2016 Ecs SM

2016
July 1, 2016–June 30, 2017
Employment and Community Services
Standards Manual
© 2016 by the Commission on Accreditation of Rehabilitation Facilities
All rights reserved • Published 2016 • Printed in the United States of America
Any copying, republication, or redistribution of the content by any means is expressly prohibited.
Unauthorized use of any content may violate copyright laws, trademark laws, the laws of privacy and
publicity, and communications regulations and statutes. Data is provided for information purposes
only and is not intended for trading purposes.
CARF International
6951 East Southpoint Road
Tucson, Arizona 85756 USA
Toll free (888) 281-6531
Fax (520) 318-1129
CARF International is a group of private, nonprofit companies (including CARF, CARF Canada, and CARF Europe)
that accredit health and human services. For more information, please visit www.carf.org.
In 2016, CARF International marks its 50th anniversary—what an important
milestone! This year is a period for us to reflect and take stock of what we have
done and what needs to be done in the coming years.
Founded on September 27, 1966, we began with a mere 4 employees, a single office
in Chicago, Illinois, and 4 accredited providers in the United States. Since then,
we have experienced exceptional growth, evolving into one of the world’s leading
accrediting bodies for health and human services. Today, CARF International is
composed of 108 employees, about 1,400 surveyors, 5 offices, and almost 7,000
service providers with more than 50,000 accredited programs and services at
23,000 locations worldwide.
We remain committed to helping organizations ASPIRE to Excellence® in

the programs and services they provide to enhance the lives of persons served.
To commemorate and honor our 50th anniversary, we will showcase artwork
from some of the 8 million people served annually by CARF-accredited providers.
Please visit the website (www.carf.org) throughout the year for an ongoing
artwork display.
To all our customers, stakeholders, and friends—thank you for your continued
commitment to CARF accreditation. We look forward to the next 50 years and
making a lasting impact around the globe.
Sincerely,
Herb Zaretsky, Ph.D., Board Chair

Brian J. Boon, Ph.D., President/CEO
The CARF staff and surveyors
CONTENTS
Introduction................................................................................................ 1
Accreditation Policies and Procedures ........................................................ 5
Accreditation Conditions ......................................................................................................5
Accreditation Decisions.........................................................................................................6
Overview of the Steps to Accreditation .................................................................................8
CARF Events........................................................................................................................11
Steps to Accreditation .........................................................................................................11
Falsification of Documents ..................................................................................................18
Public Information ..............................................................................................................18
Subsequent Surveys ...........................................................................................................19
Extension of Accreditation Awards ......................................................................................20
Allegations, Suspensions, and Stipulations .........................................................................21
Disputed Decisions ............................................................................................................21
Changes in the 2016 Manual .................................................................... 25
Section 1. ASPIRE to Excellence® ............................................................... 29
Assess the Environment.......................................................................................... 31
A. Leadership..............................................................................................................31
B. Governance (Optional) ..........................................................................................40
Set Strategy ........................................................................................................... 49
C. Strategic Planning ..................................................................................................49
Persons Served and Other Stakeholders—Obtain Input........................................... 53
D. Input from Persons Served and Other Stakeholders ................................................53
Implement the Plan ............................................................................................... 57
E. Legal Requirements................................................................................................57
F. Financial Planning and Management......................................................................60
G. Risk Management...................................................................................................67
H. Health and Safety ...................................................................................................69
I. Human Resources...................................................................................................89
J. Technology ............................................................................................................96
K. Rights of Persons Served.......................................................................................100
L. Accessibility..........................................................................................................104
Review Results ..................................................................................................... 111
M.Performance Measurement and Management......................................................111
Effect Change ...................................................................................................... 121
N. Performance Improvement...................................................................................121
2016 Employment and Community Services Standards Manual i

Contents
Section 2. Quality Individualized Services and Supports .........................125

A. Program/Service Structure ...................................................................................132
B. Individual-Centered Service Planning, Design, and Delivery .................................141
C. Medication Monitoring and Management............................................................148
D. Employment Services Principle Standards ............................................................152
E. Standards for Workforce Development Services ...................................................159
F. Community Services Principle Standards..............................................................163
G. Children and Adolescents Specific Population Designation ..................................166
H. Older Adults and Older Adults/Dementia Care Specific
Population Designations ......................................................................................172
I. Medically Fragile Specific Population Designation ................................................180
J. Autism Spectrum Disorder Specific Population Designation (ASD) .......................189
Principle Standards ......................................................................................................................... 190
Children/Adolescents with Autism Spectrum Disorder (ASD:C) ...................................................... 194
Adults with Autism Spectrum Disorder (ASD:A) .............................................................................. 197
Section 3. Employment and Community Services....................................203

A. Employment Planning Services (EPS)....................................................................204
B. Evaluation Services ...............................................................................................207
Comprehensive Vocational Evaluation Services (CVE) ..................................................................... 207
Targeted Employment Screening Services (TES).............................................................................. 213
C. Community Employment Services .......................................................................215
Job Development (CES:JD) .............................................................................................................. 216
Employment Supports (CES:ES)....................................................................................................... 222
D. Self-Employment Services (SES)............................................................................227
E. Employee Development Services (EDS) ................................................................230
F. Employment Skills Training Services (EST)............................................................233
G. Organizational Employment Services (OES) .........................................................236
H. Affirmative Business Enterprise (ABE) ....................................................................240
I. Child and Youth Services (CYS) ............................................................................246
J. Family-Based/Shared Living Supports...................................................................252
Family Services (FS) ......................................................................................................................... 252
Foster Family Services (FFS) ............................................................................................................. 253
Host Family/Shared Living Services (HF/SLS)................................................................................... 258
K. Community Housing (CH)....................................................................................262
L. Supported Living (SL)...........................................................................................267
M.Respite Services (RS).............................................................................................271
N. Services Coordination (SC)...................................................................................273
O. Transition Services (TS) ........................................................................................277
P. Community Integration (COI) ..............................................................................279
Q. Assistive Technology Supports and Services (AT)..................................................283
R. Behavioral Consultation Services (BCS) ................................................................289
S. Comprehensive Benefits Planning (CBP)...............................................................294
T. Mentor Services (MS) ...........................................................................................298
ii 2016 Employment and Community Services Standards Manual

Contents
U. Personal Supports Services (PSS) ..........................................................................301

Short-Term Immigration Support Services (ISS)...............................................................................304
V. Self-Directed Community Supports and Services (SDCSS) ....................................306
Flexible Supports Planning (FSP) .....................................................................................................308
Employer of Record for Support Services (EOR) ...............................................................................314
W.Supported Education Services (SE) .......................................................................319
X. Centers for Independent Living (CIL)....................................................................322
Y. Home and Community Services (HCS) .................................................................327
Z. Rapid Rehousing and Homelessness Prevention Program (RRHP)..........................337
Section 4. Psychosocial Rehabilitation Programs ....................................345
A. Program/Service Structure....................................................................................345
B. Medication Use ....................................................................................................357
C. Nonviolent Practices.............................................................................................364
D. Records of the Persons Served ..............................................................................371
E. Case Management/Services Coordination (CM) ...................................................374
F. Community Integration (COI) ..............................................................................376
G. Community Housing (CH)....................................................................................379
H. Supported Living (SL)...........................................................................................383
I. Assessment and Referral (AR)................................................................................385
J. Diversion/Intervention (DVN) ...............................................................................387
K. Prevention (P) ......................................................................................................390
L. Children and Adolescents (CA) .............................................................................393
Appendix A. Required Written Documentation.......................................397
Appendix B. Operational Time Lines .......................................................411
Appendix C. Required Training ...............................................................417
Glossary ..................................................................................................429
Index.......................................................................................................445
2016 Employment and Community Services Standards Manual iii

INTRODUCTION
CARF International is a private, nonprofit

organization that is financed by fees from
Moral Ownership
accreditation surveys, workshops, and confer- The CARF Board of Directors has identified
ences; sales of publications; and grants from that the persons served, as defined below,
public entities. shall be the moral owners of CARF.
The CARF International group of companies Persons served are the primary consumers
includes: of services. When these persons are unable
■ CARF to exercise self-representation at any point in
■ CARF Canada
the decision-making process, persons served
is interpreted to also refer to those persons
■ CARF Europe
willing, able, and legally authorized to make
Since its inception in 1966, CARF has benefited decisions on behalf of the primary consumer.
from organizations joining together in support
of the goals of accreditation. These organizations,
representing a broad range of expertise, sponsor Values
CARF by providing input on standards and other
CARF believes in the following core values:
related matters through membership in CARF’s
■ All people have the right to be treated
International Advisory Council (IAC). A list of
current IAC members is available on the CARF with dignity and respect.
website, www.carf.org/members. ■ All people should have access to needed
services that achieve optimal outcomes.
■ All people should be empowered to
Mission exercise informed choice.
The mission of CARF is to promote the quality, CARF’s accreditation, research, continuous
value, and optimal outcomes of services through improvement services, and educational activities
a consultative accreditation process and con- are conducted in accordance with these core
tinuous improvement services that center on values and with the utmost integrity.
enhancing the lives of the persons served. In addition, CARF is committed to:
■ The continuous improvement of both
Vision organizational management and service
delivery.
Through responsiveness to a dynamic and
■ Diversity and cultural competence in
diverse environment, CARF serves as a catalyst
all CARF activities and associations.
for improving the quality of life of the persons
■ Enhancing the involvement of persons served
served.
in all of CARF’s activities.
■ Persons served being active participants in
the development and application of standards
of accreditation.
■ Enhancing the meaning, value, and relevance
of accreditation to persons served.
2016 Employment and Community Services Standards Manual 1

Introduction
Purposes Development of the

In support of our mission, vision, and values, Standards
CARF’s purposes are:
The CARF standards have evolved and been
■ To develop and maintain current, field-
refined over 50 years with the active support
driven standards that improve the value
and involvement of providers, consumers, and
and responsiveness of the programs and
purchasers of services. The standards are main-
services delivered to people in need of
tained as international consensus standards. The
life enhancement services.
standards define the expected input, processes,
■ To recognize organizations that achieve and outcomes of programs for persons served.
accreditation through a consultative peer- CARF recognizes and accepts its responsibility
review process and demonstrate their com- to assess and review the continuing applicability
mitment to the continuous improvement of and relevance of its standards. CARF convenes
their programs and services with a focus on its International Advisory Council; advisory
the needs and outcomes of the persons served. committees; and regional, national, and inter-
■ To conduct accreditation research emphasiz- national focus groups to systematically review
ing outcomes measurement and management and revise CARF’s standards and develop
and to provide information on common standards for new accreditation opportunities.
program strengths as well as areas needing Composed of individuals with acknowledged
improvement. expertise and experience, these committees
■ To provide consultation, education, training, and groups, including persons served, make
and publications that support organizations recommendations to CARF concerning the
in achieving and maintaining accreditation adequacy and appropriateness of the standards.
of their programs and services. This work is viewed as a starting point in the
■ To provide information and education to process of standards development and revision.
persons served and other stakeholders on the Recommendations from this input are used to
value of accreditation. develop proposed new and revised standards,
which are then made available for review by the
■ To seek input and to be responsive to persons
public, persons served, organizations, surveyors,
served and other stakeholders.
national professional groups, advocacy groups,
■ To provide continuous improvement services
third-party purchasers, and other stakeholders.
to improve the outcomes for organizations This input from the field is carefully scrutinized
and the persons served and their community by CARF and results in changes to the standards.
of influence.
2 2016 Employment and Community Services Standards Manual

Introduction
Applying the Standards Blended Surveys

The organization is expected to demonstrate Some organizations may want to become
conformance to the applicable standards accredited for programs or services included
during the site survey so that the survey team in different standards manuals. This is possible
can determine the organization’s overall level using what CARF terms a “blended” survey.
of conformance and, ultimately, allow CARF Blending allows an organization to seek accredi-
to determine the accreditation decision. On tation through one survey for programs or
subsequent surveys, the organization is expected services with applicable standards in more than
to demonstrate continuous conformance from one manual. For example, services found in the
any previous period of CARF accreditation. Employment and Community Services Standards
Manual can be blended into a survey using the
Some sections of the standards, such as the
Medical Rehabilitation Standards Manual. The
ASPIRE to Excellence® section which relates to
primary manual (i.e., the one into which other
the overall business practices of the organization,
standards are blended) is determined by the
are applicable regardless of the programs or
predominant focus of the programs or services
services for which the organization is seeking
for which the organization is seeking accredita-
accreditation. The standards in other sections
tion. Factors that CARF considers when blending
are applicable in accordance with instructions
programs include the integrity of the programs
in those sections.
and services and whether to incorporate stan-
Some standards have intent statements that dards from a related program or service section,
help to explain, clarify, and provide additional such as the rehabilitation process or quality
information about the standard. When there is services for the persons served.
an intent statement, it immediately follows the
For more information please contact CARF, as
standard to which it relates.
specific guidelines are used for blended surveys.
Some intent statements are followed by examples It is important to make this contact early in the
that illustrate potential ways an organization may accreditation preparation process.
demonstrate conformance to the standard.
Some standards may suggest resources that an
organization may find helpful in implementing
or conforming to the standard(s). Resources
may include references to websites, organiza-
tions, or publications that provide information
or assistance relevant to topics or areas included
in the standard.
NOTE: Before initiating the self-evaluation process
or applying for a survey, an organization should
contact CARF to discuss the programs and services
it intends to include in the accreditation process.
This step helps determine which standards will be
applicable. If an organization provides a program
or service that is not listed in this manual, the
organization should also contact CARF for more
information.

Introduction
CARF Publications
CARF offers publications and products through the online store at www.carf.org/catalog. Publications
are available in alternative formats to accommodate persons with disabilities. Please contact CARF’s
Publications department at (888) 281-6531 for assistance.
Organizations are encouraged to call CARF toll free with any questions regarding which manual to use,
which standards apply, interpretation of the standards, and clarification of the survey process. It is impor-
tant to access CARF resources throughout the preparation process. Following is a list of CARF’s customer
service units (CSUs) and the publications related to each.
Customer Service Unit Standards Manuals and Related Publications
Aging Services ■ Aging Services Standards Manual

■ Aging Services Survey Preparation Workbook*
■ Continuing Care Retirement Community Standards Manual
■ Continuing Care Retirement Community Survey Preparation Workbook*
■ Standards Manual Supplement for Networks**
Behavioral Health ■ Behavioral Health Standards Manual

■ Behavioral Health Survey Preparation Workbook*
■ Opioid Treatment Program Standards Manual
■ Opioid Treatment Program Survey Preparation Workbook*
Child and Youth Services ■ Child and Youth Services Standards Manual
■ Child and Youth Services Survey Preparation Workbook*
Employment and ■ Employment and Community Services Standards Manual

Community Services ■ Employment and Community Services Survey Preparation Workbook*
■ One-Stop Career Center Standards Manual with Survey Preparation Questions
■ Standards Manual Supplement Employment Service Centres in Canada**
Medical Rehabilitation ■ Medical Rehabilitation Standards Manual

■ Medical Rehabilitation Survey Preparation Workbook*
Vision Rehabilitation ■ Vision Rehabilitation Services Standards Manual with Survey Preparation
Services Questions
*CARF recommends using the companion survey preparation workbook for your standards manual.
The workbook assists in conducting a self-evaluation in preparation for the accreditation survey.
**Supplements for the standards manuals are available for download at:
www.carf.org/Accreditation/QualityStandards/OnlineStandards.
NOTE: Standards manuals become effective on July 1, 2016, to allow organizations sufficient time to incorporate
changes into their operations.

ACCREDITATION
POLICIES AND PROCEDURES
The accreditation policies and procedures relate the survey application, the organization expressly
to the site survey, accreditation process, and con- waives and releases CARF from any and all
tinuation of accreditation. Because all aspects of claims, demands, actions, lawsuits, and damages
the accreditation process are reviewed regularly that may arise from or relate to, directly or indi-
for appropriateness, these policies and proce- rectly, the survey, accreditation decision, and
dures may be changed between standards manual continuation or termination of accreditation.
publication dates. Notification of changes, addi-
tional information, and clarification can be
obtained from the CARF website, www.carf.org, Accreditation Conditions
or by contacting CARF. Organizations that are The following Accreditation Conditions must
currently accredited or have begun the process be satisfied in order for an organization to
of becoming accredited and have obtained achieve or maintain accreditation by CARF:
Customer Connect access can obtain current
accreditation policies and procedures at the 1. For a minimum of six months prior to
Customer Connect website the site survey, each program/service
(customerconnect.carf.org). for which the organization is seeking
NOTE: Customer Connect is CARF’s secure, dedicated accreditation must demonstrate:
website for accredited organizations and organiza- 1.
a. The use and implementation of

tions seeking accreditation. To increase efficiency CARF’s organizational and service
and support CARF’s commitment to the environ- standards applicable to the program/
ment, Customer Connect has been implemented
service.
as the primary means of transmitting certain 1.a.
documents such as the survey fee invoice and b. The direct provision of services
quality improvement plan. Rather than sending to the persons served.
1.b.
these documents through the mail, they are posted Intent Statements
to Customer Connect and an email is sent to the This time frame is required to ensure that the
individual identified as the organization’s Survey CARF survey process is not merely a paper review,
Key Contact. Organizations should use Customer but that the service seeking accreditation is
Connect regularly to view accreditation- and actually having an impact on the persons served.
survey-related documents and to keep CARF In addition, this time frame allows for the collec-
informed of any changes in the name or email tion of sufficient historical data, information,
address of the key contact person. and documentation to assess the organization’s
The submission of a survey application consti- conformance to the standards.
tutes the organization’s agreement to adhere to It is also expected that services will have been pro-
the CARF policies and procedures that are in vided for at least six months prior to the site survey.
effect on the date on which the survey application This condition applies to organizations that have
is submitted to CARF and to all subsequent newly initiated services and to those that have
changes as they become effective. The review and ongoing services that are provided sporadically.
appeal process set forth in these policies and pro- Therefore, in the six months prior to the survey,
cedures, as amended from time to time, shall be the organization should have served at least one
the organization’s sole remedy with respect to the person in each service seeking accreditation.
survey, accreditation decision, and continuation In a network, direct services are provided by its
or termination of accreditation. By submitting participants.

Accreditation Policies and Procedures
2. The organization must provide such Intent Statements

records, reports, and other information In order to maintain accreditation, organizations
as requested by CARF. are expected to operate in conformance to CARF’s
2.
standards and comply with CARF’s policies and

Intent Statements
procedures on an ongoing basis. They must incor-
It is the responsibility of the organization to pro- porate changes to the standards, accreditation
vide evidence to the survey team to demonstrate conditions, and policies and procedures as they
conformance to the standards. are published and made effective by CARF.
This condition also applies to information CARF will provide the organization with the for-
requested by CARF prior to, during, and after mat for this report, which must be completed and
the site survey. The intent of this condition is for returned.
CARF to have access to all information deemed
NOTE: If any of these conditions are not met, CARF
necessary to assess conformance to the stan-
will determine the appropriate course of action,
dards. Access to stakeholders, including persons
which may include denial or withdrawal of an
served, is also covered by this condition, as is
accreditation award.
access to all documents, including but not limited
to files of persons served (active and closed),
human resource files, strategic plans and reports, Accreditation Decisions
and financial statements. In certain circum-
stances, unavailability of key organizational To be accredited by CARF, an organization
staff necessary to demonstrate conformance must satisfy each of the CARF Accreditation
to standards at the on-site survey may be Conditions and demonstrate through a site
grounds for Nonaccreditation. survey that it meets the standards established
by CARF. While an organization may not be in
3. A Quality Improvement Plan (QIP) must full conformance to every applicable standard,
be submitted within 90 days following the accreditation decision will be based on the
notice of accreditation. This plan shall balance of its strengths with those areas in
address all areas for improvement which it needs improvement.
identified in the report.
3. CARF uses the following guidelines to determine
Intent Statements each accreditation decision:
CARF will provide the organization with the
format to use for this plan with its notification Three-Year Accreditation
of the accreditation decision. The organization satisfies each of the CARF
If consultation in completing the QIP is needed, Accreditation Conditions and demonstrates
the organization is encouraged to contact CARF. substantial conformance to the standards.
If an organization requests a review of a Non- It is designed and operated to benefit the persons
accreditation decision and the outcome of that served. Its current method of operation appears
review is a One-Year, Provisional, or Three-Year likely to be maintained and/or improved in
Accreditation decision, the QIP must be submit- the foreseeable future. The organization dem-
ted to CARF within 45 days of notice of the onstrates ongoing quality improvement and
outcome of that review or appeal. continuous conformance from any previous
period of CARF accreditation.
4. An organization that achieves a
Three-Year Accreditation must submit a One-Year Accreditation
signed Annual Conformance to Quality
Report (ACQR). The report is submitted in The organization satisfies each of the CARF
each of the two years following the Accreditation Conditions and demonstrates
Three-Year Accreditation award. conformance to many of the standards. Although
4.
there are significant areas of deficiency in rela-
tion to the standards, there is evidence of the

organization’s capability to correct the deficien- Accreditation, or Nonaccreditation decision

cies and commitment to progress toward their is issued. If this follow-up survey has not been
correction. On balance, the services benefit those applied for and scheduled within six months of
served, and the organization appears to protect the first survey, this Preliminary Accreditation
their health, welfare, and safety. will expire.
An organization may be functioning between NOTE: Some of the accreditation policies and
the level of a Three-Year Accreditation and that procedures are supplemented, revised, or not
of a One-Year Accreditation. In this instance, applicable for organizations seeking Preliminary
accreditation will be awarded for one year. Accreditation. Please contact CARF for details.
An organization will not be awarded a second
consecutive One-Year Accreditation.
Provisional Accreditation
Following the expiration of a One-Year Accredi-
tation, 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
an accreditation decision of Nonaccreditation.
Nonaccreditation
The organization has major deficiencies in
several areas of the standards; there are serious
questions as to the benefits of services or 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
Prior to the direct provision of services to
persons served, the organization demonstrates
substantial conformance to applicable standards.
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
Preliminary Accreditation is awarded to allow
new organizations to establish demonstrated
use and implementation of standards.
A full follow-up survey is conducted approxi-
mately six months following the initiation
of services to persons served, at which time
a Three-Year Accreditation, One-Year

Overview of the Steps to Accreditation

The table below provides an overview of the steps to accreditation. These steps are explained in more
detail in the sections following the table.
STEP 1
Consult with a An organization contacts CARF, and a resource specialist is designated

designated CARF to provide guidance and technical assistance.
resource specialist. ■ For an organization preparing for its first survey, it is important to make
this contact early in the process. The resource specialist is available to
answer questions in preparation for a survey and throughout the tenure
of the accreditation.
■ For an organization preparing for a resurvey, the designated resource
specialist may already be known. It is suggested that contact still be
made early in the reaccreditation process to verify relevant organiza-
tional or program information.
■ The resource specialist provides the organization access to Customer
Connect (customerconnect.carf.org), CARF’s secure website for trans-
mitting documents and maintaining ongoing communication with
accredited organizations and organizations seeking accreditation.
■ The organization orders the standards manual in which its programs
and services best fit. Visit www.carf.org/catalog.
■ The CARF Accreditation Sourcebook, which explains the accreditation
process, and other publications are also available to assist the organiza-
tion in the preparation process.
■ The organization maintains ongoing contact with CARF for assistance.
STEP 2
Conduct a The organization conducts a self-study and evaluation of its conformance

self-evaluation. to the standards using the standards manual and its companion publica-
tion, the survey preparation workbook.
The self-evaluation is part of the organization’s internal preparation process
and is not submitted to CARF.

STEP 3
Submit the survey The organization submits the survey application via Customer Connect,
application. customerconnect.carf.org.
■ The survey application requests detailed information about leadership,
programs, and services that the organization is seeking to accredit and
the service delivery location(s).
■ The organization submits the completed survey application, required
supporting documents, and a nonrefundable application fee at least
three full calendar months before the two-month time frame in which it
is requesting a survey. Organizations undergoing resurvey submit their
survey application on the date that corresponds with their accreditation
expiration month (see page 12).
■ The submission of the completed survey application indicates the
organization’s desire for the survey and its agreement to all terms
and conditions contained therein.
■ If any information in the survey application changes after submission,
the organization should notify CARF immediately.
STEP 4
CARF invoices for the After reviewing all information in the survey application, CARF invoices
survey fee. the organization for the survey fee. The survey fee invoice is posted to the
Customer Connect website and an email notification is sent to the organi-
zation’s key contact person. Scheduling of the survey begins immediately
upon invoicing. Any changes in problem dates must be communicated in
writing to CARF by this time. The fee is based on the number of surveyors
and days needed to complete the survey.
STEP 5
CARF selects the survey CARF selects a survey team with the appropriate expertise.
team. ■ Surveyors are selected by matching their program or administrative
expertise and relevant field experience with the organization’s unique
requirements.
■ CARF notifies the organization of the names of team members and
the dates of the survey at least 30 days before the survey.
STEP 6
The survey team The survey team determines the organization’s conformance to all applica-
conducts the survey. ble standards on site through the observation of services, interviews with
persons served and other stakeholders, and review of documentation.
■ Surveyors also provide consultation to organization personnel.
■ The organization is informed of the survey team’s findings related

to the standards at an exit conference before the team leaves the site.
The survey team submits its findings to CARF, but the team does
not determine the accreditation decision.

STEP 7
CARF renders the CARF reviews the survey findings and renders one of the following
accreditation decision. accreditation decisions:
■ Three-Year Accreditation
■ One-Year Accreditation
■ Provisional Accreditation
■ Nonaccreditation
Approximately six to eight weeks after the survey, the organization
is notified of the accreditation decision and receives a written report.
The organization is also awarded a certificate of accreditation that lists
the programs and services included in the accreditation award.
STEP 8
Submit a Quality Within 90 days after notification of an accreditation award, the organiza-
Improvement Plan. tion fulfills an accreditation condition by submitting to CARF a Quality
Improvement Plan (QIP) outlining the actions that have been or will be
taken in response to the areas identified in the report.
STEP 9
Submit the Annual An organization that achieves a Three-Year Accreditation award submits a
Conformance to Quality signed Annual Conformance to Quality Report (ACQR) to CARF on the
Reports. accreditation anniversary date in each of the two years following the award.
This is a condition of accreditation.
■ CARF sends the organization the form for this report approximately
ten weeks before it is due.
■ The ACQR reaffirms the organization’s ongoing conformance to the
CARF standards.
STEP 10
CARF maintains contact CARF maintains contact with the organization during the tenure of
with the organization. accreditation. Organizations should also contact CARF as needed to
help maintain conformance to the standards and keep CARF informed
of administrative or other items.
■ CARF offers publications to help organizations provide quality
programs and services.
■ CARF’s public website, www.carf.org, and its secure customer website,
Customer Connect (customerconnect.carf.org), provide news,
information, and resources.
■ CARF seminars and conferences are excellent ways to receive
updates and other information about the accreditation process
and the standards.

CARF Events manual and its companion publication, the sur-

vey preparation workbook. Depending on the
CARF sponsors a series of educational and train- level at which the organization initially assesses
ing sessions to assist organizations to prepare its conformance, a number of successive assess-
for CARF accreditation, help them remain ments may be appropriate. The organization’s
current with changes in the standards, present designated resource specialist is available to
new standards, and discuss field practices. CARF provide free technical assistance during the
also offers web-based educational events. To self-evaluation process.
obtain the dates and locations of all events, visit The self-evaluation is part of the organization’s
www.carf.org/events or contact the Education internal preparation process, and there is no
and Training Department at (888) 281-6531, requirement for it to be submitted to CARF
ext. 7114. or shared with the surveyors. However, some
organizations find it useful to share the
self-evaluation with the survey team during
Steps to Accreditation the on-site survey.
Step 1. Consult with a designated CARF Step 3. Submit the survey application
Resource Specialist
The survey application is completed and
The first step in the accreditation process is to submitted online via Customer Connect. After
contact CARF. When an organization contacts preparing under the appropriate standards
CARF, a dedicated resource specialist is assigned manual, an organization seeking accreditation
to provide guidance and technical assistance for the first time requests access to the survey
regarding the appropriate standards manual, application for completion and submission to
programs to be accredited, interpretation and CARF. Resurvey organizations are notified of
application of standards, and accreditation pro- the survey application automatically.
cess. The resource specialist is available to answer The survey application is submitted with the
questions both in preparation for a survey and nonrefundable application fee when the organi-
throughout the entire term of accreditation. zation is ready for survey dates to be established
After initial contact with a resource specialist, in accordance with the accompanying chart. It
the organization orders the standards manual generally takes two to three months for a survey
in which its programs and services best fit. to be scheduled after the survey application has
The CARF Accreditation Sourcebook, which been received.
explains the accreditation process in detail,
and other publications are also available to
assist the organization in the preparation
process. The manual and other publications
can be ordered at www.carf.org/catalog.
Step 2. Conduct a self-evaluation

To earn accreditation, an organization must
meet Accreditation Conditions 1 and 2 and
demonstrate that it meets the applicable CARF
standards. The starting point is an assessment by
the organization of its current practices against
the applicable standards set forth in the appropri-
ate standards manual. The organization conducts
a self-study and evaluation of its conformance
to the standards using the appropriate standards

Survey Time Frame At a Glance Selection of Programs and Services to be

Surveyed
An organization seeking accreditation for the
first time uses the due date corresponding to In the survey application, the organization identi-
its preferred time frame. fies the programs and services it desires to have
Resurvey organizations use the due date corre- surveyed by CARF and the site(s) where they
sponding to expiration month, not preferred time are provided, including administrative locations.
frame. This lead time is needed for timely sched- The number and expertise of surveyors and the
uling and rendering of a new decision before length of survey required are based on infor-
expiration of the current accreditation. mation in the survey application and will be
determined at CARF’s sole discretion. Additional
Preferred Survey Expiration information, such as the organization’s budget,
Time Frame application Month* brochures, and other materials, must be sent to
due to CARF CARF when the survey application is submitted.
no later than
An organization has the right and responsibility
Jul/Aug* Feb 28 Aug to choose the programs or services to be accred-
ited. However, all locations that offer any of the
Jul/Aug* Feb 28 Sept
programs or services must be included in the
Aug/Sept Apr 30 Oct accreditation. CARF will not accredit a program
or service if only a portion of it is submitted for
Sept/Oct May 31 Nov
accreditation.
Oct/Nov Jun 30 Dec CARF does not consider the funding or referral
entities as differentiating a program so as to
Nov/Dec Jul 31 Jan
exclude portions of it from being included in the
Dec/Jan Aug 31 Feb accreditation. If the organization needs assistance
in interpreting or applying this policy, it should
Jan/Feb Sep 30 Mar
contact CARF.
Feb/Mar Oct 31 Apr CARF may change the size and/or scope of
Mar/Apr Nov 30 May any accreditation survey or decision as it deems
appropriate.
Apr/May Dec 31 Jun
Organizations with Multiple Programs and
May/Jun
Services
*CARF does not award July expirations since the
If one survey includes multiple programs and
standards manuals become effective on July 1
services or sites for accreditation, and any one
of each year.
program or service or site is operating at a lower
NOTE: Actual survey time frames are assigned level of conformance to the standards than the
by CARF based upon surveyor availability.
others, the level of accreditation awarded for
Please note that a survey application received that survey will be the level at which the weakest
after the due date is at risk for a delay in survey program, service, or site is functioning.
time frame. Organizations are encouraged to An organization may submit more than one
submit their survey application at least ten survey application if it wishes to have separate
business days before the indicated due date. surveys for different programs or sites that it
Submission of the completed survey application operates. In separate surveys, each accreditation
confirms the organization’s agreement to all decision is independent and based solely on the
terms and conditions contained therein. If any individual survey and the level of conformance
information in the survey application changes demonstrated by the organization and the pro-
after submission, CARF should be notified in grams and services that are part of that survey.
writing immediately. In this case, different decisions may be awarded
as appropriate.

Step 4. CARF invoices for the survey fee The organization may request a change of
After reviewing the survey application and other any surveyor assigned to conduct the survey
materials to determine the number of surveyors in the event of a bona fide conflict of interest.
and days needed to conduct the survey, CARF CARF must receive the request for a surveyor
invoices the organization for the survey fee. change in writing within 14 calendar days of
the date on which CARF transmits notification
CARF’s survey fee applies to any type of site
of surveyor assignment. A change in surveyor
survey conducted by CARF—an initial survey,
assignment is made when just cause, as
resurvey, or special visit (e.g., a supplemental
determined by CARF, has been presented.
survey or a One-Year, Provisional, or Nonaccred-
itation review). Any part of a day that a surveyor Subject to surveyor availability, the organization
spends at any site of the organization, including may be required to provide language interpreters
the last day, is billed as a whole day. at its expense to assist the surveyors; please
contact CARF for details.
The survey fee must be paid in full within
30 calendar days of the invoice date. Any public Scheduling the Survey Dates
agency for which advance payment of the survey
fee is not legally permissible must submit, before Survey dates are established by CARF based on
the survey, a binding purchase order for the full the survey application and in consultation with
amount of the survey fee. surveyors. A time frame of no fewer than four
weeks within a specific period of two consecutive
CARF reserves the right to cancel any scheduled months is required for scheduling. CARF must
survey if the fee is not paid sufficiently in be advised at the time of submission of the survey
advance of the survey. application if there are days during the desig-
Once the surveyors are in transit to a survey site, nated time frame that will pose problems for
the survey fee is not refundable in whole or in the organization. Examples of such days may
part. Thus, if a survey is terminated on site or include community events, religious holidays,
is shortened for any reason, no portion of the and vacation plans. A survey is scheduled during
survey fee will be refunded. the organization’s workweek and hours of opera-
Please contact CARF for current fees. tion. The use of Saturdays and Sundays as survey
days is limited to organizations that provide ser-
Outstanding Debt vices on those days and only with prior approval
All survey and other fees referenced in this man- from the organization.
ual shall be paid when due. CARF will not accept
Cancellation and Rescheduling
a survey application from any organization that
has an outstanding past due debt to CARF until The organization is notified of the specific survey
that debt has been paid. CARF also reserves the dates at least 30 calendar days prior to the survey.
right to withhold an accreditation decision or An organization is considered scheduled for a site
issue a Nonaccreditation if an outstanding debt visit on the date the notification is sent. The dates
remains. CARF may modify an organization’s established by CARF are final. A cancellation/
existing accreditation, up to and including termi- rescheduling fee, plus all related nonrefundable
nation of accreditation, in the event any fees are travel cancellation expenses, will be assessed if
not paid in a timely manner. an organization requests any change affecting
the scheduled dates or configuration of its survey,
Step 5. CARF selects the survey team whether cancellation, postponement, or other
date change, or if the survey is cancelled by
Surveyors are assigned to surveys based on
CARF due to survey fees not paid sufficiently
a number of factors, the most important of
in advance of the survey.
which is the surveyors’ knowledge of the types
of services being surveyed. Other considerations It should be noted that CARF does not wait for
include the availability of surveyors, language, receipt of the survey fee to schedule the survey.
and the need to avoid conflicts of interest. Therefore, to avoid a cancellation/rescheduling

fee, the organization must notify CARF in organization may have regarding the survey pro-
writing of any changes in available survey dates cess or interpretation of the standards. Inquiries
prior to CARF’s notice of established dates. about the standards or survey process can be
When CARF is unable to schedule a survey in the made as frequently as needed by an organization
designated time frame, the organization’s current seeking accreditation, and there is no charge for
accreditation will not lapse but will be extended this support.
until notification of the next survey decision. The survey poster
Step 6. The survey team conducts the survey At least 30 days prior to the survey, the organi-
zation must display a poster announcing the
Involvement of the Persons Served pending survey and the survey dates. This poster
CARF considers the involvement of the persons can be downloaded in various languages from
served vital to the survey process. As such, per- the Resources section of Customer Connect
sons served are involved in a variety of ways prior (customerconnect.carf.org) in an editable for-
to, during, and after the survey. mat so that organizations may make adjustments
(such as font, color, and size) to ensure the poster
Before the survey, persons served are notified
is accessible for all persons served. This poster
of the pending survey and may submit comments must remain conspicuously posted at all loca-
about the organization’s performance and their
tions until the survey concludes. Information
satisfaction with services. During the survey, the
on the poster includes a description of CARF
organization identifies persons served for inter-
as a review organization and instructions for
view by the survey team; however, the surveyors interested persons to contact CARF to submit
may also select additional persons served in each
comments about the organization’s performance
program or service area for interviews.
and their satisfaction with services. These com-
Some of the persons interviewed may be those ments can be submitted through a toll-free phone
who contacted CARF prior to the survey. The number or via email, fax, or letter. Information
surveyors may conduct some of the interviews received by CARF may be sent to the surveyors.
in a focus group forum or via telephone. After The survey team may interview persons who
the survey, the persons served are encouraged have submitted comments or contacted CARF
to continue to provide CARF with feedback prior to the survey when on site. All interviews
about the services provided at any organization are confidential.
with accredited programs.
Pre-survey contact
A person served is the preferred person to be
interviewed. A family member, guardian, or sig- Approximately three weeks before the visit,
nificant other may, as appropriate, be interviewed the survey team coordinator will contact the
instead of or in addition to a person served dur- organization to discuss logistics and answer
ing the survey process. Community members, questions the organization may have regarding
employers, and others may also be interviewed. scheduling interviews and other items. The sur-
All interviews are confidential. vey team may request that additional information
that is not confidential be made available at the
Before the Survey hotel the night before the survey or otherwise
Preparation in advance. While provision of such information
in advance of the survey is at the discretion of
In conjunction with the appropriate standards the organization, it can help facilitate an efficient
manual, the organization should use CARF’s and consultative on-site survey.
other publications to adequately prepare for
the site survey. Many of these publications have Assemble or arrange access to records
been written to help an organization prepare Records needed to substantiate conformance
for a survey. CARF may be contacted by tele- to the CARF standards should be assembled
phone or email to answer questions that the in one room of the organization to be available

for surveyor use throughout the survey, or should be prepared to provide the team with a
arrangements should be made for surveyor access brief overview of its operations, including the
to electronic records. Many of these items are population served, the services provided,
listed as documentation examples in the survey the programmatic objectives of the organization,
preparation workbook. and other important areas.
NOTE: During an original survey the organization
After the orientation conference
is expected to demonstrate, for standards that
specify an activity be conducted on or within The survey team is given a brief tour of the physi-
a specific time period (e.g., quarterly, at least cal facilities. Some team members may proceed
annually), that the activity has occurred at least directly to community sites that are a part of the
once within such period prior to the survey; survey rather than participate in the tour.
during a resurvey the organization is expected
to demonstrate conformance to all applicable Mid-morning
standards throughout the entire period since its The survey team meets to coordinate efforts and
last survey. to identify the personnel whom the team will
Third-party representatives interview during the site survey. The organiza-
tion is asked to schedule interviews with these
Each organization is required to have at least individuals based on their availability. Every
one representative of a major purchaser or user effort is made to minimize disruption to ongoing
of its services available, either in person or by operations. If the organization has any question
phone, to be interviewed by the survey team. about the scheduling of interviews, these should
CARF also routinely requests information prior be addressed with the survey team coordinator.
to the survey about an organization from the
governmental oversight agency and funding or Late Morning to Late Afternoon
referral sources. Although the organization gen- With a short lunch break, the team spends the
erally chooses the individuals to be interviewed rest of the day observing the programs and
during the survey, the survey team may select services being surveyed; interviewing various
other stakeholders to interview. An organization personnel, persons served, leadership, funding
has the option of inviting third-party represen- source representatives, community members,
tatives to observe the orientation and exit and others; and reviewing documents such
conferences. Observations of interviews and as records of the persons served, fiscal reports,
survey team meetings, however, are prohibited administrative records, and other materials.
because of the confidential nature of the matters Records for review shall be selected by the survey
discussed. team. A responsible person from the organiza-
The Survey tion should be on the premises at all times to
facilitate the process and answer questions for the
NOTE: The daily schedule of a survey will vary for
team; however, this person should not attend
each organization. The following is only a sample.
individual interviews or survey team meetings.
First Day
Evening
Opening of business
The survey team reviews findings relative to con-
The survey team arrives at the organization and formance to the standards. The surveyors may
conducts an orientation conference with the request permission to remove nonconfidential
leadership, personnel, and others invited by the documents from the survey site for review in
organization. The orientation conference pro- the evening. Approval of this is at the discretion
vides the opportunity for the surveyors to clarify of the organization. If the organization offers
the purpose of the site survey, how the team will residential programs, community housing, or
conduct the survey, and verify the programs, ser- supported living services, evening hours may
vices, and sites to be surveyed. The organization also be used to visit sites.

The work that the survey team must do in the NOTE: If any issues or questions arise before or
evenings prior to the last day of the survey during the survey that the organization cannot
is quite extensive. Therefore, the organization resolve with the surveyors, the organization is
should never schedule any social activity that encouraged to call CARF for guidance and
would involve surveyors. resolution prior to completion of the survey.
Second or Last Day After the Survey

If the survey involves more than two days, the After the survey has ended, all questions or
following schedule applies to the last survey day. concerns should be directed to the CARF office
The other day(s) will be used for further obser- rather than to members of the survey team.
vation, interviews, and documentation review.
It should be noted that the last day of the survey Step 7. CARF renders the accreditation
typically ends not later than 3:00 pm. decision
Opening of business The survey team reports its findings to CARF.

