna

Q: If you could give a piece of advice to someone considering a career in nursing, what would you tell that person?

Be patient with yourself as you continue to learn and practice. There will be challenging days, but there will also be rewarding ones. Anjanette

Get your basic degree in nursing and then explore the different specialty areas until you find the one that best matches your interests. Diane

It is a highly respected profession that cannot be taken away from you, as there is always a need for nurses across all areas of healthcare. The opportunities are endless with what you can do with a degree in nursing.  Jill

Nursing offers a complete array of focus areas much different from other professions. You can work at different levels of care, with different age groups, academics, insurance and case management, school, etc. There are varying roles and responsibilities during different shifts or working hours. It’s very flexible. Paula

Nurses enter the field because it is their passion, not to have a job. Remember, there are many avenues to take in nursing.
Carolyn

I encourage people to follow their heart. Nursing is a wonderful career, if you are called into the profession. There are so many avenues to pursue and many specialties within nursing. I consider nursing a ministry, in which we have the opportunity to serve others in such meaningful ways. It is important to achieve the highest degree of education possible and remember we are all lifelong learners. Gail

Nursing is a wonderful career that can take you in so many directions. The possibilities are endless. My top three pieces of advice: Stay humble, work hard, and be kind! Martha

Do it! I would do it all over again, even the parts I didn’t like (it was tough serving in the newborn ICU) because of all I have learned and all those I have interacted with over the years. Nursing has made me who I am today. Donna

CARF wishes a “Happy Nurses Week” to all those who have served or are currently serving in the nursing field. We wish to thank those CARF surveyors and staff members of accredited programs who contributed to this article as well as all nurses across the health and human services field.

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Accreditation supports a balanced response to COVID-19 in senior living https://carf.org/blog/accreditation-supports-balanced-response/ Sun, 19 Jul 2020 15:00:08 +0000 https://carf.org/?p=4131 Residents and staff in senior living have been hit particularly hard by...

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Residents and staff in senior living have been hit particularly hard by the COVID-19 virus. For months now, news stories and public reports have highlighted the rapid spread of COVID-19 and high fatality rate in nursing homes, which provide care to seniors with significant medical needs, but assisted living programs have many of the same risk factors, including shared living spaces, congregate dining, and residents with multiple chronic health issues that predispose them to a more serious form of COVID-19. An investigation opened by Senators Elizabeth Warren and Edward Markey and the House Oversight Committee found that:

  • Rates of coronavirus infection in assisted living facilities are more than five times the national average.
  • Hospitalization and fatality rates are dangerously high for assisted living residents with COVID-19.
  • Assisted living facilities are not reporting COVID-19 cases and fatalities directly to the federal government. As a result, there is no comprehensive information on COVID-19 occurrence and fatality rates.
  • Inadequate sick leave policies for employees put assisted living facility workers and residents at risk.
  • Lack of testing and inadequate testing protocols in assisted living facilities place workers and residents at risk of COVID-19 outbreak.
  • Widespread shortages of personal protective equipment (PPE) impose significant hardship on assisted living providers.

Where regulatory oversight is varied by state and inconsistent, the CARF standards can position assisted living providers to prepare for and respond to a pandemic using an approach that:

  1. Promotes the health and safety of residents and staff.
  2. Fosters a culture of transparency.
  3. Focuses on individual needs.
  4. Implements continuous quality improvement.

CARF-accredited providers are accustomed to this transparent and person-centered approach to care. CARF spoke with Vice President of Operations Ron Mead of Senior Resource Group (SRG), which operates 33 senior housing communities, including independent and assisted living. SRG started the CARF accreditation process in 2003 when it operated 8 campuses mainly on the West Coast. SRG now has communities throughout Arizona, California, Oregon, Washington, Georgia, Florida, and Texas, for a total of 33 campuses. Like all providers, SRG has been challenged by the pandemic, especially given the varied severity of outbreak and regulatory response by each state.

Promotion/prevention

Mead said each community must adhere to the regulations set forth by the state in which it operates, “and going through the CARF process has certainly helped,” when it comes to setting infection control policies and procedures. “Although we never anticipated the scale of the pandemic, we felt well prepared for infection control and didn’t need to reinvent the wheel.” In February, a policy review was under way, and by early March, SRG went full speed ahead with implementing infection control and other emergency procedures. To protect staff and residents, SRG implemented the use of Accushield®, a kiosk that checks each visitor’s temperature and asks the CDC-recommended questions to screen for COVID-19. In addition, SRG went forward with streamlining its sanitation practices by contracting a single vendor for infection prevention. Masks are also required.

