2000 Conference Proceedings

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Beyond Accreditation: CARF’s Quality Improvement Products for Assistive Technology Services in the New Century

Dale Dutton, National Director
CARF - Employment & Community Services Division
4891 East Grant Road, Tucson, AZ 85712
Phone (520) 325-1044, FAX (520) 318-1129
Website: http://www.carf.org 
Email: ddutton@carf.org

Quality improvement is the real outcome of today's CARF accreditation. Today's accreditation product from the Employment and Community Services (ECS) Division of CARF is a close-up look at the organization and the results of the services it delivers. In the fast-changing ECS field, CARF standards remain in the vanguard of changes in the way our field delivers services. In fact, no single ECS standard or section of standards has been left untouched from 1997!

The value of accreditation has to be much more than a certificate on the wall. Organizations seeking accreditation from CARF must demonstrate a clear focus on their customers, their customer's expectations, and the results of services provided in terms of the achievement of desired goals, and customer satisfaction.

As a first step, an organization seeking accreditation makes a commitment to enhancing the lives of the persons served-as defined by the person served. Organizational values are developed or revised to reflect this commitment.

Next, the organization examines its structure and mission in light of current environmental factors. To do this, stakeholders are identified, their needs identified and prioritized, and changes in service delivery are implemented when appropriate.

The organization sets up an outcomes measurement system to observe changes in the lives of persons served, the organization, or the community as a result of services provided. The results from these observations drive changes to individuals' service plans and services, as well as the organization's daily operations and future plans.

The role of the CARF site survey visit is to provide an impartial, external review by a team of professional peers. This review is made using accepted standards and accessing the organization's policies or value statements. In other words, is the organization walking its walk and not just talking its talk? It becomes, in effect, a celebration of past success, and a guide to future improvement.

Conformance to the standards is demonstrated through team observations; interviews with consumers, families, staff, and other stakeholders; answers to questions about important points in the standards; and a review of appropriate documentation.

The Survey Report from these observations contains commendations to reinforce the organization and staff for their best practices. It contains suggestions for improving services based on the experiences of the Survey Team and questions from the organization, and it also contains recommendations for improvement in areas that the Survey Team identified to be in need.

Equipped with this information, the organization prepares a Quality Improvement Plan to address these recommendations during the term of the accreditation award. Using its outcome measurement system, the organization continues to refine and improve its services, operations, evaluation, methods, organization, and policies.

Throughout the term of accreditation, training and publications are available from CARF to help the organization implement its own QI plans and continue to improve customer-focused services for its stakeholders.

Today’s dynamic "Learning Organization" uses the CARF accreditation process and results for its marketing, staff development, and strategic planning activities to improve the quality of life for each person it serves!

What's New?

The 2000 Employment and Community Services Standards Manual reflects the continual refinement of the move toward accreditation based on results, or outcomes, begun in 1994. It represents input from persons served, their families, providers, surveyors, funders, advocates and other persons interested in improving the quality of services to people with disabilities in our field.

The 2000 ECS standards include the practical application of a six-year effort to raise Carf's accreditation emphasis on outcomes, or results of service. Field response from accredited organizations, funding sources, and surveyors favor the standards' new emphasis. The result? Fewer standards, greater clarity, and less duplication. Surveyors are thus able to provide constructive consultation to organizations about redesigning their outcome measurement systems and improving service quality as indicated by customer satisfaction.

Managed care concepts and one-stop community service centers signal major changes in the field. Standards for Service Coordination were first included in the 1996 manual and have already led to accreditation for many of these new service designs. These new accreditation opportunities are available in both Employment and Community Services. They may be applied to free-standing organizations or as part of direct service. They were joined in 1998 by quality outcome measures for accreditation in three new program areas:

In 1999, new standards for an accreditation opportunity for Foster Family Services were added in the Community Services section. As with Host Family Services, Carf will not accredit, or "license" the actual family unit, but rather the organization providing the referral, support, and advocacy for the child with disability.

The ECS Standards Manual has also been redesigned for easy use and readability.

It features a separate section on outcomes – focusing attention on this key part of quality service design and delivery. Opportunities for accreditation in Assistive Technology, Transition, and Service Coordination exist in either or both of the general areas of Employment Services and Community Services.

What's Next? These new accreditation opportunities signal a growing need to recruit and train surveyors with experience in these fields, as well as provide continuing education for existing surveyors and providers of direct service. Carf is currently developing a Field Practice publication, covering these new areas as well as the traditional service arena. If you provide creative services, enjoy consultation, and would like to be trained as a surveyor or contribute your expertise to a Carf publication, please contact us.

Revised standards for Residential Services, to be called Community Living Services, are under development in 1999, for publication and implementation in 2000. Contact us for more information, or a preliminary look at the draft new standards.

A new streamlined report format, coupled with a standards conformance rating system is expected to enhance the reliability of the survey process, and provide a foundation for differentiating the levels of conformance by programs seeking accreditation, for example, highlighting programs with excellent conformance. The system will utilize a 4-point rating scale for each standard. Carf will retain the hallmark consultative accreditation procedures and deliver information to the accredited organization in a more useful format.

Extensive input received from Carf’s constituents in the early phases of the Strategic Outcomes Initiative identified the need for a limited set of uniform Performance Indicators (based on quantitative measures) of rehabilitation program performance. During 1999 Carf is continuing to conduct a project across all three divisions to identify such performance indicators for rehabilitation. Performance indicators are those structure, process or outcome topics used to point to program quality. They represent a limited set of data items or measures that the persons served and their payers/sponsors can look to for key information to assess the quality of a rehabilitation program, and to compare or shop for the program best suited to their needs.

A new public Information Policy, together with additional standards, clearly establishes the organization’s responsibility to provide appropriate information to the public on request, and to demonstrate that capacity and execution during survey.

This is an exciting and challenging period for the Employment and Community Services Division of Carf. We value your support and participation.

For more information, please contact:
National Directors, ECS Division
Dale Dutton, phone extension 133, email - ddutton@carf.org or Paul Andrew, phone extension 112, email - pandrew@carf.org

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