After the accreditation decision has been made,
The survey team returns to the organization to a written report is sent to the organization.
obtain additional information, continue its inter- The length of time from the site survey to the
views, review documents, and perform other organization’s notification of the decision is
survey activities. The organization’s personnel approximately six to eight weeks.
may be asked for assistance in locating informa-
The report contains the accreditation decision
tion to show conformance in specific areas.
and standards that were not met. When the
Late Morning organization is resurveyed, it is held accountable
for follow up on areas for improvement identified
The survey team meets to compile its findings
in the previous report and for evidence of con-
and prepare for the exit conference. A pre-exit
formance to standards throughout the tenure
meeting may be requested with or by the person-
of accreditation, and for all applicable standards
nel in charge to summarize the findings and/or
in the current standards manual.
discuss any areas still to be resolved.
NOTE: CARF personnel, acting during the course and
Early Afternoon within the scope of their employment, are the only
persons authorized to officially represent CARF in
The exit conference, which is approximately
interpreting its policies, procedures, standards, and
one hour in length, is conducted by the survey
accreditation conditions.
team with those invited by the organization.
The organization may record the exit conference. Step 8. Submit a Quality Improvement Plan
The purpose of the conference is for the survey
team to provide feedback concerning the Within 90 days of notification of the accredita-
strengths of the programs and operations in tion decision, the organization submits to CARF
relation to the standards, identify areas for a Quality Improvement Plan (QIP) in which it
improvement, and offer suggestions and outlines the actions that have been or will be
consultation. taken in response to the areas identified in the
report. The QIP form with instructions is posted
The organization may question any areas identi-
on Customer Connect (customercon-
fied for improvement by the survey team at the
exit conference, or immediately after the exit nect.carf.org) at the time of the accreditation
decision. CARF may be contacted for assistance
conference, and present further evidence of con-
if any areas for improvement require further
formance to the standards before the surveyors
leave the site. Once the survey team has left the explanation or if the organization needs assis-
tance in determining whether its planned action
site, the organization may not contribute any
is adequate to demonstrate conformance to the
further information to demonstrate conformance
to the standards. CARF standards. Submission of the completed

QIP is required by Accreditation Condition 3 ■ Relocation of an accredited program

in order to maintain accreditation. or service or the organization itself.
If an organization requests a review of a One- ■ Change in mail and/or email addresses.
Year or Provisional Accreditation decision, the ■ Relocation, expansion, or elimination
QIP must be submitted to CARF within 45 days of an accredited program or location.
following notice of the outcome of the review.
■ Financial distress.
If an organization requests a review of a Non-
■ Acquisition, consolidation, joint venture,
accreditation decision and the outcome of that
or merger.
review is a Provisional, One-Year, or Three-Year
Accreditation decision, the QIP must be submit- Changes in ownership and/or leadership, the
ted to CARF within 45 days of notice of the addition of a site to an existing accreditation,
outcome of that review or appeal. mergers, consolidations, joint ventures, and
acquisitions involving accredited programs
Step 9. Submit the Annual Conformance may require the payment of an administrative
to Quality Reports fee or a supplemental survey.
As part of the commitment to ongoing perfor- Communication Regarding Significant Events
mance excellence that all CARF-accredited During the term of accreditation, the organiza-
organizations are expected to demonstrate, each tion must provide CARF with information on
organization that achieves a Three-Year Accredi- significant events that occur within the organi-
tation must submit an Annual Conformance to zation and its accredited programs and services.
Quality Report (ACQR) in a format supplied Some situations may require further actions to
by CARF for each year of its accreditation. The be taken by CARF, including alleged incidents
report is due on the first and second anniversary concerning conformance to the standards. Signif-
dates. Through the ACQR, the organization icant events that involve or may affect accredited
certifies that it at all times conforms to the stan- programs and the organization’s response to
dards, satisfies the Accreditation Conditions, and those events must be communicated to CARF
complies with CARF’s policies and procedures within 30 days of their occurrence. Significant
as changes are published and made effective from events are:
time to time.
■ Investigations.
Submission of the completed ACQR is required
■ Material litigation.
by Accreditation Condition 4 in order to main-
tain accreditation. ■ Catastrophes.
■ Sentinel events.
Step 10. CARF maintains contact with the ■ Governmental sanctions, bans on admissions,
organization fines, penalties, or loss of programs (e.g.,
Communication Regarding Administrative Items sanctions imposed by U.S. Centers for
Medicare and Medicaid Services).
During the term of accreditation, the organiza-
tion must provide CARF with information on Forms for reporting administrative items and
significant events
situations that may affect the continuation of
accreditation status. Some situations may require Forms for reporting administrative items
further actions to be taken. (See the “Supplemen- and significant events are available on the
tal Surveys” section.) The following types of CARF website at www.carf.org/Accreditation/
administrative items must be communicated AccreditationProcess/OngoingCommunica-
to CARF within 30 days of their occurrence: tion and in the Resources section of Customer
■ Change in the leadership. Connect (customerconnect.carf.org). Please
■ Change in the ownership.
contact CARF for more details.
■ Change in the organization name.

Falsification of Documents involving accreditation without prior approval

from CARF. An organization may, however,
The information provided by an organization disseminate or quote from the report.
seeking CARF accreditation is a critical element
in the accreditation process and in determining Certificate of Accreditation
the organization’s conformance to the standards. An organization is provided, at no charge, one
Such information may be obtained via interviews certificate of accreditation. Additional certificates
or direct observation by surveyors or may be pro- are available for purchase. This free certificate,
vided through documents reviewed by the survey which is suitable for framing, identifies the
team or submitted to CARF. organization that submitted the survey applica-
CARF presumes that each organization seeking tion, the level of accreditation, the programs and
accreditation is doing so in good faith and that services for which the organization is accredited,
all information is accurate, truthful, and com- and the month and year in which the accredita-
plete. Failure to participate in good faith, tion expires. It also contains areas to place annual
including CARF’s reasonable belief that any seals to demonstrate ongoing conformance to
information used to determine conformance standards as attested through the ACQR.
to CARF’s standards during or subsequent to An organization may use or display its certificate
the survey has been falsified, may be grounds of accreditation to demonstrate conformance to
for Nonaccreditation or a decision to modify the CARF standards, but it may not use or display
or withdraw the existing accreditation. the certificate in any manner that is inconsistent
In the event that an organization loses accredi- with the purposes of CARF and its accreditation
tation or is not accredited because of CARF’s function or that misrepresents the availability
reasonable belief of falsification of documents or quality of the services offered by the organiza-
or information, CARF will not accept a survey tion. The certificate should never be used either
application from the organization for a period explicitly or implicitly as a claim, promise, or
of at least twelve months. CARF may also notify guarantee of successful service. Accreditation
the appropriate governmental agencies. indicates an organization’s demonstrated use of
professionally approved standards and practices
in connection with particular programs and ser-
Public Information vices, and the certificate is regarded as providing
information and guidance for the public at large
Identification of Accreditation by the and for persons considering services.
Organization An accreditation award applies only to the
CARF accreditation is awarded to an organiza- organization’s specific programs and services
tion for identified programs and services. An surveyed by CARF. The certificate may be
organization that has been awarded accreditation displayed only by that organization. If an
should identify this achievement publicly. Use organization closes one or more of its accredited
of the CARF logo by an accredited organization programs and other programs remain accredited,
for this purpose is encouraged. The CARF logo the certificate should be returned to CARF and
is available online in the Resources section of a revised certificate will be issued free of charge.
Customer Connect (customerconnect.carf.org) Each unexpired certificate must be returned
and at www.carf.org/logo. All references to upon dissolution of the organization or loss of
CARF accreditation by the organization must accreditation for any reason and the organization
clearly identify the accredited programs and must refrain from representing itself or its
services, unless all programs and services offered programs and services as accredited and must
by the organization are accredited by CARF. cease to use or display the certificate or the CARF
CARF personnel and surveyors may not be logo in any manner. Similarly, if accreditation is
referred to or quoted in any public release suspended, the organization must not represent

itself or its programs and services as accredited

or use or display the certificate or the CARF logo
Subsequent Surveys
until and unless accreditation is restored. Depending on the circumstances, CARF may
conduct three types of surveys of the organiza-
Release of Information by CARF tion’s programs following the initial survey.
To enhance the value of accreditation to These survey types are described below.
persons served and other stakeholders, CARF
may release information related to an organiza- Resurveys
tion and its accreditation to the extent that it is To maintain accreditation beyond the expiration
not confidential or protected by law, including, date of its current accreditation, an organization’s
but not limited to: programs must be resurveyed or be in the process
1. Whether CARF has received a survey of a resurvey by the expiration date. CARF noti-
application from a specific organization. fies an organization of the need for a resurvey
2. Scheduled survey dates for a specific approximately seven months before expiration
organization. of its accreditation.
3. Whether a survey has been completed. The resurvey process is the same as the initial
survey process in that a completed survey
4. The date of expiration of accreditation
application is required and all applicable stan-
of a particular organization.
dards are applied. During a resurvey, however,
5. An organization’s accredited programs the organization is expected to be able to dem-
and services. onstrate conformance during the entire period
6. An organization’s accreditation decision since its last survey. Also, special attention is
and status. given to implementation of changes made in
7. Whether an organization has requested response to the Quality Improvement Plan
review of a One-Year Accreditation, Provi- from the previous survey.
sional Accreditation, or Nonaccreditation If new programs and services are being added
decision. or the mission and focus of the organization
8. Whether an organization is involved or its programs have changed since the previous
in appealing or may still appeal a survey, it is suggested that the organization
Nonaccreditation decision. contact its CARF resource specialist.
9. As required by law or contract.
Supplemental Surveys
For convenient access to information,
The main objective of a supplemental survey is
CARF includes on its website a searchable list
to recognize the dynamic status of organizations
of organizations with accredited programs,
and permit changes in accreditation between
including identifying information such as name,
surveys. Supplemental surveys may be required
address, and telephone number. This posting
under two circumstances:
allows the public to review the accreditation
status of an organization’s accredited programs
1. When an organization changes its
at any time.
leadership or ownership or engages in
a merger, consolidation, joint venture,
or acquisition transaction.
1.
When an organization’s leadership or ownership

changes after the survey is conducted, it may be
necessary to conduct a supplemental survey of
conformance to the standards applicable to the
organization’s administration and programs. For
the same reasons, a supplemental survey may

also be required when an organization is party CARF receives information that an organization
to a merger, consolidation, joint venture, or may no longer be conforming to the standards.
acquisition involving accredited programs. The organization’s accreditation award may be
modified as a result of a monitoring visit and
2. When an organization wishes to add submission of a new Quality Improvement Plan
a new program, service, or location to may be required.
an existing accreditation.
An organization with currently accredited pro-
grams and services may be required to have a
Extension of Accreditation
supplemental survey for the purpose of adding Awards
a new location to its existing accreditation. CARF
will determine the need for a supplemental sur- Extensions of up to three months for extenuating
vey once the organization notifies CARF, in circumstances may be granted by CARF, at its
writing, of the changes in the organization. CARF sole discretion, for an organization with a current
will contact a representative of the organization Three-Year Accreditation. The organization must
to get more details, if required. request this extension in writing when submit-
A supplemental survey is always required if ting the completed survey application at least
an organization wants to add a new program five months before its expiration date. CARF
or service that is not currently accredited. will review the request and determine whether
the extension will be approved. Although the
If a supplemental survey is required, the
request for extension will not be approved prior
organization must submit a completed survey
to the submission of the survey application, an
application to CARF with a nonrefundable appli-
organization may contact CARF to seek prior
cation fee. A survey fee for a supplemental survey
authorization to request an extension.
is assessed for the number of days and surveyors
required. An extension will not be considered or granted
for an organization with a One-Year, Provisional,
The maximum tenure of the accreditation of the
or Preliminary Accreditation.
new program, service, or location added will be
the remaining tenure of the current accreditation. If an organization with a Three-Year Accredita-
If during the supplemental survey the program, tion intends to request an extension greater than
service, or new location is found to be function- three months, additional information must be
ing at a lower level of accreditation than the submitted for consideration. The organization
programs and services currently accredited, the must submit written information with the com-
result will be a reduction in the level and tenure pleted survey application and application fee that
of the entire accreditation decision. details demographic and program changes since
the last survey and an update on the performance
A supplemental survey focuses on the program,
of each accredited program. The organization
service, or location being added. The standards
should also send the following items and/or
that are applied may vary in accordance with the
information to CARF at least five months prior
length of time since the previous survey.
to the expiration month:
Organizations seeking to add a program, service,
■ A letter from the organization’s leadership
or location to their current accreditation should
contact CARF for instructions regarding the explaining the reasons that the extension
applicable standards. is being requested.
■ A copy of the most recent performance
Monitoring Visits analysis, as specified in Standard 1.N.1.
in this manual.
CARF may from time to time conduct
announced or unannounced monitoring visits ■ An update of the Quality Improvement Plan
of organizations with accredited programs. A completed after the last survey.

monitoring visit may be conducted any time

■ If the organization is required to be accredited warranted, CARF will notify the organization
by any funding or referral entity, then a letter of this action.
of support for consideration of the extension If an allegation is received after a survey but
from that entity. before the report and the accreditation decision
All information will be reviewed before CARF are released, CARF may withhold the release
renders a decision on the extension request. In of the report and decision until an investigation
no case will an organization be granted more of the allegation has been completed and the
than a six-month extension. matter resolved.
If an organization is granted an extension, the
survey will be conducted using the standards Disputed Decisions
manual that is current on the date of the survey.
After the survey, the expiration date will revert
Review of One-Year or Provisional
to the original month of expiration.
Accreditation Decisions
If an extension is granted, only those programs
and services that are currently accredited and When a One-Year or Provisional Accreditation
that the organization intends to have resurveyed is awarded, the organization may submit
will be included in the extension. a written request for an on-site review of the
findings of the first survey team to determine
Organizations that submit their survey applica-
whether, in light of this on-site review, the
tion and request for an extension after the date
One-Year or Provisional Accreditation decision
the survey application was due risk a lapse in
is appropriate. In connection with this review,
their accredited status.
the following procedures apply:
1. The organization must submit a written
Allegations, Suspensions, request for a review of the accreditation
decision, to be received by CARF within
and Stipulations 30 calendar days of the date of the accredita-
Upon being informed by any source of a change tion letter. In the written request for review,
in an organization’s conformance to the CARF the organization must identify in detail its
Accreditation Conditions, standards, or policies specific disputes regarding items cited in
and procedures, CARF, at its sole discretion, may the report and why it believes they are not
review and modify the organization’s accredita- appropriate.
tion status up to and including revocation of 2. Upon receipt of the written request for review,
accreditation. CARF may also suspend or place CARF determines the number of surveyors
stipulations on continued accreditation. During and days needed to conduct the review and
suspension, the organization is not accredited then contacts the organization to establish
and may not communicate to third parties that the dates of the review. In the interest of time-
it is CARF accredited. liness, every effort is made to conduct the
CARF’s review may involve a request for an review within 60 calendar days of receipt
immediate response from the organization, the of the written request.
submission of documents and other information, 3. A letter of confirmation will be sent to the
solicitation of information from external organi- organization with the dates of the review and
zations and individuals, and/or the undertaking the names of the surveyors who will conduct
of an announced or unannounced monitoring the review. Also enclosed will be an invoice
visit to the site at the discretion and expense for the nonrefundable review fee, which must
of CARF. Refusal to respond or unsatisfactory be paid at least 21 calendar days prior to the
response to a CARF inquiry concerning an review. This fee will be based on CARF’s
allegation may result in modification of accredi- current survey fee.
tation status. When a change in status is deemed

4. The survey team conducts the review at the organizational staff at the on-site survey, review
organization using the same standards manual and appeal of the decision are not available.
used by the first survey team. During the
Request for Review
review, the organization must provide evi-
dence of conformance in those areas where it An organization whose programs and services
disputes items cited in the report. The CARF receive a Nonaccreditation decision may initiate
surveyor(s) conducts interviews and reviews a review by submitting a written request for
documentation to the extent necessary to review to CARF. The written request must be
determine whether at this point in time any received by CARF no later than 30 calendar days
revisions to previous findings should be made. following the date of CARF’s letter notifying the
5. Following the review, the findings of the organization of the decision.
surveyor(s) are submitted to CARF for Within seven calendar days of receipt of the writ-
reconsideration of the accreditation decision. ten notification, CARF will send the organization
6. Following the accreditation decision-making written confirmation of its receipt and an invoice
process, the organization is provided with the for the on-site review. The invoice for a review
final decision and is informed as to whether will be based upon CARF’s current survey fee
sufficient evidence of conformance has been structure. The organization is required to submit
presented to warrant a change in the accredi- payment in full for the review within ten calendar
tation decision. The organization is informed days of the invoice date. CARF will schedule the
of its accreditation status and new expiration review and notify the organization of the date(s)
date, as appropriate. and the surveyors within 30 calendar days after
payment is received.
7. If the organization does not submit a suffi-
cient written request for review or payment NOTE: If the organization does not submit a written
within the required time frames, it waives request for review or appropriate payment within
the right to a review of its One-Year or the required time frame, it waives the right to a
Provisional Accreditation. review of its Nonaccreditation decision.
On-Site Review
Review and Appeal of Nonaccreditation
Decisions The number of surveyors and days needed to
conduct the on-site review and the surveyors
CARF has established a review and appeal assigned will be determined at CARF’s sole
procedure for organizations that receive a Non- discretion. They will be selected based on
accreditation decision. This procedure offers their expertise in the service or program areas
an organization the opportunity to sequentially surveyed. The format of the review will be to
challenge such a decision at two levels: an on-site conduct a completely new, full survey. The survey
review and an appeal hearing. team will:
The organization is informed of the Non- ■ Arrive on site at the time agreed upon in the
accreditation decision and has 30 calendar presurvey call from the team coordinator.
days in which to submit a written request for
■ Conduct an orientation meeting with individ-
an on-site review.
uals invited by the organization to explain
If the outcome of this on-site review is Nonac- the process and on-site review.
creditation, the organization may appeal this
■ Observe program and service delivery and
decision. This final appeal shall only be based
review documentation to determine confor-
on questions of whether the survey was con-
mance to the standards. The organization
ducted in a manner consistent with CARF’s
must present information to demonstrate
survey policy and procedures.
conformance to all applicable standards.
NOTE: If the Nonaccreditation decision is based
on failure to satisfy one or more of the CARF
Accreditation Conditions or unavailability of key

■ Conduct interviews, as appropriate and neces- schedule the hearing within 60 calendar days of
sary for any survey, with personnel, board receipt of the organization’s materials, if practical.
members of the organization, persons served, The appeal panel may review the written
funders, and other stakeholders. information submitted by the organization, the
■ Conduct an exit conference on the last day report, and any other information, including
and share information with the organization comments from the original survey team, that
about areas of conformance and nonconfor- it considers relevant. Within seven calendar days
mance to the CARF standards. after completion of the hearing, CARF renders
Within 35 calendar days after the site review one of the following decisions, which is final:
has ended, CARF will determine if the Nonac- a. Affirm the Nonaccreditation decision.
creditation decision should be upheld or revised. or
CARF may: b. Reject the Nonaccreditation decision
a. Affirm the Nonaccreditation decision. This and issue another decision. This may be
action is final unless the organization notifies a Provisional, One-Year, or Three-Year
CARF in writing of its decision to appeal, Accreditation. CARF may also attach specific
pursuant to the following section. stipulations to the accreditation.
or
Other Provisions
b. Reject the Nonaccreditation decision. CARF
1. The organization is responsible for the cost of
may award a Provisional, One-Year, or Three-
the on-site review survey, including payment
Year Accreditation. CARF may also establish
of the current survey fee. All costs incurred by
specific stipulations that the organization
the organization or by CARF in connection
must meet. This decision is final.
with the appeal will be the responsibility of
Appeal Hearing the party incurring the expenses. Fees and
expenses incurred by the organization are
If the result of the review is to reaffirm the Non- not refundable in whole or in part.
accreditation decision, the organization, upon
written notice to CARF, is entitled to a hearing 2. Time notification requirements may be
before a designated appeal panel. The organiza- waived or modified only if agreed to in
tion’s notice of appeal must be received by CARF writing by CARF.
within 14 calendar days of the date of the letter 3. Failure by an organization to adhere to
that communicates the decision from the review any of the terms of any review or appeal
survey. This final appeal shall only be based on procedures will constitute a waiver and
questions of whether the review survey was con- relinquishment of its right to review or
ducted in a manner consistent with CARF’s appeal the Nonaccreditation decision.
survey policies and procedures. The appeal panel 4. In the case of an organization that disputes
will not consider the organization’s conformance the accreditation decision from a resurvey
to the standards. following a Provisional Accreditation, the
Review at this final level is accomplished by sub- organization must demonstrate that it is
mitting materials supporting the organization’s functioning at the level of a Three-Year
appeal, which are presented verbally to the appeal Accreditation for the Nonaccreditation
panel via conference call or an in-person presen- decision to be rejected on review or appeal.
tation. The written materials supporting the 5. The organization has no right to review
organization’s appeal and notice as to whether the CARF’s books or records.
organization wishes to present via conference call
or in person must be received by CARF within
30 calendar days of the organization’s notification
to CARF of its decision to appeal. CARF will

CHANGES IN THE 2016 MANUAL
The purpose of this section is to identify notable 1.C. Strategic Planning

changes that have been made in the programs ■ In the stem of Standard 1.C.2. the word
and standards included in this manual compared “written” has been deleted as redundant;
to the previous year’s manual. Please be aware all plans, as defined in the Glossary and
that in addition to the changes noted here, some required by CARF standards, must be
standards may have minor corrections or changes in writing.
in wording that do not change the requirements
of the standard and are not listed here. 1.G. Risk Management
In addition to the changes noted in this section, ■ In Standard 1.G.2., the wording of element
throughout the manual the Intent Statements, a.(2) has been modified slightly; the term
Examples, Resource listings, and other support- “on an annual basis” has been changed to
ing content have been revised and updated to at least annually.
remain current and/or to clarify the intent or 1.H. Health and Safety
requirements of the standards. Changes in the
Accreditation Policies and Procedures, program ■ In Standard 1.H.2., the wording of the stem
descriptions, applicable standards information, has been modified slightly for consistency.
and reference materials are also not listed here. 1.I. Human Resources
NOTE: CARF makes every effort to list all significant ■ In Standard 1.I.8., element a. has been revised
changes in the standards; however, not all changes to eliminate redundancy; previous elements
are included. All sections that are applicable to an a.(2) and a.(3) have been deleted as these are
organization should be thoroughly reviewed to covered under the annual review of policies
ensure that the current standards are implemented
required in Standard 1.A.3.k.
in the organization’s accredited programs and
services and those seeking accreditation. 1.N. Performance Improvement
■ For Standards 1.N.1. and 1.N.2., Intent
Section 1. ASPIRE to Excellence® Statements have been added for clarity.
1.A. Leadership
Section 2. Quality Individualized Services
■ In Standard 1.A.3., element m. Succession
and Supports
planning is new.
■ In Standard 1.A.6., element a.(4)(f) has been 2.A. Program/Service Structure
modified to add the word legal, and element c. ■ Standard 2.A.16. has been modified slightly to
has been revised to eliminate redundancy; clarify that training in the use of positive
“personnel” was deleted as this requirement interventions is provided to personnel who
is covered under Standard 1.I.5.b.(5). provide services to persons served.
■ In Standard 1.A.7., element b. has been ■ In Standard 2.A.17., element c.(2) has been
restructured and renumbered for clarity; modified; “staff members” was changed
requirements are not changed. to service personnel to clarify that training
is provided to personnel who provide services
to persons served.

Changes in the 2016 Manual
■ Standard 2.A.19. has been revised for clarity; to persons served, and previous element k.
requirements are not changed. “Family systems theory” has been deleted.
2.C. Medication Monitoring and Management 3.O. Transition Services (TS)
■ Standard 2.C.4. has been modified to clarify ■ Standard 3.O.1. has been modified slightly
that the medication review may be conducted to add transition-age youth.
by either a physician or a pharmacist.
3.P. Community Integration (COI)
■ In Standard 2.C.5., elements a.–c. have been
changed to add if applicable, and the Intent ■ Previous Standards 3.P.7. and 3.P.8. have been
statement for this standard was modified to deleted.
clarify that if the program does not have any 3.S. Comprehensive Benefits Planning (CBP)
role in medication purchase, transportation,
■ Standard 3.S.2. has been reworded slightly
or off-site use by persons served, it is not
for clarity; “public information materials”
required to have written procedures for these.
has been changed to information provided
2.G. Children and Adolescents Specific to the public.
Population Designation
3.X. Centers for Independent Living (CIL)
■ The stem of Standard 2.G.1. has been revised
■ The program description and standards in
slightly for clarity.
this section have been revised based on input
■ The stem of Standard 2.G.7. has been revised from the field.
to add as appropriate to the scope of services.
■ In Standard 3.X.1., element a. has been
■ Previous Standard 2.G.8. has been deleted; restructured for clarity; requirements
subsequent standards have been renumbered. are not changed.
■ Standard 2.G.9. (previously 2.G.10.) has been ■ Standard 3.X.4. has been revised and
modified. The word service was added to restructured.
the stem to clarify that training is provided
■ In Standard 3.X.5., element c. has been
to personnel who provide services to persons
revised to eliminate previous prescriptive
served, and previous element k. “Family
requirements.
systems theory” has been deleted.
■ In Standard 3.X.7., element e. has been
2.H. Older Adults and Older Adults/Dementia restructured for clarity; requirements
Care Specific Population Designations are not changed.
■ The stem of Standard 2.H.5. has been revised ■ Previous Standard 3.X.8. has been deleted;
slightly; “staff members” was changed to subsequent standards have been renumbered.
service personnel to clarify that training
■ Standard 3.X.8. (previously 3.X.9.) has
is provided to personnel who provide services
been modified; in the stem, “outcomes
to persons served.
information” has been changed to
performance information, and element e.,
Section 3. Employment and Community Transition services, is new.
Services ■ Standard 3.X.9. (previously 3.X.10.) has been
3.I. Child and Youth Services (CYS) revised to include transition services as a
required aspect of CIL services. Elements b.
■ The stem of Standard 3.I.1. has been revised
and d. have been modified slightly for clarity.
slightly for clarity.
Previous element e. “Case management and
■ The stem of Standard 3.I.7. has been revised services coordination” has been deleted and
to add as appropriate to the scope of services. replaced with a new element e. that addresses
■ In the stem of Standard 3.I.10. the word transition services for young adults who are
service was added to clarify that training is transitioning to adult services.
provided to personnel who provide services

Changes in the 2016 Manual
Section 4. Psychosocial Rehabilitation Glossary

Programs
The definitions of the following terms have
4.A. Program/Service Structure been modified:
■ The stem of Standard 4.A.19. has been ■ Corporate status
modified to increase the expectation of ■ Data

family involvement in programs. ■ Governing board
■ Standard 4.A.21. is new; subsequent standards ■ Governmental
have been renumbered.
■ Service access
■ In Standard 4.A.24. (previously 4.A.23.),
element i. has been modified slightly for
clarity.
■ In Standard 4.A.26. (previously 4.A.25.), the
words “when applicable” have been deleted
from the stem, and element h. is new.
4.B. Medication Use
■ The stem of Standard 4.B.4. has been modi-
fied to clarify that all programs where persons
served spend one or more nights must apply
this standard.
■ In Standard 4.B.6., element c. has been
modified slightly for clarity; the words
“or homeopathic” have been deleted.
■ In Standard 4.B.8., element f.(1) has been
reworded for clarity; requirements are not
changed.
■ In Standard 4.B.10., previous element a.
has been deleted; subsequent elements
have been renumbered.
4.C. Nonviolent Practices
■ In Standard 4.C.5., element b.(2) has been
changed to add the words in reduction of use,
and element c. is new.
4.D. Records of the Persons Served
■ In Standard 4.D.4., element g. is new.

SECTION 1
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Assess the Environment
To be relevant and responsive in a rapidly chang-

ing environment, the organization must be
A. Leadership
vigilant of the context in which it conducts its
business affairs. Environmental assessments Description
provide the foundation for development and CARF-accredited organizations identify leader-
implementation of organizational strategy. ship that embraces the values of accountability
Assessments should be conducted within the and responsibility to the individual organization’s
context of the organization’s purpose, location, stated mission. The leadership demonstrates
and sphere of influence, and relate to the vision corporate social responsibility.
and mission of the organization and how both
fit into the social, economic, competitive, legal, 1.A. 1. The organization identifies:
regulatory, and political environments in which 1.A. Leadership
a. Its leadership structure.

the organization operates. Collection and analy- 1.a.A. Leadership
b. The responsibilities of each level

sis of information regarding these factors provide of leadership.
the basis for the creative thought necessary to 1.b.A. Leadership
guide all organizational planning and action Examples

toward a future of service and business excel- The leadership structure can be documented
lence. The role of leadership is critical to in the form of an organizational chart, table
environmental assessment. of organization, or narrative description of
the positions and lines of authority within the
organization. Responsibilities of leadership might
be described in job descriptions, bylaws, policies,
or narrative descriptions. For small organizations
it is common to see a short narrative description
of positions, responsibilities, and lines of author-
ity since there are typically so few staff members
covering all areas of responsibility. For very small
organizations, the job descriptions may be suffi-
cient to identify this information. The survey
team verifies that whomever is identified fulfills
the responsibilities of leadership.
The governance authority and chief executive
or management demonstrate knowledge of this
relationship.
1.A. 2. A person-centered philosophy:

2.A. Leadership
a. Is demonstrated by:
2.a.A. Leadership
(1) Leadership.
2.a.(1)A. Leadership
(2) Personnel.
b. Guides the service delivery.

2.b.A. Leadership

Section 1.A. Leadership
c. Is communicated to stakeholders in j. Compliance with:

an understandable manner.
3.j.A. Leadership
2.c.A. Leadership
(1) All legal requirements.
3.j.(1)A. Leadership
Intent Statements (2) All regulatory requirements.

3.j.(2)A. Leadership
The organization’s person-centered philosophy k. Annual review of the organization’s

should be evident in the development and policies.
3.k.A. Leadership
delivery of services, systems, approaches, and l. Health and safety.

interventions. Implementation of this philosophy 3.l.A. Leadership
m. Succession planning.
from the unique perspectives of the leadership, 3.m.A. Leadership
personnel, and persons served is addressed Intent Statements

during the survey process. 3.k. Annual review of the organization’s policies
addresses all policies specific to the program(s)
Examples
seeking accreditation and policies that directly
The organization’s services are designed around relate to or impact the program(s).
the identified needs and desires of the persons
3.m. Succession planning identifies actions to be
served, are responsive to their expectations, and taken by the organization should key leadership
are relevant to their maximum participation in personnel be unavailable to perform their duties
the environments of their choice. The organi- due to retirement, resignation, serious illness,
zation is committed to a system that nurtures death, or other reasons. Succession planning
personal growth and dignity of persons served, may be formal or informal depending on the
which is emphasized during orientation and needs of the organization.
ongoing staff training. This might be demon-
strated by services being provided in a setting Examples
that provides the best access and is during hours The delegation of activities, the feedback and
most preferred by persons served. It could be collaboration of various levels of the leadership,
demonstrated by persons served being supported and the checks and balances that the leadership
to direct and manage their services to the extent has created are evident. This may be observed;
they wish. heard in interviews; or read in minutes, reports,
and orientation materials for boards and
1.A. 3. The identified leadership guides the management.
following: 3.a.–c. The leadership ensures that specific
3.A. Leadership
a. Establishment of the: activities are conducted to guide the organization

3.a.A. Leadership
ethically, effectively, and efficiently in achieving
(1) Mission of the organization.
3.a.(1)A. Leadership its mission. As the organization’s mission influ-
(2) Direction of the organization. ences service delivery, the achievement of
b. Promotion of value in the programs outcomes, and strategic planning activities, a

and services offered. regular review of the mission statement assesses
3.b.A. Leadership
c. Achievement of outcomes in the and reinforces the vision of personnel and board
programs and services offered. members regarding the outcomes for persons
3.c.A. Leadership
d. Balancing the expectations of served and focuses efforts toward achieving

the persons served and other agreed-upon outcomes.
stakeholders. Input from the persons served and other stake-
3.d.A. Leadership
e. Financial solvency. holders influences the mission as their needs,

desired outcomes, and other factors change
3.e.A. Leadership
f. Risk management.
3.f.A. Leadership
g. Ongoing performance improvement. over time.

3.g.A. Leadership
h. Development of corporate 3.c. Leadership works together to achieve and

responsibilities. improve identified outcomes. Their efforts and
3.h.A. Leadership
i. Implementation of corporate achievements are documented. The outcomes

responsibilities. performance report is used to guide these efforts,
3.i.A. Leadership

for example, through a strategic planning receives information about and complies with
process. changes in these. An organization might become
3.d. The organization is responsive to its environ- a member of a trade association as one way to
ment and conducts planning to position itself stay abreast of regulatory and legal requirements.
strategically. In strategic planning, the organiza- 3.k. Leadership may delegate responsibility for
tion may begin by doing an environmental scan review as it chooses. In some organizations, such
and asking all its stakeholders for input. as those operated by governmental or public
3.e. Leadership takes a proactive role by ensuring agencies, personnel and other policies may be
that specific activities, such as approval of the established by the agency and not by the organi-
budget and review of the independent financial zation. Human resource policies may also include
examination, are conducted annually to protect union contracts or may be identified in statute,
the organization’s assets, maintain its viability, administrative rule, or other governmental docu-
and move it forward as the stakeholder environment. The expectation is that the organization
ment changes. reviews the policies annually and brings forward
suggested changes to provide input for consider-
3.f. Leadership guides planning to manage risk
ation in policy revisions.
and reduce the severity of any potential threats to
its people, property, income, goodwill, and ability Systemwide policies that directly impact the
to accomplish goals. One component of this is programs seeking accreditation may be reviewed
arranging for insurance coverage, which can by the program leadership and suggestions for
protect many of the assets of the organization. revisions forwarded for consideration to the
A review of coverage is conducted with the assis- departments responsible for the specific policies.
tance of someone qualified to provide guidance 3.m. Succession planning might identify which
about insurance needs and types of coverage. employees within the organization could move
3.h.–i. These standards relate to the organiza- into key leadership positions, how to develop
tion’s responsibility to be prepared to respond to employees to fill needed leadership positions,
questions from the public regarding its accredited and highlight the need or opportunity to identify
services. Questions that might be expected potential leaders external to the organization or
include, but are not limited to, those about its even external to the field.
CARF survey results and the survey report, the
quality and effectiveness of services, descriptions 1.A. 4. The leadership of the organization
of services and persons served, performance out- is accessible to:
comes of the services, consumer and customer
4.A. Leadership
a. The persons served.

satisfaction with services, and other information 4.a.A. Leadership
b. Personnel.
that persons may use to make informed choices 4.b.A. Leadership
about services and service providers. Some Examples

organizations may post their annual report Management and governance authorities are
on their website to share information. available to and communicate with the persons
The organization might inform the public of its served and other stakeholders. Persons served
policy and procedure for responding to requests and other stakeholders know and feel that the
for information through such means as a bro- organization’s leadership is available to them
chure, newsletter, public service announcement, should they have any issues, concerns, etc.
newspaper article, or information posted on its For example, there could be meetings and
website. events where stakeholders can have access
See also Standard 1.A.6. in this section regarding to the organization’s leadership.
corporate responsibility.
3.j. The organization demonstrates its implemen-
tation of applicable laws and regulations. The
organization has a system that ensures that it

Examples of diversity awareness and knowledge

1.A. 5. The organization implements a cultural include areas such as spiritual beliefs, holidays,
competency and diversity plan that:
5.A. Leadership
dietary regulations or preferences, clothing,
a. Addresses: attitudes toward impairments, language, and how
5.a.A. Leadership
(1) Persons served. and when to use interpreters. The organization

(2) Personnel. should be prepared to discuss what has resulted

from the knowledge gained, e.g., modified
(3) Other stakeholders.

b. Is based on the consideration of service delivery, consideration of diversity in

the following areas: individual plans, personnel training, increased
5.b.A. Leadership
satisfaction of stakeholders.
(1) Culture.
5.b.(1)A. Leadership
(2) Age. Cultural competency can be demonstrated by

5.b.(2)A. Leadership hiring persons who are representative of the per-
(3) Gender.
sons served, by designing and delivering service
(4) Sexual orientation. in a manner that will be most effective given the
(5) Spiritual beliefs. cultures served, and by providing settings that

(6) Socioeconomic status. promote comfort, trust, and familiarity.

(7) Language. In developing a cultural competency and diver-

c. Is reviewed at least annually sity plan, an organization looks at the diversity of

for relevance. its community, internal and external stakeholders
5.c.A. Leadership
d. Is updated as needed. and potential changes in demographics to be pro-

5.d.A. Leadership
active in education, training and service delivery.
Intent Statements To facilitate a culturally competent organization
The organization demonstrates an awareness the plan might include areas such as recruitment
of, respect for, and attention to the diversity efforts for personnel, modification of educational
of the people with whom it interacts (persons materials for persons served and family/support
served, personnel, families/caregivers, and other systems, support for training and education of
stakeholders) that are reflected in attitudes, personnel, or incorporation of spiritual beliefs
organizational structures, policies, and services. into service delivery options.
The organization’s cultural competency and Training programs are designed to develop
diversity plan addresses how it will respond to awareness and sensitivity, and training specific
the diversity of its stakeholders as well as how
to the diversity of the local community would
the knowledge, skills, and behaviors will enable
be included. An organization would look at the
personnel to work effectively cross culturally
cultural and spiritual makeup of its community
by understanding, appreciating, and respecting
to note what applies in the organization and train
differences and similarities in beliefs, values,
and practices within and between cultures. personnel to that. Diversity in terms of culture,
age, gender, sexual orientation, spiritual beliefs,
Examples socioeconomic status, and language would be
Although it is not expected that personnel know addressed. Knowledge of cultural and spiritual
everything about all cultures, it is necessary diversity is a critical component when providing
to develop some understanding of the major respectful and individualized quality services/
values and beliefs of those served. Knowledge supports. Part of the benefit of this is understand-
of and response to aspects of diversity is a critical ing the things that make relationships with
component in providing respectful and individ- people in other cultures easier or more difficult.
ualized quality services to the persons served. Issues may be as simple as food preferences but
Cultural competency is an ongoing learning can include spiritual beliefs, holidays, language,
process that fosters inclusion, tolerance and how/when to get interpreters, and clothing.
respect for diversity in all forms. Training might focus on the cultures and spiri-
The organization assesses and has awareness and tual beliefs of the countries of origin, especially
knowledge of the diversity of its stakeholders. their views of disability and its causes, and the

influence of culture on the choice of service out- (4) Service delivery, including:
comes and methods. Training related to cultural
(a) Conflicts of interest.

competency is directed toward professionals 6.a.(4)(a)A. Leadership
(b) Exchange of:

working with ethnically or otherwise diverse 6.a.(4)(b)A. Leadership
(i) Gifts.
populations. 6.a.(4)(b)(i)A. Leadership
(ii) Money.
Training and education may be offered directly 6.a.(4)(b)(ii)A. Leadership
(iii) Gratuities.
by the organization, by community resources, 6.a.(4)(b)(iii)A. Leadership
or through web-based resources. It is suggested (c) Personal fundraising.

6.a.(4)(c)A. Leadership
that the training attended by each employee (d) Personal property.

6.a.(4)(d)A. Leadership
be documented, generally in the personnel file (e) Setting boundaries.

and/or training records.
6.a.(4)(e)A. Leadership
(f) Witnessing of legal

Resources documents.
6.a.(4)(f)A. Leadership
The Society of Human Resource Management (5) Professional responsibilities.

has information about diversity training on its (6) Human resources.

website at www.shrm.org that might be helpful, (7) Prohibition of:

including views of disability and its causes, and (a) Waste.

the influence of culture on service delivery and 6.a.(7)(a)A. Leadership
(b) Fraud.
predicted outcomes. 6.a.(7)(b)A. Leadership
(c) Abuse.
Many other professional, educational and advo- 6.a.(7)(c)A. Leadership
(d) Other wrongdoing.

cacy organization websites provide information 6.a.(7)(d)A. Leadership
b. Written procedures to deal with

related to diversity and cultural competency.
allegations of violations of ethical
These include:
codes, including:
■ National Center for Cultural Competence: 6.b.A. Leadership
(1) A no-reprisal approach for

nccc.georgetown.edu
personnel reporting.
■ U.S. Department of Health and Human
(2) Time frames that:

Services: 6.b.(2)A. Leadership
(a) Are adequate for prompt

www.hrsa.gov/culturalcompetence/
consideration.
index.html 6.b.(2)(a)A. Leadership
(b) Result in timely decisions.

■ Office of Minority Health, U.S. Department 6.b.(2)(b)A. Leadership
of Health and Human Services: c. Education of stakeholders on

ethical codes of conduct.
www.thinkculturalhealth.hhs.gov 6.c.A. Leadership
d. Advocacy efforts for the persons

■ Human Rights Campaign: www.hrc.org/
served.
resources/entry/lgbt-cultural-competence 6.d.A. Leadership
e. Corporate citizenship.
■ SAMSHA Treatment Improvement Protocol 6.e.A. Leadership
(TIP) 59: http://store.samhsa.gov/product/ Intent Statements

TIP-59-Improving-Cultural-Competence/ Corporate responsibility demonstrates what
SMA14-4849 an organization stands for including its ethical,
social, and environmental values. It involves
1.A. 6. Corporate responsibility efforts include, creating, communicating, and balancing value
at a minimum, the following: for all stakeholders.
6.A. Leadership
a. Written ethical codes of conduct Corporate responsibility assists in:

in at least the following areas: ■ Advocating for the persons served.
6.a.A. Leadership
(1) Business. ■ Promoting ethical business practices.

(2) Marketing. ■ Developing efficiency as an organization.

(3) Contractual relationships.