Left up to each state, SRG leadership also felt testing for COVID-19 was inadequate and proceeded with contracting outside labs within its service areas. SRG nursing staff has been trained to swab for COVID-19, and with labs now operating around the clock, results are returned more quickly. In addition, new residents are dual-tested, prior to move in and three days later, in the instance a case developed in the interim.

Communication and transparency

The CARF standards foster a culture of transparency and require an organization to implement written procedures for reporting critical incidents to CARF and all external authorities. In addition to complying with legal and regulatory requirements, CARF-accredited organization must communicate emergent and ongoing issues with staff. Throughout this pandemic, timely and transparent communication with residents and their families, staff, and regulators has been paramount. SRG communicates updates on its response to COVID-19 via the homepage of its website, www.srgseniorliving.com. At the community level, the frequency of connecting with both residents and their families has increased significantly, a feature SRG plans to continue in this “new normal.”

In a company update, CEO Michael Grust said, “We remain in the midst of this challenge committed to the rigorous precautions, contact tracing and the ongoing testing that are part of our community life today. And yet, mindful of striking a balance between needed precautions and engaging lifestyle opportunities that allow our residents to thrive.”

Person-centered approach

In senior housing, an outbreak of the flu or norovirus is not uncommon, so procedures were already in place for isolating residents and scaling back activities. Nonessential visitors could no longer be permitted. SRG has needed to balance the risk of infection spread with the risk of deteriorating emotional well-being due to resident isolation and loss of support. The organization purchased a number of iPad mobile devices and provided training on the use of Zoom Cloud Meetings, so residents could visit with family and friends online. For others, “drive-by” or balcony visits were possible. Rites of passage like the graduation of a staff member and the 104th birthday of a resident were still celebrated but at a distance. More recently, when it has become safe to do so, visitors are able to schedule an outdoor visit with their loved one.

Congregate dining in assisted living contributes largely to residents’ social opportunities, which is a factor for many when choosing a community. Typically, SRG communities operate full-service dining rooms and buffet-style meals for special occasions, which have always been well received. Buffet service has now ceased, and dining room services operate at a limited capacity. Meals are now cooked to order and delivered to each resident’s room. Despite limitations placed on dining, SRG continues to meet residents’ unique needs and tastes (quite literally), a cornerstone of the person-centered approach to care recommended in the CARF standards.

Continuous quality improvement

The CARF standards require an adequate workforce to deliver care, and CARF’s person-centered approach extends to staff as well. With much of the global workforce in aging services stretched thin and overworked, SRG prepared for the stress to its own staff early on. To cover absences, some SRG staff members were redirected. For example, drivers who would ordinarily take residents to appointments or off-site activities and some dining staff were trained in sanitation practices. Leadership implemented the SRG Strong initiative, a sick-leave policy, which allocated an additional 80 hours of paid sick time to any employee missing work for a COVID-related reason. All employees were also given an increased rate of pay for the months of April through June. Mead said, “Some call it “hazard pay;’ we call it ‘hero pay.’”

Living the CARF standards, always focusing on the persons served, and the forethought of hard-working SRG executives have positioned SRG’s communities to serve residents safely during this unprecedented pandemic. CARF’s comprehensive standards go beyond state regulations to guide assisted living providers in their response to a pandemic and mitigate risk to residents and staff. CARF has more than 20 years of experience in developing and maintaining up-to-date international consensus standards in the area of assisted living, having published the first standards manual for assisted living in January 2000.

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Social Workers: Generations Strong https://carf.org/blog/social-workers-generations-strong/ Tue, 31 Mar 2020 15:00:11 +0000 https://carf.org/?p=6753 March is Social Work Month. This year’s theme, Social Workers: Generations Strong,...

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March is Social Work Month. This year’s theme, Social Workers: Generations Strong, honors the powerful, positive impact the profession has had on society.

