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Accreditation.

In this issue of Behavioral Healthcare, our cover stories' focus is accreditation. The following articles provide updates on recent initiatives and standards changes at four accrediting organizations active in the behavioral health field, commonly known as CARF, COA, the Joint Commission, and URAC. In addition, Linda Rosenberg, MSW, president and CEO of the National Council for Community Behavioral Healthcare, discusses the challenges and benefits National Council members have experienced by seeking accreditation.

Focusing on integration

CARF plans to start offering accreditation to integrated behavioral health/primary care settings in July

Discussion around the need for integration of behavioral health and primary care, while certainly becoming more prevalent, is definitely not new. But within the past couple years the dialogue has become universal. The Institute of Medicine's Crossing the Quality Chasm reports and the National Association of State Mental Health Program Directors' compilation of state studies clearly support the need to adequately assess and respond to the holistic needs of persons with behavioral health concerns.

CARF, International, which develops standards in response to needs identified "by the field," began its internal discussion around the possibility of accreditation for integrated behavioral health and primary care (IBH/PC) settings in early 2003. While communication was occurring with representatives of some federally qualified health centers (FQHCs), the Veterans Health Administration (VHA), and national associations such as the National Council for Community Behavioral Healthcare (NCCBH), it was important to assess the market potential and desire for distinct program accreditation in this area. After significant national dialogue, a Leadership Panel convened in December 2005 to confirm the need for national IBH/PC standards and to identify themes critical to include.

In response to the Leadership Panel's confirmation of the growing importance and recognition of integrated treatment settings, CARF convened an International Standards Review Committee (CARF ISRC) in August 2006, comprised of consumers, national association representatives (including members of the CARF International Advisory Council), integrated service providers, state and federal funding authorities, and other national experts. This group was charged with developing a progressive and state-of-the-art set of standards to be presented to the field.

In addition to developing the draft standards, the CARF ISRC identified descriptions of IBH/PC settings the standards would cover:

* contractual, where two separate legal entities enter into an agreement to staff and operate a single program;

* a distinct, integrated program located within a large entity such as a VHA campus;

* the colocation of complementary disciplines such as behavioral staff in a primary care setting (as in an FQHC) or primary care staff in a community mental health center (as described by NCCBH in the December 2006 issue of Behavioral Healthcare); or

* a single organization that incorporates both behavioral health and primary care services in an integrated model.

One of the ISRC participants was Morna Pederson-Rambo, executive director of DaySpring Behavioral Health Services, Inc., which operates integrated programs in Oklahoma and Arkansas. She offered the following as support for the importance and value of the new CARF standards:

"To launch standards that guide the integration of primary care and behavioral health services, CARF has opened the door for another method of ensuring access to care and greater potential for positive outcomes to persons served. Many who see their medical doctor have complaints related to depression, extreme or acute life situations that cause distress, or ongoing relationship issues that interfere with medical conditions. The physician who has behavioral health specialists on-site can ask them to become acquainted with the patient at the time the complaint is raised. By introducing or giving a warm handoff to a behavioral specialist, the physician indicates his/her confidence in this provider to attend to yet another facet of the symptoms or stresses that are contributing to disease. Working as a team, the physician and behavioral health specialist provide for a better opportunity to achieve changes in the patient's behavior that positively affect his/her functioning. These changes also promote greater physical health.

"The simple availability of the behavioral health specialist makes it more likely that the patient will follow through with a recommendation for needed behavioral health services. Secondly, the nature of integrated service delivery supports short-term, solution-focused interventions, which can be accessed multiple times if necessary, and can support progressive work toward greater mental and physical health care. In addition, the overview of medications from both the medical and behavioral health sides of care lead to the potential for quicker assessment and introduction of positive pharmaceutical regimes. Because of integration, the individual has the attention of several providers working together to ensure a positive outcome of the treatment plan."

The draft standards were posted on the CARF Web site (www.carf.org) in December, and although specific notice was sent to providers who have CARF accreditation, CARF-affiliated associations, and state mental health directors, all interested individuals were invited to participate. Initial review indicated a strong response. The field review was analyzed in January 2007 and changes made where necessary.