■ Considering the impact of organizational 6.a.(4)(e) The code of ethical conduct might
activities on persons served, personnel, address relationship issues such as personnel
other stakeholders, and the environment. dating other personnel at the organization or
See the Glossary for the definition of stakeholders. persons served, sexuality, and boundaries in
the relationships between providers and the
Examples persons served.
6.a. The organization identifies, develops, and 6.a.(4)(f) Examples of legal documents that
documents its required ethical practices, mission, personnel may be asked to witness include
and values. Although these statements may be powers of attorney, guardianship, and advance
found in any of a number of various written directives.
materials such as personnel policies and opera-
tions manuals, many organizations find it helpful 6.a.(7) Government has made a sizeable com-
mitment to the elimination of healthcare fraud,
to include this information in one set of docu-
waste, and abuse. Organizations are subject to
ments for use in personnel and board member
training. Personnel and members of the gover- audits of how funds they have received are used.
Organizations can encourage their personnel
nance authority are knowledgeable of and follow
to maintain high ethical standards by making
the organization’s required codes of practices and
values. This is evident in its daily operations. organizational commitment to such standards
abundantly clear.
Values are the core beliefs that guide attitudes
6.b. The organization has a mechanism in place
and actions. A written ethics code states the
to follow up and address all allegations of viola-
major philosophical beliefs, principles, and val-
ues of an organization. Codes should be designed tions of its ethical codes. An organization could
use an ethics committee to investigate and act
to promote the kind of relationship within which
on allegations of violations of ethical conduct. It
services/supports can best be carried out and to
give guidance in decision-making situations. could also use the same or a similar mechanism
to address allegations of violations of both ethical
The codes of ethical conduct can be developed conduct and rights.
using information from such sources as practice
acts for the various disciplines/professions involved The organization can demonstrate, possibly by
written records, how it has addressed allegations
in services; the codes of professional associations
of violations, if any, and how and when they were
for the various disciplines/professions involved
in services; the codes of business, marketing, and resolved. Confidentiality of any records is
maintained.
human resource management associations; and
the organization’s own mission and core values 6.d. Leadership promotes full program and ser-
statements. vice access for all persons. One way advocacy
might be demonstrated is by ensuring that lan-
6.a.(4)(c) Examples of personal fundraising that
guage and cultural differences are not barriers
may be addressed in an organization’s written
code of ethical conduct include personnel solicit- to participating in services.
ing funds on behalf of a personal cause, selling Advocacy also involves promoting the recruit-
cookies for a daughter in girl scouts, selling candy ment of qualified persons with disabilities,
or wrapping paper for a child’s school, having providing reasonable accommodations to
persons served selling items on behalf of the promote equal opportunities for participation
organization, allowing persons served to raise throughout all levels of the organization, and
funds by appeals to personnel or other persons providing access or referral to social, legal, or
served. economic advocacy resources.
6.a.(4)(d) Ethical conduct might include respect 6.d.–e. Examples of advocacy and corporate
for and safeguarding of the personal property citizenship efforts could be:
of persons served, visitors, and personnel and ■ Positions on local boards that address
property owned by the organization. accessibility, housing, leisure pursuits,

and employment for persons in need Designing Ethical Practices for Quality Services.
of human services. An electronic copy may be requested by
■ Educational events for communities contacting your CARF resource specialist.
on caregiver issues.
■ Educational events for schools on safety 1.A. 7. An organization in the United States
issues, such as wearing helmets while receiving federal funding demonstrates
riding bikes. corporate compliance through:
7.A. Leadership
■ Drug and alcohol programs. a. Implementation of a policy on

corporate compliance that has been
■ Education on health issues.
adopted by the organization’s
■ Employment opportunities. leadership.
Active involvement in community organiza-
7.a.A. Leadership
■ b. Designation of a staff member to

tions and service groups, such as chambers of serve as the organization’s compli-
commerce, rotary clubs, governor councils, ance officer:
advisory committees, and meals on wheels. 7.b.A. Leadership
(1) That is documented.

■ Providing reasonable accommodations to 7.b.(1)A. Leadership
(2) Who:
promote equal opportunities for participation 7.b.(2)A. Leadership
(a) Monitors matters pertaining

throughout all levels of the organization. to corporate compliance.
■ Providing access or referral to social, legal, 7.b.(2)(a)A. Leadership
(b) Conducts corporate compli-

or economic advocacy resources. ance risk assessments.
■ Involvement in projects and programs to 7.b.(2)(b)A. Leadership
(c) Reports on matters pertain-

inform, educate, protect and promote a ing to corporate compliance.
healthy and sustainable environment such 7.b.(2)(c)A. Leadership
c. Training of personnel on corporate

as recycling, use of environmentally friendly compliance, including:
products, reduction of consumption in the 7.c.A. Leadership
(1) Role of the compliance officer.

areas of water and energy, or reduction of 7.c.(1)A. Leadership
greenhouse gas emissions. (2) The organization’s procedures for

allegations of fraud, waste, abuse
Advocacy efforts for the person served could and other wrongdoing.
include the organization conducting or partic- 7.c.(2)A. Leadership
d. Internal auditing activities.

ipating in public education or activities that 7.d.A. Leadership
promote the elimination of discrimination and Intent Statements

stigma for the persons served. These activities The acceptance of federal funding requires
could include participation in a variety of public acceptance of the responsibility and account-
education efforts, community boards and ability for tracking the funds and determining
committees, newspaper articles, and radio and and overseeing how funds are being used and
television presentations. The organization can reported. Receiving federal funding not only
directly provide these sessions or actively partic- relates to direct federal funding but also indirect
ipate in them. Maintaining a log or file of the funding, such as that funneled through state
activities in which the organization is involved Medicaid or vocational rehabilitation systems.
can be helpful in demonstrating conformance. A The receipt of federal funding may occur in a
method of demonstrating internal conformance variety of ways including the direct receipt of
to this standard would be the use of “people first” Medicaid or Medicare funding, funding through
language in its publications, operations, and another entity (such as a block grant or funds
activities. received through a vocational rehabilitation or
other state agency contract), or funding through
Resources being a federally funded network.
A publication CARF has available for guidance
in developing or reviewing codes of conduct is

7.d. Internal auditing activities include audits suspected fraud, waste, and abuse from
that would reasonably uncover improper organizational personnel.
conduct and/or billing errors. 7.d. The internal auditing activities should
Examples be designed to evaluate the organization’s com-
Under corporate compliance systems, organiza- pliance with federal requirements as well as
tions develop and implement processes to assess determining the effectiveness of the compliance
compliance issues, take corrective measures, and program.
continually monitor compliance in all areas A corporate compliance program must be “effec-
including administration and service provision. tive” as defined by the U.S. sentencing guidelines
These systems should be guided by regulations and be “...reasonably designed, implemented, and
provided by the Centers for Medicaid and Medi- enforced so that it generally will be effective in
care (CMS), and consistent with Section 6401 preventing and detecting criminal conduct.”
of the Patient Protection and Affordable Care Perhaps the most practical benefit of having an
Act of 2010. effective corporate compliance program in place
Generally speaking, the term “compliance” is is the mandatory reduction in any monetary fines
used to describe the act of complying with or and penalties ordered by a judge who imposes a
acting in accordance with a set of standards or sentence on an organization. The implementa-
expectations mandated by an outside entity and tion of a corporate compliance program
is frequently used in conjunction with regulatory establishes an atmosphere that prompts early
reviews, licensing audits, etc. detection of any wrongdoing before it becomes
too serious and/or before it is detected through
The organization, by assigning an individual to
a regulatory or governmental audit or survey.
ensure that these business practices are followed,
demonstrates that it can be a responsible agent. Additional benefits of an effective corporate
compliance program are:
With these responsibilities, the organization is
■ Reducing the likelihood of a violation
committed to protecting its personnel when
actions of the organization are being put under occurring.
scrutiny. Personnel will be given assistance ■ Reducing the likelihood of civil liability,
during any investigative process. which comes chiefly in the form of demands
7.a. A policy on corporate compliance typically for return of overpayments, civil money
articulates the organization’s strong ethical cul- penalties, and whistle-blower lawsuits.
ture and commitment to compliance with all ■ Providing management with a different
applicable laws, regulations, and requirements. and generally more accurate view of the
The role of the compliance officer may be organization.
defined, including the compliance officer’s access ■ Establishing a structure of information
to top-level leadership and/or the governing relevant to the compliance program.
board. ■ Establishing a structure to maximize the right
7.b.(2)(a) The compliance officer may perform of confidentiality under the attorney-client
compliance related activities or monitor activities privilege.
delegated to other personnel.
The seven fundamental elements of an effective
7.b.(2)(b) Compliance risk assessment activities compliance program are to:
can be included in the organization’s risk man-
1. Implement written policies, procedures,
agement activities.
and standards of conduct.
7.b.(2)(c) The compliance officer reports to top-
2. Designate a compliance officer and
level leadership regarding compliance related
compliance committee.
activities, results of internal auditing activities,
and results of investigations from reports of 3. Conduct effective training and education
of all personnel.

4. Develop effective lines of communication. Intent Statements

5. Conduct internal monitoring and auditing. Leadership support is critical to the ability
of personnel to learn and implement current
6. Enforce standards through well-publicized
strategies and interventions.
disciplinary guidelines.
7. Respond promptly to detected offences and Examples
undertake corrective action. Examples of resources that leadership might pro-
vide include journal subscriptions, online access
Resources
to learning opportunities and reference materials
■ Office of Inspector General, U.S. Department or journals, guest speakers, sponsoring educa-
of Health and Human Services: tional events at the organization, in-service
– http://oig.hhs.gov programs, journal clubs, collaborative resource
– http://oig.hhs.gov/compliance/101/ or education efforts with other area providers
index.asp of services, financial support and/or time off to
– http://oig.hhs.gov/compliance/compli- participate in special interest groups or to attend
ance-guidance/index.asp conferences.
– http://exclusions.oig.hhs.gov/ Resources
■ System for Award Management (exclusion): Professional associations are frequently used
www.sam.gov/portal/public/SAM/ resources for information on evidence-based
practices, clinical practice guidelines, accepted
■ CMS regulations and guidance: practices in the field, and peer-reviewed publica-
www.cms.gov/Regulations-and-Guidance/
tions. Additional resources for information on
Regulations-and-Guidance.html?redirect=/
research and evidence-based practice include:
home/regsguidance.asp
■ National Rehabilitation Information Center
■ CMS outreach and education:
www.naric.com/research
www.cms.gov/Outreach-and-Education/
■ National Center for Dissemination of
Outreach-and-Education.html
Disability Research www.ncddr.org
■ Federal Register (final rulings for
■ United States Department of Veterans Affairs
regulations):
www.federalregister.gov Rehabilitation Research and Development
www.rehab.research.va.gov
■ Office for Civil Rights (HIPAA):
■ Center for International Rehabilitation
www.hhs.gov/ocr/office/index.html
Research Information and Exchange
■ ADA: www.ada.gov/ cirrie.buffalo.edu
■ Social Security (Title XIX, grants to states
■ NHS Evidence www.evidence.nhs.uk/nhs-
for medical assistance programs):
evidence-content
http://www.ssa.gov/OP_Home/ssact/title19/
1900.htm
1.A. 8. Leadership provides resources and edu-

cation for personnel to stay current in the
field in order to demonstrate program
strategies and interventions that are
based on accepted practices in the field
and current research, evidence-based
practice, peer-reviewed scientific and
health-related publications, clinical
practice guidelines, and/or expert
professional consensus.
8.A. Leadership

Section 1.B. Governance (Optional)
Documentation Examples B. Governance (Optional)

The following are examples of the types of infor-
mation you should have available to demonstrate Description
your conformance to the standards in this sub-
section. See Appendix A for more information The governing board should provide effective
on required documentation. and ethical governance leadership on behalf of
its owners’/stakeholders’ interest to ensure that
■ Organizational chart
the organization focuses on its purpose and
■ Corporate compliance policy, if applicable outcomes for persons served, resulting in the
■ Corporate responsibility plan, if applicable organization’s long-term success and stability.
■ I-9 information, if applicable
The board is responsible for ensuring that the
organization is managed effectively, efficiently,
■ Policy on Family Medical Leave Act (FMLA),
and ethically by the organization’s executive
if applicable
leadership through defined governance account-
■ Affirmative Action policy, if applicable ability mechanisms. These mechanisms include,
■ Code(s) of ethics or code(s) of ethical conduct but are not limited to, an adopted governance
■ Policy/procedure for resolving allegations of framework defined by written governance poli-
violations of codes of ethical conduct cies and demonstrated practices; active and
timely review of organizational performance and
■ Information showing resolution using this
that of the executive leadership; and the demar-
procedure, if any allegation has occurred
cation of duties between the board and executive
■ Outcomes management report/performance
leadership to ensure that organizational strate-
analysis gies, plans, decisions, and actions are delegated to
■ Governing documents (bylaws, articles of the resource that would best advance the interests
incorporation, etc.), if applicable and performance of the organization over the
■ Minutes from governance meetings, if long term and manage the organization’s inherent
applicable risks. The board has additional responsibilities
■ Mission and vision statements
under the domain of public trust, and as such, it
understands its corporate responsibility to the
■ Job description of chief executive
organization’s employees, providers, suppliers,
■ Management/leadership meeting minutes and the communities it serves.
■ Cultural competency and diversity plan
■ A file of information related to advocacy

Applicable Standards
activities
These governance standards may be applied,
at the option of the organization, if the organi-
zation has a corporate governing board. The
organization must indicate on its survey appli-
cation that it wishes to have the governance
standards applied.
When elected, these standards apply only to
the board vested with legal authority to direct
the business and affairs of the organization’s
corporate entity. These standards may not be
applied to bodies lacking governance authority
granted by state or provincial corporation laws,
such as advisory and community relations
boards and management committees.

For example, if a hospital is seeking accredita-

tion at the level of its brain injury program, and
1.B. 2. Governance policies address:
2.B. Governance
the hospital requested that these standards be a. The selection of the board, including:
2.a.B. Governance
applied as an effort to review the governance (1) Board membership criteria.

2.a.(1)B. Governance
practices in the organization, the standards (2) Selection process.

would be applied to the hospital’s governing
(3) Exit process.

board and not to the program’s leadership 2.a.(3)B. Governance
b. Board member orientation.

(unless the program is separately incorporated, 2.b.B. Governance
c. Board development.
in which case they would apply to the pro- 2.c.B. Governance
gram’s board if it has the vested authority). d. Board education.

2.d.B. Governance
e. Board leadership, including

For more information, please contact your
selection of:
customer service unit. 2.e.B. Governance
(1) Board chair.

2.e.(1)B. Governance
1.B. 1. The board has governance policies that: (2) Committee chairs.
1.B. Governance
a. Facilitate ethical governance f. Board structure, including:

2.f.B. Governance
practices. (1) Board size.

2.f.(1)B. Governance
1.a.B. Governance
b. Assure stakeholders that governance is: (2) Board composition.

1.b.B. Governance
(1) Active in the organization. (3) Definition of independent,

1.b.(1)B. Governance
(2) Accountable in the organization. unrelated board representation.

1.b.(2)B. Governance
c. Meet the legal requirements of (4) Duration of board membership.

governance. g. Board performance, including:

2.g.B. Governance
1.c.B. Governance
(1) Financial matters, if any, between

Intent Statements
the organization and individual
The board should clearly document its approach board members, including:
and duties related to governance including its 2.g.(1)B. Governance
(a) Compensation.
compliance with applicable statutes and provi- 2.g.(1)(a)B. Governance
sions of articles of incorporation and bylaws. (b) Loans.

2.g.(1)(b)B. Governance
Board members are subject to three basic legal (c) Expense reimbursement.
2.g.(1)(c)B. Governance
duties in performing their responsibilities: duty (d) Stock ownership.

of care, duty of loyalty, and duty of obedience. 2.g.(1)(d)B. Governance
(e) Other matters of financial

Accountability requires that oversight mecha- interest.
nisms be in place, such as meetings, reports, 2.g.(1)(e)B. Governance
(2) Use of external resources,

and timely reviews of corporate performance.
including, as applicable:
Examples 2.g.(2)B. Governance
(a) External auditors.

Examples could include: 2.g.(2)(a)B. Governance
(b) Executive compensation

■ Documented governance policies. advisors.
2.g.(2)(b)B. Governance
■ Annual review of bylaws (legal requirements). (c) Other advisors, as needed.

2.g.(2)(c)B. Governance
■ Delegation of authority to executive leader- (3) Annual self-assessment of the

ship with defined limits, such as financial entire board.
2.g.(3)B. Governance
limits. (4) Periodic self-assessment of

■ Assurance that internal control and risk individual members.
management systems, delegated to executive (5) Annual written and signed

leadership, are in place. conflict of interest declaration.
■ Timely reviews of corporate performance (6) Annual written and signed ethi-
(e.g., quarterly). cal code of conduct declaration.
■ Annual reports to stakeholders. (7) External interactions.

■ Input meetings with stakeholders.

Intent Statements and terms—are all decisions unique and specific

2.a. The board has sole responsibility to deter- to each organization.
mine appropriate skills and characteristics Each organization should assess the optimum
required for a competent and contributing board number of board members it needs with the
member. Each organization and its board must requisite skills to thoroughly exercise governance
consider and identify its own member criteria oversight. It is the board’s responsibility to decide
(such as skills, diversity, representation of person how it should strike a balance between the
served) and follow a selection process that broad-based skills and experiences necessary
accounts for the perceived needs of the board at for the board, with the pragmatic consideration
the time of selection, attracting board members of managing the structure and process of a larger
who have the time to devote to board activities to board. Although larger boards may bring diverse
advance the organization’s purpose. Establishing skills, they do not necessarily bring better
membership criteria and defining a selection governance.
process should attract board members with The approach an organization takes regarding
the necessary skills and knowledge to do their the term of board membership is also subject to
job well. board deliberation and decision. No term limits,
The board should also manage its own gover- with acceptable board performance, ensures
nance performance by reviewing the collective continuity in knowledge and community rela-
board and individual members. In the event that tionships. Natural attrition and term limits bring
performance issues arise with any specific board renewal and new vigilance by virtue of new skills
member (such as not attending meetings or lack and experiences of new members. Boards that
of meaningful participation) the board must frequently turn over tend to create organizational
clearly identify its protocol to discharge a board instability as both knowledge and experience is
member in a defined exit process. lost to the organization. The board must deter-
2.b. Board member orientation usually requires mine its approach in the context of the
that both the board and executive leadership organization.
conduct a comprehensive orientation process Board member independence and unrelatedness
to ensure the board member becomes familiar to executive leadership allows the board to act
with the organization’s vision—mission, strategic without undue influence from management.
direction, values, ethics, financial matters, gover- Further, when selecting a qualified candidate for
nance practice, and policies in keeping with legal board membership, a mix of members who have
and/or other reporting requirements (e.g., annual no ties or relationships to the organization is one
tax filings). way of ensuring independence. This effort can
2.c.–d. The organization should continually make be satisfied through at-large members who can
efforts to build governance capacity through balance the varied interests of board members.
ongoing education. Rather than specifically rely- Independent and unrelated board members may
ing on the individual expertise of a particular sometimes lead the governance management or
board member, the organization should make a executive compensation committees to enhance
concerted effort to advance the skills of the entire accountability.
board, as the whole board is ultimately account- 2.g.(1) The board must set the ethical tone in the
able, speaking with one voice. organization and model integrity in its conduct.
2.e. The board should act freely to select a chair In the case of publicly traded or other for-profit
who is best for the board and organization at a organizations, the board may receive compen-
given time. With respect to selecting the board sation and other forms of financial incentives. In
chair or specific committee chairs, the organiza- not-for-profit organizations, there may be other
tion should identify those criteria and selection financial links not directly apparent. Board policy
processes. should address these issues, supported by signed
2.f.(1)–(4) Good governance means performing conflict of interest and ethical code of conduct
effectively in clearly defined roles and functions. declarations.
The structure of governance—board size, mix,

2.g.(2) Many governance decisions are complex ■ Discussing the board’s effectiveness at the
and significant; therefore, the board should seek conclusion of each board meeting, rolled
expert advice. Although expert advice can be into a year-end review documented in
provided through the organization’s internal board minutes.
experts, the board should seek external profes-
■ Completing a year-end questionnaire tallied
sional advice on complex legal and financial
for board discussion. The following are
issues as necessary. Access to external expert
sample questions, which can be rated by
advice can be coordinated and supported by
board members as Excellent, Good, Fair,
the organization’s executive leadership.
Poor, or N/A:
2.g.(3)–(4) The board as a whole should con-
tinuously assess its performance in an effort – Legal Frameworks:
to determine its effectiveness in governing the - Statements in the governing documents
organization. This assessment ensures that the (e.g., bylaws, policies) setting forth the
board is fulfilling its duties and evolving within board’s function and duties are:
the context of challenges the organization may
– Board Structure:
face. Assessing board achievement and oppor-
tunity to improve will facilitate an evolving -The board’s size in relation to the
governance model to ensure that its activities organization’s needs is:
remain relevant and effective on behalf of - The board’s spread and balance in
owners/stakeholders. This concept also applies regard to expertise, age, diversity,
to individual board members. interest, and points of view are:
2.g.(7) Outside parties may include advisors, – Board Comprehension:
regulators, investors, press, consumers, and
customers. - The board’s comprehension of the inter-
ests of various constituencies (funders,
Examples persons served, and advocates) with
2.e. A selection criterion for the finance/audit which the organization deals is:
committee chair could ideally be a board – Board Practices:
member with a finance background.
- The board’s orientation to the
2.g.(2) Examples of situations in which the organization is:
use of external advisors or resources would
- The frequency of board meetings in
be appropriate could include:
relation to organizational needs is:
■ Seeking financial or legal advice on a
merger or acquisition. - The board’s practices with regard to
amendments of bylaws are:
■ Getting advice from an expert on corporate
- The board’s practices with regard to
risk management.
election of officers are:
■ Getting advice from a financial expert
- The board’s practices with regard to
on organization investment policies.
establishing committees and their
2.g.(3) Whole board assessment strategies mandates are:
can include:
– Board Performance:
■ Completing meeting questionnaires
- The board’s performance in formulating
(e.g., questions rated strongly agree, agree,
the organization’s long-term goals is:
neutral, disagree, or strongly disagree).
– We (the board) spent our time on the - The board’s ability to monitor its own
accomplishments and progress is:
most important governance topics.
- Performance standards expected by
– We used our time effectively.
the board for attending all regularly
– The meeting was chaired effectively. scheduled meetings are:

- Performance standards expected by the 3.a. Determining the relationship between the
board for committee participation are: board and the organization’s executive leadership
- Performance standards expected by the requires significant thoughtfulness and diligence
board for referral of prospective board to be clear about the functions of governance
versus the duties delegated appropriately to the
members are:
organization’s management. Although each
– Relations with Executive Leadership: organization determines appropriate roles, gen-
- The board’s working relationship with erally boards ensure that the organization has a
the chief executive officer is: vision for its future via goals, aims, missions, or
ends and that management work is conducted
- The definitions of the roles of the chief
legally, ethically, and with integrity to achieve
executive officer and board are:
those goals. The board’s accountability to its
2.g.(4) Individual board self-assessment can stakeholders is achieved by holding the organiza-
include: tion’s management accountable for performance.
■ A yearly self-assessment questionnaire and The board delegates authority to management to
resulting discussion with the board chair. conduct business via resource use (e.g., money,
The following are sample questions, which people, technology) and ensures that executive
can be rated by board members as Excellent, leadership develops plans and acts to achieve
organizational goals. This delegation and review
Good, Fair, Poor, or N/A:
process is a continuous oversight mechanism,
– My understanding of the organization’s culminating in an annual review of the organiza-
mission, vision, and core values is: tion’s (and therefore, the executive leadership’s)
– My understanding of the legal requirements success.
and stipulations under which the board acts This delegation of authority differentiates
is: between the authority of the executive leader-
– When outside auditors present the financial ship and the authority of the board.
statements, my understanding of those 3.b. From time to time, the board may need
documents is: access to varied management and staff in carry-
– My attendance at board meetings is: ing out its governing duties. So as not to cross
into management authority, the board should be
– My preparedness for board and committee
clear on when and how it may consult with other
meetings is: management/staff to enhance its governance
– My working relationship with other board duties. This relationship is established between
members is: the board and executive leadership so that mana-
gerial operations are maintained as a priority for
1.B. 3. The board’s relationship with executive those assigned to that responsibility. The organi-
leadership includes: zation should ensure that the board has
3.B. Governance
appropriate administrative support.
a. Delegation of:
3.a.B. Governance
(1) Authority to executive Examples

leadership. 3.c. The organization may show support of the
governing body by how it shares information
(2) Responsibility to executive

leadership. with members of the governing body; how
b. As appropriate, access to personnel. time and space are provided in support of

3.b.B. Governance
governance-related work; the types of resources
c. Support of governance by the
made available to the board for educational
organization.
3.c.B. Governance purposes such as orientation to the organization,
Intent Statements memberships in professional associations in the
See the Glossary for the definition of executive field, or membership in an organization such as
leadership. Boardsource (www.boardsource.org) which
promotes effective governance practices.

(4) Professional accomplishments.

1.B. 4. Board processes include: 5.a.(4)B. Governance
4.B. Governance (5) Professional opportunities.

a. Agenda planning. 5.a.(5)B. Governance
4.a.B. Governance b. An annually reviewed executive

b. Developing meeting materials.
4.b.B. Governance
leadership succession plan.
c. Distributing meeting materials. 5.b.B. Governance
4.c.B. Governance
Intent Statements
d. Overseeing the following committee
work, as applicable: Evaluation of executive leadership is an essential
4.d.B. Governance
part of performance management and should
(1) Governance development.
4.d.(1)B. Governance include opportunities for continued growth and
(2) Governance management. development.
4.d.(2)B. Governance
(3) Financial audit. 5.b. Succession planning for executive leadership

(4) Executive compensation. ensures continuity of leadership due to the

(5) Other pertinent activities, planned or unplanned departure of the chief

as defined by the board. executive. To manage associated risks of
unplanned leadership vacancies, the board

Examples
should have a plan for this. Details of such a
4.d.(2) Governance management would be plan vary by organization and often the current
demonstrated by the operational implementation executive leadership is charged with providing
of the governance policies of the board. Is the this plan to the board annually.
“work” of the board being managed to be timely,
Examples
in accord with its policies, and accountable
to the organization? Consider things such as 5.b. The succession plan for review may include
how the selection process of new members is an annual letter from the executive leadership
handled; evaluating board performance (the to the board identifying two internal candidates
self-assessment process both of the board and who can fill the position on a temporary or per-
individual members); and addressing any manent basis. Often, this leads the board into a
perceived deficiencies, ensuring that meeting joint discussion with executive leadership on the
protocols are properly followed and that annual skills, capacity, and depth of leadership potential
activities such as signing of conflict of interest in the organization.
and ethical code of conduct declarations are A complex and thorough competency-based
completed. Many of these would be demon- succession program should assess competencies
strated by what is recorded in board minutes necessary for organizational leadership positions,
and actual documents that were completed. match against annual 360 review of potential
The board might have a schedule or calendar internal candidates, and identify promotion or
of when specific things such as the self- development opportunities.
assessments are to be completed and ensures
that they are. 1.B. 6. Governance policies address executive
compensation, including:
1.B. 5. Governance policies address executive 6.B. Governance
a. A written statement of total executive

leadership development and evaluation, compensation philosophy.
including: 6.a.B. Governance
b. Review by an authorized board com-

5.B. Governance
a. Formal annual written review of mittee composed of independent,

executive leadership performance unrelated board members.
in relation to: 6.b.B. Governance
c. Defined total compensation mix,

5.a.B. Governance
(1) Overall corporate performance up to and including, as warranted:

versus target. 6.c.B. Governance
(1) Base pay.

(2) Individual performance versus 6.c.(1)B. Governance
(2) Incentive plans.

target, if applicable. 6.c.(2)B. Governance
(3) Professional development.


(3) Benefit plans. compensation arrangement, followed by docu-

6.c.(3)B. Governance
(4) Perquisites. menting the process that supports that decision.

6.c.(4)B. Governance
d. Total compensation references to: Examples

6.d.B. Governance
(1) Market comparator data. As a general guide, publicly traded for-profit

(2) Functionally comparable companies have models of executive compensa-

positions. tion programs/approaches or protocols that
detail the principles and philosophies of various
e. A documented process that outlines:

6.e.B. Governance
(1) Terms of compensation compensation models. These, with modification,

arrangements. could be used by not-for-profit organizations.
(2) Approval date. Comparison to or benchmarking of total

(3) Names of board members on compensation plans can include many sources:
salary surveys (regional/national), profit versus
the committee who approved
nonprofit, functional responsibility of leadership
the compensation decision.
6.e.(3)B. Governance regardless of tax status, and comparators or
(4) Data used in the compensation comparator mixes that can establish a policy
decision.
line for executive leadership pay.
(5) Disclosures of conflict of interest,
if any. Resources
(6) Annual review of executive For U.S. nonprofits, Section 53.4958-6 of the
compensation records. Treasury Regulations also outlines a process
(7) Authority of board members to that a board of a tax-exempt entity should follow
exercise executive compensation to reduce exposure to penalties in relation to
actions. unreasonable compensation.
 The Canadian Society of Association Executives

Intent Statements
may be a useful resource for information on
The board’s role in determining executive executive compensation.
compensation remains a high-profile task for
the governing board whether organizations are
for-profit or not-for-profit. A board-endorsed 1.B. 7. The governing board annually reviews
compensation philosophy is intended to provide its governance policies.
7.B. Governance
a broad-based foundation for designing an Examples

effective compensation and performance man- Examples of how to conduct this annual review
agement plan for executive leadership. It should
may include a review of policies by a board com-
be broad enough to provide an enduring founda-
mittee with the review documented in meeting
tion, yet be specific enough for the board to make
minutes, or a staff liaison to the board may help
annual compensation decisions on an informed
and reasonable basis. A compensation plan must
to facilitate this review with the board.
attract and retain leadership talent, yet respond
to market trends, reflecting the value of the func-
tional demands of executive work and rewarding
performance results. Further, tests of reasonable-
ness regarding executive pay also place board
members at potential personal risk. That risk is
minimized by ensuring that executive compensa-
tion decisions are independently approved by the
governing board or committee acting on behalf
of the board in a non-conflict-of-interest position.
Further, appropriate practice would also involve
using comparability data before approving a

Documentation Examples
mation you should have available to demonstrate
section. See Appendix A for more information
on required documentation.
■ Board organizational chart
■ Ethical practices policy
■ Board selection and composition policies
■ Board leadership policies
■ Board structure and performance policies
■ Board annual self-assessment documentation
■ Individual board member self-assessment

documentation
■ Annual signed conflict of interest declarations
■ Annual signed ethical code of conduct

declarations
■ Sample board meeting agendas
■ Sample meeting materials
■ Executive leadership development and

evaluation policies
■ Executive compensation policies
■ Annually reviewed executive leadership

succession plan
■ Formal annual written review of executive
leadership performance

Set Strategy
Each organization has at its core a purpose

developed through environmental assessment.
C. Strategic Planning
Setting strategy is the activity of understanding
the environment and organizational compe- Description
tencies, identifying opportunities and threats, CARF-accredited organizations establish a foun-
and articulating a high-level map of the direction dation for success through strategic planning
to take in order to achieve, sustain, and advance focused on taking advantage of strengths and
organizational purpose in a competitive opportunities and addressing weaknesses and
environment. Strategy translates the salient threats.
environmental factors into tangible planning
assumptions, sets goals and priorities, and 1.C. 1. The ongoing strategic planning of the
globally aligns resources to achieve performance organization considers:
targets. 1.C. Strategic Integrated Planning
a. Expectations of persons served.

1.a.C. Strategic Integrated Planning
b. Expectations of other stakeholders.

1.b.C. Strategic Integrated Planning
c. The competitive environment.

1.c.C. Strategic Integrated Planning
d. Financial opportunities.
1.d.C. Strategic Integrated Planning
e. Financial threats.
1.e.C. Strategic Integrated Planning
f. The organization’s capabilities.

1.f.C. Strategic Integrated Planning
g. Service area needs.

1.g.C. Strategic Integrated Planning
h. Demographics of the service area.

1.h.C. Strategic Integrated Planning
i. The organization’s relationships

with external stakeholders.
1.i.C. Strategic Integrated Planning
j. The regulatory environment.

1.j.C. Strategic Integrated Planning
k. The legislative environment.

1.k.C. Strategic Integrated Planning
l. The use of technology to support:

1.l.C. Strategic Integrated Planning
(1) Efficient operations.

1.l.(1)C. Strategic Integrated Planning
(2) Effective service delivery.

(3) Performance improvement.

m. Information from the analysis of

performance.
1.m.C. Strategic Integrated Planning
Intent Statements
1.l.(1)–(3) Technology has an ever increasing
role and presence in today’s human services
environment. While the use of technology and
the sophistication of that technology will vary
among organizations, each organization consid-
ers current literature and professional consensus
in determining its current and future technology
needs and identifies the resources needed to
advance its use of technology to support

Section 1.C. Strategic Planning
operations, effective service delivery, and

performance improvement. 1.C. 2. A strategic plan:
2.C. Strategic Integrated Planning
This standard relates to Standard 1.J.1. a. Is developed with input from:

(1) Persons served.

See the glossary for the definition of strategic 2.a.(1)C. Strategic Integrated Planning
planning. (2) Personnel.

2.a.(2)C. Strategic Integrated Planning

Examples 2.a.(3)C. Strategic Integrated Planning
b. Reflects the organization’s financial

1.f. Capabilities can include areas such as human position:
resources, research and development, and succes- 2.b.C. Strategic Integrated Planning
(1) At the time the plan is written.

sion planning for key positions in administration, 2.b.(1)C. Strategic Integrated Planning
finance, and service delivery. (2) At projected point(s) in the

future.
1.g. Consideration of service area needs may 2.b.(2)C. Strategic Integrated Planning
include waiting list and information regarding (3) With respect to allocating
persons served found ineligible for, or excluded resources necessary to support
from, services. accomplishment of the plan.
2.b.(3)C. Strategic Integrated Planning
c. Sets:
1.h. Consideration of your community demo- 2.c.C. Strategic Integrated Planning
graphics is important in planning as changes in (1) Goals.

2.c.(1)C. Strategic Integrated Planning
demographics directly impact the population (2) Priorities.

2.c.(2)C. Strategic Integrated Planning
your programs serve. Consider as an example an d. Is implemented.

organization that was started more than 30 years
2.d.C. Strategic Integrated Planning
e. Is reviewed at least annually for

ago in a very rural area, which has become indus- relevance.
trial or has experienced a settlement of a large 2.e.C. Strategic Integrated Planning
f. Is updated as needed.
immigrant population. Such a demographic 2.f.C. Strategic Integrated Planning
change affects many areas including finances Intent Statements

and expectations of the community members. The strategic plan sets forth an organizational
1.i. External stakeholders may include educa- roadmap for the future in consideration of rele-
tional institutions. vant business, environmental, and other factors.
Because sound business practice demands that
1.k. An organization evaluates changes in the plan be used as a dynamic tool, it should
public funding from legislation, such as the be reviewed at least annually and modified as
Patient Protection and Affordable Care Act appropriate.
and Medicaid waivers, and integrates the
information into the planning process. Examples
1.l.(1)–(2) Some organizations have found that The strategic plan addresses the programs/
providing community-based staff with laptop services seeking accreditation. If the programs/
computers and/or tablets increases the amount of services are part of a larger organization and not
time they can spend in services as it relieves the specifically addressed in its strategic plan, the
travel-time associated with having to go to an programs/services may establish a separate plan
administrative site to complete notes and reports. or generate a supplement to the organization’s
plan that addresses input, financial position, and
Resources goals and priorities pertinent to the programs/
1.l.(1)–(2) There are numerous web-based services.
resources that may be used, including: 2.a. Input used is directly related to Standard
■ www.techsoup.org 1.D.1. in which input is gathered from all stake-
■ www.nonprofit.about.com holders using a variety of mechanisms. Input
might include information from input forums,
surveys, and performance improvement
activities.

Section 1.C. Strategic Planning
2.b.(2) An organization is better able to define Documentation Examples

success with proactive long-term financial plan- The following are examples of the types of infor-
ning measures. Since the future financial position mation you should have available to demonstrate
of an organization is impacted by ever changing your conformance to the standards in this sub-
marketplace factors such as coding, payment, section. See Appendix A for more information
reimbursement, and costs, the strategic plan on required documentation.
might include information reflecting long-term
■ Strategic plan
financial planning to support the goals and prior-
■ Leadership or management meeting minutes,
ities identified. Points in the future might be one
year, two years or other points in time depending where strategic planning was discussed
on regulatory and business factors impacting the ■ Meeting agendas or minutes where strategic
organization. plan has been shared with personnel

2.e. An organization determines the method of
review and update. Since environmental factors
play an important role, if there are significant
changes, this could prompt leadership to con-
sider updating more often than annually to
maintain the relevance of the plan to current
conditions.
Resources
A helpful planning resource is the CARF
monograph Strategic Positioning and Planning
in the 21st Century. An electronic copy may be
requested by contacting your CARF resource
specialist.
1.C. 3. The strategic plan is shared, as relevant

to the needs of the specific group, with:
3.C. Strategic Integrated Planning
a. Persons served.
b. Personnel.
3.b.C. Strategic Integrated Planning
c. Other stakeholders.
3.c.C. Strategic Integrated Planning
Examples
An annual report might include information
on the strategic direction and achievement of
an organization’s strategic objectives. It is not
expected that an organization share information
it considers confidential and critical to its
positioning.

Persons Served and Other Stakeholders—
Obtain Input
In a service environment, organizational success

cannot be achieved or sustained without success
D. Input from Persons
for the persons served. Actively engaging the Served and Other
persons served as part of the planning and ser-
vice processes has been demonstrated to result Stakeholders
in better outcomes. In fact, the more the organi-
zation obtains feedback from persons served and Description
other stakeholders relative to all appropriate CARF-accredited organizations continually focus
organizational functions, the better the outcomes on the expectations of the persons served and
reported. The important role of input from per- other stakeholders. The standards in this subsec-
sons served and other stakeholders is recognized tion direct the organization’s focus to soliciting,
by its prominent position in the ASPIRE to collecting, analyzing, and using input from
Excellence framework. This input process all stakeholders to create services that meet or
engages all parties in a sense of shared future that exceed the expectations of the persons served,
promotes long-term organizational excellence the community, and other stakeholders.
and optimal outcomes.
1.D. 1. The organization demonstrates that
it obtains input:
1.D. Person Served-Stakeholder Input
a. On an ongoing basis.
1.a.D. Person Served-Stakeholder Input
b. From:
1.b.D. Person Served-Stakeholder Input
(1) Persons served.

1.b.(1)D. Person Served-Stakeholder Input
(2) Personnel.

c. Using a variety of mechanisms.

1.c.D. Person Served-Stakeholder Input
Intent Statements
Input is requested and collected to help deter-
mine the expectations and preferences of the
organization’s stakeholders and to better under-
stand how the organization is performing from
the perspective of its stakeholders. The input
obtained relates to the organization’s services,
persons served, and business practices. The
organization identifies the relevant stakeholders,
besides the persons served, from whom it solicits
input.
Examples
1.a. It is important to not only use a variety of
mechanisms to collect information but also to
collect information throughout the year. For
example, simply having an annual public forum

Section 1.D. Input from Persons Served and Other Stakeholders
would not meet the intent of this standard Examples

since the standard requires ongoing collection Input can be used in various ways: changing
of information. service delivery designs; developing, improving,
1.b.(3) Please refer to the glossary for the or eliminating services; developing short- and
definition of stakeholders. long-range planning; and identifying personnel
1.c. There are a variety of mechanisms to solicit training needs.
and collect information, which may range from The organization uses stakeholder input to direct
the informal to the formal. ongoing quality improvement. This process is
Mechanisms may include: a continuous cycle of quality improvement in
which the organization seeks and uses the input
■ Advisory groups, consumer forums, or
it gets from its stakeholders.
focus groups.
During the survey, the organization might share
■ Telephone or online surveys.
how it has analyzed the input it has obtained
■ Social media. and used that analysis for program planning,
■ Conferences. performance improvement, strategic planning,
■ Suggestion boxes.
organizational advocacy, financial planning, and
resource planning. For example, the organization
■ Complaint or incident summaries.
might have started providing Employer of Record
■ Performance improvement activities. services to families of persons who are in self-
■ Environmental scans for strategic planning. directed services and have asked for this assis-
Please see the Glossary for the definition of tance, or offering a specialized employment
strategic planning. support program to serve persons with autism
because key funding sources have indicated a
need.
1.D. 2. The leadership:
2.D. Person Served-Stakeholder Input
2.b.(4) Organizational advocacy may be defined
a. Analyzes the input obtained.
2.a.D. Person Served-Stakeholder Input as intentional and possibly ongoing activities of
b. Uses the input in: personnel/leadership intended to enhance the
2.b.D. Person Served-Stakeholder Input
(1) Program planning. achievement and wellbeing of the persons served

(2) Performance improvement. by the organization. These activities are also

referred to as social accountability. Examples
(3) Strategic planning.

(4) Organizational advocacy. include having the organization engaged in

legislative advocacy for research on conditions
(5) Financial planning.
2.b.(5)D. Person Served-Stakeholder Input impacting persons served, increased funding for
(6) Resource planning. services, greater availability of on-demand trans-
Intent Statements portation services, or employment-related issues

The input is continually analyzed, and the analysis that may impact the workforce of the organiza-
is integrated into the business practices of the tion. It might also relate to neighborhood safety
organization. The input is analyzed to help deter- or zoning-related topics.
mine if the organization is:
■ Meeting the current needs of the persons
■ Offering services/products that are relevant to
the persons served and other stakeholders.
■ Identifying potential new opportunities for
the growth and development of programs
and services.

Section 1.D. Input from Persons Served and Other Stakeholders
■ Minutes of consumer meetings
■ Information regarding consumer and

community input
■ Minutes of staff and board meetings
■ Satisfaction surveys from consumers and

other stakeholders, such as board members,
funder and referral sources, parents and
guardians, staff persons, and other
community members
■ Short- and/or long-range planning
documents

Implement the Plan
The strategic plan, based on a thorough assess-

ment of environmental factors, provides a
E. Legal Requirements
roadmap to achieving organizational purpose.
To actually achieve its purpose, the organization Description
must translate strategic goals into tangible action. CARF-accredited organizations comply with all
Implementation is the development and enact- legal and regulatory requirements.
ment of tactical steps designed to achieve
strategic goals. Sound implementation requires 1.E. 1. The organization demonstrates a process
a solid foundation of service delivery and busi- to comply with the following obligations:
ness practices operationalized via organizational 1.E. Legal Requirements
a. Legal.
resources, including personnel, technology, 1.a.E. Legal Requirements
b. Regulatory.
and assets. Excellence is attained through the 1.b.E. Legal Requirements
c. Confidentiality.
translation of strategy into practices that, when 1.c.E. Legal Requirements
performed by a competent workforce and d. Reporting.

1.d.E. Legal Requirements
enhanced by the effective use of available e. Licensing.

1.e.E. Legal Requirements
resources, achieves the desired outcomes. f. Contractual.

1.f.E. Legal Requirements
g. Debt covenants.
1.g.E. Legal Requirements
h. Corporate status.
1.h.E. Legal Requirements
i. Rights of the persons served.

1.i.E. Legal Requirements
j. Privacy of the persons served.

1.j.E. Legal Requirements
k. Employment practices.
1.k.E. Legal Requirements
l. Mandatory employee testing.