During this unprecedented pandemic, CARF acknowledges all social workers during National Social Work Month in collaboration with our International Advisory Council member, the National Association of Social Workers (NASW). We deeply value the courageous work of those in the field who continue to serve their communities and connect persons in need to essential services. We echo the combined statement of solidarity by NASW and the Canadian Association of Social Workers (CASW) in supporting our network of social services. Read the statement.

During the month of March, CARF recognized social workers across health and human services. Following this year’s Generations Strong theme, we reached out to social workers at various stages of their careers in the aging services field. Below are their insights on the social work profession.

Q: Briefly describe your career in the social work field. How did you get started? What motivated you?

I started in the social work field to make a lasting impact on individual lives one little victory at a time. We know there are significant system-related issues; however, it motivated me to start this career to be the bridge for patients’ access to services and counseling. 
—Jonathan Moore, M.S.W., Clinical Social Worker, Maple Health Centre, Maple, ON

I was working in geriatrics as a psychiatric treatment assistant in the summers while I completed college. I was thinking at first of environmental studies, but the head nurse on my unit strongly encouraged me to be in a “people field” like social work. I listened to her advice.
— Karen Appel, LICSW, Director of Social Services, Heritage Health Care Center, Utica, NY

I was motivated to serve at a young adult age—after someone provided local agency support for my maternal grandparent who received dialysis services that required a lot of care coordination by a case manager. This was gratifying to learn that someone cared about a member of my family that much when we lived three hours away. The support services were in place, and this gave my family members advocacy services that allowed us to focus on the caregiver role more. 
— Andrea Mckie-Bradley, Social Services Director, ACTS Retirement-Life Communities, Charlotte, NC

I have always had an interest in working with people in a helping profession. I started by working in community services and quickly realized that in order to better serve my clients as well as to develop myself professionally, I would need formal training and education. 
— Devora Waxman, Director, Social Work and Care Coordination, Better Living Health and Community Services, Toronto, ON

I studied social work in college with a concentration in gerontology and graduated in 1985. I originally wanted to work with children; however, I was required to do an internship in a nursing home. After that, I never left the long-term care setting. 
— Linda Unger, Social Service Coordinator

I have been in the field for almost 21 years, all in geriatrics. I got into the field because my grandmother lived with Alzheimer’s disease, and I wanted to help others who are affected. Now I am providing dementia education to other staff in my community. 
— Catherine Nakonetschny, LCSW, Social Services Coordinator, The Evergreens, Philadelphia, PA

While getting my undergraduate degree, I rented housing from an 86-year-old woman, and we became friends. I saw her spirit, her strength, and her challenges. She taught me to grow roses and bake bread, how to keep house and to go on adventures. I changed my major from music to social work, graduating in 1974 with a B.S.S.W., and going on to attain an M.S.W. in 1978, obtaining my LCSW, and finding a long, satisfying career in geriatrics. I have loved every job, some more than others, but have always learned and grown. I am very near retirement, and I could be considered a peer counselor at this point, but my passion for the work is stronger than ever. I love coming to work each day, feeling strong and committed, and going home knowing I connected, supported, and helped clients and team members. 
— Barbara Bolin, M.S.W., LCSW, Social Worker, Goodwin House, Alexandria, VA

I started my career in 1996, working at a children’s residential facility as mental health home-based clinician, then as a case manager, helping others to help themselves and advocating for those who do not have a voice.
— Teri Miskowski, Assistant Administrator, Rice Manor, Parma, MI

Q: What was it like to be a social worker when you began your career?

It was quite the experience as I was only 22 when starting my career. I was assisting individuals a lot older than me, but over time I gained confidence. I started to see the impact of my work and of my fellow social workers. That is what pushed me to complete my M.S.W. to create further systemic change.
— Jonathan

I started in [redacted] and worked in subsidized housing for senior citizens. I was a jack of all trades there, calling Bingo, taking residents on trips, etc. After a few years, I returned to [redacted], but as a social worker, having completed my B.S.W. and a master’s degree in geriatrics as I knew it was my profession of choice. 
— Karen

It was hard. There was not a lot of guidance when I first started, but that has improved over the years. 
— Catherine

When I began my career, the field of geriatrics was fairly new. Services for behavioral health were more comprehensive and Medicare coverage was more comprehensive. There seemed to be more community-based programs for mental health, in-home support, and activism. On the bright side, there is so much more knowledge about aging, dementia, and abilities in the aging person. People are living longer; have a “younger opinion” of themselves; and have access to information about fitness, diet, and healthy aging.  
— Barbara

Q: How has social work changed over your time in the field?

