Addiction Treatment Accreditations and Why They Matter Published February 26, 2020 By Addiction Helpline America

Finding the right drug and alcohol rehab center for yourself or a loved one can be challenging. The opioid epidemic has led to a rise in the number of addiction treatment providers across the country. However, not all rehabs are the same. While there are many reputable treatment centers, there are also those who solely wish to profit from other people’s pain and suffering. These disreputable and dishonest treatment providers cut corners and offer subpar care to those who need quality care to recover. Choosing a quality rehab that offers effective programs and therapies is critical to overcoming addiction. At Addiction Helpline America, we believe a good way to determine if you are dealing with an ethical treatment provider is to make sure they are accredited.

What Is Addiction Treatment Accreditation?

Each state has their own addiction treatment licensure requirements. Licensing requirements vary from state to state and are subject to change from time to time. In addition to these basic requirements, most rehabs seek to earn a seal of approval from an accreditation agency by participation in an evaluation process. As defined by the Commission on Accreditation of Rehabilitation Facilities (CARF): “Achieving accreditation requires a service provider to commit to quality improvement, focus on the unique needs of each person the provider serves, and monitor the results of services.”. Most organizations choose to become accredited in order to hold themselves to a higher standard and set themselves apart from other providers. In some cases, however, regulatory agencies will require accreditation as a precursor to becoming licensed or certified, to maintain funding, or to meet regulatory requirements.

To become accredited, a rehab must submit to a thorough review by the accrediting body. During the process, the drug rehab facility will undergo a detailed evaluation of their rehabilitation programs, therapy offerings, business practices and relationships, staff, client care, and adherence to the Health Insurance Portability and Accountability Act (HIPAA) guidelines.

The accreditation process is thorough for several reasons:

• The seal of accreditation represents high quality addiction treatment standards, and therefore should only be given to those that earn it.
• The primary goal of all staff at an accredited rehab center should be to care for their patients. The detailed review of patient care performed by the accrediting body ensures they meet this high standard.
• The accrediting body needs to ensure that the provider is dedicated to using effective therapies that meet or exceed their standards.

Nationally Recognized Accrediting Bodies

Within the US, there are three nationally recognized accrediting bodies for addiction treatment facilities.

The Commission on Accreditation of Rehabilitation Facilities (CARF)

CARF was founded in 1966 and is an independent, nonprofit organization devoted to advancing the quality of rehabilitation services, from substance use treatment to retirement living. CARF grants accreditation to 90 different types of programs and has issued more than 25,000 individual accreditations. Their accreditation process is both extensive and rigorous. The process includes a consulting with a CARF resource specialist, a detailed self-evaluation, and a survey from a hand-select team. CARF’s surveyors are chosen based upon their relevant experience and conduct detailed on-site inspections to determine the providers’ adherence to all applicable standards. Upon completing the accreditation review process, CARF renders an accreditation decision. The decision will be one of the following classifications:

• Three-Year Accreditation:“The organization satisfies each of the CARF Accreditation Conditions and demonstrates substantial conformance to the standards. It is designed and operated to benefit the persons served. The organization demonstrates quality improvement from any previous periods of CARF accreditation.”
  
• One-Year Accreditation:“The organization satisfies each of the CARF Accreditation Conditions and demonstrates conformance to many of the standards. Although there are significant areas of deficiency in relation to the standards, there is evidence of the organization's capability to correct the deficiencies and commitment to progress toward their correction.”
  
• Provisional Accreditation:“Following the expiration of a One-Year Accreditation, a Provisional Accreditation is awarded to an organization that is still functioning at the level of a One-Year Accreditation. A Provisional Accreditation is awarded for a period of one year. An organization with a Provisional Accreditation must be functioning at the level of a Three-Year Accreditation at its next survey or it will receive a survey outcome of Nonaccreditation.”
  
• Nonaccreditation:“The organization has major deficiencies in several areas of the standards, and there are serious questions as to the benefits of services; there are serious questions as to the health, welfare, or safety of those served; the organization has failed over time to bring itself into substantial conformance to the standards; or the organization has failed to satisfy one or more of the CARF Accreditation Conditions.”
  
• Preliminary Accreditation:“This allows new organizations to establish demonstrated use and implementation of standards prior to the direct provision of services to persons served. There is evidence of processes and systems for service and program delivery designed to provide a reasonable likelihood that the services and programs will benefit the persons served. A full follow-up survey is conducted approximately six months following the initiation of services to persons served.”
  
• Accreditation with stipulations:“If an organization's accreditation status is displayed as having stipulations, CARF may require ongoing reporting or other action from the provider regarding its progress in maintaining conformance to the accreditation standards.”

Source: CARF International, http://www.carf.org/Accreditation_Decisions/

Once accredited, the provider must submit a Quality Improvement Plan and Annual Conformance to Quality Report to CARF to remain accredited. This demonstrates the provider’s continued commitment to high quality treatment and improved patient outcomes.

The Joint Commission (Formerly JCAHO)

The Joint Commission (formerly The Joint Commission on Accreditation of Healthcare Organizations) is a not-for-profit, independent organization responsible for the accreditation and certification of over 21,000 health care programs in the US. The Joint Commission’s standards for behavioral health care providers are developed by experts and informed by industry best practices and addiction treatment data.