1.l.E. Legal Requirements
Intent Statements
The organization should engage in activities
designed to promote awareness, understanding,
and satisfaction of its various obligations at all
times. Satisfaction of obligations is necessary for
the organization’s success, sustained existence,
and ability to positively affect the lives of persons
served. Failure to satisfy obligations may result
in monetary or other penalties, potentially
impacting the viability of the organization, as
well as harm to those the obligations are
intended to protect. The organization should
monitor its environments for new and revised
obligations and utilize knowledgeable resources
to become familiar with obligations and the
requirements to meet them.
Examples
This standard encourages organizations to com-
ply with legal and regulatory requirements and to

Section 1.E. Legal Requirements
maintain and update its policies and practices to 1.i. The organization ensures that the rights of
reflect changes. Often, professional associations persons served are promoted and protected.
can be excellent resources for guidance and Procedures and practices of personnel dem-
updates. onstrate compliance with all applicable laws.
Systems are in place for ongoing review and Policies regarding the human rights and dignity
monitoring of legal and regulatory requirements of the persons served have been written and
to ensure compliance. Policies, procedures, and communicated to personnel through the organi-
practices are revised to reflect changes in require- zation’s code of ethics and to the persons served
ments. Information on legal/regulatory topics is in a manner understandable to them. A good
provided to personnel through trainings, meet- practice an organization may follow is to include
ings, alerts, or other communications to ensure this information in its employee handbook or
accurate knowledge and compliance. present it through audio recordings, videos,
pictures, and other media.
1.a. All U.S. employers must complete and
retain a Form I-9 for each individual they hire 1.l. Local health and licensing agencies can
for employment in the United States. This provide guidance in this area.
includes citizens and noncitizens. On the form, Resources
the employer must examine the employment For organizations in the United States receiving
eligibility and identify document(s) an employee
Federal funds, information about the List of
presents to determine whether the document(s)
Excluded Individuals and Entities and associated
reasonably appear to be genuine and relate to the
penalties:
individual and record the document information
■ oig.hhs.gov/exclusions/index.asp
on the Form I-9. This list of acceptable docu-
ments can be found on the last page of the form. ■ oig.hhs.gov/fraud/enforcement/cmp/
Forms are available in English and Spanish. index.asp

For more information and forms, see ■ oig.hhs.gov/fraud/enforcement/cmp/
www.uscis.gov/i-9; www.uscis.gov/files/form/i- false_claims.asp
9.pdf; www.uscis.gov/files/form/m-274.pdf.
It is suggested that the I-9 forms not be kept in 1.E. 2. The organization implements written
the personnel files. procedures to guide personnel in
The organization ensures compliance with other responding to:
legal authorities, as applicable, including the 2.E. Legal Requirements
a. Subpoenas.
Federal Exclusions List. The Office of Inspector 2.a.E. Legal Requirements
b. Search warrants.
General has the authority to exclude individuals 2.b.E. Legal Requirements
and entities from federally funded healthcare c. Investigations.

2.c.E. Legal Requirements
programs and maintains a current List of d. Other legal action.

Excluded Individuals and Entities (LEIE). Examples

Anyone who hires an individual or entity on With these responsibilities, the organization is
the LEIE may be subject to civil monetary committed to protecting its personnel when
penalties. For more information, refer to actions of the organization are being put under
oig.hhs.gov/exclusions/index.asp. scrutiny. Personnel will be given assistance
1.b. Regulatory requirements would include during any investigative process.
registration and licensing of organization-owned
vehicles.
1.E. 3. Policies and written procedures address:
Regulatory requirements for organizations pro- 3.E. Legal Requirements
a. Confidential administrative records.

viding direct personal care supports may include 3.a.E. Legal Requirements
b. The records of the persons served.

bonding or other mechanisms for protecting 3.b.E. Legal Requirements
assets of the person served. c. Security of all records.

3.c.E. Legal Requirements
d. Confidentiality of records.

Section 1.E. Legal Requirements
e. Compliance with applicable laws are stored in locations other than the central
concerning records. location, safeguards for each of these locations
are in place. It would also be the responsibility
3.e.E. Legal Requirements
f. Time frames for documentation in

the records of the persons served. of an organization to determine what the content
3.f.E. Legal Requirements
of its records will include or exclude.

Intent Statements
3.c. Protection of records from permanent
In order to protect the privacy of all stakeholders
loss or damage includes protection from fire
and any confidential information that its records
and water damage as well as records recovery
may contain, an organization ensures that it
in the event of damage.
addresses the applicable legal and regulatory
requirements concerning privacy of health 3.c.–d. Safeguards can include:
information and confidential records. Security ■ Limited access, including to electronic
includes such things as storage, protection, records.
retention, and destruction of records. Safeguards
■ Storage under lock (in a locking drawer or
such as reasonable protection against fire, water
a room that is locked when unattended).
damage, and other hazards do not need to be
described in writing. ■ Storage in a portable case that can be locked.
This is particularly necessary for case manag-
This standard applies to current and historical
records and to hard copy records as well as ers and other service providers who use
electronic records. records in the field, while conducting home
visits, or at satellite offices used for periodic
Organizations are encouraged to review current
service delivery.
provisions of legislation on freedom of informa-
tion and protection of privacy (such as HIPAA ■ Appropriate protection against fire, water
and HITECH in the USA and PIPEDA in Canada) damage, and theft. This is particularly impor-
for potential impact on the maintenance and tant if records are not returned to the central
transmission of protected health information. records area for overnight storage.
Of particular note are provisions related to ■ Fireproof file cabinets are not required;
information security, privacy, and electronic however, organizations without complete fire
data interchange. protection of records may choose to provide
Examples off-site storage of duplicated critical data.
Security and confidentiality can be addressed ■ Backup of electronic systems may occur to
through such mechanisms as having designated a server that is located in another building,
personnel who are responsible for records to a network system, or through contracting
maintenance and control; limiting access to with a specialized service that provides
confidential records to authorized personnel internet-based backup services.
only; protecting records from permanent loss 3.f. An organization would establish its own
or damage; ensuring that electronic records time frames for entries into records which could
have regular backup; and clearly defining and include time frames for entering critical incidents
implementing time frames and procedures for or interactions into the records of the persons
retention and destruction of records. served and time frames for entering confidential
3.a. Confidential administrative records could data into administrative records.
include personnel records, contracts, budgets, Funding or regulatory agencies may identify
billing information, legal information, and other specific time frames that must be followed,
protected or sensitive information and records. especially regarding critical incidents.
3.b. Records are not required to be kept in a sin-
gle location. However, if they are kept in several
locations, they may be controlled from a central
location by a designated staff member, with the
location of each file readily identified. If records

Section 1.F. Financial Planning and Management
Documentation Examples F. Financial Planning and

The following are examples of the types of
information you should have available to demon- Management
strate your conformance to the standards in this
subsection. See Appendix A for more informa- Description
tion on required documentation. CARF-accredited organizations strive to be
■ Reports from regulatory agencies financially responsible and solvent, conducting
■ Reports associated with legal actions fiscal management in a manner that supports
■ Reports associated with contractual
their mission, values, and annual performance
relationships objectives. Fiscal practices adhere to established
accounting principles and business practices.
■ Policies and written procedures regarding
Fiscal management covers daily operational
administrative records and records cost management and incorporates plans for
of the persons served long-term solvency.
■ Personnel policies manual
1.F. 1. The organization’s financial planning

and management activities are designed
to meet:
1.F. Financial Mgmt
a. Established outcomes for the

persons served.
1.a.F. Financial Mgmt
b. Organizational performance
objectives.
1.b.F. Financial Mgmt
Examples
The organization is knowledgeable of and
reviews all indirect and direct costs of providing
a specific service. Its strategic planning and
financial planning are integrated to ensure that
initiatives or changes in programs are adequately
funded and supported to maximize success.
Some of the ways the organization may address
cost-effectiveness include using natural supports
and other generic community services. Contract-
ing and networking with other agencies can be an
effective means for efficient service provision.
1.a. This may tie to Section 1.M. Performance
Measurement and Management. See Standard
1.M.6. related to service performance indicators
such as efficiency, effectiveness, access, and
satisfaction.
1.b. The organization’s performance objectives
may include, but are not limited to areas of
potential financial risk such as reductions in
funding or new regulations that might impact
services or expand the population to be served.
This may tie to Standard 1.M.3. related to setting
and measuring performance indicators for busi-
ness function improvement.

governing board, or other authority. If an organi-

1.F. 2. Budgets are prepared: zation is dependent on funding from an external
2.F. Financial Mgmt
a. Prior to the start of the fiscal year. entity’s budget which has not been finalized prior
b. That: to the beginning of the fiscal year, an organiza-

(1) Include: tion may adopt a provisional budget until the

final budget is approved for the year.
2.b.(1)F. Financial Mgmt
(a) Reasonable projections of:

2.b.(1)(a)F. Financial Mgmt
(i) Revenues.
2.b.(1)(a)(i)F. Financial Mgmt
(ii) Expenses. 1.F. 3. Actual financial results are:

3.F. Financial Mgmt
2.b.(1)(a)(ii)F. Financial Mgmt
(iii) Capital expenditures. a. Compared to budget.

2.b.(1)(a)(iii)F. Financial Mgmt
(b) Input from various stake- b. Reported, as appropriate, to:

holders, as required. (1) Personnel.

2.b.(1)(b)F. Financial Mgmt
(c) Comparison to historical (2) Persons served.

performance. (3) Other stakeholders.

2.b.(1)(c)F. Financial Mgmt 3.b.(3)F. Financial Mgmt
(d) Consideration of necessary c. Reviewed at least monthly.

cash flow. 3.c.F. Financial Mgmt
2.b.(1)(d)F. Financial Mgmt Examples

(e) Consideration of external
environment information. Summary reports are generated on a regular basis
2.b.(1)(e)F. Financial Mgmt and are reviewed by management and leadership.
(2) Are disseminated, as appropriate,
These reports include information on actual and
to:
budgeted income and expenses on a monthly and
(a) Personnel. year-to-date basis, with variances and a balance
(b) Other stakeholders. sheet. The level of detail corresponds to the size
(3) Are: of the organization’s budget and to its fiscal con-

(a) Written. straints. Management and leadership use these

(b) Approved by the identified reports as tools to plan for maintaining financial
authority. stability.
Financial records and reports should also include

Examples
those necessary to retain charitable status, as
The annual budget reflects projected income appropriate, such as the charitable information
and expenses, and the organization regularly return to the Canada Revenue Agency.
monitors its performance against the budget.
3.c. The monthly review of actual financial
Leadership reviews the budget at least annually.
results may be conducted by program manage-
The time frame for approval of the budget may
ment, finance staff, or the governing board.
be dictated by funders’ and organizational
requirements and contracting processes. Input
from professional and administrative personnel 1.F. 4. The organization identifies and reviews,
in budget development demonstrates the organi- at a minimum:
4.F. Financial Mgmt
zation’s intent to anticipate its fiscal needs. a. Revenues.

Input from persons served can be gathered b. Expenses.

by a variety of means. For example: c. Internal:

4.c.F. Financial Mgmt
■ Formal meetings to discuss the budget. (1) Financial trends.

4.c.(1)F. Financial Mgmt
■ Informally, via ongoing conversations (2) Financial challenges.

with staff. (3) Financial opportunities.

■ Through participation on the board or (4) Management information.

advisory groups. d. External:

4.d.F. Financial Mgmt
2.b.(3)(b) Approval of the budget could be (1) Financial trends.

4.d.(1)F. Financial Mgmt
conducted by an owner, executive leadership, (2) Financial challenges.


(3) Financial opportunities. industrial/safety regulations for the particular

type of business, an increase in sales tax,
(4) Industry trends.

e. Financial solvency, with the devel- or a change in environmental protection

opment of remediation plans if regulations.
appropriate. ■ Practices in service delivery or business
4.e.F. Financial Mgmt
management that are becoming more

Examples
widespread and could impact the program.
4.c.–d. An organization could demonstrate that
■ Legislative changes and impact on non-profit
consideration of these items occurred through
reporting and operations.
meeting minutes or during interviews with a
surveyor in which the process of how these were An organization can demonstrate that consider-
considered is described. ation of these items occurs through meeting
Once collected, this information is incorporated minutes or during interviews with a surveyor in
into the organization’s strategic and financial which the process of how these were considered
planning processes. are described.
4.c.(4) Management information includes items 4.e. Financial solvency could be described as the
such as: ability of an organization to meet its financial
obligations, long-term expenses, and to accom-
■ Percentage of private pay versus Medicare/
plish long-term expansion and growth.
Medicaid or pay from other public funds.
The organization demonstrates good business
■ Staff turnover trends that may impact
practices and complies with applicable legal
revenue.
requirements to maintain and retain financial
■ Preparing for the financial impact of contract/ stability. The organization provides written
grant sunsets (grants with ending dates). documentation of its plans to maintain and retain
■ Time spent on billable versus non-billable financial solvency, if appropriate. Attention to
activities. environmental trends, such as financial trends,
■ Caseload size.
funding guidelines, and legislative changes, is
important to maintaining financial solvency and
4.d. External events that have a financial impact planning proactively to retain it. Guidance for
on the organization include items such as: financial stability can be established with the
■ Changes in reimbursement rates. assistance of local United Way organizations,
■ Competition in the marketplace. auditors, funding sources, and other agencies.
■ Changes in consumer preferences.
■ Regulatory and legislative changes.

1.F. 5. If the organization has related entities,
it identifies:
■ Changes/impacts of interest revenue. 5.F. Financial Mgmt
a. The types of relationships.

4.d.(4) Industry trends may include items such 5.a.F. Financial Mgmt
b. Financial reliance on related entities.

as: 5.b.F. Financial Mgmt
c. Responsibilities between related enti-

■ Information that may be at a national,
ties and the organization, including:
regional, or other level. This could be a 5.c.F. Financial Mgmt
(1) Legal.
comparison to providers of similar services 5.c.(1)F. Financial Mgmt
throughout the region at the time or it could (2) Contractual.

also mean comparison to similar business (3) Other.

activities that are operated. An organization d. Any material transactions.

may operate a large recycling center, indus- Intent Statements

trial laundry, box factory, restaurant, or
Full disclosure of relationships demonstrates
other business and might be looking at the
an organization’s commitment to excellence
industry trends in the region for comparable
and transparency. The organization discloses
businesses, such as an increase in state

information to persons served and other stake-

holders that explains its assets and liabilities, 1.F. 6. The organization:
6.F. Financial Mgmt
reflects the position and responsibilities of any a. Implements fiscal policies and
parent or sponsoring organizations, and discloses procedures, including internal
any material and legal relationships with other control practices.
entities. b. Provides training related to fiscal

Examples policies and procedures to appro-
priate personnel including:
Organizations often form strategic relationships 6.b.F. Financial Mgmt
with other entities to share financial and non- (1) Initial training.
financial resources or to guarantee debt. At times, (2) Ongoing training.

organizations benefit from a third party revenue Intent Statements

source. The relationship of this revenue source To reduce risk, it is important that the organi-
and the risks or value of this relationship should zation, regardless of size, establish who has
be disclosed. responsibility and authority in all financial activi-
Examples of relationships include: ties, such as in purchasing materials and capital
■ Parent-subsidiary structures. equipment, writing checks, making investments,
and billing.
■ Affiliations.
■ Alliances.
Examples
■ Guarantees.
The sophistication of the system of internal
controls is based on the sophistication of the
■ Limited partnerships.
organization’s fiscal activities.
■ Other third-party operating support.
6.a. Policies and procedures may address meth-
■ Material contracts such as food services, ods for receiving cash, checks, or other financial
pharmacy, and therapy. instruments; disbursing funds, including petty
Disclosure of these relationships can be cash, other cash, checks, or other financial
accomplished through: instruments; managing the use, receipt, or dis-
■ Audited financial statements.
bursement of funds through purchase orders,
invoices, organizational credit/debit cards and
■ Annual reports distributed to residents
lines of credit with outside vendors; and investing
and persons served. funds.
■ Marketing materials.
The organization may want to seek guidance
■ Tax report filings. from a source with the expertise to confirm that
5.d. Material, when used in accounting, is it is in accord with legal requirements and follow-
defined as the magnitude of an omission or ing generally accepted accounting principles.
misstatement of accounting information that
makes it probable that the judgment of a reason-
able person relying on that information would
have been changed or influenced by the omission
or misstatement. When used in finance, it refers
to the magnitude of the financial impact on
an organization. If the magnitude of the items
relative to the whole organization is significant,
then it is material. For example, a company
with $2,000 of total assets has $1,000 worth
of investments, the investment is material.
A $1,000 impact on a $500 million total asset
corporation is immaterial.

1.F. 7. If the organization bills for services 1.F. 8. The organization, if responsible for
provided, a review of a representative fee structures:
sampling of records of the persons
8.F. Financial Mgmt
a. Identifies the basis of the fee

served is conducted: structures.
7.F. Financial Mgmt
a. At least quarterly.

b. Demonstrates:
b. To:

(1) Review of fee schedules.
(1) Document that dates of services
(2) Comparison of fee schedules.

provided coincide with billed 8.b.(2)F. Financial Mgmt
(3) Modifications when necessary.

episodes of care. 8.b.(3)F. Financial Mgmt

c. Discloses to the persons served
(2) Determine that the bills accu- all fees for which they will be
rately reflect the services that responsible.
were provided. 8.c.F. Financial Mgmt

Intent Statements
(3) Identify necessary corrective
action. An accountable organization assists the persons
served in understanding the fee structure and
Intent Statements whether there might be any additional charges
Determining that billing statements match to the individual.
service information in the records of the persons
Examples
served is a proactive method for an organization
to help reduce or eliminate costly audit excep- On a regular basis, the organization can evaluate
tions. This review and corresponding corrective its current fee structure to ensure that the fees
action will assist in that process. are adjusted as necessary to reflect changes in
Refer to the Glossary for the definition of services, the cost of delivering service, and the
representative sampling. local market.
8.b. The organization may demonstrate this in
Examples
different ways. It might include dates on docu-
This review focuses specifically on the appro- ments, mention this activity in meeting minutes,
priateness of billing and coding practices. The various staff could discuss how this process
review is conducted by persons trained to occurred, etc.
compare the dates and service codes on the
8.b.(2) Comparison of fee schedules could be
organization’s billing system to the dates, units,
with what it has charged before and what new
and types of services provided to the persons
analysis might show is needed; it could be com-
served and, if possible, by someone not involved
paring to fee schedules from the funding source.
with the original billing to protect integrity of the
It does not require that it be external to the
process. This type of review is often conducted by
organization.
trained support staff.
8.c. Upon entry to the program, persons served
This may be required by some funding or regu-
are provided with an explanation of the fees for
latory sources, but it is also a good practice to
which they are responsible; and when changes
incorporate into a fiscal management program
in fees are necessary, the organization shares this
to ensure that services are being billed
information also.
appropriately.
Although only a quarterly review is required,
as part of risk management an organization may
choose to conduct this review more frequently,
such as when billing or coding procedures are
revised, new personnel are hired, or new infor-
mation systems are implemented or to determine
accuracy of billing following corrective training.

■ Designating responsibility for expending or

1.F. 9. If the organization takes responsibility investing funds.
for the funds of persons served, it imple-
ments written procedures that define: ■ Providing evidence that funds were expended
9.F. Financial Mgmt
or invested in the manner authorized.
a. How the persons served will give
informed consent for the expenditure 9.c.–d. Methods employed may include a system
of funds. to identify the purposes for which the funds are
b. How the persons served will access expended. This system may include accounting
the records of their funds. codes or line items to identify the reasons for
c. How funds will be segregated for expenditures of funds of the persons served. The
organization is not required to establish separate
accounting purposes.
9.c.F. Financial Mgmt bank accounts or other physically separate
d. Safeguards in place to ensure that
accounts for the funds of the persons served.
funds are used for the designated
and appropriate purposes.
e. How interest will be credited to the

1.F. 10. There is evidence of an annual review
or audit of the financial statements of
accounts of the persons served,
the organization conducted by an inde-
unless the organization is subject
pendent accountant authorized by the
to guidelines that prohibit interest-
appropriate authority.
bearing accounts. 10.F. Financial Mgmt
9.e.F. Financial Mgmt
f. How monthly account reconciliation Intent Statements

is provided to the persons served. An accountant authorized by the appropriate
authority means a CPA in the United States; in
9.f.F. Financial Mgmt
Examples
countries outside the United States, the terminol-
This standard applies if the organization serves ogy for a similar accountant qualified to conduct
as a representative payee for the persons served, a review or audit would be used.
is involved in managing the funds of the persons It is important for the organization to determine
served, receives benefits on behalf of the persons that its financial position is accurately repre-
served, or temporarily safeguards funds or per- sented in its financial statements. Accountants
sonal property for the persons served. may typically undertake three types of engage-
The organization demonstrates it has a system in ments: audit, review, and compilation. Each is
place to protect the fiscal interests of the persons described in more detail below, but in summary,
served. Personnel and the persons served and/or the audit is the most extensive effort and accord-
their guardians are informed of the practices in ingly the highest cost to the organization.
place. Guidance may be obtained from providers An audit requires an examination of the financial
of legal assistance and/or public and private statements in accordance with generally
human rights and advocacy agencies. Persons accepted auditing standards, including tests
served have access to records of their funds. of the accounting records and other auditing
In the context of expending or investing funds, procedures as necessary. An audit will result in a
consent may be required for the following: report expressing an opinion as to conformance
of the financial statements to generally accepted
■ Limiting the amount of funds expended or
accounting principles.
invested in a specific instance.
A review consists principally of inquiries of
■ Designating the funds to be expended or
company personnel and analytical procedures
invested for a specific purpose. applied to financial data. It is substantially less
■ Establishing time frames for expending or in scope than an examination using generally
investing funds. accepted auditing standards. Typically, a review
will result in a report expressing limited assurance
that there are not material modifications that
should be made to the statements.

As part of a compilation engagement, an accoun- Documentation Examples

tant will compile the financial statements based The following are examples of the types of
on management representations without information you should have available to
expressing any assurance on the statements. demonstrate your conformance to the standards
A compilation will not meet this standard.
in this subsection. See Appendix A for more
Examples information on required documentation.
The scope of this independent examination may ■ Annual approved budgets
vary based on the accounting requirements to ■ Written financial plans
which the organization is subject. For CARF
■ Fee schedules, if applicable
either a full audit or a review is acceptable. How-
■ Financial audits or reviews
ever, an organization should always be sure it is
meeting other applicable requirements. ■ Fiscal records
The accountant retained must be independent of ■ A management letter, if applicable
the organization and may not be contracted with ■ Documented review of billing and coding
the organization for its regular accounting needs, accuracy of client services and records,
represent the organization’s funding sources, or if applicable
be a member of the governance authority. ■ Written plan to address financial instability,
For a governmental entity, such as the Veterans if applicable
Administration, this standard may be met by ■ Financial remediation plans, if appropriate
review within its own system of oversight.
■ Financial reports
Some states’ Boards of Accounting may authorize
■ Cash management policies
a different level of accountant (in lieu of a CPA)
to conduct a review or audit. ■ Annual report
■ Cost analysis of services provided
1.F. 11. If the review or audit generates a ■ Written procedures regarding the handling
management letter, the organization: of funds of the persons served, if applicable
11.F. Financial Mgmt
a. Provides the letter during the survey ■ Documented review of accuracy of billing
for review. and coding of services with services provided,
b. Provides management’s response, if applicable

including corrective actions taken or
reasons why corrective actions will
not be taken.

Section 1.G. Risk Management
G. Risk Management threats to all areas of the organization, including

personnel, property, reputation, income, and
ability to accomplish mission and goals. These
Description areas include internal or external events that
CARF-accredited organizations engage in a could expose the organization to litigation,
coordinated set of activities designed to control government sanction, property loss, or business
threats to its people, property, income, goodwill, interruption. Potential risks may include changes
and ability to accomplish goals. in funding, new or growing populations, prob-
lems with the organization’s facilities or grounds,
1.G. 1. The organization implements a risk newly identified security issues, or internal
management plan that: procedures.
1.G. Risk Mgmt
a. Includes: 1.a.(2) Analyzing exposure (risk analysis) deter-

mines the potential frequency and severity of any
1.a.G. Risk Mgmt
(1) Identification of loss exposures.

1.a.(1)G. Risk Mgmt
(2) Analysis of loss exposures. identified risk, as well as the overall financial
1.a.(2)G. Risk Mgmt
burden of aggregate losses. Consider the nature
(3) Identification of how to rectify
of each area of risk. What is the likelihood of
identified exposures.
1.a.(3)G. Risk Mgmt an adverse event occurring? If an event were to
(4) Implementation of actions occur, how would it impact the organization?
to reduce risk. Are there certain areas of the organization or
1.a.(4)G. Risk Mgmt
(5) Monitoring of actions to programming where the risk is greatest? What

reduce risk. factors cause or contribute to increased risk
1.a.(5)G. Risk Mgmt
(6) Reporting results of actions exposure?

taken to reduce risks. 1.a.(3) Pinpoint actions that can be taken to
1.a.(6)G. Risk Mgmt
(7) Inclusion of risk reduction in mitigate, reduce, or eliminate risks. Such actions
performance improvement could include policies and procedures, staff
activities. education and training, practices of verifying
1.a.(7)G. Risk Mgmt
b. Is: credentials, safety and performance improve-

ment initiatives, reporting processes, and
1.b.G. Risk Mgmt
(1) Reviewed at least annually

for relevance. maintenance of adequate insurance coverage.
1.b.(1)G. Risk Mgmt
(2) Updated as needed. There are several methods available to deal with
1.b.(2)G. Risk Mgmt
the potential loss:
Intent Statements
■ Risk control through avoiding the exposure
The risk management plan is designed to manage altogether (if possible), reducing the proba-
risk and reduce the severity of a loss if one were bility of loss, reducing the severity of the
to occur. consequences if a loss were to occur, and/or
Examples transferring the loss to another organization
There will be a range of risks in all organizations, through a contractual transfer.
regardless of whether they are a for-profit or ■ Risk financing is done by either assuming the
a nonprofit organization. Risk management financial responsibility for the loss (through
focuses on an in-depth assessment of these risks self-insurance) or by transferring it to an
and what must or can be done as preventive outside organization (through insurance).
measures, coping measures should the risk occur, 1.a.(4) To implement actions, develop time lines
measures to protect the organization and prevent and identify the individual(s) responsible for
loss, and corrective measures to prevent the risk carrying out the actions. This will lend account-
of further occurrence. ability for the implementation of risk-reduction
1.a.(1) Identifying exposure highlights those strategies. Consider tracking methods to assist
risks that may cause a loss and those resources in verifying implementation of the strategies.
of value that may be affected. Take inventory of

Section 1.G. Risk Management
1.a.(5) Monitoring measures and comparing insurance coverage is essential. Insurance policies
actual versus planned performance of the provide types of coverage for all aspects of the
selected techniques enables the organization to organization’s operations and protect and defend
evaluate the plan and determine whether differ- persons, such as personnel and board members,
ent options may be necessary. Who is responsible volunteers, and persons served, against reason-
for monitoring various areas of risk? What types able claims due to adverse events for which the
of events should be reported and to whom should organization is liable. Types of coverage include
reports be submitted? Are individual incidents vehicles, workers’ compensation, directors’ and
reported, or are indicators tracked monthly or officers’ liability, errors and omissions, profes-
quarterly? sional liability, business interruption, property,
1.a.(6) Determine if the actions taken to reduce and casualty.
risk have been effective. Based on information The organization conducts a regular review of its
received through the established monitoring insurance coverage with the assistance of some-
processes, are there any positive or negative one who is trained in insurance needs and types
trends in risk exposure? How and to whom is of coverage. This person may be an experienced
this information communicated? insurance broker who is informed of the needs,
1.a.(7) Areas of risk could be periodically risks, and assets of the organization.
reviewed as part of continuous performance
improvement. When the desired or necessary 1.G. 3. The organization implements written
results are not achieved, the organization can procedures regarding communications
complete a new analysis of risk, add new or that address:
change existing strategies to rectify risk, monitor
3.G. Risk Mgmt
a. Media relations.
the effects of the changes, and report the new 3.a.G. Risk Mgmt
b. Social media.
results. 3.b.G. Risk Mgmt
Examples
1.G. 2. As part of risk management, the insur- Media relations procedures might include who
ance package of the organization: may or may not talk to the media, whom to
2.G. Risk Mgmt
a. Is reviewed: notify of requests for interviews, whom to

2.a.G. Risk Mgmt contact after hours, use of press releases, or
(1) For adequacy.
2.a.(1)G. Risk Mgmt
media relations philosophy.
(2) At least annually.
2.a.(2)G. Risk Mgmt Social media procedures might address the
b. Protects assets. organization’s definition of social media, e.g.,
2.b.G. Risk Mgmt
c. Includes: Facebook, Twitter, blogs, message boards; accept-

2.c.G. Risk Mgmt
(1) Property coverage. able uses of social media; who has access and
2.c.(1)G. Risk Mgmt
(2) Liability coverage. authority to post or modify information; privacy

2.c.(2)G. Risk Mgmt
(3) Other coverage, as appropriate. settings; parameters for communicating with

2.c.(3)G. Risk Mgmt
persons served and prospective persons served;
Intent Statements protection of health information; and how
When effectively managed, insurance, whether violations of the procedures will be managed.
third-party or self-insurance, can cover many
tangible risks an organization faces. The organiza-
tion’s insurance package includes appropriate
coverage for any services it may provide in more
than one state/province or other jurisdiction.
Examples
The organization recognizes that although
insurance is only one aspect of an organization’s
overall risk management strategy, adequate

Section 1.H. Health and Safety
Documentation Examples H. Health and Safety

section. See Appendix A for more information CARF-accredited organizations maintain healthy,
on required documentation. safe, and clean environments that support quality
services and minimize risk of harm to persons
■ Reports from regulatory agencies
served, personnel, and other stakeholders.
■ Reports associated with legal actions
■ Performance improvement plans

■ Personnel policies manual
When determining applicability, please refer to
■ Risk management plan
the Glossary for the definitions and clarification
■ Insurance policies of all italicized terms.
■ Risk analysis reports Standards in this subsection apply to all
■ Written procedures regarding media relations locations of an organization that meet the
and social media following descriptions, unless an identified
exception applies:
■ Locations owned/leased by the organiza-
tion that are:
– Used for delivery of the programs or
services seeking accreditation.
or
– Administrative locations where personnel
related to the programs or services seek-
ing accreditation are located.
■ Donated locations/space that are controlled/
operated by the organization and are:
– Used for the delivery of the programs
or services seeking accreditation.
or
– Administrative locations where personnel
related to the programs or services
seeking accreditation are located.
Identified exceptions:
Standards 1.H.7., 1.H.13., and 1.H.14. are
NOT applied to locations that meet any
of the following criteria:
■ Private homes of persons served.
■ Community settings that are not owned/

leased or controlled/operated by the
organization.
■ Used solely by an employee-owner for
administration and no other persons
or personnel are located, meet, or are
served at the location.

■ Used by the organization for service delivery Examples

one hour or less in any week. A successful safety program strives to manage
■ Used by the organization for administration risk and protect consumers wherever services
by less than the equivalent of one full-time are provided.
employee in any week. When safety concerns are identified for persons
Please contact your CARF resource specialist served, information and training relative to that
if you have questions or need further risk are offered as a means to reduce risk and
clarification. promote safety. Examples of risks include throw
rugs on uneven surfaces that raise fall risk,
burners on stoves in the person’s house, or over-
1.H. 1. The organization maintains a healthy loaded electrical outlets. Classes may be provided
and safe environment.
1.H. Safety
or arranged for persons served on emergency
Examples preparedness, minimizing trip hazards, crime
A successful health and safety program goes prevention, or self-defense.
beyond compliance with regulatory requirements
and strives to manage risk and to protect the 1.H. 4. Personnel receive documented
health and safety of persons served, employees, competency-based training:
and visitors. A successful health and safety 4.H. Safety
a. Both:
program addresses both minimizing potential 4.a.H. Safety
(1) Upon hire.

hazards and compliance activities. 4.a.(1)H. Safety
(2) Annually.
The physical environment of the organization 4.a.(2)H. Safety
b. In the following areas:

shows evidence of ongoing attention to safe prac- 4.b.H. Safety
tices, reduction of health and safety risks, and an (1) Health and safety practices.
4.b.(1)H. Safety
overall concern for the health and safety of the (2) Identification of unsafe
persons served and personnel. Health and safety environmental factors.
4.b.(2)H. Safety
requirements are sometimes determined by local (3) Emergency procedures.

4.b.(3)H. Safety
or other governmental authorities. Documenta- (4) Evacuation procedures, if

tion of daily maintenance tasks is not required. appropriate.
4.b.(4)H. Safety
(5) Identification of critical incidents.

1.H. 2. The organization implements written 4.b.(5)H. Safety
(6) Reporting of critical incidents.

procedures to promote the safety of: 4.b.(6)H. Safety
(7) Medication management,

2.H. Safety
a. Persons served. if appropriate.

2.a.H. Safety
4.b.(7)H. Safety
b. Personnel. (8) Reducing physical risks.

2.b.H. Safety
4.b.(8)H. Safety
Intent Statements Intent Statements

Regardless of setting, the organization must See the Glossary for the definition of competency-
demonstrate satisfactory efforts to provide based training.
services as safely as possible and promote a
safe work environment. Examples
The organization provides comprehensive
Examples
training so that personnel can demonstrate their
Written procedures could include the identifica- competency in health and safety. Ways to struc-
tion of personnel responsible for implementation ture trainings so that they are competency-based
of health and safety procedures. may include “demonstration and return dem-
onstration” in which the trainer demonstrates a
1.H. 3. Persons served receive education skill (such as using a fire extinguisher or other
designed to reduce identified equipment) and the trainee performs the same
physical risks. skill in return to ensure competency. Another
3.H. Safety
technique might be to have a written quiz or

assessment following a training presentation to of overlap and confusion before conducting

ensure that key concepts are understood. Verbal more demanding training activities.
quizzes in which the trainee describes to the ■ Walk-Through Drill—The emergency man-
trainer how he/she would respond in an agement group and response teams actually
emergency may also be useful in assessing perform their emergency response functions.
competencies. This activity generally involves more people
Content of the education and training may vary and is more thorough than a tabletop exercise.
with the required competencies, job duties, and ■ Functional Drills—These drills test specific
responsibilities of the personnel. In addition to functions such as medical response, emer-
training on health and safety in an organization gency notifications, and warning and
setting, training is provided on an ongoing basis communication procedures and equipment,
regarding the potential risks involved in working though not necessarily at the same time. Per-
in community settings or a person’s home when sonnel are asked to evaluate the systems and
applicable to the services provided. Training identify problem areas.
includes, but is not limited to, identification of
■ Evacuation Drills—Personnel walk the evac-
potential risks, ways to prevent or minimize risks,
uation route to a designated area where the
and emergency procedures.
procedures for accounting for all persons are
It may be helpful to begin by assigning respon- tested. As they evacuate, personnel are asked
sibility for developing a training program. The to note things that might become possible
training and information needs of personnel hazards during a real emergency evacuation,
and those with an emergency response role such as stairways cluttered with debris or
are identified. These might be included in the inadequate lighting in the hallways.
twelve-month health and safety program
■ Full-Scale Exercise—A real-life emergency
planning:
situation is simulated as closely as possible.
■ Who will be trained. This exercise involves the organization’s emer-
■ Who will do the training. gency response personnel, other employees,
■ What training will take place. persons served, the management, and com-
munity response organizations.
■ When and where each session will take place.
■ What the outcomes of each session will be.

General training for all employees addresses:
■ Individual roles and responsibilities.
■ How the session will be documented and
evaluated. ■ Individualized needs of persons served.
Reviews are conducted after each training ■ Information about threats, hazards, and
activity. Training participants are involved in protective actions.

the evaluation process. ■ Notification, warning, and communication
Some training activities that organizations may procedures.

consider using are: ■ Continuation/contingency for essential
■ Orientation and Education Sessions—These services and supports.

are regularly scheduled to allow discussion, ■ Means for locating family members in an
provide information, answer questions, and emergency.
identify needs and concerns. ■ Emergency response procedures.
■ Tabletop Exercise—Members of the ■ Evacuation, shelter, and accountability
emergency management group meet in a procedures.
conference room setting to discuss their
■ Emergency shutdown procedures.
responsibilities and how they would react
to emergency scenarios. This is a cost- The scenarios developed during vulnerability
effective and efficient way to identify areas analysis can serve as the basis for training events.

4.a.(2) Annual training helps to ensure that all organization ensures skill in this area, e.g., core
personnel are kept current on changes in policies training and inservice training. A record of the
and procedures. successful completion of this training may be
4.b.(1) Training is provided on an ongoing basis kept in each employee’s confidential file or in
regarding the potential risks involved in settings training records.
appropriate to services provided, which might 4.b.(7) Training on medication management
include working in community settings or a would be included if the organization has a role
person’s home. Training includes, but is not in either medication management or monitoring,
limited to, identification of potential risks, ways as described in Section 2.C. of this manual.
to prevent or minimize risks, and emergency
procedures. The organization determines which 1.H. 5. There are written emergency
employees will be mandated to receive specific procedures:
training applicable to their position as detailed 5.H. Safety
a. For:
in their job description. The training might 5.a.H. Safety
(1) Fires.
include CPR, first aid, preventive disease control, 5.a.(1)H. Safety
physical and verbal interventions, medication (2) Bomb threats.

5.a.(2)H. Safety
awareness, safety awareness, and any specialty (3) Natural disasters.

5.a.(3)H. Safety
training, including physical restraint training, (4) Utility failures.

specific to the safety of a particular population.
5.a.(4)H. Safety
(5) Medical emergencies.

It is suggested that the organization maintain 5.a.(5)H. Safety
(6) Violent or other threatening

documentation of each employee’s recertification situations.
in applicable courses (including courses that do 5.a.(6)H. Safety
b. That satisfy:
not require annual recertification) so that review 5.b.H. Safety
of this might coincide with annual performance (1) The requirements of applicable
evaluations. For training that does not require authorities.
5.b.(1)H. Safety
an annual certification process, the organization (2) Practices appropriate for the
would include review of the procedure in its locale.
5.b.(2)H. Safety
own training program. c. That address, as follows:

5.c.H. Safety
4.b.(2) The organization trains personnel to (1) When evacuation is appropriate.

5.c.(1)H. Safety
identify unsafe environmental factors and deter- (2) Complete evacuation from the
mines personnel competency in this area on an physical facility.
annual basis (such as post-tests and annual
5.c.(2)H. Safety
(3) When sheltering in place is

employee evaluations). appropriate.
5.c.(3)H. Safety
4.b.(3)–(4) The organization’s procedure to (4) The safety of all persons

train personnel on emergency and evacuation involved.
procedures includes the method the organization 5.c.(4)H. Safety
(5) Accounting for all persons

uses to ensure proficiency of personnel (e.g., involved.
mock drills, post-tests, and annual employee 5.c.(5)H. Safety
(6) Temporary shelter, when

evaluations). The emergency and evacuation applicable.
procedures include the plans for fires, bomb 5.c.(6)H. Safety
(7) Identification of essential

threats, natural disasters, utility failures, medical
services.
emergencies, and safety during violent or other 5.c.(7)H. Safety
threatening situations. Personnel skill in imple- (8) Continuation of essential

menting these procedures is reviewed. services.
5.c.(8)H. Safety
4.b.(5)–(6) The organization’s procedure for (9) Emergency phone numbers.

5.c.(9)H. Safety
training personnel in the identification and (10) Notification of the appropriate

reporting of critical incidents/serious occur- emergency authorities.
5.c.(10)H. Safety
rences (terminology used in Canada may

be serious occurrences) includes how the

Intent Statements 4. Identifying critical products, services,

Established emergency procedures that detail and operations for potential emergencies
appropriate actions to be taken promote safety and backup systems.
in all types of emergencies. 5. Identifying internal resources and capabil-
Being prepared and knowing what to do help the ities that the organization would need in
persons served and personnel to respond in all case of an emergency, such as equipment,
emergency situations, especially those requiring evacuation plans, and arrangements for
evacuation. The evacuation process guides the backup systems for payroll, communica-
personnel to assess the situation, to take appro- tions, emergency power, and information
priate planned actions, and to lay the foundation systems support.
for continuation of essential services.
6. Identifying external resources that the
Examples organization may need in an emergency,
The procedures should include actions to be such as the fire department, hospitals,
taken by personnel in the event of an emergency, police, utilities, insurance carriers, sup-
consider any unique needs of the persons served, pliers of emergency equipment, and
and be appropriate and specific to the service hazardous materials response
delivery site or location. organizations.
Depending on the type of emergency, the pro- B. Analyzing potential hazards and the organiza-
cedure could include immediate response, tion’s capabilities and addressing them with
evacuation, use of appropriate suppression tech- internal plans. Documentation for analysis
niques, notification of the proper authorities, may include such things as evacuation proce-
sheltering in place, and reporting requirements. dures, security procedures, drills, employee
In developing emergency procedures the organi- manuals, insurance programs, hazardous
zation identifies critical products, services, and materials information, a facility closing policy,
operations that may be impacted in an emer- safety assessments, and risk management
gency and backup systems, internal capabilities, plans. Included in the analysis are:
and external resources that may be needed or 1. Potential emergencies.
accessed. 2. Historical emergencies.
Considerations for emergency management 3. Geographic emergencies.
planning may include:
4. Technological emergencies.
A. Establishing a planning team or health and
5. Human error.
safety committee which initiates planning
steps such as: 6. Identification of training needs.
1. Establishing a policy and procedure to 7. Physical plant emergencies.
demonstrate the organization’s commit- 8. Regulatory emergencies.
ment to emergency management. 9. An assessment of internal and external
2. Meetings with providers of utilities such resources.
as the electric company and community The analysis of each potential emergency
organizations such as the Red Cross, might consider assessing the:
community emergency management, the
a. Probability.
fire department, and the police depart-
ment to identify potential emergencies b. Potential human impact.
and procedures. c. Potential property impact for loss and
3. Identifying applicable governmental damage.
regulations such as fire codes, zoning d. Organizational impact.
regulations, and occupational health C. Emergency management plan components
and safety regulations. most often include direction and control,

communications, life safety, property pro- into the emergency plan for bomb threats is the
tection, community resources, recovery and training of personnel who would likely receive
restoration, administration, and logistics. the threatening call. (A sample of a checklist that
Consider including: could be used for such a call may be requested
1. Emergency response procedures in the from CARF.)
form of checklists. The emergency plan for bomb threats might also
2. Specific emergency response procedures identify the process for exploring with local law
for potential situations. enforcement and the local telephone company
the resources available for tracing repeated phone
3. Support documents such as emergency
threats.
call lists, facility site maps, resource lists,
and designated responsibility lists. 5.a.(3) Natural disasters.
D. To be optimally effective, the emergency man- The organization evaluates safety concerns
agement plan is developed and written for related to possible natural disasters and their
persons served and personnel to enable them potential effects on the organization's staff
to observe, participate, and be trained in all members, the persons served, and property
aspects of the emergency plan and evacuation and develops procedures detailing action to be
procedures. Consider including a training taken in the event of occurrence of a natural
schedule, local community resources and disaster. Possible natural disasters are those
communications, communications from the typical of your particular geographic location.
planning committee or health and safety com- They might include tornadoes, severe rainstorms,
mittee, and a distribution list for the process hurricanes, floods, earthquakes, blizzards, ice
of analysis used throughout the organization. storms, and snowstorms.
To be prepared in the event of a natural disaster,
5.a.(1) Fires.
the organization considers:
In developing comprehensive procedures to
1. Storing basic emergency supplies (e.g.,
respond to fires, consider:
drinking water, food, flashlights, batteries,
1. Training and use of primary exits and alterna- battery-operated radios, a first aid kit, elec-
tive routes, fire extinguisher use and location, trical generators, clothing, bedding, cellular
and the primary place of safety in the event phones, vital documentation, and money),
of an emergency. which would be needed for sheltering in
2. Training and use of the evacuation plans and place.
the responsibilities of participants. 2. Availability of medications and medical
3. Needs of persons participating who have devices for persons served.
hearing impairments, mobility impairments, 3. Collaboration with community resources
speech impairments, low vision, or intellec- to assist with priority needs.
tual or developmental disabilities, or who
are Deaf, hard of hearing, or blind. 5.a.(4) Utility failures.
4. Personnel orientation and training require- To be prepared in the event of a utility failure,
ments and schedules. such as electrical, water, gas, sewer, telephone,
or internet, the organization considers:
5.a.(2) Bomb threats.
1. Health risks for persons served.
The organization adopts specialized procedures
2. The cooking and eating requirements for
to prepare for bomb threats to ensure the safety
persons served, if applicable.
of persons served and personnel. If your bomb
threat procedure includes a site for temporary 3. The preparation of an emergency kit includ-
evacuation, then a letter of agreement with the ing flashlights, radios, food, canned meat,
site’s owner might be written and regularly utensils to open food containers, electrical
reviewed. Another critical feature to incorporate generators, batteries, and chafing dishes.