I have been in the field for about eight years now. When I first started, it was very much based on advocacy. However, with systemic pressures and funding cuts, unfortunately clients suffer. However, over time, I learned when working in the healthcare system, the more informed the clients are, the more you can empower them. This is where I started to see the impact I wanted to have in society. I learned you have to change the system from within and celebrate the small victories along the way. As social workers, we continue to push for change and advocate for our clients. I foresee there will be a big shift in the coming years in healthcare especially. 
— Jonathan

As our population is aging and drawing more resources from the healthcare system, the system is becoming strained and struggling to meet the needs of patients. Social workers in the community are providing services to clients who years ago would have been in long-term care beds. Our clients are incredibly frail and complex, and our practice has needed to change in order to meet our clients’ needs. 
— Devora

I believe over time the role of the social worker has become more important in long-term care. 
— Linda

I think we have access to more resources, including colleagues from other states and backgrounds. It gives me different perspectives to consider. 
— Catherine

I see social work as leading the way in bringing attention and empathy to so many populations such as LGBTQ, transgender, immigrants, considering and calling out racial and religious discrimination, mental health, social media, and so many more realms. Social work has not shunned tough societal problems, and always seeks to assure dignity and respect for all. 
— Barbara

Q: If you could give a piece of advice to someone considering a career in social work, what would you tell that person?

I would tell them to consider a career in geriatric social work. With our aging population, there is tremendous professional opportunity as well as the opportunity for a very rewarding career! 
— Devora

Remember why you are a social worker. Some days are going to be really difficult, but if you remember why you do this work, it will make those days few and far between. 
— Catherine

Learn all you can about the art and craft of social work, keep your horizons as broad and diverse as possible, and seek knowledge and awareness from every place and everything. Keep asking ‘what if’ and ‘what next’ and ‘what more.’ 
— Barbara

Focus on the individuals you serve, speak your mind, and share your thoughts and concerns in advocating for them. They are our focus, and we work strictly for them and their well-being. 
— Teri

As we enter this new decade and Social Work Month comes to an end, CARF honors the powerful and positive impact social work has on society. We wish to thank those who contributed to this article as well as all social workers across the health and human services field.

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When the opioid crisis comes home https://carf.org/blog/when-the-opioid-crisis-comes-home/ Thu, 27 Feb 2020 15:00:07 +0000 https://carf.org/?p=4142 When an opioid treatment program opens its doors in a residential area,...

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When an opioid treatment program opens its doors in a residential area, its neighbors may have concerns, but these programs are providing life-saving treatment that will ultimately strengthen the community.

As local, state, and federal leaders continue to address the opioid epidemic, there is much discussion around access to care. Some of this discussion centers on concerns about programs, particularly those offering medication-supported recovery, opening in communities. Although there may be nuances specific to an opioid treatment program (OTP), there are many similarities to any new business opening in a community with residents asking questions. 

Who are the proprietors? Why this neighborhood? How will this impact traffic, noise, and parking? Can this affect my home’s value? Fortunately, OTPs have federal requirements and accreditation standards to address some of these concerns.

These questions might be especially important if the community has little history or information about the business, or worse, if the community has been misinformed about OTPs or what are sometimes referred to as methadone clinics. OTPs are opening across the nation, including in residential areas, to combat the opioid crisis. Unfortunately, they carry a stigma that can evoke a “Not in my backyard” reaction from community members. Residents may worry the program would bring loitering, crime, active drug dealing, and drug use into their community. 

The reality is OTPs provide life-saving treatment and ultimately strengthen communities. 

What is an OTP?

OTPs provide comprehensive opioid-use disorder treatment that includes FDA-approved medications, such as methadone, buprenorphine, and naltrexone, along with counseling, medical services, and connections to social services.

OTPs are heavily regulated at the federal and often state and local levels. They are licensed (and visited) by the Drug Enforcement Agency. They must also be certified by the federal Center for Substance Abuse Treatment (CSAT), a division of the Substance Abuse Mental Health Services Administration (SAMHSA). CSAT has developed robust regulations included in 42 CFR, Part 8 under which OTPs operate. Additional oversight is provided through national accreditation by an independent accreditor like CARF International. The CARF accreditation process occurs at least every three years to ensure quality treatment services and to assess compliance with CSAT regulations. CSAT is notified if an OTP is not in compliance with a federal regulation or guideline. Beyond this rigorous federal oversight, most OTPs also have the added layer of their state or local licensing body.