Programs seeking accreditation under the IBH/PC standards would need to meet existing CARF Business Practice and General Behavioral Health program standards, as well as areas such as:

* identification of parameters of populations served and services provided;

* colocation requirements;

* coverage requirements;

* staffing requirements;

* requirements for education on wellness and recovery;

* processes ensuring consent for treatment;

* written procedures for communication and collaboration; and

* clearly identified performance measurement indicators that include both medical and behavioral healthcare.

The new standards are anticipated to be "published" on the CARF Web site by March 1 and will be an addition to the 2007 CARF Behavioral Health Standards Manual. Accreditation of IBH/PC programs will begin July 1, 2007, for those organizations able to demonstrate at least six months of conformance to the CARF standards. Providers interested in learning more about this accreditation opportunity should contact Lisa Palmer (ext. 129) or me (ext. 117) at the CARF Tucson office, (888) 281-6531.

BY NIKKI MIGAS, MPA

ABOUT THE AUTHOR

Nikki Migas, MPA, is Managing Director of the Behavioral Health and Child & Youth Services Customer Service Units of CARF, International.

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Emphasizing best practices

COA's latest standards are oriented toward outcomes

When the Council on Accreditation (COA) began revising its standards in 2002 for the human service field, including behavioral healthcare providers, it was with the goal of documenting best practices clearly linked to positive outcomes. As a result, COA's 8th Edition Standards, released this past summer, make a connection between strong administration and management practices and effective service delivery.

While the new standards retain COA's commitment to client rights and rigorous health and safety standards, they mark a number of exciting changes in approach and philosophy. A rigorous, multistage development and vetting process was used to ensure that the standards are field-driven and evidence-based. The 8th Edition Standards are also at the core of COA's Contextual Accreditation process, which is tailored to the unique strengths and characteristics of each organization. This means, for example, recognizing how intake and assessment practices in behavioral healthcare organizations are impacted by the unique needs of the populations served.

Instead of offering prescriptive practices, Contextual Accreditation asks organizations to demonstrate how they measure the impact of their services on their clients, and what they are doing to continually improve organizational performance. Client involvement, community partnerships, internal culture, and use of data are emphasized. At the beginning of the accreditation process, a realistic timetable is established and technical assistance needs are identified so that the organization is able to successfully attain accreditation.

The new standards are firmly oriented toward outcomes, and are written in measurable program output language rather than being process oriented. For instance, the intended outcome of outpatient mental health services is that adults with serious and persistent mental illness should have reduced symptoms and an enhanced ability to function in their communities. In addition, services should help manage co-occurring health and substance use conditions, as well as support psychosocial adjustment. At the core of all of the standards related to behavioral healthcare is a focus on recovery for service recipients.

For a program to be successfully implemented, agency staff must have the competence to fulfill their responsibilities, while organizations must have the technical expertise to function efficiently. To those ends, embedded in the 8th Edition Standards is the principle that increased organizational capacity leads to improved service delivery, which in turn leads to better outcomes. Capacity building is emphasized in administration and management standards related to ethical practice, financial management, human resource management, performance and quality improvement, and risk prevention and management.

Several other features distinguish the new standards. All organizations undergoing accreditation must demonstrate implementation of administration and management standards, as well as service delivery administration standards. Administration and management standards apply to all organizations regardless of the services provided. These management practices promote sound organizational operations and accountability. Service delivery administration standards cover practices related to the administration of services. The organization additionally is reviewed using the specific service sections applicable to it. Prior editions of COA's standards included generic standards for service delivery practices, such as intake, assessment, screening, service planning, case closing, aftercare, and follow-up, and placed these within the administration and management standards. These practices now are integrated into each of the 38 specific service areas and tailored accordingly.

In addition, some sections in previous editions, such as those on counseling and mental health standards, raised questions for behavioral healthcare providers undergoing COA accreditation when trying to identify the best fit for their service or program. In the new edition, service sections have been more clearly defined, and counseling, support, and education services have been clearly distinguished from clinical counseling services.