4. Extra battery packs for electric wheelchairs, Best practices for an evacuation plan may have
breathing devices, and other electric life various exits for different types of emergencies.
devices. The routes for evacuation consider speed and
5. Plans for a primary location for persons special considerations for persons based upon
served. their needs. Procedures include a predetermined
site for gathering of all individuals upon evac-
6. Prearranged community resources for
uation. It may be helpful to have an outside
support.
authority (e.g., the fire marshal, risk manager,
7. Checking properties for potential hazards and or other) evaluate the designated routes and
effecting preventive measures when possible, assembly points to determine viability and
such as tree trimming, as trees may cause a practicality.
disruption of power lines.
The evacuation plan considers not only the pos-
5.a.(5) Medical emergencies. sible physical barriers of the facility, but also the
To prepare for medical emergencies, the organi- individualized needs of those to be evacuated,
zation considers: such as persons with mobility impairments who
1. Thorough individualized documentation will need assistance or persons with low vision or
of medical needs and histories. who are hard of hearing. How many persons with
mobility impairments will need assistance? Can a
2. Immediate responses and responsible persons
wheelchair be used to facilitate quicker egress?
(e.g., identifying who is trained in CPR and
Are ramps needed and in place at evacuation
defibrillation).
sites? Are flashing lights needed to alert persons
3. Emergency on-call plans. with hearing impairments or are Braille strips to
4. Persons to notify in case of an emergency. mark routes needed?
5. Hospital plans for persons served. The procedures for evacuation identify the
5.a.(6) Violent or other threatening situations. responsibilities of all personnel who might assist
in the process of evacuation. Evacuation assign-
Violent or other threatening situations may ments are a part of the plan. Emergency roles
include explosions, gas leaks, biochemical include identification of personnel responsible
threats, acts of terrorism, and use of weapons. for taking attendance rosters to the designated
To ensure safety in the event of a violent or other assembly area to ensure that all persons are
threatening situation, the organization considers: accounted for. Procedures include the process
1. Training requirements for personnel. for notifying personnel if individuals are not
2. Training requirements for persons served. present. An attendance monitoring system would
prevent personnel from mistakenly assuming
3. Identification of risk factors in relation to the
that a person was lost when in fact the person
facility.
is at home with family, at a doctor’s appointment,
4. Assessment and identification of the individu- or elsewhere. Good practice would establish an
alized needs of persons served. attendance system that accounts for all persons
5. A plan that is communicated to community served on a regular basis throughout the course
resources for priority needs. of a given day.
6. Training and drill documentation at staggered In establishing a predetermined assembly area,
time periods. thought is given to whether the area provides
7. Safe areas and evacuation procedures. for rapid exit and avoids interference with emer-
gency personnel such as the fire department
5.c.(1)–(10) Evacuation may be addressed in a or police, who may need access to the physical
separate procedure or incorporated into relevant facility. Is the site far enough away from the
emergency procedures such as those for fire. emergency to ensure safety? The procedures
Regardless of the type of emergency evacuation, address the entire spectrum of an evacuation,
all plans for evacuation include clear procedures. including an evacuation when evacuees cannot

return to the facility. Procedures identify protocol 5.c.(7)–(8) Essential services may include the
to follow in the event that an incident may provision of medications, residential or other
require movement to a temporary shelter. Pro- housing support services, or assistance with
cedures address the process for transportation, daily living requirements, such as personal care
communication, and the inclusion of emergency supports provided in a private home.
information for all persons served. Procedures
Resources
may include protocols that provide direction to
personnel if services will be curtailed. Written Local Red Cross associations, state/provincial or
agreements with potential shelters are in place. other jurisdictional regulations, regional disaster
The temporary shelter considers the unique preparedness groups, and many websites offer
health, safety, and accessibility needs of persons current and useful information in the develop-
served, to the extent possible. ment of emergency plans.
Procedures take into account the essential ser- The Federal Emergency Management Agency
vices and supports that the organization provides (FEMA) is a national resource for education,
(e.g., medical, behavioral, dietary, transportation, training, and emergency information in the
and communication services). Procedures iden- United States. FEMA has established an emer-
tify personnel, both internal and external, who gency planning guide for business and industry.
would be required for the continuation of The guide provides advice for creating and main-
essential services. Procedures may include a taining an overall emergency management plan
vulnerability analysis to determine potential specific to each organization’s corporate culture.
threats that might necessitate evacuations. The In addition, there are resources on the internet.
analysis may include a historical analysis of what Try websites such as www.fema.gov/about/
has occurred in the community in the past, a geo- divisions/cpg.shtm (Developing and
graphic analysis of the location of the facility, a Maintaining Emergency Operations Plans–
technological analysis in the event of a systems Comprehensive Preparedness Guide),
failure, and an analysis of potential human error, www.disability.gov/emergency_preparedness,
such as incidents caused by untrained employees and www.ada.gov/emergencyprepguide.htm
or recipients of services and supports. where free copies of emergency procedures
may be requested that could be incorporated
The procedures may outline supporting docu-
into your plans.
ments that could help in evacuation and
emergency situations. Supporting documents Other websites that are resources in developing
include blueprints of the facility with sufficient emergency procedures are:
detail to guide emergency personnel to exits, ■ www.ready.gov/are-you-ready-guide
water shutoffs, stairways, gas valves, air condi- ■ inclusivepreparedness.org

tioning ducts, storm drains, electrical shutoffs, ■ Occupational Safety and Health Administra-
etc. Procedures also identify the individuals tion at the United States Department of Labor
designated to maintain and implement emer- www.osha.gov/SLTC/emergencyprepared-
gency contact lists of essential internal and ness/index.html
external personnel, parents/guardians, the health
■ Office of Disability Employment Policy
department, the fire department, the police,
at the United States Department of Labor
emergency medical resources, local emergency
www.dol.gov/odep/programs/
response teams, hospitals, utilities, the phone
company, shelters, and the water department. emergency.htm
■ U.S. Department of Transportation
5.c.(6) Temporary shelter is typically needed if
www.dotcr.ost.dot.gov/asp/
the organization provides a residential/housing
program or a program such as respite in which emergencyprep.asp
the persons served remain at the site for extended ■ Emergency Evacuation Preparedness Guide
hours, overnight, or for several days, weeks, or www.cdihp.org/products.html

months.

■ Disaster Resources for People with Disabili- Accessibility of signage considers location
ties and Emergency Managers www.jik.com/ and height of signage and other needs relative
disaster.html to the persons served and other stakeholders.
■ Disaster Preparedness for People with Additionally, the exit ways should be clear of
Disabilities www.disability911.com obstructions such as equipment, furniture or
locked doors. Evacuation routes should not result
■ National Organization on Disability
in individuals getting to an unsafe location such
nod.org/disability_resources/
as ungraded land, a rooftop with no opportunity
emergency_preparedness_for_persons_with
for egress, or where emergency personnel cannot
_disabilities
reach the individuals.
■ Amputee Coalition of America resources
for emergency preparedness www.amputee-
coalition.org/limb-loss-resource-center/
1.H. 7. Unannounced tests of all emergency
procedures:
resources-by-topic/emergency-preparedness/ 7.H. Safety
index.html and special supplement to ACA a. Are conducted at least annually:

7.a.H. Safety
InMotion When Disaster Strikes—a Pocket (1) On each shift.

7.a.(1)H. Safety
Survival Guide www.amputee-coalition.org/ (2) At each location.

inmotion/jan_feb_08/
7.a.(2)H. Safety
b. Include complete actual or simulated

pocket_survival_guide.html physical evacuation drills.
■
7.b.H. Safety
The Disaster Recovery Information Exchange c. Are analyzed for performance that
(DRIE) has chapters throughout Canada addresses:
www.drie.org 7.c.H. Safety
(1) Areas needing improvement.

7.c.(1)H. Safety
(2) Actions to be taken.

 ■ Public Safety Canada www.publicsafety.gc.ca.
Provincial or territorial emergency measures
7.c.(2)H. Safety
(3) Results of performance improve-

organizations can also be used as resources. ment plans.
7.c.(3)H. Safety
(4) Necessary education and training

■ The Canadian Centre for Emergency
Preparedness www.ccep.ca
of personnel.
7.c.(4)H. Safety
d. Are evidenced in writing, including

■ The Canadian Red Cross www.redcross.ca the analysis.
7.d.H. Safety
NOTE: This standard does not apply to services

1.H. 6. The organization has evacuation routes in this standards manual that are provided
that are: in private homes or apartments.
6.H. Safety
a. Accessible. Intent Statements

6.a.H. Safety
b. Understandable to: Practicing emergency procedures helps the

6.b.H. Safety
(1) Persons served. persons served and personnel to better respond

6.b.(1)H. Safety
in actual emergency situations. Simulated
(2) Personnel.
6.b.(2)H. Safety evacuations should be limited to situations where
(3) Other stakeholders, including actual evacuations are not possible. Emergency
visitors. procedure testing is part of an organization’s
6.b.(3)H. Safety
Examples performance improvement activities. Analysis of

results of the tests may indicate ways to improve
6.a. When appropriate, accessible evacuation
performance.
routes may be identified by simple Exit signs
posted over doors, but this would not be Examples
expected in a small residential setting where Each emergency procedure (e.g., the procedure
the route of egress is clearly visible and known. for fires, bomb threats, natural disasters, utility
Some locations may choose to use signage such failures, medical emergencies, and other threat-
as Braille representation or diagrams showing ening situations) is tested annually on all shifts
corridors and line of travel to exit doors. and at all locations that pertain to the service

seeking accreditation whether they are service ■ Documentation and reporting regarding
sites or administration only, in accord with CARF exercises and analysis of training drills
applicable standards (see page 69). The test or for modification, if needed.
drill should be realistic and occur at random on 7.d. Documentation and reporting regarding
different shifts, if applicable to the organization. exercises and analysis of training drills are
Emergency tests may be done in a variety of important to identify modifications, if needed
ways. Actual physical tests or drills that move to improve performance.
personnel through the procedure allow for prac- Evaluation considerations include:
tice and provide an indication of how personnel
■ Involving a health and safety committee or
might respond in an actual emergency. All per-
sonnel who would be expected to participate in planning team to evaluate and update the
an emergency should be included in the testing. organization’s emergency management
The emergency procedure testing is used to procedure.
improve the knowledge and readiness of person- ■ Identifying need areas and vulnerability
nel and persons served in the event of actual and addressing these issues.
emergency situations. If persons served are not ■ Emergency procedure lessons learned
involved in the test, personnel should simulate from drills and actual events.
the types of restrictions that persons served may ■ Ensuring that responsibilities and roles are
have during an evacuation when actually moving understood by all persons on the emergency
through the process of evacuation. management team.
Implementation of an emergency procedure in ■ Emergency procedures reflecting physical
response to an actual emergency and its subse- plant or practice changes.
quent documentation may be used in place of a
■ Up-to-date records.
test of an emergency drill.
■ Ensuring that outcomes of training objectives
7.a. Use of a grid to track tests of all emergency
are met.
procedures may help facilitate completion of all
tests annually at all locations and on all shifts. ■ Ensuring that community resources are
consulted with annual updates.
7.c.(1)–(2) An organization may establish a
benchmark or target prior to the test. Many times ■ Updating letters of agreement annually.
this is met and no improvement is needed. This Procedures are considered for evaluation and
confirms that current practice is appropriate. modification during the following times:
However, other times analysis may indicate ■ Training.
revision is needed for an improvement to the
■ After training drills.
procedure itself or that additional training of
personnel or persons served is needed. When ■ As risks increase.
persons served require additional practice in ■ After actual emergencies.

emergency procedures, consider: ■ When responsibility is reassigned.
■ Assessments that determine the individual
■ When changes are made to the physical plant.
needs in the event of an emergency situation
■ When changes occur in proximity to the
of persons served.
physical plant.
■ Task analysis of procedures to teach
■ When a policy or procedure is revised.
sequencing of steps.
■ When briefing personnel on emergency
■ Assistance from local resources emergency plan changes.
planning resources.
■ Random and shift drills, as determined
by the needs of persons served.

YMCA, and various other service organizations.

1.H. 8. There is immediate access to: The organization may choose to have designated
8.H. Safety
a. First aid expertise. personnel become trainers in first aid and CPR,
8.a.H. Safety
b. First aid equipment and supplies. or it may contract with other agencies to provide
8.b.H. Safety
c. Relevant emergency information training.

on the: 8.b. The organization may implement guidelines
8.c.H. Safety
(1) Persons served. defined by local health and safety authorities

8.c.(1)H. Safety
(2) Personnel. regarding the availability of first aid equipment

8.c.(2)H. Safety
and supplies. The organization makes first aid

Intent Statements
supplies easily accessible to personnel at all sites
It is important to provide a safe setting for the it owns/leases/controls where services or admin-
persons served and personnel. The adequacy istration are located and in all vehicles in which
of first aid expertise reflects the needs of the persons served are transported.
population served as well as the service setting.
Necessary emergency resources, including First aid supplies are regularly checked through
people trained to respond and the location of a systematic process and replenished as needed.
first aid equipment and supplies, are known A monthly checklist may be completed by desig-
and quickly available during program hours. nated personnel documenting that needed items
are available and that any outdated supplies are
Examples disposed of. The designated person would be
The adequacy of first aid expertise reflects the responsible for immediately procuring any
needs of the population being served as well as items needed.
the service setting and may include first aid, CPR, 8.c. This standard gives the organization flexibil-
universal precautions, or other safety training. ity in determining the most accessible location
Necessary emergency resources, including people for emergency information. The location could
trained to respond and the location of first aid depend on the size of the program or the organi-
equipment and supplies, are known and quickly zation, staffing patterns, and the type of program
available during program hours. or setting. The organization may collect such
8.a. The organization defines how it will have information in the personnel or administrative
immediate access to first aid. This may be accom- files, records of persons served, a notebook, or a
plished by training key personnel in first aid. It special file. In an inpatient or residential setting,
identifies which employees are mandated to it would be appropriate for the information to be
receive training in first aid and CPR. The need in a format that could be removed from the site
for this training may be included in the signed when an evacuation is necessary.
job description, indicating that employees have This is information that might be needed if
been informed of the need for this training in personnel or a person served has an emergency
maintaining their employment. If services are and may include information on medical condi-
provided in a school or medical setting, person- tions, emergency contact persons, a primary
nel within the program/service site could be used care doctor, allergies, or the use of medications
to meet the requirement for immediate access. or assistive devices. If the persons served are
The organization can contact licensing agencies transported for group activities or services,
to determine whether there is a mandated time this information is available to the personnel
frame within which employees are expected overseeing the outing.
to complete training in first aid and CPR. A The organization also needs to identify how
procedure could be put into place to track the it will ensure that emergency information is
completion of mandated training within the kept current.
specified time period.
First aid and CPR classes are available from local
service agencies such as the Red Cross, the

terminology used in Canada may be serious

1.H. 9. The organization has written procedures occurrences. Reporting requirements can be
regarding critical incidents that include:
9.H. Safety
obtained from regulatory and licensing agencies,
a. Prevention. protection and advocacy services, and funding
9.a.H. Safety
b. Reporting. sources. An incident log may also be kept to sum-

9.b.H. Safety
c. Documentation. marize causes and trends of incidents at a glance.

9.c.H. Safety
d. Remedial action. Written procedures are in place for determining

9.d.H. Safety
e. Timely debriefings conducted follow- what constitutes a critical incident/serious occur-

ing critical incidents. rence, how investigations are to be conducted,
9.e.H. Safety
f. The following critical incidents, how documentation is to be completed, who is

if appropriate: responsible for completing documentation, who
9.f.H. Safety
is to be notified, and where written documenta-
(1) Medication errors.
9.f.(1)H. Safety tion of incidents is to be kept.
(2) Use of seclusion.
9.f.(2)H. Safety
Regulations and/or policy may require documen-
(3) Use of restraint.
9.f.(3)H. Safety tation of what is considered a “near miss,” in
(4) Incidents involving injury. which serious consequences were avoided, but
9.f.(4)H. Safety
(5) Communicable disease. which would require review in order to promote

9.f.(5)H. Safety
(6) Infection control. a safer environment. This is a concept being

9.f.(6)H. Safety
(7) Aggression or violence. effectively used by some organizations.

9.f.(7)H. Safety
(8) Use and unauthorized possession Training is important to ensure that all personnel
of weapons. are trained in, and aware of, the reporting
requirements. It may be helpful to document the
9.f.(8)H. Safety
(9) Wandering.
9.f.(9)H. Safety
(10) Elopement. completion of the training in an employee’s per-

9.f.(10)H. Safety
sonnel file and review the information at the time
(11) Vehicular accidents.
9.f.(11)H. Safety of the employee’s annual review.
(12) Biohazardous accidents.
9.f.(12)H. Safety The reporting of critical incidents/serious
(13) Unauthorized use and possession
occurrences is essential. Reporting ensures that
of legal or illegal substances.
9.f.(13)H. Safety
information is communicated and that signifi-
(14) Abuse. cant events that could jeopardize the health and
9.f.(14)H. Safety
(15) Neglect. safety of participants and personnel are

9.f.(15)H. Safety
(16) Suicide or attempted suicide. documented.

9.f.(16)H. Safety
(17) Sexual assault. An incident reporting form can be developed so

9.f.(17)H. Safety
(18) Other sentinel events. that all necessary information about the incident
9.f.(18)H. Safety
is included, such as the date, time, and location

Intent Statements
of the incident; who was involved; what led to
Although an organization is expected to have the incident; a description of what happened;
procedures that include all of the types of critical the consequences of the incident; witnesses; who
incidents listed in this standard that are applica- was notified; and follow-up recommendations.
ble to its operations, it would be possible for a Personnel completing the form are to provide
procedure to adequately address more than one
descriptive and factual information. Software
type of critical incident. An organization is not
programs are increasingly being used for report-
required to have a separate procedure for each
ing critical incidents to ensure more consistency
type of incident as long as all critical incidents are
in documentation, timely review, remediation,
appropriately considered.
and sharing of information with involved person-
Examples nel, and to facilitate analysis.
The organization follows legal requirements The organization implements a written proce-
regarding investigation and the reporting dure identifying what format and where the
of incidents to the proper authorities. The documentation of incidents is to be maintained.

Licensing agencies view incident reports as confi- and education needs that may differ from the rest
dential legal documents and require them to be of the organization. The written analysis might
stored in a secure area. Time lines regarding how be a separate report or contained within the
long documentation of critical incidents/serious organizationwide report.
occurrences must be kept are also typically set by This analysis is a critical component to the con-
licensing agencies. cept of prevention in both risk management and
As applicable, organizations should note require- performance improvement activities. In order to
ments of: determine the causes and trends of critical inci-
■ Child abuse and neglect laws. dents/serious occurrences (terminology which
may be used in Canada), an organization imple-
■ Vulnerable adult regulations.
ments a process for review at least annually and,
9.f.(13) In its written procedures the organiza- based on leadership structure, indicates the per-
tion addresses the possession and use of medical sons or positions responsible for the review.
marijuana, including topics such as whether it is Critical incidents/serious occurrences may
legal or illegal, how it is managed, the impact of be reviewed by leadership or by one or more
its use on other persons served, and sharing with committees to ensure that a thorough analysis
or selling to other persons served. is completed. An organization implements a
process for reviewing all incidents involving acci-
1.H. 10. A written analysis of all critical incidents dents, injuries, illnesses, and “near miss” events.
is provided to or conducted by the A well-rounded committee would include mem-
leadership: bers from the administration, transportation,
10.H. Safety
a. At least annually. social services, human resources, and training

and development departments.
10.a.H. Safety
b. That addresses:
10.b.H. Safety
(1) Causes. An organization may also develop a human

10.b.(1)H. Safety
(2) Trends. rights committee to review critical incidents/

10.b.(2)H. Safety
(3) Actions for improvement. serious occurrences. Effective members of this

10.b.(3)H. Safety committee likely have experience in behavior
(4) Results of performance improve-
analysis and rights of persons served. This
ment plans.
10.b.(4)H. Safety
committee would review all critical incidents
(5) Necessary education and training to determine antecedents, changes in behavior
of personnel. observed during the incident, the influence of
10.b.(5)H. Safety
(6) Prevention of recurrence. personnel interactions and interventions, the

10.b.(6)H. Safety
(7) Internal reporting requirements. need for environmental modifications, that client
rights are upheld, and that individuals are treated
10.b.(7)H. Safety
(8) External reporting requirements.

10.b.(8)H. Safety
with dignity and respect.
Intent Statements
Regardless of who reviews critical incidents/
An integrated approach to the management of
serious occurrences, a thorough analysis includes
critical incidents is essential to effective risk
the following:
management.
■ 10.b.(1) A determination of the cause of each
Examples incident. Did the incident occur as the result
If critical incidents are analyzed at the level of of an environmental flaw, a lack of personnel
the larger entity or organization, there is still a training factors, or a failure to follow the
process to review, analyze, and address the data organization’s policies and procedures?
associated with critical incidents specific to the ■ 10.b.(2) Identification of trends in critical
programs/services seeking accreditation. Analyz- incidents/serious occurrences. Are common
ing critical incidents at the level of the program/ themes emerging in the incident reports? An
service could identify program/service specific examination of trends evaluates the location
causes, trends, actions, prevention of recurrence, of critical incidents, the time of incidents,

the personnel involved in incidents, the

involvement of persons served in incidents,
1.H. 11. The organization implements
procedures:
the types of incidents, methods of interven- 11.H. Safety
tion, etc. a. For:

11.a.H. Safety
(1) Infection prevention.

10.b.(3)–(4) The purpose of the above analysis 11.a.(1)H. Safety
is to enable the development of actions for (2) Infection control.

11.a.(2)H. Safety
improvement to prevent similar events from b. That include:

11.b.H. Safety
occurring in the future. Once an analysis of the (1) Training regarding:

11.b.(1)H. Safety
incidents has been completed, the committee (a) Infections.

members are responsible for making recom- 11.b.(1)(a)H. Safety
(b) Communicable diseases.

mendations and determining actions that the 11.b.(1)(b)H. Safety
(2) Appropriate use of standard or

organization needs to take to improve the areas universal precautions.
identified. 11.b.(2)H. Safety
(3) Guidelines for addressing these

Recommendations may include environmental procedures with:
modifications, additional personnel training, 11.b.(3)H. Safety
(a) Persons served.

changes in policies and procedures, and other 11.b.(3)(a)H. Safety
actions. The designated committee subsequently (b) Personnel.

11.b.(3)(b)H. Safety
revisits recommendations to evaluate the results (c) Other stakeholders.

11.b.(3)(c)H. Safety
of the actions taken for improvement, ensuring Intent Statements

that the recommended changes that have been
The persons served, personnel, and other stake-
made were effective. holders should be provided with training based
Meeting minutes could be used to share infor- on individual needs. Each organization is encour-
mation with those in all areas affected by the aged to check legal and regulatory requirements
committee’s recommendations to ensure com- regarding the use of standard or universal pre-
munication of need areas, as well as provide cautions in the programs provided and with the
documentation of actions. populations served.
10.b.(7)–(8) Requirements with regard to the
reporting of an incident to the appropriate
 11.b.(2) In Canada this may be referred to as
routine practices.
personnel and/or authority may vary. Some Examples
incidents may involve issues that are internal
to the operation of the organization and that The organization could provide staff education
are reported only to the appropriate supervisors. on universal precautions, hand washing tech-
However, incidents of neglect, abuse, or death nique, the use of alternative cleansing solutions,
must be reported to the appropriate external or the use of aseptic techniques. Posted signs,
authorities, as required by regulation or law. items in the newsletter, or other means could
CARF requires reporting of sentinel events to be used to educate family members, volunteers
the organization’s designated resource specialist and other visitors about preventing the spread
at CARF within 30 days of their occurrence. of infection. The organization could have sur-
A form for reporting these is available online. veillance activities for monitoring and trending
acquired infections. A written infection control
procedure could be developed to include sur-
veillance, isolation and precautions, health of
persons served, employee health, education,
antibiotic usage and resistance, and HIV-related
issues.
11.b.(2) Each organization is encouraged
to check legal and regulatory requirements
regarding the use of standard or universal
precautions in the programs provided and

with the populations served. Laws and regula- h. Written emergency procedures
tions often vary by jurisdiction and by program available in the vehicle(s).
type.
12.h.H. Safety
i. Communication devices available

11.b.(3)(a) Teaching the persons served consid- in the vehicle(s).
12.i.H. Safety
ers individual needs such as risk-taking behavior, j. First aid supplies available in the
drug use, long-term involvement in services/ vehicle(s).
supports, or greater potential risk of exposure. 12.j.H. Safety
k. Maintenance of vehicles owned

Education for the persons served regarding the or operated by the organization
prevention and control of infection or communi- according to manufacturers’
cable diseases can occur during orientation, in recommendations.
individual and group sessions, and through 12.k.H. Safety
l. If services are contracted, an annual

provision of written or video materials. review of the contract against ele-
Resources ments a. through k. of this standard.
12.l.H. Safety
Resources used in the development of infection Intent Statements

control plans could include the Centers for Transportation for the persons served is provided
Disease Control www.cdc.gov, the Association in a safe manner consistent with the regulations
for Professionals in Infection Control and of the local authorities. This standard will apply
Epidemiology www.apic.org, the Public Health when any vehicle, including a personal vehicle,
Agency of Canada www.phac-aspc.gc.ca, is used to provide transportation for persons
Infection Prevention and Control Canada served.
www.ipac-canada.org, or state/provincial
Examples
or other jurisdictional departments of health
outbreak manuals. This standard is not applied to transportation
services, such as a citywide system, that provide
services to those who participate in the program
as well as others in the general population. This
Standard 1.H.12. applies only to programs that standard also does not apply if only materials
provide transportation for the persons served. are transported.
NOTE: This standard does not apply to vehicles This standard applies when transportation is
used only for transporting materials. provided either on a regular or an occasional
basis for persons served.
1.H. 12. When transportation is provided for 12.a.–b. The licensing requirements of drivers
persons served there is evidence of: are regulated by state/province or other juris-
12.H. Safety
a. Appropriate licensing of all drivers. diction, and the organization complies with any
12.a.H. Safety
b. Regular review of driving records special licensing requirements needed to operate

of all drivers. a particular vehicle. Organizational procedures
12.b.H. Safety
c. Insurance covering: may require that the individual personnel file

12.c.H. Safety
(1) Vehicles. contain a copy of the driver’s license (if regular or

12.c.(1)H. Safety
occasional driving is part of the job description);
(2) Passengers.
12.c.(2)H. Safety a safe driving record check completed at the time
d. Safety features in vehicles. of hire; and any additional certificates, insurance,
12.d.H. Safety
e. Safety equipment. or licenses applicable to the individual’s position.

12.e.H. Safety
f. Accessibility. The organization may implement a policy that

12.f.H. Safety
g. Training of drivers regarding: authorizes it to have access to driving and insur-

12.g.H. Safety
(1) The organization’s transportation ance records and obligates the employee to notify
procedures. the employer immediately of any driving viola-
12.g.(1)H. Safety
(2) The unique needs of the persons tions, restrictions placed on his or her license,
served. or changes in insurance coverage.
12.g.(2)H. Safety

Regulations the organization is subject to may ing of passengers, once in the vehicle. Most
include identified criminal record checks on vehicles with special restraints and lifts have
persons providing transportation for children, training programs and videos.
adolescents, or vulnerable adults in addition to Training drivers in the organization’s require-
the review of driving records. The organization ments takes place prior to any driver operating
sets its own parameters regarding acceptability a vehicle. The training might include vehicle
of driving records and determines the most operations, rules and regulations for the drivers,
opportune time to secure this information. It equipment usage, safety procedures, procedures
should, however, adhere to a time frame that for reporting incidents and accidents, what to do
ensures regular review occurs. and who to contact in the event of an accident,
12.c. Insurance guidelines and minimum and passenger assistance techniques. It’s a good
requirements are established by the state/ practice when a new driver assumes operation
province or other jurisdiction and by the proof the vehicle that someone who knows the route
vider agreement. Generally the insurance policy and passengers goes along until the new driver
will list all vehicles utilized, owned, or leased, has attained proficiency. Keeping an information
along with the name and driver’s license iden- log of the route and passengers is also beneficial,
tification number of each operator. Insurance especially when photos of the passengers are kept
information is kept in the vehicle. When an with their personal information.
employee uses his or her personal vehicle for Skill training in passenger assistance and infor-
transporting persons served, it is suggested that mation on the unique transportation needs of
the organization keep a copy of his or her vehicle each individual are provided. Orientation of
insurance on file and update it at renewal. passengers and documentation of their unique
12.d.–e. A paramount objective of the organiza- transportation needs are accomplished prior
tion is ensuring the safety and welfare of those it to first providing transportation. The driver is
serves, personnel, and drivers. Most vehicles have trained to identify and provide assistance to
standard safety features and devices. Prior to the persons with orthopedic and neurological con-
operation of a vehicle, the brakes, horn, lights, ditions, sensory impairments, and seizure or
mirrors, windshield wipers, tires, and other behavior disorders if such information is needed
features are checked as being in satisfactory oper- for the safety of persons served. Knowledge of the
ating condition. A daily written log indicating passengers’ special needs and the assistance they
good working order is one way to operationalize require will reduce injuries and help prevent
this. In addition, seat belts and, when indicated, emergency situations.
child restraint seats are standard equipment. If an Some organizations have implemented the
organization transports infants and children, this innovative practice of providing defensive driver
includes the use of age-appropriate restraining training to personnel whose responsibilities
devices to be secured in the vehicles. Height, include transportation. Some insurance com-
weight, cognition, etc., need to be taken into panies even offer such training online.
consideration.
12.h. Written emergency procedures are
Safety experts suggest that any road hazard developed. The written procedures for handling
equipment in a van be safely secured in a specific emergencies include roadside emergencies and
location in the vehicle. Equipment might include individual emergencies that may occur during
a flashing light, portable red/yellow reflector operation of the vehicle. The plans are kept in the
warning device, or a road sign that can be placed vehicles, and all drivers are trained on the pro-
outside the vehicle. cedures. Emergency plans could include severe
12.g. Drivers are trained in assisting passengers weather conditions, evacuation procedures,
who have a variety of needs in order to make the vehicle fires, and accidents.
vehicles accessible to them. This may include 12.i. The ability of the driver to communicate
training in wheelchair management, needs of the with the dispatcher or transportation manager is
blind, provision of seating assistance, and secur-

also a safety requirement. A direct two-way radio Resources

setup gives both the driver and dispatcher instant A resource for information on safety when
communication or cell phones can be installed driving persons served is http://www2.work-
with automated preset emergency numbers that safebc.com/i/posters/2014/ws14_06.html.
can be activated. An employee’s personal cell
phone would meet the intent of this standard. 1.H. 13. Comprehensive health and safety
12.j. A standard first aid kit is on board. It is a inspections:
good practice to regularly check the supplies in 13.H. Safety
a. Are conducted:
the kit so that it always contains the necessary 13.a.H. Safety

items. 13.a.(1)H. Safety
(2) By a qualified external authority.

12.k. Vehicle maintenance procedures and 13.a.(2)H. Safety
b. Result in a written report that

schedules comply with the manufacturer’s rec-
identifies:
ommendations. These organization procedures 13.b.H. Safety
may identify the staff responsible to ensure that (1) The areas inspected.
13.b.(1)H. Safety
all vehicles operated are in safe working order at (2) Recommendations for areas
all times. Maintenance records provide written needing improvement.
13.b.(2)H. Safety
documentation of regular preventive mainte- (3) Actions taken to respond to

nance, regular inspections, and repairs. If a the recommendations.
vehicle is leased or a person/agency lends the
13.b.(3)H. Safety
Intent Statements
organization a vehicle, the organization has
access to the records of the vehicle containing Annual external inspections are completed to
enhance and maintain the organization’s health
this same information.
and safety practices. External inspections must
12.l. If an organization contracts with another include all facilities regularly utilized by the
entity to provide transportation, the agreement organization.
contains clauses that ensure that all service and
performance standards are being met. These con- Examples
tracts are reviewed and updated annually. Each 13.a.(1) One comprehensive external inspection
contract specifies the provider’s responsibilities, is the minimum requirement of the standard.
compliance assurances, quality of services, fare This inspection may be conducted in a single,
structure and conditions, insurance require- uninterrupted process that moves methodically
ments, assignment clauses, and termination and comprehensively through an entire program
provisions. area or physical location, or the organization may
As this standard does apply when personal have several external inspections conducted that
vehicles of staff members are used to provide together constitute a comprehensive inspection
transportation for persons served, it is advisable of all areas relevant to the operation of its
to maintain safety supplies and equipment in per- programs or services. Multiple inspections are
sonal vehicles that are regularly used to do so. For not required unless one authority cannot com-
a staff member who infrequently may transport prehensively address all aspects. If an authority
persons, stocking a “ready-to-go” safety bag or kit does not include both health and safety, then
with supplies that could be picked up whenever a additional inspections by as many other qualified
personal vehicle is used might suffice. If personal authorities as needed to do so would be required.
vehicles are used to transport persons served or The inspections cover all applicable areas, includ-
other staff members, the organization and other ing as appropriate:
staff members must review this activity with their ■ Heating and cooling systems.
insurance carriers. ■ Electrical systems.
■ Emergency warning devices.
■ Walking and working surfaces.
■ Ingress and egress.

■ Health and sanitation related to: The plan for corrective action is time specific
– Food preparation. (generally within 30 days) and is distributed to
personnel who received the inspection report.
– Eating areas.
The regulatory body or inspection personnel may
– Restrooms. be included, placing them in a position to offer
■ Structural integrity of facility. feedback regarding the plan of action.
■ The working environment, including: Procedures also include follow-up for scheduling
– Illumination. of corrective actions with assigned responsibility,
accountability, and target dates for the correction
– Noise.
of hazards and areas for improvement discovered
– Air contaminants. in the inspections. This could involve a range of
– Ventilation. corrective techniques (i.e., training, maintenance,
■ Storage of hazardous materials. etc.), necessitate participation at all levels of the
organization, and involve a variety of functions.
■ Fire protection systems and equipment. Procedures should include a way for manage-
■ Air protection systems or warning devices, ment to ensure that the actions are completed.
such as carbon monoxide detectors. Annual external inspections serve to enhance
■ Safety devices installed on equipment. and help maintain good health and safety
■ Other protective devices. practices. Any external authority used by the
■ Recreation/visitation areas. organization (e.g., a representative of a licensure
body) should be qualified by training and may
■ Other areas appropriate to the services
even be credentialed as such (e.g., a licensed or
provided.
registered safety engineer or risk management
13.a.(2) External means external to the entire authority).
system, not just to a unit of the organization. External authorities may include:
Exceptions to this include some settings such
■ A representative of a local health department.
as Veterans Health Administration or Veterans
Affairs Canada sites, other federal or tribal ■ A licensed or registered safety engineer or
programs, and government-owned organizations safety specialist.

where certain functions may be conducted by ■ A representative of a governmental agency
departments within the larger organization. In that provides workplace safety, health, or
these instances if there is any question regarding physical plant inspection on a consultative or
the application of this policy, the organization licensing basis; in Canada, this could include
should contact its designated resource specialist a representative from a provincial or territo-
in the CARF office. rial body designated under legislation related
13.b.(1)–(3) Each inspection process concludes to workplace safety.
with a written report, which becomes part of ■ An engineer involved in industrial operations
organizational records. The inspection report or a plant engineer familiar with health and
identifies the health and/or safety areas addressed safety requirements applicable to the services/
and exact location of each inspection, the date it supports provided.
was completed, the agency and auditor/inspector ■ A safety consultant who is in private practice.
that conducted the inspection, and any areas of
■ A representative of the organization’s fire or
noncompliance in the areas inspected.
workers’ compensation carrier or who is in
The organization establishes procedures that private practice.
identify the personnel responsible to develop and
■ A risk management specialist.
implement a corrective action plan, if needed, to
■ An industrial health specialist.
respond to identified recommendations for areas
needing improvement. Any actions taken for ■ A local fire control authority or representative
correction are documented. of the fire department.

The self-inspections cover all applicable areas,

1.H. 14. Comprehensive health and safety self- including as appropriate:
inspections:
14.H. Safety
■ Heating and cooling systems.
a. Are conducted at least semiannually
■ Electrical systems.
on each shift.
■ Emergency warning devices.
14.a.H. Safety
b. Result in a written report that

identifies: ■ Walking and working surfaces.
14.b.H. Safety
(1) The areas inspected. ■ Ingress and egress.

14.b.(1)H. Safety
(2) Recommendations for areas ■ Health and sanitation related to:

needing improvement.
14.b.(2)H. Safety
– Food preparation.
(3) Actions taken to respond to
– Eating areas.
the recommendations.
14.b.(3)H. Safety
– Restrooms.
Intent Statements
■ Structural integrity of facility.
Regular self-inspections help personnel to
internalize current health and safety require- ■ Storage of hazardous materials.
ments into everyday practices. Self-inspections ■ Fire protection systems and equipment.
must include all facilities regularly utilized by ■ Air contaminants and ventilation.
the organization.
■ Air protection systems or warning devices,
Examples such as carbon monoxide detectors.
A self-inspection is defined as one that is ■ Safety devices installed on equipment.
conducted by individuals or groups within the ■ Other protective devices.
organizational structure. This includes profes-
sional personnel or internal groups who have ■ Recreation/visitation areas.
received training in conducting inspections. ■ Other areas appropriate to the services
Internal groups include safety committees, safety provided.
circles, or operation teams. Anyone within the A small site may be fully evaluated in a single
organizational structure, such as managers, inspection, while inspection of a larger facility
supervisors, direct service employees, persons might need to be conducted in phases. Health
served, and maintenance personnel, may and safety inspections are scheduled for the
participate in a self-inspection. entire workplace twice a year on each shift.
The purpose of self-inspections is to identify Knowing when, where, and how specific safety
and correct existing workplace hazards and to policies and procedures are succeeding or failing
determine whether regulatory standards are is crucial to continuous improvement. Thorough
being met. A good practice for self-inspection and objective evaluation of the overall health
is to use the same format and criteria as the and safety program requires that an inspection
external authority. A self-inspection can also be be completed on each shift with a sample of
used to keep the organization ready for compli- staff members. Management needs to identify if
ance inspections by external regulatory agencies. employees and persons served are adhering to
Ongoing evaluations are the key to continuous established health and safety policies and pro-
improvement. Because personnel are more cedures. Regular inspections help determine if
readily available than outside parties to partici- safety practices are being followed at each site
pate in ongoing evaluation, self-inspections and on each shift.
figure prominently in the overall organizational
Any inspection process is incomplete until its
health and safety audit plan and schedule.
findings have been reported to and acted on
by management in a timely and meaningful
manner. Management establishes standards for
inspection reports and procedures for follow-up

that facilitate improvement. Each inspection ■ Self-inspection reports and follow-up,

process concludes with documentation that iden- including response to recommendations
tifies areas covered in the inspection. Reported ■ Written emergency procedures
areas of noncompliance cite regulatory standards
■ Written evidence of unannounced tests of
and describe the physical hazard, unsafe work
emergency procedures and corrective actions,
practice, or other area for improvement in
if any recommendations were noted
specific terms.
■ Written incident procedures and copies of
Good documentation goes beyond the descrip-
incident reports
tion of inspection details. It includes the factors
causing each deficiency, an evaluation of when ■ Documentation showing all incidents are
and where similar hazards or deficiencies may reviewed and analyzed to identify trends and
exist, and guidelines for responding to them, an action plan established to reduce risks
which could include interim corrective measures. ■ Records of training for staff on incident
Management or the designated personnel then reporting
assign a person or group as responsible and ■ Infection prevention and control procedures
accountable for completion of corrective action. ■ Medication management procedures, if
Management requires verification of completion applicable
from the accountable personnel. Evaluation and ■ Procedures for the use of standard or
assessment of the outcomes of corrective actions universal precautions
are monitored so that the desired goals are being ■ Documentation of provision of competency-
attained. based safety training for personnel
■ Minutes of safety committee meetings
1.H. 15. If applicable, there are written proce-
dures concerning hazardous materials ■ A list of personnel trained in safety
that provide for safe: techniques
15.H. Safety
a. Handling. ■ A list of personnel and others on the

15.a.H. Safety
safety committee
b. Storage.
15.b.H. Safety
c. Disposal. ■ Information on vehicles and drivers,

15.c.H. Safety if applicable
Examples ■ Copies of licenses and certificates
Hazardous materials could include biohazardous when applicable
substances, industrial strength cleaning supplies, ■ Accident reporting requirements
oil-based paints, fluorescent light bulbs, copier
toner, and computer monitors. ■ Written emergency procedures available
in vehicles that are used to transport
Documentation Examples persons served, if applicable
The following are examples of the types of infor- ■ Transportation procedures, if applicable
mation you should have available to demonstrate ■ Documentation of safety training for
your conformance to the standards in this sub- persons served
section. See Appendix A for more information ■ Written procedures concerning safe han-
on required documentation. dling, storage, and disposal of hazardous
■ Health and safety policies and procedures materials
■ Health and safety training information
■ Inspection report from an external authority

and corrective actions, if any recommenda-
tion were noted

Section 1.I. Human Resources
I. Human Resources 1.I. 2. The organization implements written

procedures that address:
2.I. HR
Description a. Verification of:

2.a.I. HR
CARF-accredited organizations demonstrate that (1) Backgrounds of personnel in

they value their human resources. It should be the following areas, if required:
evident that personnel are involved and engaged
2.a.(1)I. HR
(a) Criminal checks.

in the success of the organization and the persons 2.a.(1)(a)I. HR
(b) Immunizations.
they serve. 2.a.(1)(b)I. HR
(c) Fingerprinting.
2.a.(1)(c)I. HR
(d) Drug testing.