The evaluation performed by The Joint Commission includes the environment of care, leadership, continuing education of staff, patient care, evidence-based treatment, medication safety, screening procedures and assessments, consumer rights, and background checks.

Once a treatment provider has undergone the accreditation process, The Joint Commission will notify the provider of their decision. The decision will be one of the following classifications:

• Accreditation – “Accreditation is awarded to a health care organization that is in compliance with all applicable standards at the time of the on-site survey or has successfully addressed all Requirements for Improvement (RFIs) in an Evidence of Standards Compliance (ESC) submission within 60 days following the posting of the Accreditation Survey Findings Report and does not meet any other rules for other accreditation decisions.”
  
• Accreditation with Follow-up Survey – “Accreditation with Follow-up Survey results when a health care organization is in compliance with all standards, as determined by an acceptable ESC submission. A follow-up survey is required within six months to assess sustained compliance.”
  
• Limited Accreditation – “Limited Accreditation results when a health care organization is in satisfactory compliance with the limited set of standards and elements of performance (EPs) assessed in the first of the two surveys conducted under the Early Survey Policy.”
  
• Preliminary Denial of Accreditation – “Preliminary Denial of Accreditation is recommended when there is justification to deny accreditation to a health care organization as evidenced by one or more of the following: an immediate threat to health or safety to patients or the public; submission of falsified documents or misrepresented information; lack of a required license or similar issue at the time of survey; failure to resolve the requirements of an Accreditation with Follow-up Survey status; or significant noncompliance with Joint Commission standards. This decision is subject to review and appeal by the organization before the determination to deny accreditation.”
  
• Denial of Accreditation – “Denial of Accreditation results when a health care organization has been denied accreditation. All review and appeal opportunities have been exhausted. For an organization undergoing an initial survey, the organization has failed to demonstrate compliance with all applicable Joint Commission standards.”

Source: The Joint Commission, https://www.jointcommission.org/-/media/tjc/documents/fact-sheets/accreditation-and-certification-decisions-1-8-20.pdf

The Council on Accreditation

Founded in 1977, The Council on Accreditation (COA) is an international, independent, nonprofit, human service accrediting organization. They currently accredit more than 1,600 organizations and programs serving more than 7 million individuals and families. They divide their standards into three parts:

1. Administration and Management Standards - The Administration and Management Standards address practices that promote sound operations and management, including governance, financial management, and quality improvement. These apply to all organizations regardless of the services provided or populations served.
   
2. Service Delivery Administration Standards - The Service Delivery Administration Standards address practices related to the administration of services, including client rights, training and supervision, and program administration. These also apply to all organizations.
   
3. Service Standards - Service Standards address practices related to service provision areas across the full continuum of community-based social and behavioral healthcare services. These standards apply based on your organization’s scope and service population.

COA evaluates the facility based upon information collected during their evaluation. This evaluation includes:

• Intake and assessment process
• A self-evaluation that helps the facility review their current policies, procedures, and practices
• A site visit performed by a team of COA volunteer Peer Reviewers trained directly by COA
• A Ratings Report and Pre-Commission Review (PCR)

The PCR Report is reviewed by our Accreditation Commission, a group made up of our most experienced Peer Review volunteers, which will look at the evidence you provided (as well as your updated evidence) and either approve your accreditation or request more information. Once a decision is reached, we send your organization a Final Accreditation Report (FAR) with a complete set of ratings for all assigned standards.

Source: Council on Accreditation, https://coanet.org/accreditation-process/

Comparing Accrediting Bodies

For a comparison on different accrediting bodies discussed in this article, refer to this comparison chart provided by The Council on Accreditation.

How Accreditations Can Help You Choose A Rehab

An accredited rehab as taken the initiative, time, and money to undergo the rigorous accreditation process. In addition to the initial review, accredited rehabs continue to report their policies, practices, and outcomes to the respective accrediting body in regular set intervals. By doing so, they show the world they are dedicated to ethical, quality care in the addiction treatment industry. Less reputable treatment providers cannot pass the rigorous evaluations these accrediting bodies subject them to. Long story short, if you see that a treatment center is accredited, you can feel comfortable knowing they took the steps to attain the seal of approval. You should always choose a provider that prides themselves on providing the highest standard of care possible. Due to the nature of the accreditation review process, accredited treatment centers are considered safer than non-accredited treatment centers. Accreditation ensures the rehab facility is providing high-quality care that meets the standards of the accrediting body, therefore providing peace of mind.

Over half of addiction treatment programs are not accredited. You should always use caution before you or a loved one turns to a non-accredited rehab for treatment. When discussing treatment options at one of these centers, always ask about their accreditation status and ask why they are not accredited.

Does Accreditation Guarantee Success in Recovery?

There is no guarantee in addiction treatment. Each person responds differently to different treatments. Success in a rehab program depends on several factors. These factors include the person’s history of abuse, chronic diseases and health conditions, the presence of a co-occurring disorder, and past traumatic life experiences. All accreditation can do is ensure the client that they are receiving treatment from a provider than has been recognized for providing care according to the accredited body’s standards. The existence of the accreditation means that the rehab has in place a solid structure, staff, program, and therapy regime that has met the highest standards.

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