For the first time, the psychiatric rehabilitation services standards incorporate assertive community outreach programs and the use of a multidisciplinary team approach to provide community-based psychiatric treatment, rehabilitation, and support services to adults with serious and persistent mental illness. These standards require an individualized, coordinated service approach by an outreach team in order to support recovery, reduce symptoms, and encourage membership in the community. Referring to research that shows a team approach can decrease staff burnout and turnover, the standards call for the entire outreach team to share the program caseload and work with all persons receiving services.

The new standards also emphasize integrated treatment. Given that patients often suffer from multiple conditions, behavioral healthcare providers are encouraged to assess for mental health, substance use, and physical health conditions and provide services that integrate treatment within the same core program, when possible, or through collaborative services. Other best practices highlighted throughout the standards for behavioral healthcare service standards include those for crisis planning, illness management, support services for individuals and families, and engaging recipients in treatment.

Research evidence, clinical experience, and practice wisdom all were used during the standards development process to ensure the standards support evidence-based best practices. COA staff conducted in-depth reviews of all available literature and data. A behavioral healthcare advisory panel comprised of researchers, academics, consumers, and representatives of accredited organizations provided input and suggestions. The standards were posted on COA's Web site for field comments, which were reviewed and incorporated where appropriate. More than 1,000 comments were received during this phase. The new standards then were field-tested with several organizations during 2005 and 2006.

In response to agency requests that COA share its knowledge base with the field, great efforts were made to make the 8th Edition Standards more transparent. The new standards include research notes to describe the literature and research, where available, that COA used to determine best practices. The standards also have been enhanced by including a reference list for each section of standards that highlights evidence-informed practices. Additionally, standards have been organized in a more streamlined and user-friendly manner. Redundancies have been eliminated, while every effort was made to use clear, succinct, and nonregulatory language.

To further support best practices across the human service field, COA for the first time has made its standards available to the public at no cost at www.COAStandards.org. Organizations can review best practices and the supporting evidence regardless of whether they are pursuing COA accreditation.

In today's challenging climate, all human service organizations are facing increasing pressure to demonstrate that they are making a difference for their clients. COA believes that the 8th Edition Standards, together with Contextual Accreditation, form a vital strategy that an organization can use to measure, strengthen, and validate its effectiveness, and consequently achieve its specific mission.

Bojana Stoparic is a Public Relations Associate with the Council on Accreditation.

BY BOJANA STOPARIC

Refining requirements

The Joint Commission introduces behavioral health-specific tracers and other accreditation enhancements

While accreditation standards and survey processes for behavioral healthcare organizations accredited by the Joint Commission have not changed significantly, several notable refinements take effect for 2007.

Behavioral Health-Specific Tracers

To better address the unique characteristics and relevant issues of each accredited organization, Joint Commission behavioral healthcare surveyors will have a wider range of behavioral health-specific tracers during surveys. The tracer methodology is a significant component of the accreditation process, providing a framework for Joint Commission surveyors to assess standards compliance and patient safety during on-site surveys. The new setting-specific tracers were identified through a review of expert literature, research, input from the field, and advisory group suggestions. The tracers are:

Continuity of foster/therapeutic foster care. The objectives of this tracer are to evaluate the effectiveness of the foster/therapeutic foster care agency processes surrounding placement of children and identify process- and possibly system-level issues contributing to multiple placements. This tracer is applicable to foster/therapeutic foster care settings (in the presence of multiple placements within the same foster care agency). This tracer only will be used in agencies responsible for foster care placement decisions.

Elopement. Surveyors will evaluate the effectiveness of processes to prevent elopement, therefore enhancing safety and identifying process- and possibly system-level issues contributing to successful elopements. This tracer is applicable to a wide range of settings in which elopement is an issue.

Suicide prevention. This tracer examines the effectiveness of the organization's suicide prevention strategy and identifies process- and possibly system-level issues contributing to suicide attempts. This tracer is applicable to 24-hour settings such as residential care (when organizations have experienced suicide, suicide attempts, or a series of near misses).