1.I. 1. There are an adequate number of 2.a.(1)(d)I. HR
(2) The credentials of all applicable

personnel to:
1.I. HR personnel (including licensure,
a. Meet the established outcomes certification, and registration):
of the persons served. 2.a.(2)I. HR
1.a.I. HR (a) With primary sources.

b. Ensure the safety of persons served. 2.a.(2)(a)I. HR
1.b.I. HR (b) When applicable, in all

c. Deal with unplanned absences of states/provinces or other
personnel. jurisdictions where person-
1.c.I. HR
d. Meet the performance expectations nel will deliver services.

of the organization. 2.a.(2)(b)I. HR
b. Time frames for verification of back-

1.d.I. HR
Intent Statements grounds and credentials, including:

2.b.I. HR
Personnel may be employed full- or part-time, (1) Prior to the delivery of services
by contract, or other arrangement. to the persons served or to the
organization.
Examples 2.b.(1)I. HR
(2) Throughout employment.

Required and needed staffing levels are main- 2.b.(2)I. HR
tained, and personnel turnover does not have c. Actions to be taken in response to the
a negative impact on the delivery of quality information received concerning:
2.c.I. HR
services and supports. No ratios are established (1) Background issues.

2.c.(1)I. HR
by CARF for the number of persons served to (2) Credentials verification.

2.c.(2)I. HR
the number of personnel. Sufficient backup is Intent Statements

available in the event of personnel absences.
Primary source verification can occur when
The backup personnel plan is sufficient to
credentials are initially earned, at the time of hire,
allow minimal impact on the delivery of
or for existing personnel, prior to an accreditation
services and supports.
survey. Copies of licenses/credentials provided
The organization’s performance improvement directly by personnel do not meet the primary
system can be used to measure the staffing source verification requirement. When the licens-
pattern needs and configurations. See related ing authority requires and verifies the education
standards in Sections 1.M. and 1.N. regarding required for the license, evidence of licensing
the collection of effectiveness and efficiency data, from the licensing authority as the primary source
the analysis of data for planning implications, will also serve as evidence that the education has
and the use of information from performance been verified.
reports to guide decision making related to 2.a.(2)(b) If personnel deliver services in more
resource allocation and personnel development. than one state/province or jurisdiction, the
organization is knowledgeable about reciprocity
of licensure and how this would impact service
delivery in person or via use of information and
communication technologies.

2.b. Time frames are established by external designated personnel who are responsible for
authorities or in their absence by the obtaining verification of credentials or current
organization. licensure and other employee information. Des-
Examples ignated personnel may obtain documentation
through a variety of means, including the
The organization demonstrates compliance with
following:
all applicable guidelines and legal requirements
■ An original letter or copy of a letter received
(from funding sources; governmental authorities;
etc.), including when required, criminal back- directly from the appropriate credentialing,
ground checks for personnel working with licensing, or certification board.
vulnerable persons. ■ A copy of a webpage listing (for those situa-
Evidence of procedures for the verification of tions where verification is actually completed
credentials may include documentation such online or through the internet by checking a
as a standard form or checklist that is used by listing of licensed/certified personnel).
designated personnel who are responsible for ■ A copy of the license or certification provided
obtaining verification of credentials or current by the credentialing organization.

licensure and other employee information. ■ A phone log or other notation made by an
Evidence that backgrounds/experience and individual responsible for conducting pri-

credentials/degrees have been verified is typically mary source verification.
maintained in personnel records. Reference A high school diploma is not considered by
checks and/or fingerprinting may be used to CARF to be a credential and so is not subject
verify backgrounds. to primary source verification.
2.a.(1) An organization in the U.S. complies with
Resources
all required background checks, as applicable,
including the Federal Exclusions List. The Office A resource for information on medical license
of Inspector General has the authority to exclude portability in the United States is
individuals and entities from federally funded www.licenseportability.org.
healthcare programs and maintains a current List
of Excluded Individuals and Entities (LEIE). 1.I. 3. The organization demonstrates:
Anyone who hires an individual or entity on the
3.I. HR
a. Recruitment efforts.
LEIE may be subject to civil monetary penalties. 3.a.I. HR
b. Retention efforts.
For more information, refer to 3.b.I. HR
c. Identification of any trends in

oig.hhs.gov/exclusions/index.asp.
personnel turnover.
2.a.(1)(a) CARF standards require criminal 3.c.I. HR
background checks for personnel providing Intent Statements

direct services to children or adolescents. It is important to recruit and retain qualified
personnel. Personnel turnover is problematic for
2.a.(2)(a) High school diplomas do not need
the persons served and for the continued good
primary source verification, but college degrees,
business practices of the organization.
when required for the position and not verified
through a licensing authority, would need to be Examples
verified with primary sources. Verbal, written, or 3.a.–b. Recruitment efforts and retention efforts
electronic confirmation of credentials (including both help to ensure that required staffing levels
degrees) from state/provincial or other jurisdic- are maintained and personnel turnover does not
tional boards; schools or institutions; and/or negatively impact the delivery of quality services
trade associations; or verification through a and supports.
credential verification organization is required. 3.c. There are numerous ways to capture infor-
Evidence of procedures for the verification of mation on personnel turnover to review trends.
credentials may include documentation such First, information is gathered from sources such
as a standard form or checklist that is used by

as exit interviews, surveys on the climate of the only to existing skills and competencies needed,
organization, industrywide salary surveys, or but emerging skills and competencies that will
vacancy rate trends. For example, an organization contribute to an agile organization and improved
experiencing a high turnover of personnel may future individual and organizational productivity
investigate and find that employees are quitting and effectiveness.
to work with a competitor that provides better Other aspects of competencies required may
benefits or sign-on bonuses. Finally, targets are relate to the rights of the persons served, use of
established and a strategy is outlined to reach specialized equipment, and demonstration of
those targets. sensitivity to the diversity of the persons served.
4.b. Competencies may be assessed in a number
1.I. 4. The organization: of ways, including:
4.I. HR
a. Identifies the competencies needed ■ Post-tests after trainings.

by personnel to:
4.a.I. HR ■ Personnel demonstrating the skill.
(1) Assist the persons served in
■ Certificates of successful course completion.
the accomplishment of their
established outcomes. 4.c. A variety of techniques may be used, such
as holding staff meetings focused on theoretical
4.a.(1)I. HR
(2) Support the organization in the

accomplishment of its mission concepts, presenting training films or guest
and goals. speakers, or reviewing other reference materials,
4.a.(2)I. HR
b. Assesses the current competencies which could include books, articles, professional
of personnel at least annually. journals, magazines, newspapers, and internet
4.b.I. HR
access. The type of information will vary depend-
c. Provides resources to personnel for
ing on the nature of the services provided.
professional development.
4.c.I. HR
Training and education may be offered directly
Examples by the organization or by qualified community
4.a. Governmental regulations, credentialing resources. Other resources to consider for train-
bodies, or professional associations may be ing and education are journals and the internet.
excellent resources for establishing qualifications
Resources
including educational experience and require-
ments. These requirements are listed in job Your CARF accreditation may provide your
descriptions to ensure that all personnel are organization with a bottom-line benefit through
qualified to fill the positions for which they are e-learning that will be valued by your staff and
hired. A timely personnel orientation is typically customers alike. CARF has joined the EditU
conducted within the first few weeks of employ- consortium and through the EditU consortium,
ment or placement. The organization ensures SkillSoft—a leading provider of corporate online
that all personnel new to a program are ade- learning—has made its extensive online course-
quately trained prior to their providing direct ware library available for distribution of
services and supports. scholarships to CARF-accredited providers
that are also members of the Association
Job descriptions address the minimum require-
of Rehabilitation Programs in Computer
ments of each position, including education and
Technology (ARPCT).
experience qualifications, overall responsibili-
ties, specific duties, and physical expectations. The scholarships are for use by two groups
of individuals:
The organization’s training program addresses
knowledge and competency needs. Personnel ■ People with disabilities.
training supports the achievement of consumer ■ Rehabilitation professionals who provide

and other stakeholders expectations. There is training and job development rehabilitation
an effective annual personnel development goal services for people with disabilities.
planning in place that evidences attention not

For more information about taking advantage of specific ethical or conduct-related issues that
EditU’s resources, please check CARF’s website: the organization risks facing or has faced.
www.carf.org/editu.html. Examples
5.a.(1) The organization ensures that personnel
1.I. 5. The organization provides documented who are new to a program are adequately trained
personnel training: prior to their providing direct services. A variety
5.I. HR
a. At: of techniques may be used, such as holding staff

5.a.I. HR
(1) Orientation. meetings focused on theoretical concepts, pre-

senting training films or guest speakers, or
5.a.(1)I. HR
(2) Regular intervals.

5.a.(2)I. HR
b. That addresses, at a minimum: reviewing other reference materials, which could

5.b.I. HR
include books, articles, professional journals,
(1) The identified competencies
magazines, newspapers, and internet access.
needed by personnel.
5.b.(1)I. HR
(2) Confidentiality requirements. 5.b.(4) Training in cultural competency could

5.b.(2)I. HR
be one of the ways to address diversity.
(3) Customer service.
5.b.(3)I. HR
To achieve individualized service plan develop-
(4) Diversity.
5.b.(4)I. HR ment that includes consideration of a person’s
(5) Ethical codes of conduct. cultural background, training specific to the
5.b.(5)I. HR
(6) Promoting wellness of the cultural diversity of the local community is

persons served. included. Knowledge of cultural diversity is a
5.b.(6)I. HR
(7) Person-centered practice. critical component of providing respectful and

5.b.(7)I. HR
(8) Reporting of: individualized quality services and supports. For

5.b.(8)I. HR
(a) Suspected abuse. organizations that serve persons with disabilities,

5.b.(8)(a)I. HR
(b) Suspected neglect. it is important to acknowledge that persons and

5.b.(8)(b)I. HR
families served, like all people, bring with them
(9) Rights of the persons served.
5.b.(9)I. HR their own values, thoughts, beliefs, and attitudes.
(10) Rights of personnel. Training related to cultural competency is
5.b.(10)I. HR
(11) Unique needs of the persons directed toward promoting competency among
served. professionals in working with ethnically or other-
5.b.(11)I. HR
Intent Statements wise diverse populations.

In addition to training that occurs at or near 5.b.(6) Orientation and training for personnel on
the time of hire, training may occur following promoting wellness of the persons served might
revisions to policies and procedures, during times include topics such as special equipment, tech-
of high turnover, and when new programs or nology, and support services that would allow the
services are added or new populations served. persons served to remain active in their commu-
5.b.(2) The confidentiality of the person served nities of choice; special health considerations and
is protected by law. Personnel need training in screenings that might be appropriate to the needs
these regulations so that they may demonstrate of persons served; how to assist persons served to
knowledge of and compliance with the laws gain increased knowledge and capability to man-
related to confidentiality. age their own health and advocate for their health
5.b.(4) Training related to diversity is directed needs; and information on advocacy groups and
toward promoting competency of personnel other resources they might access.
in working with culturally or otherwise diverse 5.b.(7) Person-centered practice may also include
populations. An organization might integrate family-centered services when applicable.
training on diversity as a component of all the
training it conducts.
5.b.(5) Training on ethical codes of conduct can
include professional and business ethics and/or

as is a sole direct service professional who

1.I. 6. Performance management includes: is the organization’s only shareholder.
6.I. HR
a. Job descriptions that are:

6.a.I. HR
Examples
(1) Reviewed annually.
6.a.(1)I. HR
(2) Updated as needed.
6.a.(2)I. HR ments of each position, including education
b. Performance evaluations for all and experience qualifications, overall responsi-
personnel directly employed by bilities, specific duties, and physical expectations.
the organization that are: Essential functions are those duties that are
6.b.I. HR
(1) Based on: fundamental to the position and cannot be

6.b.(1)I. HR
(a) Job functions. reasonably performed by another employee.

6.b.(1)(a)I. HR
(b) Identified competencies. These functions are considered essential for

6.b.(1)(b)I. HR
(2) Evident in personnel files. the individual to perform the job. Removing
6.b.(2)I. HR
(3) Conducted: an essential function would fundamentally

6.b.(3)I. HR
change the job as the position exists to perform
(a) In collaboration with the
the function.
direct supervisor.
6.b.(3)(a)I. HR
Job descriptions are updated and revised, as
(b) With evidence of input from
needed, to maintain their currency. Some organi-
the personnel being
zations review the job description at the time of
evaluated.
6.b.(3)(b)I. HR evaluation. It is suggested that revisions be dated.
(4) Used to: Personnel are evaluated at least annually based
6.b.(4)I. HR
(a) Assess performance related on their activities/skills that are related to their
to objectives established in job performances as defined in the job descrip-
the last evaluation period. tions. It is suggested that both the employee and
6.b.(4)(a)I. HR
(b) Establish measurable perfor- the supervisor/designee sign and date the eval-
mance objectives for the uation. The evaluation includes goals that will
next year. lead to employee development and will further
6.b.(4)(b)I. HR
(5) Performed annually. support the organization’s values and mission.

6.b.(5)I. HR
c. Reviews of all contract personnel Performance evaluations are also a critical com-
utilized by the organization that: ponent of personnel success. It should be evident
that personnel have been engaged actively in the
6.c.I. HR
(1) Assess performance of their

contracts. evaluation process and have established perfor-
6.c.(1)I. HR
(2) Ensure that they follow all appli- mance goals for the next year.
cable policies and procedures of Single or multiple records may be maintained,
the organization. but confidentiality is essential. The organization
6.c.(2)I. HR
(3) Ensure that they conform to keeps records in a secure location, such as a
CARF standards applicable to locked filing cabinet, to ensure confidentiality.
the services they provide. Surveyors will review some personnel records
while on site to verify that procedures as called
6.c.(3)I. HR
(4) Are performed annually.

6.c.(4)I. HR
for in the standards and pertinent legal require-

Intent Statements
ments are being followed. The organization
Evaluation of employees is an essential part of demonstrates compliance with legal require-
performance management. However, evaluation ments pertaining to personnel records. The
is not practical when there is no independent organization’s written policy is followed.
oversight authority. Accordingly, Standards
6.b.(1)–6.b.(5) do not apply to employees with- 6.a. Job descriptions may be reviewed annually
out individual or board supervision, or who by Human Resource staff in conjunction with
are supervised by a board controlled by the management to ensure that the descriptions
employee or his or her family. For example, continue to reflect current responsibilities
an unincorporated sole practitioner is exempt, of positions. They may also be updated by

management incorporating input from employ- (2) Employee selection, including:

ees regarding current job responsibilities and
8.b.(2)I. HR
(a) Promotions.
functions. 8.b.(2)(a)I. HR
(b) Job postings.

6.c.(3) A good practice for a contract is to include 8.b.(2)(b)I. HR
(3) Nondiscrimination in the

the specific standards that the contracted profes- areas of:
sional or organization is to fulfill. 8.b.(3)I. HR
(a) Employment.
8.b.(3)(a)I. HR
(b) Compensation.
1.I. 7. If students or volunteers are used by 8.b.(3)(b)I. HR
(c) Assignment of work.

the organization, there is a system 8.b.(3)(c)I. HR
of management that includes: (d) Promotion.

8.b.(3)(d)I. HR
7.I. HR
a. A signed agreement. Intent Statements

7.a.I. HR
b. Identification of: This standard does not require that each staff
7.b.I. HR
(1) Duties. member be given a copy of the personnel poli-

7.b.(1)I. HR
cies, but it does require that each staff member
(2) Scope of responsibility.
7.b.(2)I. HR has access to the personnel policies. Evidence
(3) Supervision. that the personnel policies are provided or avail-
7.b.(3)I. HR
c. Orientation. able to staff members does not have to be in

7.c.I. HR
d. Training. writing.
7.d.I. HR
e. Assessment of performance. 8.b.(1)(a) The intent of this standard is that all

7.e.I. HR
f. Policies and written procedures personnel within an organization have access

for dismissal. to an identified mechanism through which they
7.f.I. HR
may express concerns.
g. Confidentiality policies.
7.g.I. HR
h. Background checks, when required. Examples

8.b.(1)(a) Procedures may vary for different
7.h.I. HR
Intent Statements
types of personnel policies, union contracts,
Students and volunteers play a role in many individual contract language, or governmental
CARF-accredited organizations. The critical
laws or regulations.
components identified in the standard assist
the organization with decreasing its risk. 8.b.(2)(a)–(b) To retain personnel, it is important
that there be good overall management of the
Examples employee evaluation and selection process, which
Persons who volunteer to help with a onetime includes the possibility of promotion or change
project with no unsupervised direct contact or in job functions. If a job is available, personnel
interactions with persons served are not consid- know where it will be posted and are clear on
ered to be included in this volunteer category. whether there is a possibility of promotion from
Examples of this could be volunteers who are within the organization.
assisting with a facility painting/makeover 8.b.(3) Demonstration of nondiscrimination
project or a fundraising event. may include:
■ An affirmative action or employment equity
1.I. 8. The organization implements personnel plan that demonstrates the organization’s
policies that: attempts to identify and solicit applications
8.I. HR
a. Are accessible to personnel. from members of equity target groups and

8.a.I. HR
b. Address, at a minimum: protected classes.

8.b.I. HR
(1) Employee relations, including: ■ Published statements regarding equal employ-

8.b.(1)I. HR
(a) Grievance and appeal pro- ment opportunities and affirmative action.
cedures for all personnel. ■ Evidence of contacts with public or private
8.b.(1)(a)I. HR
(b) Disciplinary action. employment agencies soliciting qualified

8.b.(1)(b)I. HR
(c) Termination.
8.b.(1)(c)I. HR

applicants who are members of equity target Documentation Examples

groups and protected classes. The following are examples of the types of infor-
■ Other areas in which the organization dem- mation you should have available to demonstrate
onstrates nondiscrimination, in addition to your conformance to the standards in this sub-
race, ethnicity, religion, disability, gender, section. See Appendix A for more information
sexual orientation, age, nation of origin, and on required documentation.
other protected classes, including the persons ■ Human resources/personnel policies and
served. procedures
■ Performance evaluations
1.I. 9. As applicable, the organization dem- ■ Job descriptions
onstrates a process that addresses the
■ Orientation and training information
provision of services by personnel that
are consistent with relevant: ■ Personnel records
9.I. HR
a. Legislation governing practices. ■ Personnel turnover rates

9.a.I. HR
b. Licensure requirements. ■ Verification of background checks, when

9.b.I. HR
c. Registration requirements. required

9.c.I. HR
d. Certification requirements. ■ Record of initial and subsequent credential

checks
9.d.I. HR
e. Professional degrees.
9.e.I. HR
f. Professional training to maintain ■ Written agreement for contracted services,
established competency levels. if such services are used

9.f.I. HR
g. On-the-job training requirements. ■ Training curricula for personnel

9.g.I. HR
h. Professional standards of practice. ■ Documentation of training attended

9.h.I. HR
Intent Statements
by personnel
■ Record of initial and ongoing compe-
The organization verifies and ensures that
personnel provide services in accordance tency-based training
with relevant external or internal requirements ■ Personnel policies
and education. ■ Grievance and appeal procedures for
Examples personnel
Supervisors could include this as part of the ■ Review of all contract personnel, if applicable
annual performance evaluation. ■ Signed volunteer agreements and written

policies and procedures, if applicable

Section 1.J. Technology
J. Technology of multiple computers. The organization’s

technology personnel, if applicable, would be
involved in the development of the plan.
Description
Key questions for organizations to address
CARF-accredited organizations plan for the use include: How well do our current hardware and
of technology to support and advance effective software meet our needs? Are our technological
and efficient service and business practices. resources and data secure, confidential, and
protected from computer viruses? What is the
1.J. 1. The organization implements a technol- backup plan? Do we have off-site storage of our
ogy and system plan that: backup? When were the backup data last tested?
1.J. Technology
a. Includes: Do we consistently work on quality improvement

with our data management? Does the technology
1.a.J. Technology
(1) Hardware.
1.a.(1)J. Technology
(2) Software. help us do our job better?

(3) Security. Generally, personal information is hosted on

an intranet website set up for an organization’s
(4) Confidentiality.
1.a.(4)J. Technology internal use only, but personal data are often
(5) Backup policies.
posted and available for users. If personal data
(6) Assistive technology. are posted, it is imperative that the webmaster
(7) Disaster recovery preparedness. (developer and/or administrator of the site) gives
(8) Virus protection. the organization specific assurances that the data
are secure and clearly explains any potential risks
b. Supports:
1.b.J. Technology
(1) Information management. of personal data exposure. Complete security

1.b.(1)J. Technology
generally cannot be absolutely guaranteed; how-
(2) Performance improvement
ever, assurances that the webmaster has made the
activities for:
1.b.(2)J. Technology system as secure as possible is of critical impor-
(a) Program/service delivery. tance if the organization chooses to make any of
1.b.(2)(a)J. Technology
(b) Business functions. the data available.

1.b.(2)(b)J. Technology
c. Is reviewed at least annually for 1.a.(5) Backup of electronic records occurs

relevance. regularly in relation to the organization’s use
1.c.J. Technology
d. Is updated as needed. of electronic systems, including security in

1.d.J. Technology
Intent Statements case of a fire or other destruction.

Information technology is an integral part of 1.a.(6) Assistive technology may include elec-
business strategies and practices. It is critical tronic medical records, a Wii® game console,
for organizations to proactively plan and take eBook readers, screen reading software, adaptive
measures to avoid potential threats and ensure telephones, wander guard equipment, sensors on
uninterrupted access to systems. doors, adaptive mouse devices for using comput-
An organization should consider, as part of its ers, and voice recognition software.
technology and system planning, how it can The organization plans to implement a system
use various types of technology to manage of handheld devices for access and entries to the
information and support its various improvement chart/record of the person served. The organiza-
activities. tion considers whether the screen size, font, etc.
Examples
are adequate for ease of access and use by staff.
Most organizations have some form of informa- The organization reviews the technology used
tion technology. Large and small organizations to see if it is accessible for persons with visual
will have very different plans, as will organiza- impairments or if additional options need to be
tions that have been utilizing technology for available for persons who use a screen reader.
years and those that are new to computerization. The organization is considering incorporation of
A system could be a single desktop or a network applications such as recording cueing strategies

into community integration and vocational pro- Standards for Service Delivery Using
gramming, but not all persons served have access Information and Communication
to tablets or internet access to incorporate this Technologies
new technology. The organization explores
options for access.
1.b. The organization assesses its use of
technology to: If the organization uses information and
communication technologies (ICT) to deliver
■ Enhance individual services.
services, Standards J.2. through J.8. apply.
■ Improve efficiency of personnel.
NOTE: The use of technology for strictly informa-
■ Improve productivity of personnel. tional purposes does not qualify as providing
■ Communicate with stakeholders. services via the use of ICT. Please refer to
■ Improve services to isolated populations,
Section 1.J. in the standards manual or call
when applicable. your resource specialist for further clarification.
The organization may review its need to use or

increase its use of the telephone or the internet to Description
better serve persons who are geographically or Depending on the type of program, a variety of
otherwise isolated. An organization that is served terminology may be used to describe the use of
by a board of directors might develop a secure information and communication technologies
website with password access where it can post to deliver services; e.g., telepractice, telehealth,
meeting agendas, plans, reports, and other mate- telemental health, telerehabilitation, telespeech,
rials for review by board members rather than etc. Based on the individualized plan for the
having to duplicate and send these materials out person served, the use of information and
by mail or by attachments to multiple emails. As communication technologies allows providers
information compiles on the website over time, it to see, hear, and/or interact with persons served,
would also allow board members to easily access family/support system members, and other pro-
meeting minutes and reference historical infor- viders in remote settings. The use of technology
mation for items related to those in the current for strictly informational purposes does not
period. qualify as providing services via the use of
information and communication technologies.
Resources
The provision of services via information and
There are numerous web-based resources for
communication technologies may:
developing a technology plan. Some sites have
■ Include services such as assessment, monitor-
fully developed plan outlines that can be down-
loaded at no cost. Resources include: ing, prevention, intervention, follow-up,
supervision, education, consultation, and
■ www.techsoup.org
counseling.
■ www.nonprofit.about.com
■ Involve a variety of professionals such as
case managers/service coordinators, social
workers, psychologists, speech-language
pathologists, occupational therapists, physical
therapists, physicians, nurses, rehabilitation
engineers, assistive technologists, and
teachers.

■ Encompass settings such as: e. Safety considerations.

3.e.J. Technology
– Hospitals, clinics, professional offices, and f. Infection control.

3.f.J. Technology
other organization-based settings. g. Troubleshooting.

3.g.J. Technology
– Schools, work sites, libraries, community Intent Statements

centers, and other community settings.
For service delivery to be effective, personnel
– Congregate living, individual homes, and are trained to use equipment and technology
other residential settings. to deliver services as well as to guide persons
served, members of the family/support system,
1.J. 2. The organization implements written and others in the remote setting on its use.
procedures: Examples
2.J. Technology
a. That address: 3.f. Infection control addresses equipment used

2.a.J. Technology
(1) Consent of the person served. at the originating site and the remote site. For
(2) Audio recording, video recording, example:

and photographing the person ■ Equipment that touches any part of the body
served. or is used to look into someone’s eyes, ears, or
(3) Decision making about when mouth is properly sanitized between each use.
to use information and commu- ■ The person served and family members in the
nication technologies versus home are instructed in proper hand washing
face-to-face services. technique, shielding coughs and sneezes, and
(4) Decision making about when the use, if necessary, of gloves or masks to
to use monitoring devices. minimize risks associated with sharing
b. To confirm prior to the start of each equipment.

session that all necessary technology ■ When the person served is using a computer
and/or equipment: at a school or library, the keyboard, mouse,
2.b.J. Technology
(1) Is available at: and headset are cleaned appropriately before

(a) Originating site. they are used.

(b) Remote site.

4. As appropriate, instruction and training
(2) Functions properly at: 1.J.

(a) Originating site. are provided:

4.J. Technology
(b) Remote site. a. To:

4.a.J. Technology
(1) Persons served.

Intent Statements 4.a.(1)J. Technology
(2) Members of the family/support

2.a.(1) The organization’s procedures include
system.
obtaining written consent to participate in 4.a.(2)J. Technology
service delivery via information and communi- (3) Others.

cation technologies when applicable. b. On equipment:

4.b.J. Technology
(1) Features.
1.J. 3. As appropriate, personnel who 4.b.(2)J. Technology

(2) Set up.
deliver services via information and (3) Use.
communication technologies receive
(4) Maintenance.
competency-based training on 4.b.(4)J. Technology
(5) Safety considerations.

equipment: 4.b.(5)J. Technology
3.J. Technology (6) Infection control.

a. Features. 4.b.(6)J. Technology
3.a.J. Technology (7) Troubleshooting.

b. Set up. 4.b.(7)J. Technology
3.b.J. Technology
c. Use.
3.c.J. Technology
d. Maintenance.
3.d.J. Technology

1.J. 5. Service delivery includes: 1.J. 6. Prior to the start of each session:
5.J. Technology 6.J. Technology
a. Online information 24 hours a day, a. All participants in the session are

7 days a week. identified, including those at:
5.a.J. Technology 6.a.J. Technology
b. Personnel to provide assistance with (1) Originating site.

accessing services provided by the
(2) Remote site.

organization. 6.a.(2)J. Technology
b. The organization provides informa-

5.b.J. Technology
c. Based on identified need: tion that is relevant to the session.

5.c.J. Technology
(1) An appropriate facilitator at the

6.b.J. Technology
Examples
site where the person served
is located. 6.b. Information may be shared on the creden-
5.c.(1)J. Technology
tials of the provider, structure and timing of
(2) Modification to:
5.c.(2)J. Technology services, record keeping, scheduling, contact
(a) Treatment techniques/ between sessions, privacy and security, potential
interventions. risks, confidentiality, billing, rights and responsi-
5.c.(2)(a)J. Technology
(b) Equipment. bilities, etc.

5.c.(2)(b)J. Technology
(c) Materials.
5.c.(2)(c)J. Technology
(d) Environment of the remote 1.J. 7. The organization maintains equipment

site, including: in accordance with manufacturers’
5.c.(2)(d)J. Technology
(i) Accessibility. recommendations.

5.c.(2)(d)(i)J. Technology 7.J. Technology
(ii) Privacy.
5.c.(2)(d)(ii)J. Technology
(iii) Usability of equipment.

5.c.(2)(d)(iii)J. Technology
Examples 1.J. 8. Emergency procedures address the

unique aspects of service delivery
5.a. Online information may include:
via information and communication
■ A description of the services offered via
technologies, including:
information and communication technolo- 8.J. Technology
a. The provider becoming familiar with

gies, providers, referral process, etc.
the emergency procedures of the
■ Technology requirements such as high-speed remote site, if the procedures exist.
internet access, computer headset with micro- 8.a.J. Technology
b. Identification of local emergency

phone, webcam, etc. resources, including phone numbers.
■ Contact information for scheduling or techni-
8.b.J. Technology
Examples
cal support, e.g., the person or department to
contact, phone number, and/or email address. When the person served is located at an organi-
zation or a community setting the provider
■ Information to support or supplement the
becomes familiar with the procedures of that
services provided, e.g., home exercise pro-
setting in the event there is an emergency
grams, forms to use for tracking information,
involving the person served. In the absence of
when to seek emergency care or assistance
emergency procedures for the setting where the
between scheduled sessions, a calendar of
person served is located, or when the person
group sessions, etc.
served is in his or her own home, the provider
NOTE: This standard does not require live help or has immediate access to emergency contact
actual service delivery 24/7 but rather the availa- information for the person served and informa-
bility of information regarding the service. tion on local emergency resources, including
5.c.(1) Depending on the purpose of the session their phone numbers.
and the needs of the person served, professional
personnel, support personnel, family members,
or caregivers might function in the role of
facilitator.

Section 1.K. Rights of Persons Served
Additional Resources K. Rights of Persons

■ American Telemedicine Association:
www.americantelemed.org Served
■ VA Telehealth Services: www.tele-
health.va.gov/real-time Description
■ International Journal of Telerehabilitation: CARF-accredited organizations protect and
telerehab.pitt.edu/ojs/index.php/Telerehab promote the rights of all persons served. This
■ US Department of Health and Human Ser-
commitment guides the delivery of services
vices Health Resources and Services and supports and ongoing interactions with
Administration: www.hrsa.gov/ruralhealth/ the persons served.
about/telehealth/telehealth.html
■ Department of Health and Human Services
1.K. 1. The rights of the persons served are:
1.K. Rights
Centers for Medicare & Medicaid Services a. Communicated to the persons

Telehealth Services: www.cms.gov/Outreach- served:
1.a.K. Rights
and-Education/Medicare-Learning-Net- (1) In a way that is understandable.

1.a.(1)K. Rights
work-MLN/MLNProducts/downloads/ (2) Prior to the beginning of service

TelehealthSrvcsfctsht.pdf delivery or at initiation of service
■ Center for Connected Health Policy National delivery.
1.a.(2)K. Rights
Telehealth Policy Resource Center: (3) Annually for persons served in a

http://cchpca.org program longer than one year.
1.a.(3)K. Rights
b. Available at all times for:

Documentation Examples 1.b.K. Rights
(1) Review.
The following are examples of the types of infor- 1.b.(1)K. Rights
(2) Clarification.
mation you should have available to demonstrate 1.b.(2)K. Rights
your conformance to the standards in this sub- Intent Statements

section. See Appendix A for more information To ensure that the persons served have a clear
on required documentation. understanding of their rights, the organization
■ Technology and system plan
communicates and shares these rights in a
manner that is understandable to the persons
■ Backup policies
served.
■ Performance improvement plans
Examples
■ Written procedures for the use of information
Rights information might be shared during
and communication technologies,
individual service planning meetings, consumer
if applicable
meetings/councils, etc. The method used for
■ Records of equipment maintenance in
communication should reflect the needs of the
accordance with manufacturer’s instructions, person served and may include verbal presen-
if applicable tation, large print, translation into a different
■ Emergency procedures that address service language, or use of a representative for the person
delivery via information and communication served. A good practice is to include rights
technologies, if applicable information in a consumer handbook or present
it through audio recordings, video recordings,
pictures, and other formats.
1.a.(3) It is important that programs providing
services in a continuing relationship of longer
than one year establish a process to ensure that
rights are reviewed with the person on an annual
basis. Some programs choose to do so at the

annual service plan review and update. It is a system of rights that nurtures and protects
suggested that the review be documented in the dignity and respect of the persons served.
some manner. All information is transmitted in a manner that
is clear and understandable.
1.K. 2. The organization implements policies Examples
promoting the following rights of the The organization advocates for and ensures that
persons served: the rights of persons served are protected. Proce-
2.K. Rights
a. Confidentiality of information. dures and practices of personnel demonstrate

2.a.K. Rights
b. Privacy. compliance with all applicable laws. Policies

2.b.K. Rights
c. Freedom from: regarding the human rights and dignity of the

2.c.K. Rights
(1) Abuse. persons served have been written, adopted, and

2.c.(1)K. Rights
communicated to personnel through the organi-
(2) Financial or other exploitation.
2.c.(2)K. Rights
zation’s code of ethics and training and to persons
(3) Retaliation. served in a manner understandable to them. A
2.c.(3)K. Rights
(4) Humiliation. good practice an organization may follow is to

2.c.(4)K. Rights
(5) Neglect. include this information in its employee

handbook.
2.c.(5)K. Rights
d. Access to:
2.d.K. Rights
(1) Information pertinent to the 2.a. The policies address the sharing of confi-
person served in sufficient time dential billing, utilization, clinical and other
to facilitate his or her decision administrative and service-related information,
making. and the operation of any internet-based services/
2.d.(1)K. Rights
(2) Their own records. supports that may exist. Information that is used
2.d.(2)K. Rights
e. Informed consent or refusal or for reporting or billing is shared according to

expression of choice regarding: confidentiality guidelines that recognize applica-
2.e.K. Rights
ble regulatory requirements such as the Health
(1) Service delivery.
2.e.(1)K. Rights Insurance Portability and Accountability Act
(2) Release of information. (HIPAA) and the Health Information Technol-
2.e.(2)K. Rights
(3) Concurrent services. ogy for Economic and Clinical Health (HITECH)
2.e.(3)K. Rights
(4) Composition of the service Act in the United States.

delivery team.
2.e.(4)K. Rights
(5) Involvement in research projects,  In Canada, the regulatory requirements may be

found in:
if applicable. ■ The federal Personal Information Protection
2.e.(5)K. Rights
f. Access or referral to: and Electronic Documents Act (PIPEDA).

2.f.K. Rights
(1) Legal entities for appropriate In some provinces and territories, for example
representation. British Columbia, Alberta, and Quebec, the
2.f.(1)K. Rights
(2) Self-help support services. federal government has exempted organiza-

2.f.(2)K. Rights
(3) Advocacy support services. tions from PIPEDA because substantially

2.f.(3)K. Rights
equivalent provincial legislation is in place.
g. Adherence to research guidelines
and ethics when persons served ■ Provincial legislation dealing with freedom
are involved, if applicable. of information and protection of personal

2.g.K. Rights
h. Investigation and resolution of information in the public sector.

alleged infringement of rights. ■ Legislation that deals specifically with health
2.h.K. Rights
i. Other legal rights. information in those provinces and territories

2.i.K. Rights
that have such legislation.
Intent Statements
The parameters of confidentiality may identify
To demonstrate relevant service delivery and
items that may or may not be disclosed without
appropriate ongoing communication with the
authorization for the release of information as
persons served, the organization implements

well as those areas identified in mandatory applicable. In short-term service settings, the
disclosure laws and regulations. Confidentiality information may be provided verbally, with some
may be limited in such settings as criminal justice written information available. In longer-term
or when providing services to someone who programs, the information may be provided
demonstrates a risk to self or others. When devel- verbally, through educational or wellness work-
oping its confidentiality policy, the organization shops/sessions, through written materials, and
takes into consideration staff use of email, tex- through active participation in team meetings
ting, blogging, and common forums such as and individual service planning.
Facebook and Twitter for work or work-related 2.d.(2) The persons served know how to access
communication. their records.
Confidentiality means limited access and that An organization does not prohibit the persons
only those staff members who have a need to served from having access to their own records,
know information have access to that informa- unless a specific state/provincial law indicates
tion. Local guidance can usually be obtained otherwise. Some information within the file
from funding and referral sources. This standard may not be released to the individual unless
applies to information in all forms, including the authorization has been given by the originating
use of electronic/computer records related to the individual, such as the psychologist in the case
persons served. of an individual’s evaluation.
This standard is relevant to aspects of the organi- A good practice is to put the policy and proce-
zation’s ethics policy (Standard 1.A.6.a.) relating dures in the consumer handbook, orientation
to its staff, its governance authority, and its treat- materials, etc. Notes in the individual record
ment of the persons served. Organization policies may show that the person served has used the
address the protection, privacy, and security of procedure to gain access to his or her own record.
records.
Depending on the individual, access may mean
The organization may establish a documentation that a person might need assistance from a
system for anyone who accesses a file. Unless staff member or an advocate to understand the
legal guardianship is assigned, parents and family information contained in the record. Some
members may not automatically have access to organizations make the person’s file available at
records of persons served. planning meetings so that the contents may be
See also Standards 1.J.2.–8. if services are reviewed at that time.
provided via the internet. 2.e. When consent is required, there is also
2.c. The organization ensures that the person discussion of informed refusal. A person served
served is protected from physical, sexual, psy- may refuse to sign a consent form, but with that
chological, and fiduciary abuse; harassment refusal, the organization is committed to explain-
and physical punishment; and humiliating, ing the risks and adverse consequences of the
threatening, or exploiting actions. Sexual abuse refusal.
or harassment may include any gestures, verbal 2.f. Information may be provided through
or physical, that reference sexual acts or sexuality service directories or a handbook for persons
or objectify the individual sexually. Fiduciary served as part of the orientation of the person
abuse refers to any exploitation of the persons served, on posted listings, or through direct
served for financial gain. This abuse could interaction with program personnel.
include misuse of the funds of the persons
served.
2.d. The persons served are provided with
information pertaining to immediate, pending,
and potential future service/support needs.
Information is offered in a manner that is clear
and understandable, with risks identified when

best practices are in plans developed by govern-

1.K. 3. The organization: ment, school districts, protection and advocacy
3.K. Rights
a. Implements a policy and written groups, employment agencies, funding sources,

procedure by which persons served and businesses.
may formally complain to the organi-
Written guidelines for practices include proce-
zation that specifies:
3.a.K. Rights dures for levels of review and the rights and
(1) That the action will not result in responsibilities of each party involved. These
retaliation or barriers to services. procedures are explained to personnel and
3.a.(1)K. Rights
(2) How efforts will be made to persons served in a way that meets their needs.
resolve the complaint. This explanation may include a video or audio
3.a.(2)K. Rights
(3) Levels of review, which include recording, a handbook, interpreters, advocates,

availability of external review. etc.
3.a.(3)K. Rights
(4) Time frames that:

3.a.(4)K. Rights
(a) Are adequate for prompt 1.K. 4. A written analysis of all formal
consideration. complaints:
3.a.(4)(a)K. Rights 4.K. Rights
(b) Result in timely decisions for a. Is conducted annually.

the person served.
4.a.K. Rights
3.a.(4)(b)K. Rights
b. Determines:
(5) Procedures for written notifica-
4.b.K. Rights
(1) Trends.
tion regarding the actions to be 4.b.(1)K. Rights
(2) Areas needing performance

taken to address the complaint. improvement.
3.a.(5)K. Rights
(6) The rights of each party. 4.b.(2)K. Rights

3.a.(6)K. Rights
(7) The responsibilities of each party. 4.b.(3)K. Rights
3.a.(7)K. Rights
Intent Statements
(8) The availability of advocates or
other assistance. An analysis of formal complaints, grievances,
3.a.(8)K. Rights and appeals can give the organization valuable
b. Makes complaint procedures and, if information to facilitate change that results
applicable, forms: in better customer service and results for the
3.b.K. Rights
(1) Readily available to the persons persons served.

served.
3.b.(1)K. Rights
Examples
(2) Understandable to the persons
served. Because complaints may be part of risk manage-
3.b.(2)K. Rights
ment in some organizations, this information
c. Documents formal complaints
may be evidenced in a variety of reports and used
received.
3.c.K. Rights for a variety of different purposes. This analysis
Intent Statements can be helpful to an organization in identifying
The organization identifies clear protocols related changes to make in service delivery and business
to formal complaints, including grievances and operations, in determining the effectiveness of
appeals. An organization may have separate poli- changes it has made, and in risk analysis and
cies and procedures for grievances and appeals, management. An organization might document
or it may include these in a common policy and when there are no formal complaints received
procedure covering complaints, grievances, and in a given analysis period to ensure that this
appeals. has been addressed.
Examples
It is generally understood that the grievance pro-
cess allows a complaint to be heard and decided,
and the appeal process allows the decision to be
challenged. Local authorities and funding sources
are good references for a model of guidelines on
prudent and responsible practices. Elements of

Section 1.L. Accessibility
Documentation Examples L. Accessibility

The following are examples of the types of
information you should have available to dem- Description
onstrate your conformance to the standards in
this subsection. See Appendix A for more infor- CARF-accredited organizations promote accessi-
mation on required documentation. bility and the removal of barriers for the persons
■ Policies addressing the rights of the persons
served
1.L. 1. The organization’s leadership:
■ Policy and procedures for formal complaints 1.L. Accessibilty
a. Assesses the accessibility needs

■ Information regarding staff training on con-
of the:
sumer rights, informed consent, complaint/ 1.a.L. Accessibilty
(1) Persons served.

grievance procedures, etc. 1.a.(1)L. Accessibilty
(2) Personnel.
■ Consumer handbook, orientation materials, 1.a.(2)L. Accessibilty

updated information regarding rights 1.a.(3)L. Accessibilty
b. Implements an ongoing process

■ Records of the persons served showing
for identification of barriers in
informed consent
the following areas:
■ Conflict resolution information 1.b.L. Accessibilty
(1) Architecture.
■ Grievance and appeal process
1.b.(1)L. Accessibilty
(2) Environment.
■ Documentation of formal complaints received
(3) Attitudes.
■ Documentation showing annual review of
(4) Finances.
complaints 1.b.(4)L. Accessibilty
(5) Employment.
■ Action plan or changes made to improve
(6) Communication.
performance and to reduce complaints 1.b.(6)L. Accessibilty
(7) Technology.
■ External and internal investigation reports
(8) Transportation.
and related corrective action plans 1.b.(8)L. Accessibilty
(9) Community integration,

■ Documentation that consumer rights are
when appropriate.
reviewed annually with persons served 1.b.(9)L. Accessibilty
(10) Any other barrier identified

by the:
(a) Persons served.

