Having surpassed their 10th year in business, leaders at the Jaywalker Lodge men’s extended-care program in Colorado saw many externally driven reasons for pursuing accreditation for the first time, from highlighting the clinical rigor of their services to becoming more closely aligned with their referral sources. Now awaiting a final determination from The Joint Commission that should arrive this fall, the team at Jaywalker has come to realize that some of the richest benefits associated with accreditation involve building the teamwork and tools internally to help the organization get better.

The process has unfolded with no hint of a bureaucratic or adversarial mindset that Jaywalker’s founder had feared might characterize the accreditation process. “I felt like we were working with a consultant who was upping our game,” Bob Ferguson told ADAW. “It was us and The Joint Commission against the shortcomings — not us against The Joint Commission.”

The executive director of the Behavioral Health Care Accreditation program at The Joint Commission says that over the past two years, the accrediting organization has seen a significant increase in substance use treatment providers seeking accreditation for the first time. Tracy Collander told ADAW that when these providers are asked why, they cite factors such as responding to insurance payer mandates for accreditation and wanting to separate themselves from some of the questionable business activity going on in parts of the industry, particularly in Florida.

If a facility is active in, or seeking membership in, the National Association of Addiction Treatment Providers (NAATP), another motivating factor might involve the national association’s decision to highlight more prominently in its communications its accredited members.

“The public needs indicia of good service,” NAATP Executive Director Marvin Ventrell told ADAW. “Because no single thing by itself is a complete indicator, we need to have as many of these as possible.

“The consumer base in this industry has little capacity to assess what it needs,” Ventrell continued. “The public can be so easily misled,” he said. “Accreditation offers a more objective marker of quality for consumers and families.”

Cementing its reputation

As Jaywalker Lodge became a more mature organization, its leaders sensed that becoming accredited would help to counteract misconceptions about what the extended-care program entails. “There was a perception out there that all [our clients] do is ride mountain bikes and play softball,” Ferguson said. “We work with chronic relapsers, so we have to have a certain level of clinical rigor.”

With many of its referrals coming from other treatment centers, and virtually all of those facilities already accredited or pursuing accreditation, Jaywalker saw the value in becoming aligned with those organizations. It chose to pursue Joint Commission accreditation over its other options mainly because that was the route most of its referring facilities had taken, Ferguson said.

He added, “It is clear to me and many others in the field that payers are going to be looking more favorably on accredited organizations, if they aren’t already.”

Ventrell said that among NAATP members (43 percent of which are accredited at present), accreditation from CARF is actually slightly more prevalent than Joint Commission accreditation. Providers often have associated Joint Commission accreditation with hospital-based facilities, but the organization accredits centers with one or more services along the entire continuum of care.

One difference with Joint Commission accreditation, Collander explained, is that an applicant must subject its entire operation to review — it cannot seek accreditation for only one of its programs. Sober homes are part of the organization’s accrediting agenda, she added, but homes where no case management or other services are provided (such as a solely peer-run “Oxford House”–type model) do not fall under the scope of Joint Commission accreditation.

Ferguson said that while the process of getting ready for an on-site accreditation survey involved everyone on staff to some degree, it was important to identify one point person for the overall effort. In Jaywalker Lodge’s case, that role went to Nikki Soda, director of business development. Every other week, a 90-minute staff training session took place at the facility in preparation for the survey. “Owners love to see our staff all together, focusing on a common goal,” said Ferguson.

Jaywalker Lodge began the process last October, had its on-site Joint Commission survey over a three-day period earlier this month and by October should receive formal word regarding a three-year accreditation. Collander explained that organizations seeking Joint Commission accreditation are asked to be survey-ready within 12 months of initial application. The least expensive process for centers, on a scale that depends on the facility’s volume and intensity of services, is $8,800 for a three-year accrediting cycle, Collander said.

While the accrediting organization expects facilities to be in compliance with Joint Commission standards at the time of their survey, Collander said, “We do not require a track record of accreditation compliance prior to survey.”

One area on which The Joint Commission is placing additional emphasis for behavioral health organizations is a future requirement that the organizations assess individual outcomes through use of a standardized tool or instrument. The accrediting organization is seeking comments through Aug. 1 on an outcome measure standard that is scheduled to take effect next January.

Collander added that other compliance areas that can prove challenging for some behavioral health organizations include suicide risk assessment and person-centered treatment planning.

Not a ‘gotcha’ scenario

The Joint Commission’s core standards for behavioral health organizations cover a wide range of subjects, from treatment and continuing-care planning to staff training to organizational leadership to safety. Collander emphasized, however (and Ferguson confirmed that this was Jaywalker’s experience), that the accrediting organization has evolved considerably from a “gotcha” mentality in its process to an educational and consultative approach.

Ferguson said of the overall experience thus far, “I think it has made our culture stronger.” There also have been some concrete findings that are changing the organization’s everyday processes. In order for Jaywalker Lodge to receive accreditation, it will have to demonstrate for four months that it is routinely asking all clients questions about their experience of pain. Also, the organization is now formally tracking medication errors for the first time.

But Ferguson said one of the greatest benefits of the process has been more conceptual than quantitative. Accreditation has been “much more in alignment with the treatment center’s key messages and core values than I expected,” he said. “We tell our clients that for them to get better they need to work together and turn outside of themselves. That’s the same thing we did as an organization.”

NAATP’s Ventrell, who was involved in an accreditation renewal process during his tenure at Harmony Foundation, says the effort certainly demands a great deal from leadership and staff. “It has rigor, but it’s very achievable,” he said of the process. “I don’t think it’s only for the highly resourced center.”

Bottom Line…

A variety of outside pressures appear to be driving more substance use treatment facilities toward pursuing accreditation, with the process proving to generate a number of internal benefits to the centers as well.