Violence. The objectives of this tracer are to evaluate the effectiveness of the organization's process to control violence and ensure the safety of others, and identify process- and possibly system-level issues contributing to violent behavior. This tracer is applicable to all behavioral health settings when surveyors identify concerns related to violent behavior.

The Joint Commission plans to continue the development of additional behavioral health-specific tracers. Ultimately, a library of survey process activities will be available, which will allow surveyors to mix and match activities based on the unique characteristics of each organization.

Changes to National Patient Safety Goals

Goal 8. This previously existing goal requires behavioral health organizations to accurately and completely reconcile medications across the continuum of care. New language has been added to Requirement 8B. Specifically, the requirement now includes language that "the complete list of medications is also provided to the client on discharge from the facility." This addition is a clarification; this expectation has been implicit in the goal and the discharge planning standards.

Goal 13. This new goal applicable to behavioral health organizations encourages clients' active involvement in their own care as a client safety strategy. This concept is a component of the Provision of Care Chapter and the standards for Services that Support Recovery and Resiliency, so it is already a familiar concept to behavioral healthcare organizations.

Goal 13's Requirement 13A requires organizations to define and communicate the means for clients and their families to report concerns about safety and encourage them to do so. Requirement 13A's Implementation Expectation is that clients and families are educated on methods available to report concerns related to care, treatment, services, and client safety issues.

Goal 15. This other new goal applicable to behavioral health organizations requires them to identify safety risks inherent in its client population. Suicide consistently has been a red flag in the Joint Commission's sentinel event database. The important consideration when complying with this goal is for organizations to screen clients, identify those who are at risk for suicide, and provide resources to those individuals. This goal, which is similar to the expectations for Standard 2.10.

Goal 15's Requirement 15A requires organizations to identify clients at risk for suicide. The Implementation Expectations for Requirement 15A are that:

1. the risk assessment includes identification of specific factors and features that may increase or decrease risk for suicide;

2. the client's immediate safety needs and most appropriate setting for treatment are addressed; and

3. the organization provides information, such as a crisis hotline to individuals and their family members, for crisis situations.

New Automated Tools

New reporting tools for sentinel events and complaint reporting are now available on the Joint Commission's secure Extranet site. These online tools for complaint responses, self-reporting a sentinel event, submitting root cause analyses and action plans, and sentinel event measures of success must be used by behavioral healthcare organizations instead of mailing or faxing this information to the Joint Commission.

Due Date for eSOC Extended

Because of concerns raised by the field, the due date to convert from paper or in-house electronic format to the eSOC (electronic Statement of Conditions) has been extended to July 1, 2007. The Statement of Conditions is a proactive document that helps an organization do a critical self-assessment of its current level of compliance and describe how to resolve any Life Safety Code deficiencies. During this transition period, the Joint Commission requires:

* All accredited behavioral health organizations, which have buildings that require a Statement of Conditions (24-hour care settings) must have created an electronic Basic Building Information (eBBI, which is Part 2 of the SOC/eSOC) by January 1, 2007.

* All new life safety code deficiencies required to be managed using the Statement of Conditions should have been managed using the electronic Plan for Improvement (ePFI, which is Part 4 of the SOC/eSOC) beginning no later than January 1, 2007.

* Any life safety code deficiency that is currently identified in an existing Part 4 (paper, spreadsheet, other), and that was scheduled to be completed after December 31, 2006, should be entered into the eSOC. After discussion with the American Society for Healthcare Engineering, the Joint Commission agreed to make the effective date July 1, 2007.

To contact the Joint Commission's Behavioral Health Care Accreditation Program, call (630) 792-5771.

In an upcoming issue, Dr. Mary Cesare-Murphy will discuss emergency preparedness for behavioral health organizations.

BY MARY CESARE-MURPHY, PHD

ABOUT THE AUTHOR

Mary Cesare-Murphy, PhD, is the Executive Director for the Behavioral Health Care Accreditation Program at the Joint Commission.

