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Emphasizing best practices

February 1, 2007
by BOJANA STOPARIC
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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 8thEdition 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 8thEdition 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 8thEdition 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.

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