1.b.(10)(a)L. Accessibilty
(b) Personnel.
1.b.(10)(b)L. Accessibilty
(c) Other stakeholders.

1.b.(10)(c)L. Accessibilty
Intent Statements
The leadership has a working knowledge of
what should be done to promote accessibility
and remove barriers. Organizations address
accessibility issues in order to:
■ Enhance the quality of life for those served
in their programs and services.
■ Implement nondiscriminatory employment
practices.
■ Meet legal and regulatory requirements.
■ Meet the expectations of stakeholders

in the area of accessibility.

The leadership should address how input was served and/or personnel do not feel safe or feel
solicited from the persons served, personnel, that confidentiality may be risked. In addition
and other stakeholders to assist in the identifica- to such external environmental barriers, internal
tion of barriers, and take into consideration any barriers may include noise level, lack of sound
accessibility needs—physical, cognitive, sensory, proof counseling rooms, highly trafficked areas
emotional, or developmental—that may hinder used for service delivery, or type or lack of fur-
full and effective participation on an equal basis nishing and décor that impact the comfort level
with others. of the persons served and personnel. In a work
Examples environment, lighting may be a barrier if, for
Evidence of accessibility planning may be found instance, fluorescent lighting is used and the
in minutes of meetings where analysis, action flicker precipitates seizure activity in an individ-
planning, and goals are established; in conver- ual. The physical office environment could
sations with stakeholders; in minutes of focus present a barrier if it is noisy or is a very open
groups and council meetings; in community structure and an individual is easily distracted by
events in which the organization participates; in activity. Fragrances in the workplace may trigger
surveys; in affirmative action plans; in building physical reactions impacting health or ability to
or remodeling plans; in grant applications; in optimally perform job functions.
Americans with Disabilities Act (ADA) plans; Many popular computer headpointers, which
etc. control the cursor on a computer, use infrared
To develop an accessibility plan, an organization signals to transmit the movements of the user’s
first identifies barriers within the organization head to the computer and these systems may
itself and in the community. A self-evaluation have trouble operating under some lighting
is conducted regularly by the organization. In conditions, such as direct sunlight. In these
the U.S., an Americans with Disabilities Act environments, a headpointer that uses a different
(ADA) checklist may be helpful in conducting technology to operate, such as a microgyroscope
this evaluation. For organizations in Canada, technology that senses head movements and
accessibility issues are addressed by federal and transmits those movements to the computer
provincial regulations, including the Charter of using radio frequency signals, would overcome
Rights and Freedoms in the Constitution and the the environmental barrier.
Provincial Employment Acts. Surveys of persons Environmental barriers in a person’s home
served may also help identify barriers. Agencies environment might be addressed, for example,
have written documentation of potential barriers by installing computer controls for temperature,
to services/supports, and these barriers are lights, window shades, etc., that are activated by
addressed in the accessibility plan. a puff straw.
1.b.(1) Architectural or physical barriers are 1.b.(3) The organization evaluates any precon-
generally easy to identify and may include steps ceived opinions that its personnel and other
that prevent access to a building for an individual stakeholders may have of persons with disabili-
who uses a wheelchair, narrow doorways that ties, as these can impact access to services/
need to be widened, bathrooms that need to be supports or benefits to be gained. Attitudinal
made accessible, the absence of light alarms for barriers may include, but are not limited to:
individuals who have a hearing impairment, and ■ Terminology and language that the organi-
the absence of signs in Braille for individuals who zation uses in its literature or when it
are blind. communicates with persons with disabilities,
1.b.(2) Environmental barriers can be interpreted other stakeholders, and the public (e.g, does
as any location or characteristic of the setting that the organization use person-first language?).
compromises, hinders, or impedes service deliv- ■ How persons with disabilities are viewed
ery and the benefits to be gained. Some service and treated by the organization, their families,
sites may be located in areas where the persons and the community (e.g., dependent versus

independent or interdependent, not valuable equated with user-friendliness. Ask your team a
versus valuable). few important questions to measure the friendli-
■ Whether or not input of persons served is ness of your site. Does your site make sense to
solicited and used. people who are new to the site? Do you ask for
input on how users experience the site? What
■ Whether or not the eligibility criteria of the
kind of input have you received or responded to?
organization create barriers for individuals
Is this a priority for the organization at this time,
with specific types of disabilities.
or does the site serve its purpose adequately? If
1.b.(4) Financial barriers include insufficient time permits upgrading of the site now, then
funding for services/supports, and the organi- what can be done to make the site better? Are you
zation might advocate at a legislative level for addressing your needs or changes in your tech-
increased funds, or it might promote activities nology plan?
to directly raise money for the support of a Information should be provided in an accessible
service or a person served. and understandable format for the person served.
1.b.(5) Providing flexibility in the workplace, For example, if the individual is blind, the infor-
such as considering requests for flex time, job mation might be provided in an electronic format
sharing, part-time work, or compressed work accessible to computer screen readers.
schedules, can help many persons with disabili- 1.b.(8) Transportation barriers include persons
ties better manage their needs. These low- and being unable to reach service locations or being
no-cost arrangements are also found in lists of unable to participate in the full range of services/
what it takes for businesses and employers to supports and activities offered.
be more family-friendly. With appropriate use,
these practices can lead to more productive 1.b.(9) Barriers to community integration
workplaces for employers and more satisfying include any barrier that would keep the persons
settings for all employees. served from returning to full participation in
their community of choice. For example, partici-
Tools and technology that were once only used pation in sports may be limited by the lack of a
by persons with a disability are now being used lift at the public swimming pool for access by
to help anyone complete tasks more effectively persons served with limited mobility or the lack
and efficiently. Voice recognition technology is of scheduling availability of the local gym for an
a good example of an aid that has become a adaptive sports program; accommodations may
regular part of the work environment. be needed for the persons served to return to
1.b.(6) Communication barriers include the previous volunteer activities with the community
absence of a teletype machine (TTY) or the food bank.
absence of materials in a language or format 1.b.(10) Other barriers to services/supports
that is understood by the persons served. If an identified by the persons served or other stake-
organization has a website, it could request holders would also be addressed. These could
assistance from technical centers to evaluate include those raised by evolving technology, the
its website to ensure the clarity of the site and upkeep of equipment/assistive technology, and
ease of accessing information. In 1996, a U.S. issues more specific to the populations served.
Justice Department ruling stated that the ADA Customer satisfaction surveys may help identify
applied to the internet as well as to more physical other barriers.
realms. Depending on the stakeholders of the
organization and others who access the website, Resources
alternative formats could be developed. Information on the ADA is provided by the
Developing a user-friendly interface is an U.S. Department of Justice. The ADA website
ongoing process that is best measured by how is located at: www.ada.gov.
easy it is for any user to navigate throughout the
site without getting lost. Every web developer has
 Information on the Accessibility for Ontarians
with Disabilities Act, 2005 (AODA) is provided
a different sense of style, but style shouldn’t be by the Ontario Ministry of Community and

Social Services. The AODA website is located Intent Statements

at www.mcss.gov.on.ca/mcss/english/pillars/ There may be barriers identified that the organi-
accessibilityontario. Information and resources zation does not have the authority or resources
for accessibility planning are available through to remove; effective accommodations may be
this website. the appropriate action to be taken in those
Additional resources that may be helpful are circumstances.
available through the Canadian Standards Examples
Association, a not-for-profit membership-based The organization develops a plan that meets the
association serving business, industry, govern- accessibility needs of persons served, personnel,
ment and consumers in Canada and the global and other stakeholders. The plan identifies areas
marketplace. The Canadian Standards Associa- for improvement in accessibility and includes a
tion website is located at www.csa.ca. schedule for improvement. In its planning, an
1.b.(6) Resources on health literacy and accessi- organization may identify short- and long-range
bility include: actions to be taken. Barrier removal that is not
■ www.ric.org/cror/healthliteracy.aspx currently achievable may be achievable later
■ Agency for Healthcare Research and Quality
when the organization has more resources. The
of the United States Department of Health organization’s planning may have options for
and Human Services www.ahrq.gov/popula- referral to and the use of other generic services
tions/sahlsatool.htm and networks that may be more accessible.
■ Canadian Public Health Association
Creating an accessibility plan is one of the best
www.cpha.ca/en/pls.aspx and www.cpha.ca/ ways to ensure barrier removal. Identification of
uploads/portals/h-l/directory_e.pdf the persons responsible for correcting identified
barriers to services/supports is not required by
■ www.noslangues-ourlanguages.gc.ca/
the standard; however, many organizations find
■ www.literacybc.ca/Info/clear_language.pdf it helpful to include this in the plan.
■ www.nald.ca At a minimum, the plan:
■ www.literacy.ca/?q=literacy/clearwriting ■ Lists the barriers that limit access to programs
■ www.ahip.org/content/ and services.
default.aspx?docid=30683 ■ Provides a detailed outline of the methods to
■ www.centerforplainlanguage.org be used in removing barriers.
1.b.(10) Information and guidance for accessible ■ Develops a schedule for taking necessary steps
medical instrumentation is available at to achieve a barrier-free environment. If the

www.rerc-ami.org/ami/projects/d/4/1. time period for achieving compliance is
lengthy, the plan could identify interim steps
to be taken to provide program access and
1.L. 2. The organization implements an acces-
progress toward removal of barriers.
sibility plan that:
2.L. Accessibilty
■ May identify person(s) responsible for
a. Includes, for all identified barriers:
2.a.L. Accessibilty
implementing the plan.
2.a.(1)L. Accessibilty
(2) Time lines. The plan is not difficult to craft if a few easy
2.a.(2)L. Accessibilty
steps are followed. The organization can:
b. Is reviewed at least annually for
relevance, including: Step 1: Designate a responsible person as access
2.b.L. Accessibilty
(1) Progress made in the removal coordinator. It helps if this person has an interest
of identified barriers. and experience in disability issues.
(2) Areas needing improvement. Step 2: Consult with persons with disabilities
who are trained in accessibility. The involvement
c. Is updated as needed.
2.c.L. Accessibilty of trained persons is important because, in addi-
tion to helping identify barriers, they can often

provide creative and practical solutions to – Due date: April

address the barriers. – Responsible person: Executive director/
Step 3: Complete checklists for physical, Speech-Language Pathologist
program, employment, and communication Sources for additional information:
access. These checklists may be adapted from
several published guides. The CARF Guide to Accessibility is a CARF
publication that is available on request from
Step 4: Develop an access plan. The plan will your resource specialist.
identify the barriers and solutions, establish
priority for each item, project the costs associated Information on the ADA is provided by the
with each item, identify funding sources, target U.S. Department of Justice. The ADA website
completion dates, and identify the person is located at www.ada.gov.
responsible for each item. (See the items in Also available is a toll-free ADA information line
the example that follows Step 5.) to call to obtain answers to general and technical
Step 5: Establish a system for evaluating progress questions about the ADA and to order technical
and updating the accessibility plan. It is essential assistance materials: (800) 514-0301 (voice) and
to integrate this accessibility plan into the organi- (800) 514-0383 (TTY).
zation’s budgeting process as well as its strategic A free ADA technical assistance CD-ROM that
plans. The plan should be reviewed by the access contains a complete collection of the depart-
coordinator and the organization’s decision ment’s ADA materials can be ordered via the
makers. Progress is monitored regularly and internet or by calling the ADA information line.
the status updated annually. Designed for easy use on laptop computers in the
The organization may use one of several pub- field or other computers that lack high-speed
lished models for an accessibility plan. The internet access, the CD-ROM will make search-
following illustrates how tasks in a sample ing documents and identifying ADA information
plan might be listed. easier. Documents on the CD-ROM are provided
in a variety of formats, including HTML, Word-
Example of an access plan: Perfect, and text (ASCII), to enable persons with
■ Physical access disabilities and others to gain easy access, trans-
– Barrier: Second-floor water fountain late materials into Braille, or use screen readers.
spout too high Many documents are also provided in Acrobat
– Solution: Install paper cup dispenser PDF format so that they appear on screen as
at wheelchair level they do in print and permit the publication
to be reprinted by personal computers.
– Priority: B (next year)
– Cost: $40 Resources
– Funding source: Unrestricted funds Some resources for accessibility-related infor-

mation are:
– Due date: November
■ Checklist for Readily Achievable Barrier
– Responsible person: Program manager Removal: www.usdoj.gov/crt/ada/check-
■ Program access web.htm is a downloadable checklist
– Barrier: Written materials not understand- prepared by Adaptive Environments Center,
able to many applicants Inc., and Barrier Free Environments, Inc.
– Solution: Provide materials in a variety ■ The Work Supports RRTC program at
of formats (audio recording, video) Virginia Commonwealth University has

developed a checklist to help businesses
– Priority: A (this year)
and employers in becoming more disability
– Cost: $300 friendly. The checklist covers general
– Funding Source: RSA, Center for accessibility, interactions with customers
Independent Living with disabilities, and evaluation of

disability-friendly employment practices. For them to accomplish the same tasks or activities
a copy, check out: www.worksupport.com/ as those without disabilities.
Main/disability_friendly_checklist.asp. A questionnaire used by the organization to
■ National ADA Consultant List: Additional gather input from persons served, personnel,
resources for ADA compliance, prepared by or other stakeholders can also be an excellent
Network Consulting. tool to get information from individuals about
the need for reasonable accommodations.
■ Information on the Accessibility for
Ontarians with Disabilities Act, 2005 (AODA) Standing committees, such as safety, consumer
is provided by the Ontario Ministry of advocacy, and admissions, can be given the addi-
Community and Social Services. The AODA tional tasks of reviewing the accommodation
website is located at www.mcss.gov.on.ca/ needs of individuals in the work environment,
documents/en/mcss/accessibility/ their residence, and in the community. Addition-
iasr_guides/plan_50_en.pdf. Information ally, these committees can be trained in the use
and resources for accessibility planning are of and advances in assistive technology.
available through this website. The organization may want to develop a specific
budget to assist staff in implementing identified
■ Additional resources that may be helpful are
available through the Canadian Standards
reasonable accommodations. Perhaps there is
potential assistance from, or alternatives may be
Association, a not-for-profit membership-
identified by, other resources such as funders,
based association serving business, industry,
advocacy groups, service organizations, family
government, and consumers in Canada and
members, and other providers.
the global marketplace. The Canadian
Standards Association website is located at A request for a reasonable accommodation does
www.csa.ca. not automatically require that the organization
meet the request. There should be an investiga-
tion of the request. How is the organization
1.L. 3. Requests for reasonable accommoda-
alerted to the need for the reasonable accommo-
tions are:
3.L. Accessibilty dation? What is the review process? Who is
a. Identified. responsible for approving or denying the accom-
3.a.L. Accessibilty
b. Reviewed. modation request? What are the decision-making

3.b.L. Accessibilty
c. Decided upon. criteria? When agreement has been reached to

3.c.L. Accessibilty
d. Documented. provide the accommodation, the steps to accom-

3.d.L. Accessibilty
modation may be made part of the person’s plan.

Intent Statements
When an accommodation cannot be made, the
The organization evaluates and carefully consid-
organization demonstrates a referral system that
ers the merits of all requests for accommodation
to determine whether any remedial actions are
assists the persons served, personnel, or other
appropriate. stakeholders in the use of other resources that are
accessible. Processes can be different for requests
Please see the Glossary for a definition of reason-
from persons served versus those made by staff
able accommodations.
or personnel.
Examples
The organization may want to include in its
process of self-evaluation a system for review
of reasonable accommodations. One of the
ways that this can be accomplished is by asking
individuals with disabilities how the work
environment or community resources can be
designed or changed in such a way so as to enable

■ Meeting minutes
■ Written accessibility plan
■ Documentation regarding reasonable accom-

modations that have been provided
■ Information regarding community activities
■ Information regarding leadership advocacy

activities
■ An accessibility checklist used to identify
barriers
■ An annual review of accessibility plan
■ If virtual access to services is provided,

policies/procedures to ensure accessibility
and accommodations

Review Results
To stay on target at both strategic and tactical

levels, the organization must constantly monitor
M. Performance
and assess its performance against a series of Measurement and
performance indicators and targets. Only by
setting specific, measurable goals and tracking Management
performance can the organization determine the
degree to which it is achieving the desired service Description
and business outcomes. Appropriate organiza- CARF-accredited organizations are committed
tional and stakeholder representatives must to continually improving their organizations and
review and analyze results to determine areas for service delivery to the persons served. Data are
improvement. This review and analysis positions collected and analyzed, and information is used
the organization to develop and initiate perfor- to manage and improve service delivery.
mance improvement changes.
1.M. 1. The organization has a written descrip-
tion of its performance measurement
and management system that includes,
at a minimum:
1.M. Info Mgmt
a. Mission.
1.a.M. Info Mgmt
b. Programs/services seeking
accreditation.
1.b.M. Info Mgmt
c. Objectives of the programs/services

seeking accreditation.
1.c.M. Info Mgmt
d. Personnel responsibilities related

to performance measurement and
management.
1.d.M. Info Mgmt
Intent Statements
A critical component of quality, the imple-
mentation of performance measurement and
management systems for both business and
service delivery allows an organization to look
objectively at how well it is accomplishing its
mission. There is a direct connection between
a number of day-to-day processes addressed
throughout the CARF standards, e.g., those
related to financial management, complaint
management, professional development for
personnel, individualized service delivery, etc.,
and performance management in that those
processes become sources of information used
to analyze performance. This written description
provides the context for the organization’s efforts

Section 1.M. Performance Measurement and Management
and could be used to educate personnel and the organization subscribe to a proprietary
other relevant stakeholders about its approach data vendor in order to achieve data integrity.
to performance measurement and management, 2.a. Reliability. The organization takes steps to
included in marketing or performance informa- ensure that data are collected consistently in a
tion that is shared with stakeholders, and/or
way that could be reproduced at another time
incorporated into ongoing strategic planning
or by other data gatherers. For example:
activities.
■ New and existing personnel are trained on
Examples recording each data element they are respon-
1.c. The objectives of the programs/services sible for collecting; measures or codes are
offered include both business and service deliv- explained and periodically reviewed.
ery objectives, as noted in Standards 1.M.3.d.(1) ■ Inter-rater reliability assessments can be
and (2) in this section. For example, business conducted in which different staff members
objectives might include reduction of turnover record measures for the same persons served
in personnel who have been employed for more and data are compared statistically to assess
than a year. Service objectives might include a whether different staff members arrive at the
certain percentage of persons served will return same ratings for a given individual.
to work or will return home without the need
■ The organization wants to measure function-
for assistance.
ing at intake to the service. It searches the
1.d. Personnel may have a variety of roles and literature and selects a measure that has been
responsibilities in implementing performance widely tested and demonstrated to be reliable
measurement and management systems, such as with this population.
completing assessment tools from which data are
■ The organization serves a large number of
gathered, collecting data, analyzing data, partici-
people each year (more than 2000). Rather
pating on performance improvement teams, or
than send satisfaction questionnaires to all of
working in a quality department that has overall
them, the organization selects a representative
responsibility for performance management
sample of 50 percent of the persons served in
and quality.
each of its service areas. Before the question-
naires are sent, the data manager reviews the
1.M. 2. The organization demonstrates how characteristics of the sample to ensure that
its data collection system addresses the sample is representative of the total group
the following: served in terms of diagnosis/reason for
2.M. Info Mgmt
a. Reliability. seeking services/supports, age, gender, and

2.a.M. Info Mgmt
b. Validity. ethnicity. (See the Glossary for the definition

of representative sampling.) Sampling would
2.b.M. Info Mgmt
c. Completeness.
2.c.M. Info Mgmt
d. Accuracy. not be appropriate if the number served was

2.d.M. Info Mgmt
less than 400.
Intent Statements
2.b. Validity. The organization chooses indica-
Accurate and consistent data will be the deciding
tors, measures, and data elements that measure
factor in the success of an organization moving
what it intends to measure. For example:
to or maintaining a fact-based, decision-making
model. ■ Stakeholders express interest in returning to
work and minimizing days lost due to inca-
Examples pacity for persons referred to the service. The
There are various ways an organization can organization chooses to collect employment
demonstrate that it addresses the integrity of the status at follow-up and asks about the number
data it uses for outcomes assessment, perfor- of days of work lost due to activity limitations
mance improvement, and management decision instead of just the diagnostic data it has always
making. These approaches can range from the summarized.
simple to sophisticated. It is not required that

2.c. Completeness. The organization takes steps

to ensure that the data used for decision making
1.M. 3. The data collected by the organization:
3.M. Info Mgmt
are as complete as possible; no accredited services a. Include:

3.a.M. Info Mgmt
are omitted from the information and perfor- (1) Financial information.
3.a.(1)M. Info Mgmt
mance improvement effort; no groups of persons (2) Accessibility information.

served are omitted from the data gathering or
3.a.(2)M. Info Mgmt
(3) Resource allocation.

analysis; no data elements or indicators are sys- 3.a.(3)M. Info Mgmt
(4) Surveys, if applicable.

tematically missing; and any database is checked 3.a.(4)M. Info Mgmt
(5) Risk management.

for completeness of records before final analyses 3.a.(5)M. Info Mgmt
are run and decisions made. For example: (6) Governance reports, if
applicable.
■ The quality council and data manager collab- 3.a.(6)M. Info Mgmt
(7) Human resources activities.

orate on designing an information system 3.a.(7)M. Info Mgmt
regarding the persons served that includes (8) Technology.

3.a.(8)M. Info Mgmt
necessary data elements for all services of (9) Health and safety reports.
3.a.(9)M. Info Mgmt
the organization. They decide to design an (10) Strategic planning information.

organization wide system but identify each
3.a.(10)M. Info Mgmt
(11) Field trends, including research

record with the particular service in which the findings, if applicable.
person participates so that analysis can be 3.a.(11)M. Info Mgmt
(12) Service delivery.

done separately for all the services to be 3.a.(12)M. Info Mgmt
b. Address:
surveyed. 3.b.M. Info Mgmt
(1) The needs of persons served.

■ Staff training for the data-recording activities 3.b.(1)M. Info Mgmt
(2) The needs of other stakeholders.

includes attention to the importance of 3.b.(2)M. Info Mgmt
recording each data field for every person (3) The business needs of the
served. organization.
3.b.(3)M. Info Mgmt
■ The data manager routinely cross checks the

c. Allow for comparative analysis.
3.c.M. Info Mgmt
number of records in the database with the d. Are used to set:

3.d.M. Info Mgmt
operations officer’s report of the number of (1) Written business function:

3.d.(1)M. Info Mgmt
persons served during a reporting period to (a) Objectives.

ensure that data are available on all persons 3.d.(1)(a)M. Info Mgmt
(b) Performance indicators.

served before analysis is conducted and 3.d.(1)(b)M. Info Mgmt
(c) Performance targets.

reports are generated. Missing records are 3.d.(1)(c)M. Info Mgmt
(2) Written service delivery:

located and entered into the database before 3.d.(2)M. Info Mgmt
analysis is conducted. (a) Objectives.

3.d.(2)(a)M. Info Mgmt
(b) Performance indicators.

2.d. Accuracy. The organization takes steps to 3.d.(2)(b)M. Info Mgmt
ensure that data are recorded properly and that (c) Performance targets.
3.d.(2)(c)M. Info Mgmt
errors are caught and corrected. For example: Intent Statements

■ Spot checks of the records of the persons Organizations continually collect data from a
served are made to ensure that data abstracted variety of internal and external sources. These
from the record are correctly placed into the data are analyzed and the results are used to
database. make informed decisions about the needs of the
■ The data manager routinely reviews the dis-
persons served and other stakeholders as well as
tribution of values in test data runs and asks the business needs of the organization.
the direct care staff members to double-check Business function and service delivery objectives,
the accuracy of cases that seem to be outside performance indicators, and performance tar-
of expectations in terms of maximum or gets are set as appropriate to the specific needs
minimum values. (For example, did someone of the organization. While there does not neces-
really stay in the service for 205 days, or was it sarily need to be a performance indicator and
20 days?) target for each area of data collected, service

delivery performance indicators at a minimum services/supports, desired activities, and goals

include indicators for effectiveness of services, that persons served wish to achieve.
efficiency of services, service access, and satis- ■ At consumer planning meetings, questions
faction with service delivery from a variety of could be asked consistently to address issues
perspectives including the persons who received
that impact each person (e.g., the reasons for
the services and other stakeholders. See the
seeking services/supports, desired activities
Glossary for definitions of performance indicator
and goals, satisfaction with services/supports,
and performance target.
and plans for achieving new goals and pursu-
Examples ing new interests). Responses could be
3.a.(1)–(12) Data collected and information compiled on a form that is used in each meet-
developed relative to standards in other sections ing, and the document could be signed by the
of this manual are analyzed from all these sources persons served and any other attendees to
to provide decision-making information that will ensure accuracy and relevancy of responses.
be used to identify specific needs the organiza- 3.b.(2) In the funding environment today, pro-
tion wishes to address. There does not have to viders must design and deliver services/supports
be an indicator for each of these items. that result in the achievement of outcomes.
3.a.(4) Surveys may refer to satisfaction question- Outcomes are often mandated by government
naires, state/provincial or other jurisdictional stakeholders, such as Congress, legislatures and
surveys, national surveys, CARF surveys, other ministries, the U.S. Department of Labor, the
accreditation surveys, needs assessments, etc. local workforce development board, the Rehabili-
3.b. To be in conformance to this standard, the tation Services Administration, the Department
organization should be prepared to demonstrate of Education, and the departments of Develop-
knowledge of the needs and goals of its custom- mental Disabilities or Mental Health, crown
ers (persons served and other stakeholders). corporations, workers’ compensation boards,
Consistent with the World Health Organization’s and local health integration networks.
International Classification of Functioning, Some examples of that could address the needs
Disability and Health, the needs of the persons of other stakeholders are measurement of: the
served include the reasons they are seeking satisfaction of persons served, time lines of ser-
services, goals they want to achieve, activities vices/supports, increased use and identification
in which they want to engage, and roles and of community resources, participation by the
participation in their communities of choice. persons in the community, increased indepen-
dent living skills, the ability of the persons served
Customers define quality. An organization serves
to make informed choices for living options and
many diverse customers or stakeholders. A cus-
tomer-focused organization seeks and uses the employment, obtaining and retaining full-time
employment, an increase in hours worked per
quality outcomes expectations of persons served
week, improvement in earnings, achievement
and its other major stakeholders. Typical stake-
holders include persons served, their families, of self-employment, and business enterprise
employment.
employers, referral agents, funders, and the com-
munity at large. Once the organization identifies The organization may solicit feedback from other
its key customers or stakeholders, it establishes stakeholders through:
methods to obtain input from them regarding ■ Websites. An input section could be set up
their quality outcomes expectations. for any visitor to the organization’s website
3.b.(1) An organization may solicit feedback to provide open-ended feedback.
from persons served in many ways: ■ Surveys. These surveys, specific to each stake-
■ Through regular surveys specific to each holder group, could elicit input with respect
program, the organization could elicit input to the reasons for seeking services/supports,
with respect to the reasons for seeking desired activities, and goals that persons wish
to achieve.

3.b.(3) Practical examples to demonstrate the Analysis and Action Plan. (See related
interrelatedness of elements 3.a.(1)–(12) in standards in Section 1.N.)
identifying the business needs of the organization 3.d.(1) It is not expected that there be a business
include: function objective or performance indicator for
■ An organization ensures, as part of its analysis each of the data sources listed in 1.M.3.a.(1)–
of financial information and resource alloca- (12). However, the organization should be
tion, that money is budgeted and personnel prepared to present evidence and discuss its
are available to perform planned actions to process for using data from these sources in
reduce identified barriers in its accessibility setting objectives and determining the indicators
plans. selected. For example:
■ An organization may conduct stakeholder ■ In the area of financial planning and man-
surveys asking for input on environmental agement the organization might identify
factors (sometimes called environmental indicators related to expenses, revenues, or
scans). When considered with other elements other budgetary information; or its review
of Standard 3.a.(1)–(12), these surveys can of billing against records of the persons
form the start of an agency’s strategic posi- served.
tioning and planning. ■ In the area of accessibility status reports the
Business needs of an organization may be organization might identify an indicator
culled from the information gathered in a related to implementation of its accessibility
variety of ways: plan and progress made in the removal of
■ Periodically, an analysis could be completed barriers.
that identifies the critical issues surrounding ■ In the area of risk management an indicator
business performance. With advance planning might be identified related to the organiza-
and a clear outline to follow, the data could be tion’s actions to reduce risks.
pulled together at the end of the fiscal or cal- ■ Human resource indicators might be iden-
endar year, whichever time frame is more tified for recruitment, retention, personnel
meaningful to the organization. turnover, or the provision of training to
■ Large organizations that have several personnel.
administrative personnel can have different ■ Health and safety indicators might relate
personnel or board members gather infor- to the analysis of unannounced tests of
mation and then summarize it. Then, the emergency procedures, critical incidents,
board can address governance data, the lead or infection control.
financial person can summarize financial
data, the safety lead can comment on relevant 3.d.(1)(b) In identifying performance indicators
health/safety data, and the technology lead for business function improvement, the organiza-
personnel can summarize information tion strives to align its business processes to
regarding technology needs. A large organiza- maximize service delivery results.
tion may produce a report that contains many 3.d.(1)(c) and 3.d.(2)(c) The establishment of a
pages, attachments, charts, and other relevant performance target to be achieved is critical. To
information. identify performance targets, some organizations
■ Smaller organizations that have few admin-
may use standardized tools that will already have
istrative personnel may have one person an established benchmark, while other organiza-
effectively summarize the data since there is tions may develop their own performance targets
likely much less on which to comment in each from review of their historical performance. A
area. The analysis would still reflect specific review of the literature regarding best practices
issues facing the organization. may be helpful in this process.
■ Some organizations may choose to address
3.d.(2)(b) The performance indicators an
these items in their Annual Performance organization chooses to measure relate to the

information persons served and other stakehold- Service design can be strategically changed in
ers want to know about programs and services. such areas as eligibility and admission, languages
or formats used to present information about the
1.M. 4. The organization collects data about the organization’s services/supports, the delivery of
characteristics of the persons served. culturally sensitive services/supports, and the
4.M. Info Mgmt
provision of information for alternative resources
Intent Statements when needs are unmet.
Characteristics include a wide variety of data that
reflect relevant information about the persons
1.M. 5. The organization collects data about the
served. As data are collected and aggregated
persons served at:
at the level of each program/service seeking 5.M. Info Mgmt
accreditation, the identification and analysis of a. The beginning of services.

5.a.M. Info Mgmt
any significant performance differences of the b. Appropriate intervals during services.

5.b.M. Info Mgmt
program/service in serving relevant groups ties c. The end of services.

into later being able to target specific program 5.c.M. Info Mgmt
d. Point(s) in time following services.

improvements. 5.d.M. Info Mgmt
Examples
Examples
Data are collected and aggregated at the level
Characteristics may include a wide variety of data of each individual program/service seeking
that reflect relevant information with respect accreditation. This is important for analysis that
to the persons served. Typical characteristics can therefore identify performance differences
include demographics (e.g., age, gender, ethnic between programs and target specific
background, disability, education levels, living improvements.
arrangements, primary language) and program
It is important to include the persons the organi-
issues (e.g., length of participation, types of
zation served or intended to serve in order to
goals). Often, demographic record keeping is
ensure that those individuals who drop out pre-
already occurring through other sources and
maturely or who do not return are included in
may be tapped to avoid duplication of effort.
the performance improvement system. Valuable
Identification of the characteristics or demo- information for program improvement can be
graphics of those served by the organization, as gathered from persons who leave the program
well as those awaiting and those not accepted for prior to successful completion.
the organization’s services/supports, helps the
5.d. The ultimate measure of individualized
organization plan effectively and efficiently to
outcomes will be the impact of services/supports
strategically position the services/supports it
on the quality of life of persons served. Infor-
offers. This information can help the organiza-
mation obtained from follow-up helps an
tion compare its customer base to the population
organization determine how its services/supports
in the community, increase referrals, understand
have improved the individual’s quality of life.
and explain customer outcomes, and help in the
Obtaining follow-up information may sometimes
preparation for organizational planning.
depend on the availability of or access to the
Identification of consumer characteristics may person who has left services/supports.
be a significant decision-making tool for estab-
For follow-up, organizations may attempt to
lishing staffing patterns and configurations,
contact each person or a representative sampling
determining cultural sensitivity training needed
of persons who have left services/supports. (See
by personnel, reconsidering the organization’s
the Glossary for the definition of representative
mission, determining the strategic positioning
sampling.) If another entity conducts the follow-
of the organization, and establishing networks
up contacts, the organization may obtain the
and partnerships with other agencies that can
resulting information to use in assessing the
meet the diversity of consumer needs and
quality of its own services/supports. Creative
expectations.
approaches are encouraged when attempting

to obtain post-service information, since this indicators in each area and then collect the
information is critical to accurately assess the data to measure results.
effectiveness of services/supports. Organizations This has implications and linkages throughout
are generally not paid for follow-up, but quality- the management and delivery of quality services/
driven organizations recognize that the payoff is supports. Outcomes to be measured are devel-
in information that leads to improved services oped from the foundation of input by the
and outcomes. organization’s customers and stakeholders. By
Comprehensive exit summary reports, as comparing the actual results of the organization’s
identified in Standard 2.B.10., can be valuable services/supports to these performance goals,
for recording individual outcome achievements leadership can improve organizational design.
and postdischarge follow-up. As an example, such information could lead an
employment service provider to develop services/
1.M. 6. The organization measures: supports that are more responsive to the local job
market, or it could cause a community service
6.M. Info Mgmt
a. Business function performance

indicators. organization to provide services/supports that are
6.a.M. Info Mgmt
b. Service delivery performance indica- more responsive to developing the skills persons
tors for each program/service seeking need to live independently and to ensure com-
accreditation in each of the following munity inclusion as desired by the persons
areas: served.
6.b.M. Info Mgmt
(1) The effectiveness of services. 6.b.(1) Effectiveness measures address the quality
6.b.(1)M. Info Mgmt
(2) The efficiency of services. of services/supports through measuring change

6.b.(2)M. Info Mgmt over time. Depending on the service provided,
(3) Service access.
6.b.(3)M. Info Mgmt
specific effectiveness measures can include the
(4) Satisfaction and other feedback following:
from:
6.b.(4)M. Info Mgmt ■ Community integration.
(a) The persons served.
6.b.(4)(a)M. Info Mgmt ■ Community tenure.
(b) Other stakeholders.
6.b.(4)(b)M. Info Mgmt
■ Increased inclusion in community activities.
Intent Statements
■ Involvement in activities of daily living.
Refer to the Glossary for definitions of effective-
■ Increased self-esteem.
ness, efficiency, and service access.
■ Increased self-direction, self-determination,
Examples and self-reliance.
6.b. Service delivery data are collected and aggre- ■ Improvement in school functioning.
gated at the level of each individual program/
■ Employment with benefits.
service seeking accreditation. This enables
analysis that can therefore identify performance ■ Increased hours of work.
differences between programs and target specific ■ Increased pay.

improvements. Each program/service for which ■ Independent living situation.
the organization is seeking accreditation is
■ Housing status.
included in the organization’s system with its
individual set of performance indicators. ■ Receipt of entitlement benefits.
The performance indicators an organization ■ Quality of relationships.
chooses to measure relate to the information ■ Health status.

persons served and other stakeholders want ■ Subjective psychological well-being.
to know about programs and services.
6.b.(2) Efficiency measures usually include a
It is the intent of the standard that the organiza- ratio of resources used to results or outcomes
tion would establish measurable performance

achieved and may include, but are not limited to, ■ Overall feelings of satisfaction.
the following: ■ Use of informed choices about services/
■ Service delivery cost per service unit. supports.
■ Occupancy rates. ■ Satisfaction with physical facilities, fees,
■ Retention rates. access, service effectiveness, and service
efficacy.
■ Direct service hours of clinical staff.
■ Personnel turnover.
Data regarding the satisfaction of the persons
served with services are collected from persons
■ Length of stay.
active in long-term services as well as from those
■ Service utilization. who leave services in a relatively short time. Such
6.b.(3) A measure of service access could be the data may be collected in a variety of ways, includ-
length of time from referral to intake or deter- ing interviews following discharge, telephone
mining the number of referrals found ineligible surveys, mail surveys, proxy measures used with
for services/supports. The organization might persons unable to communicate directly, and
determine that it needs to hire staff members formalized published satisfaction surveys. The
who are bilingual in Spanish or American Sign results of consumer satisfaction surveys can be
Language to provide service access to the individ- collected either continuously throughout the year
uals who were determined ineligible for services/ or at regularly scheduled points in time, such as
supports. Access to service might also be mea- quarterly.
sured by the following:
■ Waiting time for routine or emergency 1.M. 7. For each service delivery performance
service. indicator, the organization determines:
7.M. Info Mgmt
■ Convenience of service hours and locations. a. To whom the indicator will be

applied.
■ Waiting list information on persons found 7.a.M. Info Mgmt
ineligible for services. b. The person(s) responsible for

collecting the data.
■ Time taken to set a first appointment or 7.b.M. Info Mgmt
orientation. c. The source from which data will

be collected.
■ The degree to which follow up occurs on par- 7.c.M. Info Mgmt
d. A performance target based on an

ticipants formally referred to other services.
industry benchmark, the organi-
■ A comparison of the demographics of the
zation’s performance history, or
local community to the demographics of the established by the organization
persons served by the organization in its or other stakeholder.
programs. 7.d.M. Info Mgmt
Intent Statements
6.b.(4) Satisfaction measures are oriented toward
Refer to the glossary for a definition of
consumers, family members, personnel, the com-
performance target.
munity, and funding sources and may include,
but are not limited to, the following: Examples
■ Was the person served given desired The organization’s performance measurement
supports? and management system addresses the types of
■ Was the person served treated with
data to be collected, the persons responsible for
dignity and respect? collecting and processing the data, the source
and time frame for collecting the data, and the
■ Did the organization focus on the desires
procedures for keeping data confidential.
and needs of the person served?
The establishment of a performance target of a
■ Did the persons served achieve their
level to be achieved is critical. Some organiza-
desired goal?
tions use standardized tools that already have
■ Were grievances or concerns addressed?

an established benchmark while other organiza-

tions develop their own indicator targets by
reviewing their historical performance in an
identified indicator. A review of the literature and
published best practices is helpful in this process.
The development of a performance target ensures
that there will be action for improvement if the
target is not met.
■ Description of performance measurement
and management system
■ Management reports
■ Strategic plan
■ Budgets and financial reports
■ Accessibility plans
■ Technology plan
■ Risk management plan
■ Environmental health and safety reports
■ Satisfaction information of consumers

and other stakeholders
■ Demographics information of persons served
■ Documentation of data collection process
■ Data collected

Effect Change
Following the review and analysis of results, the

organization must carefully evaluate the informa-
N. Performance
tion learned so that it may be translated into Improvement
focused actions to improve performance against
targets. The evaluation drives the organization to Description
engage in a dynamic, proactive process to review,
The dynamic nature of continuous improvement
renew, or revise its strategy and tactics, while
in a CARF-accredited organization sets it apart
ensuring alignment of organizational purpose,
from other organizations providing similar ser-
service and business practices, and organiza-
vices. CARF-accredited organizations share and
tional resources. Achieving excellence requires
provide the persons served and other interested
a disciplined continuous improvement process.
stakeholders with ongoing information about
their actual performance as a business entity and
their ability to achieve optimal outcomes for the
persons served through their programs and
services.
1.N. 1. A written analysis is completed:

1.N. Performance Improvement
a. At least annually.
1.a.N. Performance Improvement
b. That analyzes performance indicators

in relation to performance targets,
including:
1.b.N. Performance Improvement
(1) Business functions.

1.b.(1)N. Performance Improvement
(2) Service delivery of each program

seeking accreditation, including:
(a) The effectiveness of services.

1.b.(2)(a)N. Performance Improvement
(b) The efficiency of services.

1.b.(2)(b)N. Performance Improvement
(c) Service access.

1.b.(2)(c)N. Performance Improvement
(d) Satisfaction and other

feedback from:
1.b.(2)(d)N. Performance Improvement
(i) The persons served.

1.b.(2)(d)(i)N. Performance Improvement
(ii) Other stakeholders.