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Ensuring quality and safety

URAC sees behavioral healthcare management as part of a larger care-coordination picture

Beneath the visible features of a high-quality behavioral health program is a multilayered organization that depends on the coordination of many systems. While the patient sees mostly clinical personnel, patient safety and positive outcomes are grounded in the quality of core competencies largely unseen and difficult to examine by the general public or even purchasers of care.

URAC accreditation takes into account everything, from the highly visible details to those behind the scenes. URAC accreditation promotes organizational integrity and efficiency, promotes clinical effectiveness and regulatory compliance, and improves the use of information technology. For the consumer, URAC enhances quality by improving healthcare management and by setting standards that empower and protect consumers, and improve consumer safety and education.

Often a behavioral health management organization seeks URAC accreditation for one or several core functions, such as utilization management, case management, and disease management, to improve overall healthcare management. URAC accreditation promotes care coordination across these often siloed functions. The URAC accreditation process requires the organization to have care coordination and communication mechanisms in place that otherwise separate behavioral health from other health management functions, a far less than optimal and all too common scenario.

For example, a patient may suffer from depression alongside a physical illness. URAC accreditation requires organizations to create linkages in care coordination, not only to promote the involvement of a behavioral health team, but to see that all aspects of care management work synergistically, resulting in better care and improved outcomes.

In January 2006, URAC introduced revisions of its clinical accreditation standards for health management programs (including behavioral health management programs), including new requirements for ongoing consumer safety initiatives. Although the revised standards put new emphasis on consumer safety, URAC has long operated with the philosophy that safety is an essential component of overall quality, and that URAC quality standards positively influence consumer safety. Monitoring sentinel events, tracking safety data, evaluating outcomes, using evidence-based medicine, practicing prevention to avoid adverse drug events--these activities are just some of what URAC looks for in accredited behavioral health management organizations to promote consumer safety.

In December 2006, URAC released the first draft standards for pharmacy benefit management programs for public comment, with final standards targeted for release this spring. URAC is introducing the standards for a new accreditation program with the goals of promoting industry best practices, encouraging quality improvement, and protecting and empowering consumers.

Although pharmacy benefit management is often a "downstream" function from behavioral healthcare, it is an important component of the total behavioral health management picture. URAC's new pharmacy benefit management accreditation will provide another point of connectivity to improve quality and patient safety throughout the care management process. URAC's pharmacy benefit management accreditation standards promote patient safety and assure access to needed drugs and pharmacies.

The draft standards also are designed to improve the consumer experience and understanding of how these programs operate, which should help ease the burden of behavioral healthcare providers who often find themselves explaining these programs to their consumers. They establish standard definitions, offer grievance and appeals due process, and assure that health plans and pharmacy benefit management organizations communicate effectively with consumers, providers, and care management organizations to increase medication compliance, reduce medication errors, and prevent drug-drug complications, interactions, and adverse reactions. For the behavioral health community, this downstream accreditation provides a further "safety net" that does not currently exist.

In late 2006, URAC also called for public comment on an initial set of healthcare management service measures, to be applied across many of URAC's accreditation programs (including those applicable to behavioral healthcare management programs). The goal of the proposed program is to create and maintain healthcare management services measures for consumer protection, safety, and quality. URAC will collect relevant information and quality data for comparison across five categories: operational service quality, access to services, clinical decision making/support, quality improvement, and customer/consumer satisfaction. This measurement information from URAC-accredited companies will be aggregated and reported back in a way that allows the accredited organization to measure where it stands compared to its peers, for internal benchmarking and improvement.

In addition, aggregate data and reporting for the public will be introduced that provide industry benchmarking and quality data. The metrics, still under development, focus on the processes provided by organizations and the outcomes linked to them. This is a fundamentally different approach to measuring service quality than the population-based HEDIS measures, which focus on clinical quality through the reporting of administrative data.

Quality improvement doesn't just happen within an organization--it is an intentional, ongoing pursuit guided by industry-recognized standards and processes. Through accreditation, URAC is a partner to organizations as they seek to improve organizational efficiency and effectiveness and promote quality in healthcare management.