Why this community? Will this bring drug use here?

OTPs are required to measure community impact when opening. They must assess the community’s needs and understand both the negative and positive influences of their physical presence on the community. So an OTP moves into a community to address an unmet need as opposed to bringing a problem into the community. It must engage community leadership and other stakeholders throughout the opening process and an ongoing basis. CARF accreditation surveys assess the OTP’s conformance to this requirement.

Will this program bring loitering and traffic?

OTPs with CARF accreditation are required to have an ongoing community relations plan. This plan must include elements of community education on substance use and the use of medications in treatment, identification of staff members to serve in community relations activities, and written procedures to address and resolve problems such as patient loitering and medication diversion. The plan must also ensure that the program’s operation does not adversely affect community life. To conform to this standard, the OTP should monitor traffic flow and loitering and seek input from community stakeholders about the program’s impact on the community. Again, conformance is assessed during the accreditation survey.

Are the medications dangerous; will they be sold illicitly in the community?

Any medication that is not used as intended can be dangerous, and this is especially true of controlled substances. OTPs must have robust controlled-substance diversion control plans with specific measures to reduce the possibility of diversion from legitimate treatment use. They have to assign specific responsibility to medical and administrative staff to carry out the diversion control measures and functions described in the plan.

In addition, individuals served by the program must attend the clinic daily and take their dose in the presence of nursing staff. A person may be eligible for “take-home” medication on a graduated scale based on their treatment progress. Eight-point criteria assess community and individual safety in these cases.

Similar to the community relations plan, the diversion control and take-home systems are reviewed in the accreditation process.

How can I learn more about what is happening in the community?

Engage with the program leadership; learn more about how they plan to operate the program and co-exist in the community. OTPs are required to have a program sponsor whose responsibilities include ensuring compliance with all federal regulations. Community members can ask for the sponsor’s contact information and bring any concerns or complaints to that person. The accrediting body itself can also be a mechanism for sharing feedback and resolving issues.

Some questions a community member may want to ask the program sponsor and other leadership include:

  • How was the program site selected?
  • What population(s) does the program plan to serve?
  • What are the hours that you will provide dosing services?
  • How do you plan to control traffic flow and overcrowding?
  • How will you manage parking and wait times?
  • What are your measures to prevent diversion?

An OTP’s community relations activities promote recovery and integration of the persons served. Opening the conversation keeps leadership accountable to the community while providing life-saving services to its residents. Informed community members can change public perception and promote recovery.

If you have concerns about a CARF-accredited OTP, please go to www.carf.org/accreditation/public/ for tips and information on how to provide feedback about the provider to CARF.

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10 tips: How unpaid caregivers can beat burnout https://carf.org/blog/how-unpaid-caregivers-beat-burnout/ Wed, 13 Nov 2019 15:00:24 +0000 https://carf.org/?p=4136 November is National Family Caregiver Month sponsored by the Caregiver Action Network....

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November is National Family Caregiver Month sponsored by the Caregiver Action Network.

With a growing aging population, many adult children and other loved ones step up to provide care. It seems idyllic for seniors to reside with relatives instead of unfamiliar staff in a retirement community, and for those with illnesses or disabilities to be cared for by people who know and love them, but family caregivers take on a significant amount of work in addition to regular jobs and family responsibilities, which can lead to extreme burnout.

The Caregiver Action Network, formerly the National Family Caregivers Association, reports that more than 43 million Americans care for a loved one who is aging or lives with a chronic illness or disability—and the scope of their work is significant. Gallup reports that the average unpaid caregiver spends a full 13 days per month on tasks like shopping, food preparation, housekeeping, laundry, transportation, and giving medication; 6 days on feeding, dressing, grooming, and bathing; and 13 hours researching care services or information on disability or disease, coordinating healthcare appointments, and managing financial matters.

