Accreditation takes on added importance

When I was considering leaving Seabrook House, a subacute state-licensed and accredited specialty hospital, to come to New Directions for Women, a social recovery state-licensed and non-accredited treatment center, I knew I would not work for a non-accredited organization. So, during my first two years here, we worked on preparing our center for accreditation. New Directions had existed for almost 31 years without it, and now we were one of a handful of accredited centers in all of Orange County, Calif. Why is that important?

Accreditation is the national and international gold seal for behavioral health organizations that lets you know that the facility has applied countless standards of care to its services and systems. It allows you to compare facilities on equal footing, regardless of where they are located. Whether they’re in a different state, or even in a different country, the same standards are applied in every accredited organization. On a higher level of standard than licensing, accreditation is “a visible demonstration to those you serve, their families, your staff, and community of your organization’s ongoing commitment to safe, high quality care, treatment or services.”

Whereas the process of accreditation is standardized nationally and internationally, the process and requirements for certification and licensing vary from state to state, as do models of care. Some states require only a room and board license for sober livings, and some states have no requirements at all for sober livings. California does not require any licensing or certification to operate a sober living house with six or fewer people in it. In some countries, there may not be any standards at all for sober livings or treatment centers.

All accreditation processes require the facilities to be licensed by their state in good standing for the services they’re accredited for and to conduct follow-up with the patients they serve. This includes outcome data, internal requirements, safety levels, high-level documentation of the services offered, and confirmation that evidence-based best practices are in place. In addition, staff members are required to hold the proper credentials for delivering the levels of care they’re providing.

The two most widely held national and international accreditations for rehabilitation treatment centers and other behavioral health organizations are The Joint Commission (formerly referred to as the Joint Commission on Accreditation of Healthcare Organizations or JCAHO) and CARF (formerly referred to as the Commission on Accreditation of Rehabilitation Facilities). Their accreditations apply to hospitals, treatment centers, nursing homes, physical rehabilitation centers, partial day services, retirement centers, disability facilities, developmental group homes, and group services that provide medical, psychiatric, developmental, and health care diagnoses.

As an accreditation advocate, I advise all of our patients, inquiring families and friends, and referral sources such as therapists, hospitals and physicians who are looking for care to not only check licenses and state certifications, but also national and international accreditations, and to confirm that the facility is accredited for the level of care needed and wanted for the patient. In knowing the vast differences between licensing standards, I don’t simply look for a facility that is licensed to refer our patients or someone I care about. My bigger question is, “How is it accredited, by what organization, and at what level?" Accreditation is the determinant for whether or not I would utilize its services, or send a family member there, and it should be for any family looking to place their loved one or any organization looking to refer a patient.

Though I am a CARF surveyor, and have been for 16 years, I think the world of both CARF and The Joint Commission and the integrity of their processes. I encourage the practice of organizations having surveyors within their organization. CARF is a peer-to-peer review, which means that the people who come to survey live by the same standards they’re measuring. They’re able to share their methods with the organization they’re surveying, and many times experience “aha” moments and ideas that they can share with and implement in their own organizations. It’s all part of the philosophy of providing continuous quality improvement.

Fortunately, more and more of our colleagues are choosing not only to participate in maintaining licenses and certifications but also to become accredited. Even so, we are walking through some difficult and challenging times in our profession. Several organizations are choosing to operate at what one might perceive as a lower level of integrity, delivering services that appear to be one thing but are really something else. Sober living homes have been under scrutiny, particularly in California and Florida, but in other states as well. The majority of homes in southern California are not certified, because there is no legal requirement for certification for centers that house six or fewer people. Some facility operations are under the gun with questions of ethics and legalities. Many are not only unlicensed, but also are not certified or accredited. Yet they’re operating in the selling of services.

On the positive side, for decades many programs have chosen to continue to maintain the highest licensing and certification that their states provide and are nationally and internationally accredited. They are the ones I’m most proud of. New types of hospital and rehabilitative center accreditations are being introduced, including one that New Directions has willingly opted to participate in, which certifies all of our sober living houses as well as our treatment center. An accreditation for community housing that is available can only be obtained by participating in a certification or licensing process. The accreditation field is expanding, and we need to be paying attention. It is in our best interest to make sure we’re developing services that are alike in standards and high in integrity.

It pleases me to see more and more of our colleagues choosing to obtain certifications, and I support their efforts in accrediting their outpatient and residential programs. I encourage the leaders in our profession to wave the flag at the highest level of integrity by ensuring that their sober houses maintain the highest standards of licensing and certification the state will allow. I urge them to hold accreditation as their gold seal, their symbol, their badge of honor and commitment to quality—both to their organization and to those they serve. It is my vision that all treatment facilities throughout the nation join the ranks and be counted and remain inquisitive and open to continuous quality improvement.

“In today’s rapidly changing human services environment, excellence cannot be achieved by remaining static. Organizations must constantly change to remain relevant to their stakeholders. Leadership must drive and endorse change to ensure that the organization’s vision and mission are aligned with the needs and expectations of the persons served and positioned for organizational sustainability.” That’s really what that gold seal of Joint Commission and CARF accreditations symbolize, a model of organizations continuing to improve all the time. It is not a standard of perfection we’re trying to achieve. None of us are perfect. However, we know that we are in a profession committed to developing, evolving, and always striving for the quality of care that provides everyone suffering from this chronic, fatal, incurable disease a shot at a life of recovery.