To contact the author, e-mail awatson@urac.org.

BY ANNETTE WATSON, RN, CCM, MBA

ABOUT THE AUTHOR

Annette Watson, RN, CCM, MBA, is URAC's Chief Accreditation Officer, Vice-President, and General Manager of Client Services.

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Why not accreditation?

National Council members comment on the challenges and benefits of accreditation

Many of the National Council for Community Behavioral Healthcare's 1,300 members--community behavioral health organizations across the country--are accredited, most often by the Joint Commission or CARF. But some members operating in states that don't require it choose not to go the accreditation route. And to understand the debate among behavioral healthcare organizations about accreditation, we need to look at two problems--state overregulation and an industry-wide lack of standards of care.

In preparation for this article, I shared my thoughts with the National Council's membership and asked for their opinions on questions such as: Can accreditation be a vehicle for reducing excessive oversight? Are standards of care important? Has your organization benefited from accreditation? I received an overwhelming response to my questions.

None of the responding members dismissed the value of accreditation. A number pointed to the barriers to accreditation: initial and ongoing fees to obtain and retain accreditation; administrative and clinical departmental initiatives, committee meetings, and the resultant documentation, all of which entail great investments of staff time; and in some cases compliance with life safety codes beyond local requirements. For some organizations, these barriers are insurmountable.

A great majority of those who responded are accredited and highly value their accreditation. I've incorporated a sample of members' comments into this article; they provide a window into our membership--their commitment to excellence and their struggles to achieve excellence regardless of the burdens.

For some, accreditation is a goal. Kevin J. Eastman, chief operating officer of Weber Human Services in Ogden, Utah, responded, "Coincidentally, I was in a discussion about this very topic. For years now, our agency has been working to position ourselves to be able to meet accreditation standards. I fully believe that the work we have done towards this has already transitioned into better care and treatment for those we serve."

Others, like Shirley Ha-venga, CEO of the Community Psychiatric Clinic in Seattle, are leaders of organizations that have been accredited for many years and attribute their early success to the accreditation process. "One of my first goals, more than 12 years ago when I merged two mental health centers, was to bring the newly formed organization to a position wherein we could seek accreditation. The learning process from those many months of preparation did more to align practice, based on national standards, with policy than any single thing I could have done as the new CEO."

Susan Rushing, CEO of the Burke Center in Lufkin, Texas, shared the value of an ever-evolving accreditation process and her organization's fight to maintain standards in a tragically underfunded system:
 No longer do surveyors sit in offices and read manuals or watch our
 spiffy PowerPoint presentations on agency planning. They look at what
 actually happens to a subset of patients and they interview staff on
 the specifics of each selected case. We were surveyed under this
 process last year and it was a humbling experience.... With the cost
 pressures we all face and with the clinical model we in Texas are
 mandated to use, adherence to accreditation standards has never been
 harder. Or, in my opinion, more necessary. As a management team, we
 use standards compliance as the stackpole around which we build
 services. A year ago, we reluctantly closed our long-standing
 residential substance abuse treatment facility because we could no
 longer operate in compliance with accreditation standards at the rate
 Texas paid ... less than $80 per day, inclusive. This was a very hard
 decision for our Board but our commitment to accreditation provided
 the "bright line" we would not cross as an agency.


Discussions about accreditation identify unnecessary and unproductive duplicative oversight between state authorities and accrediting organizations as an ever-increasing burden. Responding members outlined the tremendous numbers of procedural, reporting, and governmental requirements that emanate from the contracts held with state authorities and dizzying numbers of reports, audits, and unique service delivery requirements.

Community-based mental health and addictions service agencies are sometimes state-run, but more often they are regional authorities or not-for-profit organizations run by boards of directors. And yet most state authorities continue to oversee and monitor these organizations with a degree of scrutiny and involvement unheard of in any other part of the healthcare industry.