Although this around-the-clock caregiver’s level of dedication is admirable, the time and effort required can take a toll—especially if a caregiver has other responsibilities and challenges. As the average age of an unpaid caregiver is 49.2 years old, many are still in full-time jobs and/or juggling parental responsibilities. AARP, a CARF International Advisory Council (IAC) member, found that 60% of caregivers in the U.S. also work other jobs, nearly half have struggled to balance caregiving with work, and 8% report their career growth is affected by caregiving responsibilities.

Caregiving stress results in a range of physical and emotional symptoms. In one American Psychological Association (also a CARF IAC member) study comparing caregivers with non-caregivers, caregivers displayed a 23% higher level of stress hormones and a 15% lower level of antibody responses. Persons caring for family members with dementia were more likely to have weakened immune systems and greater odds of developing chronic illness. And caregivers providing 36-plus hours of care per week were more likely to display depression or anxiety. Many caregivers may be unlikely to seek treatment for their own symptoms or acknowledge their burnout or need for help due to feelings of guilt and a sense of duty to the care of their loved one.

“Caregivers are taken for granted, and they are invisible in the system,” said Georgetown University Professor of Public Policy Judy Feder. “It’s bad for them, it’s bad for care recipients, and it’s bad for the system.”

What can be done to address your threat of burnout if you’re a caregiver? In recognition of National Family Caregiver Month in November, some experts weighed in with these tips:

  1. Acknowledge your challenging role. Admitting your job is not always easy doesn’t imply a lack of devotion to your loved one; rather, it’s the first step in finding solutions. “Daughters, spouses, partners, and friends frequently do not perceive themselves as a caregiver—and as a result, do not recognize the need to seek support or don’t know the ‘language’ that can open doors to valuable resources,” says Jed Johnson, CARF’s managing director of Aging Services.
  2. Don’t expect perfection. You may not be able to handle every element of your caregiving job on your own, or you may need to go part-time. You’re human; you may make mistakes; choose the wrong options; and get tired, frustrated, or snarky. Forgive yourself and move forward. “It’s normal to feel guilty sometimes, but understand that no one is a perfect caregiver,” notes staff of the Mayo Clinic. “Believe you are doing the best you can and making the best decisions you can at any given time.”
  3. Accept help. Don’t be too proud to accept help offered by friends or other family members. Keep a list of tasks others could complete for you— perhaps running errands, bringing a meal, or providing transportation for your loved one.
  4. Set realistic goals. Establish boundaries by saying no to actions and events you know to cause too much stress, such as taking your loved one on a faraway trip or hosting a major family gathering on their behalf.
  5. Stay organized. Eliminate hurry and indecision by keeping lists and calendars and breaking each day down into manageable routines.
  6. Become connected. Learn about caregiver resources in your community. Support groups made up of like-minded individuals may allow you to vent your frustrations while sharing joys and sorrows. You may also identify services such as transportation, meal delivery, or housekeeping that are geared toward caregivers.
  7. Don’t isolate yourself. Spending every day focusing on your loved one without other socialization can make you feel alone. Schedule time with other family and friends who can support you in your caregiving goals, and pursue activities you find relaxing and enjoyable.
  8. Advocate for your own health. Control your stress levels and maintain your wellness by following a solid sleep routine, staying hydrated, having regular physicals, and seeking counseling as needed. An impartial third party can help you understand and cope with your feelings.
  9. Look into respite care. Respite care comes in several forms and may be covered by insurance. Options include in-home aides, adult care centers, or short-term care programs. “Respite care provides relief for the caregiver and helps to reduce burden and stress,” advises Johnson, who recommends checking out the ARCH National Respite Network and Resource Center. “It can be for a few hours a day, a few days a week, or even a few weeks a year.”
  10. Take advantage of industry resources. Optimize the help and resources available through caregiver advocacy organizations. Johnson recommends AARP; the Family Caregiver Alliance/National Center on Caregiving; the Caregiver Action Network; and the National Alliance for Caregiving.

Caring for a loved one can be a full-time commitment. Recognizing the physical, mental, and emotional challenges of being an unpaid caregiver is crucial in keeping yourself from becoming overwhelmed. Asking for help does not mean you are any less committed to your loved one; it will only make you a better caregiver to arm yourself with resources in order to provide the best care possible.

CARF’s provider search can help you find an accredited program in your area. Visit our Resources page to explore consumer guides and articles on caring and advocating for the health of your loved ones.

