TREATING TEENS

All exemplary adolescent drug treatment programs included in Treating Teens: A Guide to Adolescent Drug Programs have been licensed by their respective states to provide addiction services. However, requirements for such licensure vary from state to state, making it difficult to compare programs nationwide. At the same time, half of the 144 teen treatment programs described in Treating Teens have also been accredited by one or more of the three leading organizations that have established national standards for drug treatment programs: the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Rehabilitation Accreditation Commission (CARF), and the Council on Accreditation (COA).

The Joint Commission, founded in 1951, is a nonprofit organization dedicated to improving safety and quality of care in organized health care settings such as hospitals, ambulatory care organizations, assisted living communities, and laboratories. Each year, the Joint Commission accredits more than 16,000 health care organizations, including over 1,600 organizations engaged in behavioral health care, developmental disabilities, foster care or addiction services. Its members are the American College of Physicians, the American College of Surgeons, the American Dental Association, the American Hospital Association and the American Medical Association. The Joint Commission develops accreditation standards, awards accreditation decisions, and provides ongoing education and consultation to health care organizations. The Joint Commission's standards provide an objective evaluation process to help in measuring, assessing and improving performance. The standards are divided into individual-focused functions (for example, assessment, care, education, rights, responsibilities and ethics) and organizational functions (leadership, management of the environment of care, human resources and information systems, etc.).

Founded in 1966, CARF, a nonprofit organization, has the support of over 25 national organizations which approve the goals of its accreditation process. These include the American Academy of Physical Medicine and Rehabilitation, the American Psychiatric Association, Goodwill Industries International and the National Association of Alcoholism and Drug Abuse Counselors. Over the past 35 years, the CARF standards have evolved through the active participation of providers, consumers and purchasers of services and are viewed as "national consensus standards" rather than ones derived solely from research.

The CARF standards cover seven areas: organizational leadership and responsibility; organizational management; quality improvement; general program standards; behavioral health core program and specific populations (such as criminal justice or children and adolescents); employment and community core services; and network administration when two or more organizations establish formal agreements to deliver rehabilitation services. Each area is divided into subsections, each with its own standards. For example, organizational management is divided into five categories: information management; fiscal management; human resources; communication; and accessibility, health, safety and transportation.

Founded in 1977 by the Child Welfare League of America and Family Service America, the Council on Accreditation (COA) is an international, nonprofit accrediting organization for children, youth, and family services. COA sets standards covering organizational, management, and service practices. The organizational and management standards (governance, fiscal management, human resources management, quality improvement) are applicable for all agencies, regardless of type of services provided. In recognizing the unique aspects of service delivery systems, separate standards were created for public and private (nonprofit and for profit) agencies. The service standards cover specific protocols for 38 types of social and behavioral healthcare programs including substance abuse, opiod treatment, residential and day treatment. Development of the standards is conducted on a consensus basis by soliciting input from service providers, funders, policymakers and consumers based in the United States and Canada. Similarly, COA uses a peer review process to accredit organizations; CEOs, senior administrative staff, clinical staff, and recently retired staff from established COA accredited organizations, as well as faculty from schools of social work, comprise the over 900 volunteer peer network who conduct on-site visits to evaluate an organization's performance. In 2001, COA accredited or was in the process of accrediting more than 1,400 private and public organizations.

Accreditation from all three organizations is based on compliance with standards listed in their manuals. All list primarily the same standards but have grouped these standards into different categories. Organizations must have implemented these standards for several months prior to the accreditation survey, which will be verified by verbal and written information, on-site observations, documents provided by the organization to the accrediting body, and interviews with consumers and staff. This process is designed to help organizations identify and correct problems and improve the quality of care and services provided. In addition, the on-site survey provides an opportunity for consultation and education.

Accreditation from these three organizations can influence consumer decisions, facilitate third party payments, reduce exposure to legal action, increase community confidence and enhance an organization's prestige. Accreditation is increasingly used as a prerequisite to establish eligibility for insurance reimbursement from managed care plans.

The process of obtaining accreditation, however, requires significant expenditure of time (on average one year) and financial resources (separate fees may be charged for accreditation, peer review team site visit and maintenance of accreditation)-assets often scarce in many organizations, particularly small ones. Despite growing interest in providing accountability, many quality programs may not wish to go through the comprehensive accreditation process since their state licenses provide eligibility to receive state funds. Some programs believe they are very effective even without obtaining national accreditation. In any case, the demand for teen drug treatment programs far exceeds the supply thus reducing the financial need for national accreditation.