Marsha Morgan, chief operating officer of Truman Medical Center Behavioral Health in Kansas City, described the burden of oversight to which her organization is subject:
 I only wish that accreditation would be a vehicle for reducing
 excessive oversight. We have tried to negotiate putting this concept
 into practice, to no avail. We continue to have 4-5 surveyors from the
 State once a year for more than a week, county surveyors 3-4 times per
 year, and JCAHO [surveyors] every 3 years (although now that the
 surveys are unannounced, we are to always be ready for a visit). In
 addition, we submit reports to all these entities depending on their
 requirements. The other thing that happens with surveys are the
 additional "look behind" surveys. We have had experience at TMC where
 there will be a State survey and then CMS comes in for a review of the
 survey.


And so the question always comes up: If an organization is accredited, will the state authority grant deemed status? That is, will the state authority accept national accreditation in lieu of its own accreditation-like process? After all, state reviews aren't any more protection than accreditation is against Medicare or Medicaid audits. And they aren't any more indicative of quality; state reviews often are conducted in the same way year after year, while accrediting bodies continuously are updating and refining their standards and processes.

William Bierie, president and CEO of the Maumee Valley Guidance Center in Defiance, Ohio, reminded me that Ohio has granted deemed status to accredited organizations and that the members of the Ohio Council of Behavioral Healthcare Providers "rated accreditation as superior to state certification rules because they learned more about their organizations and continuous performance improvement.... Accreditation is a learning process and certification is only a compliance process," he said.

Ohio is one of the very few states to pioneer deemed status, and there has been little success in getting others to follow suit. Perhaps for state authorities a barrier to embracing deemed status is the potential loss of the staff dedicated to the authority's own monitoring process. It also could mean a further shift in the relationships between behavioral health organizations and state authorities. Relationships already are changing as third-party reimbursements, particularly Medicaid, replace state general fund dollars; as states look to outsource oversight responsibilities to private administrative service organizations; and as behavioral healthcare organizations flex their state and federal advocacy clout.

Despite the burden of multiple surveys and audits, members like Rick Weaver, president and CEO of Central Washington Comprehensive Mental Health in Yakima, Washington, remain committed to accreditation as a vehicle for continuously improving services:
 The important message that we have consistently given our staff and
 Board is that accreditation is not about eliminating other audits or
 regulatory burdens. Instead it is about getting better and performing
 at peak levels.... What we have experienced is that we are constantly
 working at the right sorts of things rather than the paper compliance
 things. Our quality improvement program has become a very vibrant and
 integral part of everyday operations.... Certainly some staff point to
 accreditation as burdensome and duplicative. When discussing that with
 them I really focus on the improved processes or the community
 perception accreditation gives. We continue to fight for more
 effective deemed status and make small bits of headway but the true
 value we find is internal to our organization.


Accreditation discussions more often than not go from the issue of deemed status to a discussion of differences between states when it comes to behavioral health policies and regulations. The refrain is: No two states are alike, and accreditation is a uniform set of standards and expected organizational behaviors. And yet as you look from state to state, the issues and problems are the same, and the attempted solutions are variations on a few themes.

Could accreditation be helpful in addressing behavioral health's glaring lack of standard clinical care processes? Perhaps state authorities need to embrace deemed status and financially support accreditation, with its focus on operations and practice competencies. A Michigan member offered these final thoughts:
 If anything, behavioral health lacks the successes of and the
 respect given to the rest of medicine because of its intentional
 idiosyncrasies and isolationism. We have had 40 years of state
 oversight of mental health services. This has produced a service
 system that a national commission has concluded needs not just change
 but transformation. Why would we believe that by continuing more of
 the same we would get a different result?


To contact the author, e-mail lindar@nccbh.org.

BY LINDA ROSENBERG, MSW

ABOUT THE AUTHOR

Linda Rosenberg, MSW, is President and CEO of the National Council for Community Behavioral Healthcare. She is also a member of Behavioral Healthcare's Editorial Board.

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Title Annotation:Behavioral medicine
Publication:Behavioral Healthcare
Article Type:Cover story
Geographic Code:1USA
Date:Feb 1, 2007
Words:5466
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