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Addressing social determinants with higher standards https://carf.org/blog/addressing-social-determinants-with-higher-standards/ Thu, 25 Jul 2019 16:00:00 +0000 https://carf.org/?p=4140 The CARF standards confront barriers of access, capacity, and social determinants that weaken outcomes...

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The CARF standards confront barriers of access, capacity, and social determinants that weaken outcomes for providers and the persons they serve.

Social determinants of health (SDH) are the conditions in which people live, work, and age and include factors like housing stability, employment status, geographic location, education, and other socioeconomic circumstances. SDH, often determined by distribution of wealth and resources, has proven responsible for inequities in healthcare and has become its biggest cost-driver. And this inequity is proving very costly; some $111 billion in health-related costs in the next decade will be the direct result of unstable home conditions, according to a study published by Children’s HealthWatch at Boston Medical Center.

This relationship between SDH and health is continually monitored by the World Health Organization (WHO). WHO’s position is that unjust and avoidable inequalities in environmental risks, between and within countries, call for relevant policies and interventions to mitigate and reduce risk in the affected population groups. Echoing WHO initiatives, Healthy People 2020 has established and reports on its ten-year national objectives for SDH, with the goal of creating better health across the U.S.

These global and national initiatives aim high, but the disparity in healthcare is most prevalent at the community level, and it’s the providers of health and human services who are directly absorbing the high cost and are expected to address SDH on the frontline. “Social determinants of health are no longer a novelty; they are part of a comprehensive strategy to deliver quality, affordable healthcare,” writes Margaret A. Murray, CEO of the Association for Community Affiliated Plans, in Modern Healthcare. “Collaboration between health plans, providers, state agencies, and the federal government should be the norm, not the exception.”

Providers can turn to the CARF standards for guidance in confronting barriers of access, capacity, and social determinants that can weaken service outcomes. Outcomes- and evidence-informed service delivery involves addressing the unique, changing needs of individuals across ages and life situations. As persons served transition through life milestones related to behavioral health, disability, and medical rehabilitation, their services must adapt. Any transition can pose barriers that affect service delivery and, ultimately, a person’s quality of life and outcomes. CARF’s accreditation model is ideally constructed to address these barriers and to help maintain service continuity.

CARF accredits programs that serve individuals across the lifespan. The field review and standards development process ensures that evidence-based practices related to service integration, transitions, and population specialization are written into all areas of the standards.

“We have been developing quality standards for services that address social needs since our inception,” says Debbi Witham, CARF’s managing director of public policy. “Our standards are designed to encourage organizations to include this in their planning. For instance, the standards related to accessibility planning include financial, attitudinal, transportation, and other barriers related to social needs that may impact an individual’s ability to access services that may improve their health and community functioning.”

CARF standards require accredited programs to examine the needs of the community when developing services. These needs should inform strategic planning efforts and how outcomes and improvement data are collected. CARF’s General Program/Care Process standards support and guide organizations to better understand and stratify the needs of the population served and create collaborative relationships with community resources.

The accreditation process also connects providers with expert peers across the global health and human services community. CARF surveyors bring expertise from their own programs and offer insight and consultation stemming from hands-on experience in similar communities.

CARF works with more than 2,700 providers accredited for programs that target SDH, many in conjunction with social services that encourage a holistic health perspective. Although the concept and practice of assessing and addressing SDH appears in the ASPIRE Performance Measurement, Management, and Improvement standards, CARF does accredit specific programs that deal more directly with SDH, including:

  • Case Management/Services Coordination
  • Community Housing
  • Community Integration
  • Crisis Intervention
  • Crisis Stabilization
  • Employee Assistance
  • Health Home
  • Home and Community Services
  • Supported Living
  • Rapid Rehousing and Homelessness Prevention Program
  • Foster Family and Kinship Care

Witham says CARF will continue to concentrate on improving healthcare quality for persons served with a strong focus on social needs. “These services have not historically been purchased through traditional healthcare payment systems. However, that’s changing, and many payers are struggling with how to identify quality in those services and realize an effective return on investment. CARF’s standards and accreditation process can help payers identify quality services delivered by organizations with efficient business practices and performance management systems that focus on ensuring a strong ROI.” Deploying data-driven systems and tools, providers can effect real change—locally and globally—in reducing SDH-related barriers and improving outcomes for persons served.

For a full list of CARF program descriptions, visit www.carf.org/accreditation/programs.

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