1.b.(2)(d)(ii)N. Performance Improvement
(3) Extenuating or influencing

factors.
c. That:
1.c.N. Performance Improvement
(1) Identifies areas needing

performance improvement.
1.c.(1)N. Performance Improvement

Section 1.N. Performance Improvement
(2) Results in an action plan to ■ A conclusion, including recommendations

address the improvements for changes/actions to be taken for continued
needed to reach established or performance improvement.
revised performance targets. 1.a. An annual analysis of performance provides
(3) Outlines actions taken or information to aid in the strategic positioning

changes made to improve of the organization and in achieving its mission
performance. and targets.
Intent Statements An organization may choose to measure progress

Through implementation of the standards in and conduct reviews more frequently because of
Section 1.M., the organization establishes its the value the information provides in managing
framework for performance measurement and programs and services.
management, including the identification of 1.b. The performance analysis is designed to
objectives, performance indicators, and perfor- support the actions and activities for improving
mance targets related to business functions and the business functions and service delivery of
service delivery. Analyzing each performance the organization through reviews by leadership/
indicator in relation to its target, including con- governance and personnel. By comparing the
sideration of extenuating or influencing factors results achieved for each of the targets to those
that may impact performance, provides the
identified for business function and for service
organization with information on areas meeting
effectiveness, efficiency, service access, satisfac-
or exceeding targets and areas in need of
tion of persons served, and satisfaction of other
improvement. An action plan for improvement
stakeholders, the summary analysis gives needed
can then be developed in accordance with the
organization's priorities, resources, and other information for making decisions and improve-
considerations. ments in services. Data and information in the
report may be presented in written form, in
Examples charts, or in graphs.
The performance analysis reviews data 1.b.(3) Examples of extenuating or influencing
aggregated at a program/service level for each factors that could impact performance include
program/service seeking accreditation in order a change in leadership, relocation, reductions in
that the action plan can target improvements at budget, personnel shortages, and new
the individual program/service level. Although regulations.
CARF does not prescribe the style or structure
1.c. Although CARF does not prescribe the style
of the analysis, best practices suggest it contains
or structure of the action plan, best practices
at least the following:
suggest plans contain at least the following:
■ Demographic data.
■ Defined goals (these are those identified in
■ A report on the data collected (business per- the performance analysis as areas needing
formance indicators, effectiveness, efficiency, performance improvement).
service access, and satisfaction measure-
■ Assessment of the priorities of different goals.
ments) and discussion of analysis of the data,
■ Steps to be taken to achieve the stated goal(s).
which would include any extenuating factors
identified. ■ Time lines for steps.
■ Follow-up data collected from those who have ■ Positions or persons responsible for imple-
exited services. menting the identified steps.

■ An update on action items from the previous ■ Resources to be used to achieve the plan,
report (i.e., what has been accomplished or including those resources that are available
has resulted from changes suggested by as well as those that are needed.
analysis of the previous year’s outcomes). ■ A conclusion, including recommendations
and a to-do list with action items.

An organization demonstrates commitment to The organization demonstrates:

the continuous improvement of organizational ■ Knowledge of the needs and goals of its
quality and service excellence. Information from customers (persons served and other
the analysis is used for improving the delivery of stakeholders).
and planning for services. Some examples of its
■ Knowledge of the operational status of
use could include identifying efficient and effec-
the organization, the business strategies it
tive methods of providing services/supports;
employs to be successful, and how perfor-
recognizing personnel accomplishments; reas-
mance improvement is utilized at all levels
sessing the mission; recruiting personnel based
of the organization.
on outcome targets; and identifying issues,
■ How it measures the activities and goals
concerns, or trends that should be considered
in changing services and updating the strategic of persons served.
plan. ■ How it makes decisions to expand, open new
sites, develop new services, modify a service
1.N. 2. The analysis of performance indicators approach, or change personnel patterns.
is used to: ■ Methods for reaching these decisions,
a. Review the implementation of: which may include reviews of information,

(1) The mission of the organization. outcomes management reports, budgets,

2.a.(1)N. Performance Improvement strategic plans, and satisfaction surveys. A
(2) The core values of the
CARF-accredited organization uses a fact-
organization.
2.a.(2)N. Performance Improvement
based decision-making process to identify
b. Improve the quality of programs and respond to organizational and customer
and services. needs.
2.b.N. Performance Improvement
c. Facilitate organizational decision

making. 1.N. 3. The organization communicates
d. Review or update the organization’s performance information:

strategic plan. 3.N. Performance Improvement
a. To:
2.d.N. Performance Improvement
Intent Statements (1) Persons served.

3.a.(1)N. Performance Improvement
Mission-driven measurement underpins the (2) Personnel.

performance improvement framework that is 3.a.(2)N. Performance Improvement

created through the standards. Analyzing per- 3.a.(3)N. Performance Improvement
b. According to the needs of the

formance indicators provides a basis for decision
specific group, including:
making that aligns with and validates that the 3.b.N. Performance Improvement
organization’s mission and core values are in (1) The format of the information
place and practiced. While not every perfor- communicated.
mance indicator that is measured and analyzed (2) The content of the information
may be acted on, the information gleaned from communicated.
the analysis allows for a fact-based approach to
(3) The timeliness of the information

decision making, planning, and performance communicated.
improvement. 3.b.(3)N. Performance Improvement
c. That is accurate.
Examples
Intent Statements
The organization can demonstrate how it uses In a consumer-driven market, CARF-accredited
information collected to make decisions, such organizations realize the importance of sharing
as whether to expand, open new sites, develop their performance information with the persons
new services, modify a service, or change per- served and other stakeholders. The information
sonnel patterns. A fact-based decision-making is tailored to meet the needs of a variety of
process is used to identify and respond to stakeholders both internal and external to
organizational and stakeholder needs. the organization.

Examples Documentation Examples

Sharing performance information with internal The following are examples of the types of infor-
and external stakeholders is a vital aspect of mation you should have available to demonstrate
improving the services of the organization. The your conformance to the standards in this sub-
content of the information shared is tailored to section. See Appendix A for more information
the needs of the audience and what the specific on required documentation.
stakeholder group would like to know about ■ An annual written performance analysis
the program or services. (outcomes performance report)
For example, performance information is ■ Management reports or meeting minutes
shared with the:
■ Strategic plans
■ Consumers and potential consumers of
■ Budgets
services.
■ Accessibility plans
■ Employers.
■ Technology plan
■ Business and trade associations.
■ Risk management plans
■ Educational and vocational training
programs. ■ Environmental health and safety reports
■ Local government. ■ Satisfaction information of consumers

and other stakeholders
■ Local and state workforce investment boards.
■ Demographics information of consumers
■ Legislature.
■ Follow-up information
■ Local community.
■ Funding and referral agencies.
■ Regulatory agencies.
Information can be communicated by outcomes

press releases, annual reports, a bulleted short
summary or fact sheet, summaries or graphics
posted on the organization’s website, balanced
scorecards, and newsletters. The presentation
is tailored to the audience in an understandable
language or medium, including the use of charts,
graphs, and video or audio recordings.
Typical practice in continuous quality
improvement is to share the information
with all stakeholders who have given input.

SECTION 2
Quality Individualized Services and Supports
For an organization to achieve quality services,

the persons served are active participants in
the planning, implementation, and ongoing
review and revision of the services offered. The
organization’s commitment to quality and the
involvement of the persons served spans the
entire time that the persons served are involved
with services. The service planning process is
individualized, establishing goals and measurable
objectives that incorporate the unique strengths,
abilities, needs, and preferences of the persons
served. Services are responsive to the expec-
tations of persons served and their desired
outcomes from services, and are relevant to
their maximum participation in the environ-
ments of their choice.
The standards in Section 2 typically apply to all
of the programs in Section 3; however, some
exceptions apply. Please refer to the following
grid to determine the standards in Section 2
that are applicable to the programs and ser-
vices in Section 3 for which your organization
is seeking accreditation.
NOTE: All standards in Sections 1.A. and 1.C. through
1.N. apply to all programs/services seeking accredi-
tation. Section 1.B. Governance is optional.

126
Principle
2.B.
2.A. 2.C. Standards Optional
Individual- 2.E.
Program/ Medication Specific Population
Centered Service Workforce
Service Monitoring and 2.D. Employment Designations
Planning, Design, Development
Structure Management 2.G.–2.J.**
and Delivery
2.F. Community
Employment Services
3.A. Employment Planning 2.A.1.–13. 2.B.1. only Apply according 2.D. Optional 2.J. (ASD:A only)
Services (EPS) to guidelines in
section*
3.B. Evaluation Services
3.B. Comprehensive 2.A.1.–13. Not applicable Not applicable 2.D.1.–3. Optional Not applicable
Vocational Evaluation
Services (CVE)
Section 2. Quality Individualized Services and Supports
3.B.1.–11.
3.B. Targeted Employment 2.A.1.–11. and Not applicable Not applicable 2.D.5. Optional Not applicable
Screening Services (TES) 2.A.13.
3.B.12.–17.
3.C. Community Employment Services
3.C. Job Development Apply all Apply all Apply according 2.D. Optional 2.J. (ASD:A only)
(CES:JD) to guidelines in
3.C.1.–5. section*
3.C. Employment Supports Apply all Apply all Apply according 2.D. Optional 2.J. (ASD:A only)
(CES:ES) to guidelines in
3.C.6.–14. section*
*If a program monitors or manages medications for persons served, standards from Section 2.C. must be applied according to the guidelines in Section 2.C.
**The Specific Population Designations listed in this column may optionally be added to the identified programs. 2.G. Children/Adolescents;
2.H. Older Adults and Older Adults/Dementia Care; 2.I. Medically Fragile; 2.J. Autism Spectrum Disorder (ASD:A for adults, ASD:C for children/adolescents)
2016 Employment and Community Services Standards Manual

Principle
2.B.
Individual- 2.E.
and Delivery
2.F. Community
3.D. Self-Employment Apply all Apply all Apply according 2.D.1.–3. Optional 2.J. (ASD:A only)
Services (SES) to guidelines in
section*
3.E. Employee Apply all Apply all Apply according 2.D. Optional 2.J. (ASD:A only)
Development Services to guidelines in
(EDS) section*
3.F. Employment Skills Apply all Apply all Apply according 2.D. Optional 2.J. (ASD:A only)
Training Services (EST) to guidelines in
section*
3.G. Organizational Apply all Apply all Apply according 2.D. Not applicable 2.H.

Employment Services to guidelines in 2.J. (ASD:A only)
(OES) section*
3.H. Affirmative Business Not applicable Not applicable Apply according Not applicable Optional 2.J. (ASD:A only)
Enterprise (ABE) to guidelines in
section*
Community Services
3.I. Child and Youth Apply all Apply all Apply according 2.F.1.–4. Not applicable 2.I.
Services (CYS) to guidelines in 2.J. (ASD:C only)
section*
127
128
Principle
2.B.
Individual- 2.E.
and Delivery
2.F. Community
3.J. Family-Based/Shared Living Supports
3.J. Family Services (FS) 2.A.1.–19. Apply all Not applicable 2.F. Not applicable All
3.J.1.–5.
3.J. Foster Family Services Apply all Apply all Apply according 2.F. Not applicable All
(FFS) 3.J.6.–17. to guidelines in
section*
3.J. Host Family/Shared Apply all Apply all Apply according 2.F. Not applicable All
Living Services (HF/SLS) to guidelines in Section 2.I. must
3.J.18.–25. section* be applied when
indicated by the
support needs of
the persons served.
3.K. Community Housing Apply all Apply all Apply according 2.F. Not applicable All
(CH) to guidelines in
section*
3.L. Supported Living (SL) Apply all Apply all Apply according 2.F. Not applicable All
to guidelines in
section*
3.M. Respite Services (RS) Apply all Not applicable 2.C.1.–2. and 2.F.4. Not applicable All
2.C.5.–6., if
applicable

Principle
2.B.
Individual- 2.E.
and Delivery
2.F. Community
3.N. Services Coordination Apply all Apply all Apply according 2.F. Optional All
(SC) to guidelines in
section*
3.O. Transition Services Apply all Apply all Apply according 2.F.4. Optional 2.J. (ASD:A only)
(TS) to guidelines in
section*
3.P. Community Apply all Apply all Apply according 2.F. Not applicable All
Integration (COI) to guidelines in
section*
3.Q. Assistive Technology 2.A.1.–13. Not applicable Not applicable Not applicable Optional All

Supports and Services
(AT)
3.R. Behavioral Apply all 2.B.1.–2. Apply according Not applicable Not applicable 2.G., 2.H., and 2.J.
Consultation Services to guidelines in
(BCS) section*
3.S. Comprehensive 2.A.1.–19. Apply all Not applicable Not applicable Not applicable 2.G. and 2.J.
Benefits Planning (CBP)
3.T. Mentor Services (MS) Apply all Not applicable Apply according Not applicable Not applicable All
to guidelines in
section*
129
130
Principle
2.B.
Individual- 2.E.
and Delivery
2.F. Community
3.U. Personal Supports Services
3.U. Personal Supports Apply all 2.B.1.–2. Apply according 2.F.4. (all Not applicable All
Services (PSS) 3.U.1.–7. to guidelines in programs)
section*
2.F.5. if direct
care personal atten-
dant services
3.U. Short-Term Immigra- Apply all 2.B.1. only Not applicable Not applicable Not applicable Not applicable
tion Support Services (ISS)
3.U.1.–12.
3.V. Self-Directed Community Supports and Services
3.V. Flexible Supports 2.A.1.–13. Not applicable Not applicable Not applicable Not applicable Not applicable
Planning (FSP) 3.V.1.–12.
3.V. Employer of Record 2.A.1.–13. Not applicable Not applicable Not applicable Not applicable Not applicable
for Support Services (EOR)
3.V.13.–24.
3.W. Supported Education Apply all Apply all Apply according 2.F.1.–4. Not applicable 2.J.
Services (SE) to guidelines in
section*
3.X. Centers for 2.A.1.–19. Not applicable Not applicable Not applicable Not applicable Not applicable
Independent Living (CIL)

Principle
2.B.
Individual- 2.E.
and Delivery
2.F. Community
3.Y. Home and Apply all 2.B.1.–10. for special- Apply according 2.F.1.–5. for spe- Not applicable Optional
Community Services ized services; to guidelines in cialized services;
(HCS) 2.B.1.–2. for other section* 2.F.4. for other
service delivery (see service delivery
Applicable Standards (see Applicable
in Section 3.Y.) Standards in
Section 3.Y.)
3.Z. Rapid Rehousing Apply all Apply all Apply according 2.F. Not applicable Not applicable
and Homelessness Preven- to guidelines in
tion Program (RRHP) section*

131
Section 2.A. Program/Service Structure
A. Program/Service c. Reviews the scope of services at least

annually and updates it as necessary.
Structure 1.c.A. Prog/Service Structure
Intent Statements
The scope is defined at the level of the program/
Description service and provides the persons served,
A fundamental responsibility of the organization families/support systems, referral sources,
is to provide a comprehensive program structure. payers, and other relevant stakeholders with
The staffing is designed to maximize opportuni- information that helps them understand what
ties for the persons served to obtain and the program/service has to offer and determine
participate in the services provided. whether it will meet the needs of the persons
served. If the program is part of a continuum of
services, the scope is defined for each program
Applicable Standards or specialty program within the continuum.
For information on the applicability of the Examples
standards in this section to the services for Taken as a whole, this standard is part of the
which your organization is seeking accredita- organization’s public information activity. This
tion, please refer to the Applicable Standards information can be provided by client/consumer
statements in the individual services in Section handbook, electronic means, checklists, and/or
3 or to the grid beginning on page 126. orientation and intake processes.
Organizations have the responsibility to respond
2.A. 1. Each program/service: to all requests from the public concerning their
1.A. Prog/Service Structure
a. Documents the following parameters accredited services. This responsibility includes

regarding its scope of services: providing information defined by some of the
1.a.A. Prog/Service Structure
(1) Population(s) served. CARF standards, information defined by the

1.a.(1)A. Prog/Service Structure
(2) Settings. organization as important, and information in

(3) Hours of services. response to questions that may come from the
(4) Days of services. public.

(5) Frequency of services. Further guidance can be found in Section 1.N.

Standard 3., which encourages sharing useful
(6) Payer sources.
1.a.(6)A. Prog/Service Structure performance information.
(7) Fees.
1.a.(7)A. Prog/Service Structure 1.b.(1)–(2) The program may include service
(8) Referral sources.
information such as the various support options
(9) The specific services offered, and the organization’s ethical practices in what
including whether the services is shared. The intent is to provide information
are provided directly or by for persons to make informed choices.
referral.
Resources
b. Shares information about the scope
of services with: 1.b. Resources/links for creating printed
1.b.A. Prog/Service Structure
(1) The persons served. materials in language that can be understood

1.b.(1)A. Prog/Service Structure
by persons served include:
(2) Families/support systems, in
■ www.ric.org/cror/healthliteracy.aspx
accordance with the choices
of the persons served. ■ www.ahrq.gov/populations/sahlsatool.htm
(3) Referral sources. ■ www.who.int/classifications/icf/training/

(4) Payers and funding sources. icfbeginnersguide.pdf

(5) Other relevant stakeholders. ■ www.cpha.ca/en/pls.aspx

(6) The general public. ■ www.cpha.ca/en/portals/h-l/resources.aspx

■ www.noslangues-ourlanguages.gc.ca/

■ www.cpha.ca/uploads/portals/h-l/
directory_e.pdf
2.A. 3. Based on the scope of each program/
service provided, the organization
■ www.nald.ca/litweb/other/other.htm documents its:
■ www.literacy.ca 3.A. Prog/Service Structure
a. Entry criteria.
b. Transition criteria, if applicable.

2.A. 2. The organization provides the resources 3.b.A. Prog/Service Structure
c. Exit criteria.
needed to support the overall scope of 3.c.A. Prog/Service Structure
each program/service. Intent Statements

The organization determines which persons

Intent Statements
it is qualified and able to serve and identifies
The ability to provide the program/services conditions/time/events for transition and/or
defined in the scope statement is evidenced by exit. This includes transitions to other levels
adequate materials, equipment, supplies, space, of care/services as well as transitions within a
finances, training, and human resources. program/service. Transition criteria may also
Examples address continuing stay criteria. Transition
may not always occur based on the nature
The organization is knowledgeable of and
of the program/service.
reviews all indirect and direct costs of providing
a specific service. Its strategic planning and Examples
financial planning are integrated to ensure that While a program/service may use terms that
initiatives or changes in programs are adequately are different than those above, the concepts
funded and supported to maximize success. are the same.
Required and needed staffing levels are main- When providing these, it is important to consider
tained and personnel turnover does not have a the levels of reading and language skills of those
negative impact on the delivery of quality ser- applying and those in services. Written materials
vices and supports. No ratios are established by in the person’s primary language, pictures, large-
CARF for the number of persons served to the print written materials, and videos are some of
number of personnel. Sufficient backup is avail- the ways to present information in an under-
able in the event of personnel absences. The standable manner.
backup personnel plan is sufficient to allow 3.a. Entry criteria may also be called admission
minimal impact on the delivery of services and criteria, enrollment criteria, or move-in criteria.
supports. These criteria may be established based on local
The organization’s performance outcomes system referral policies and the mission of the organiza-
can be used to measure staffing pattern needs tion. Established criteria reduce the possibility
and the adequacy of configurations as they might that subjective judgment will be used to deter-
impact stakeholder satisfaction and achievement mine if a service is appropriate to a person’s
of program outcomes. See related standards desired outcomes. They ensure fair access to ser-
regarding the collection of effectiveness and vices for all applicants and referrals, in keeping
efficiency data, the analysis of data for planning with the organization’s commitment to provide
implications, and the use of information from accessible services, as identified in Section 1.L.
performance analysis reports to guide decision 3.b. Transition criteria may also be called transfer
making related to resource allocation and per- guidelines or something similar. For some pro-
sonnel development. grams transition criteria would not be required,
such as respite services and short-term services
of limited duration such as comprehensive
vocational evaluation.
3.c. Exit criteria may also be called agreement
termination criteria, contract termination

criteria, discharge criteria, move-out criteria, the program/service. While funding issues impact
or something similar. entry and exit decisions, the program/service
consistently advocates for needs of the persons
served.
2.A. 4. When a person served is found
ineligible for services: Examples
a. The person served is informed A funding issue might be a change in the funding
as to the reasons. level of a contract for services, or, in Canada, a
b. In accordance with the choice change in the government-imposed status of a

of the person served: person served.
(1) The family/support system is

informed as to the reasons. 2.A. 6. Service delivery models and strategies
(2) The referral source is informed are based on accepted practice in the
as to the reasons. field and incorporate current research,
c. Recommendations are made evidence-based practice, peer-reviewed

for alternative services. scientific and health-related publica-
4.c.A. Prog/Service Structure
tions, clinical practice guidelines, and/or
Examples expert professional consensus.
Persons not accepted for services are given the 6.A. Prog/Service Structure
Intent Statements
reasons and informed of other services or given
resources for this information. In some cases, The service delivery model and the strategies
the referral source may be the more appropriate used are based on accepted practice, including
source for information about alternative services. consideration of areas such as information on
the efficacy of specific techniques, pertinent
Although the person may verbally be given infor- research findings, protocols published by various
mation about alternative services, it is much professional groups, or approaches receiving
more customer-friendly to put this information professional recognition for achieving successful
in writing for later use by the person. outcomes.
Through the organization’s performance out-
Examples
comes system, the organization may gather data
on persons ineligible for services and use this The organization uses field-recognized practices
information to strategically position the organi- and, ideally, incorporates evidence-based or
zation to develop services to meet the needs of research-supported practices where the evidence
unserved or underserved populations in the and research are available and sound.
community. Some models may be more commonly accepted
4.b. In some situations, the referral source is by a particular culture or supported by evidence
providing the information for the screening as more effective when used within specific
and will obviously be informed as to reasons populations.
for ineligibility without specific consent. Evidence of conformance to this standard may
be demonstrated through minutes of meetings
2.A. 5. Each program/service implements in which these topics were discussed, literature
procedures that address unanticipated available to the personnel in a resources area, etc.
service modification, reduction, or exits/ Resources used in this process might include
transitions precipitated by funding or journal subscriptions, on-line access to learning
opportunities and reference materials or journals,
other resource issues.
5.A. Prog/Service Structure sponsoring educational events at the organiza-
Intent Statements tion, in-service programs, and collaborative
The program/service demonstrates its knowl- education efforts partnered with other area
edge of funding sources and their expectations providers of services.
and time frames for discontinuing or changing

power of attorney, and guardianship. The pro-

2.A. 7. To facilitate integrated service delivery, gram/service should be able to discuss how it
each program/service implements com- addresses the issue of the legal decision-making
munication mechanisms regarding the authority of the persons served.
person served that:
7.A. Prog/Service Structure 8.b. Any limitation on a person’s legal decision-
a. Address: making authority should be continued only as
(1) Emergent issues. long as is appropriate and necessary. The pro-

(2) Ongoing issues. gram/service assists the person served and his
(3) Continuity of services, including: or her family members/support system to access

resources, such as attorneys with expertise in this
(a) Contingency planning.
7.a.(3)(a)A. Prog/Service Structure area, who can assist with facilitating changes, if
(b) Future planning. appropriate, in legal autonomy status.
7.a.(3)(b)A. Prog/Service Structure
(4) Decisions concerning the

Examples
person served.
b. Ensure the exchange of information A provider could demonstrate knowledge of legal

regarding the person-centered plan. decision-making authority through policies that
outline levels of legal autonomy, inservices on
Intent Statements issues of legal decision-making authority, and
This standard addresses the need for timely materials for personnel and the persons served
communication to ensure services and programs that explain legal decision-making authority,
are consistently provided, whether provided such as guardianship and how it might relate
24 hours a day, 7 days a week or on a part-time, to services.
scheduled basis.
Examples 2.A. 9. When services are provided from or
Communication and collaboration may occur within a mobile unit, written procedures
in the program/service through written or oral are implemented that address, at a
communication, such as electronic formats, log minimum, the unique aspects of the fol-
books, face-to-face meetings, progress notes, lowing areas related to mobile settings:
specialized communication devices, facilitative a. Responsibilities of:

communication, handheld devices and comput- (1) Drivers.

ers, videos, audio recordings, and one-on-one 9.a.(1)A. Prog/Service Structure
(2) Service providers.

teaching. 9.a.(2)A. Prog/Service Structure
b. Confidentiality of:
(1) Records of persons served.

2.A. 8. The program/service demonstrates: 9.b.(1)A. Prog/Service Structure
(2) Communication.
a. Knowledge of the legal decision- 9.b.(2)A. Prog/Service Structure
c. Privacy related to service delivery.

making authority of the persons 9.c.A. Prog/Service Structure
served. d. Accessibility.
9.d.A. Prog/Service Structure
b. When applicable, the provision of e. Availability of information on

information to the persons served resources to address needs unable
regarding resources related to legal to be met at the mobile setting.
9.e.A. Prog/Service Structure
decision-making authority. f. Security of:

9.f.A. Prog/Service Structure
(1) Medications provided from or

Intent Statements
within the mobile unit, when
The person served may not have the capacity or applicable.
be of the age to make decisions in his or her own 9.f.(1)A. Prog/Service Structure
(2) Equipment and supplies used

best interests. An individual may need to be
in service provision.
assigned to make decisions regarding healthcare 9.f.(2)A. Prog/Service Structure
choices, financial decisions, or life care planning. (3) The mobile unit when not in use.
9.f.(3)A. Prog/Service Structure
Legal terminology may vary from jurisdiction to

jurisdiction; e.g., healthcare power of attorney,

g. Safety of: 9.h. Maintenance of mobile units might include

keeping logs of mileage, gasoline use, oil changes,
9.g.A. Prog/Service Structure

9.g.(1)A. Prog/Service Structure
(2) Personnel. and tire wear.

9.g.(2)A. Prog/Service Structure
h. Maintenance of:
9.h.A. Prog/Service Structure
(1) Equipment. 2.A. 10. The organization’s policies and proce-

9.h.(1)A. Prog/Service Structure
dures for acceptance into services
(2) Vehicles.
9.h.(2)A. Prog/Service Structure identify:
Intent Statements a. The acceptance process.

Mobile unit services are services provided from b. The position or entity responsible
a vehicle such as a motor home or van that func- for making acceptance decisions.
tions as a site for the program/service seeking 10.b.A. Prog/Service Structure
c. The process that will be followed in

accreditation.
the event there is ever a wait list.
NOTE: If you are unsure whether this standard 10.c.A. Prog/Service Structure
applies to a program/service for which you are Intent Statements

seeking accreditation, please contact your CARF These policies and procedures reduce the possi-
resource specialist to discuss. bility that subjective judgment will be used to
determine if a service is applicable to a person’s
Examples
needs and desired outcomes. They ensure fair
9.b. Written procedures address confidentiality access to services for all applicants and referrals,
related to the use of mobile technology for docu- in keeping with the organization’s commitment
mentation and communication about the persons to provide accessible services, as identified in
served. Section 1.L. As appropriate, assistive technology
9.d. The mobile unit: is considered.
■ Provides adequate space for persons served to 10.c. The organization’s acceptance policies and
approach and safely move around inside of it. procedures must include a process for handling
a wait list in the event there is ever a need for
■ Is equipped with a ramp, handrails, and
persons to wait for services, even if the program
adaptive equipment for use by personnel does not currently have or use a wait list.
and/or persons served.
Examples
■ Operates from a location where there is ample
parking when possible. 10.a. These policies may be established based
on local referral policies and the mission of the
■ Operates from a location that limits exposure
organization.
to the sun and noise in the environment such
as traffic noise when possible. Written materials in the person’s primary
language, pictures, large-print written materials,
9.f.(3) Security of the mobile unit when it is not and videos are some of the ways to present infor-
in use might address the location where the unit mation in an understandable manner.
is parked overnight and between stops, locking
the unit, protection of records, and the use of
security personnel or surveillance systems to 2.A. 11. Information about the organization
monitor the unit. provided to the persons inquiring
about services:
9.g. Safety considerations might include com- 11.A. Prog/Service Structure
munication systems available, availability of a. Includes:

emergency procedures in the mobile unit, what (1) Its values and mission statement.
to do in the event of an emergency situation, (2) Expected results or outcomes

determination of the location where the mobile of services.
unit provides services, and minimum personnel (3) Services availability, including
that must be present during hours of operation. possible wait time for services.

(4) Options for persons served to certain information be maintained. The organi-
direct their service design and zation also complies with its own service delivery
delivery. design for the development of the record. Elec-
(5) Organizational certifications, if tronic records are acceptable.

any, and if applicable to services. Examples
b. Is provided in an understandable The record may include demographic data;

format. names of personal representatives, such as
c. Is updated as necessary to reflect parents, guardians, and advocates; intake infor-

changes in information provided. mation; initial orientation to services and rights;
referral reports; functional abilities; medical

Intent Statements
information, such as medications taken and
To be informed, make choices, and be involved,
name of physician (Standard 2.C.1.); Do Not
the persons served should be able to easily access
Resuscitate (DNR) protocols; individual plans
accurate and current information about the
(Standards 2.B.3.–7.); release forms (Standard
organization’s potential to deliver services
2.A.13.); follow-up reports; exit summaries
relevant to their needs and desires.
(Standard 2.B.10.); progress reports; and referrals
Information is provided about the variety of to other resources (Standard 2.B.9.).
service options available or support approaches
to a service need and the volume of services an The organization may find it helpful to keep an
organization can support, which may be number orientation checklist in each person’s record so
of persons, geographical coverage, etc. that documentation can be made when items are
shared with the individual, such as responsibili-
Examples ties (Standard 2.B.5.), setting goals and planning
This standard is part of the organization’s public services (Standard 2.B.2.), and securing/retaining
information activity. This information may be benefits (Standard 2.B.8.).
provided by electronic means, printed brochures, Working files can be used if security of files is
checklists, handbooks, etc. maintained.
Organizations have the responsibility to respond During a survey, surveyors will randomly select a
to all requests from the public about their representative sample of files for review from the
accredited services. This responsibility includes different programs and sites, including “closed”
providing information defined by some of the records of persons who have exited services.
CARF standards, information defined by the
organization as important, and information in
response to questions that may come from the 2.A. 13. Any release of confidential information:
public. a. Is authorized by the person served

and/or his or her legal representative.
Further guidance can be found in Section 1.N. 13.a.A. Prog/Service Structure
Standard 3., which encourages sharing useful b. Is limited to the specific information
performance information, and in Section 1.I. identified.
Standard 4., which supports current and knowl- c. Has a time limitation.
edgeable staff. d. Conforms to the guidelines of funders

and/or referral sources.
2.A. 12. A complete record is maintained for e. Complies with applicable laws.
13.e.A. Prog/Service Structure
each person served. Intent Statements

Intent Statements Guidelines are in place and followed regarding

The organization determines what information the sharing of any confidential information about
should be kept in the records of the persons a person served. The procedure complies with all
served. The record communicates information legal regulations governing such release of infor-
that is complete, clear, organized, and current. mation [Standard 1.K.2.e.(2)]. The time limitation
Funders and referral agencies may require that is specific and not open-ended.

Examples
2.A. 15. When applicable, there are policies and
The records contain signed releases that are spe-
written procedures that address the
cific to the information released and the duration
program’s use of positive interventions,
of the release. This does not mean that there must
including:
be a separate release for every instance (every 15.A. Prog/Service Structure
phone call, conversation, etc., to the same a. An emphasis on building positive

agency) in which information is released. One relationships with persons served.
release per agency, person, etc., with a time limi- b. Evaluation of:
tation may be sufficient. (1) The environment.

This standard does not relate solely to printed (2) Personal stressors.
information released. The same level of confiden- c. Appropriate interaction with staff
tiality should also be observed with regard to to promote:
verbal information and photographs or video
(1) De-escalation.
of the person served. 15.c.(1)A. Prog/Service Structure
(2) Socially acceptable behavior.

A good resource is to “mirror” the guidelines 15.c.(2)A. Prog/Service Structure
d. Empowering persons served to

of local funding and referral sources. change their own behavior.
Employee orientation and training reinforce the
Intent Statements
meaning and importance of confidentiality and
the organization’s codes of ethical conduct The organization’s policies and procedures
support the use of positive alternatives to
reinforce it as well (Standard 1.A.6.a.).
behavioral interventions such as redirecting and
de-escalation in its effort to empower the persons
2.A. 14. If behavioral change approaches are served to effect positive behavioral changes. The
used, positive behavioral interventions: policies and procedures should reflect the use of
a. Are implemented prior to the use positive approaches prior to the implementation
of restrictive procedures. of restrictions. The organization demonstrates
b. Continue to be used in conjunction commitment to a system that nurtures personal

with any restrictive procedures. growth and dignity, and it supports the use of
positive approaches and supports. This standard
Intent Statements would apply to any program that deals with
The organization demonstrates a commitment persons with a history of behavioral problems
to a system that nurtures personal growth and (e.g., anger, PTSD) or where the goal is to help
dignity, and it supports the use of positive the persons served change their behavior.
approaches and supports. Even when other
Examples
approaches have not been successful and a
short-term restrictive procedure is determined Records of persons served for whom any restric-
to be needed, positive interventions continue tions have been implemented show specifics
to be used in conjunction with any restriction about the restrictions as well as detailed informa-
and constitute the main approach. tion about the positive interventions being used
concurrently, such as identifying personal stress-
Examples
ors and approaches to de-escalation to be used.
This commitment is emphasized during ori-
entation and ongoing staff training. The
2.A. 16. Personnel providing services are trained
organization’s policies, procedures, and staff
in the use of positive interventions:
members deal with maladaptive or inappropriate 16.A. Prog/Service Structure
behaviors without undue force that could lead a. Initially.

to the injury of a person served. b. Annually.


Intent Statements Standard 2.B.5.b.(2)–(3). A good practice is for

The use of positive interventions is emphasized an organization to develop its own human rights
in policies and procedures and through regular committee involving community members
provision of training. outside the organization as a quality element.
NOTE: This standard applies even if the program/ Agencies such as Protection and Advocacy may
service does not use behavioral change approaches also perform this function.
as identified in Standard 2.A.14. When rights are restricted, prior informed
Examples consent of the persons served is evident.
In providing training on positive interventions, The individual planning process and the proce-
organizations also typically provide training to dures used reflect the integration of methods to
clarify and recognize actions that constitute remove restrictions on rights. A good practice is
restrictions on rights and any prohibited prac- for the organization to ensure that any restriction
tices (such as the use of squirt bottles, use of on a person’s rights is subject to frequent and
noxious stimulants, splints, mitts, time out planned reviews by advocates. The method used
procedures, etc.) should ensure that rights are reinstated as soon
as possible in all cases.
2.A. 17. If restrictions are placed on the rights
of a person served: 2.A. 18. If any part of the services for which the
organization is seeking accreditation is
a. The organization ensures that its poli-
provided by another organization or
cies are in compliance with funding
person, these contracted services are:
guidelines and governmental 18.A. Prog/Service Structure
regulations. a. Provided under a written agreement.

b. The organization follows its policies b. Monitored by the organization to

and written procedures. ensure that performance effectively
meets responsibilities as identified
c. Prior to implementation:
17.c.A. Prog/Service Structure in the individual plans of the persons
(1) The organization obtains served.
informed consent of the 18.b.A. Prog/Service Structure
c. Evaluated at least annually:

person served. 18.c.A. Prog/Service Structure
17.c.(1)A. Prog/Service Structure

(1) For cost-effectiveness.
(2) Service personnel are trained in 18.c.(1)A. Prog/Service Structure
the use of restrictive procedures. (2) To ensure the health and safety
17.c.(2)A. Prog/Service Structure
of persons served.
d. The organization: 18.c.(2)A. Prog/Service Structure
(1) Implements methods to reinstate Intent Statements

rights as soon as possible. This refers to contracted services related to
persons served and not to clerical-type services.
17.d.(1)A. Prog/Service Structure
(2) Monitors the effectiveness of

these methods to reduce rights Contracted service provision is included in the
restrictions. survey only when it is part of a service for which
17.d.(2)A. Prog/Service Structure
the organization is seeking accreditation. Quality
Intent Statements is maintained in the service whether provided
Policies and procedures are in place and staff directly or contracted.
is trained to ensure that informed consent is
Examples
obtained prior to any restrictions and that
rights are reinstated as soon as possible. The interpretation of contracted services, for
purposes of this standard, must include some
Examples direct service relationship, such as when the
Legal guidelines are carefully followed regarding organization shares personnel or direct service
the use of rights restrictions. delivery with another agency or service provider.
Specific measurable objectives, methods, and It implies a relationship that may include service
techniques should be identified, as called for in personnel, direct service efforts, sharing of

facilities and resources, or sharing of case

records/individual planning, etc., and is not
2.A. 20. The organization has a policy that identi-
fies whether or not it has any role related
just a financial contract for funding.
to medications that are used by the per-
Written agreements detail responsibilities, sons served in the programs seeking
applicable policies and procedures, etc. Annual accreditation, including whether or not
evaluations allow the organization to review it directly provides:
the continuing appropriateness and/or cost- 20.A. Prog/Service Structure
a. Medication monitoring.
effectiveness of the contracted services and to 20.a.A. Prog/Service Structure
ensure that contractual requirements are fol- b. Medication management.

lowed. Regular review also helps to ensure the Intent Statements

quality of the services/supports which are being The organization clearly identifies whether or not
provided. See the Glossary for the definition it has any role in medications for persons served
of regular. in order that personnel, persons served, and
Contracts may be written to reference appropri- other stakeholders understand and comply.
ate CARF standards. If an organization’s policy has identified a role
related to medications used by persons served in
2.A. 19. When services are provided to a person the program seeking accreditation, Section 2.C.
placed in services through an arrange- Medication Monitoring and Management must
ment with a court or criminal justice be applied. See the Glossary for the definitions
system, the organization: of medication monitoring and medication
management.
a. Provides information to the person
served concerning the relationship Examples
between the criminal justice entity An organization might use the terms medication
and the organization. management and monitoring in its policy, or it
b. Maintains, when and as required by might use equivalent terms such as prescribing,
governmental authorities, a record dispensing, administering, or physical control of
of the person’s criminal history. medications that persons served self-administer.
c. Coordinates services with other sys-

tems, as needed and/or required.
Intent Statements
The organization follows the specific require-
ments it must meet in providing services to this
population. This standard applies only to persons
who are in an active relationship with a court
system or other criminal justice entity.
Examples
Before providing such services, it is suggested
an organization check with governmental and
legal authorities so it can establish procedures
to ensure that it is in compliance with all regula-
tions. The information provided to the person
served is an important extension of informed
consent and should be given before services
begin.

Section 2.B. Individual-Centered Service Planning, Design, and Delivery
Documentation Examples B. Individual-Centered

mation you should have available to demonstrate Service Planning,
section. See Appendix A for more information on
Design, and Delivery
required documentation.
Description
■ Documented scope of services for each
program Improvement of the quality of an individual’s
services/supports requires a focus on the person
■ Client/consumer handbook
and/or family served and their identified
■ Records of the persons served, both open
strengths, abilities, needs, and preferences. The
and closed organization’s services are designed around the
■ Acceptance policies and procedures identified needs and desires of the persons
■ Entrance, transition, and exit criteria served, are responsive to their expectations and
■ Policy for the order of acceptance
desired outcomes from services, and are relevant
to their maximum participation in the environ-
■ Individual service plans
ments of their choice.
■ Release-of-information forms
The person served participates in decision mak-
■ Referral information ing, directing, and planning that affects his or her
■ Exit summary report life. Efforts to include the person served in the
■ Policies and written procedures regarding the
direction or delivery of those services/supports
use of positive interventions and limitations are evident.
on use of restrictive procedures NOTE: Throughout this section reference is to the
■ Documentation of staff training regarding the
person/persons served. Please refer to the Glossary
definition of person served for understanding of
use of positive interventions and limitations
when this might include other individuals acting on
on use of restrictive procedures
behalf of the primary consumer, such as family
■ Policy on whether the organization has any members.
role related to medications in the program
seeking accreditation (if Standard 2.A.20.
is identified as applicable to the program) Applicable Standards
For information on the applicability of the
standards in this section to the services for
which your organization is seeking accredita-
tion, please refer to the Applicable Standards
statements in the individual services in Section
3 or to the grid beginning on page 126.
2.B. 1. Prior to the planning of services, infor-

mation is gathered from a new person
entering services about his or her desired
outcomes from services.
1.B. Ind. Service Planning, Design, and Delivery
Intent Statements
Before actual planning of services, an informal
discussion with persons about goals or outcomes
they desire from services gives guidance to per-
sonnel regarding service planning. This standard

does not require the use of a formal assessment ■ Possible alternatives for services within
document or instrument. the organization and in the community.
Examples ■ How results will be evaluated.
Information may be gathered from face-to-face ■ Futures planning.
meetings, telephone interviews, or by other Surveyors will want to verify this by talking with
technological means. persons served. Some questions may be asked of
There may be instances where the information persons about satisfaction with their involvement
gathered indicates an immediate goal for which in the process.
only minor assistance is needed and that there- Information might be presented to persons in a
fore does not require development of an handbook or video and also be included as an
individualized plan. Some examples of this orientation item. As required by funding sources
would be: and for legal reasons, signed informed consent
■ The person wants assistance with developing for services may be obtained and retained, but
a résumé for job seeking. this is not required by CARF. Organizations are
■ The person wants to be able to conduct job encouraged to check with local authorities
search on a computer and simply needs access regarding legal requirements to determine when
or a basic orientation to doing so. signed informed consent is required. Staff mem-
bers are familiar with and comply with informed
consent procedures and requirements when this
2.B. 2. The persons served are given informa-
is required.
tion about:
a. Their role in setting their individual For example, in an employment program the
service goals. person served is involved in making informed
2.a.B. Ind. Service Planning, Design, and Delivery
employment-related decisions, including the
b. How planning the services/supports
expected outcome for services and his or her role
to be delivered is conducted.
2.b.B. Ind. Service Planning, Design, and Delivery and responsibilities related to achieving desired
c. Requirements for their continued employment outcomes. Informed choice is
participation in services. reflected in the individual planning process
2.c.B. Ind. Service Planning, Design, and Delivery
Intent Statements through full disclosure of the capabilities of the

The result is that the persons served are knowl- organization to meet the person’s outcomes
edgeable about the individual service-planning expectations, the person’s needs, and the person’s
process and their active role in or direction, if understanding of his/her responsibilities. Deci-
desired, of the process. sion making based on informed choice may be
reflected in:
Examples
■ The scope, duration, and expected outcomes
Services demonstrate a focus on the importance of the employment services.
of input from the persons served throughout the
■ Employment choices, plans, and options,
planning process and the importance of their role
in making decisions. The persons and/or families including:
served participate in making decisions about – Paid or unpaid work.
their services including: – Work settings.
■ The expected results of the services – Career development and/or training
for the individuals. activities.
■ How the design of the services meets – Career advancement opportunities.
their identified needs.
2.c. Requirements for continued participation in
■ How the services will be delivered. services at this point of orientation to services are
■ The expected duration of the services, likely generalized and not specific to individual
if applicable. plans, because these have not been developed yet.

Examples of requirements or expectations individual, the person’s cultural background,

for participation in services might be: spiritual beliefs, and faith/religious background.
■ Regular attendance.
■ Punctuality. 2.B. 4. As appropriate to the persons served and

the scope of the services provided, the
■ Appropriate clothing for work or function.
following information is considered for
■ Good personal hygiene.
service planning:
a. Relevant medical history.

2.B. 3. An individualized service plan is devel- 4.a.B. Ind. Service Planning, Design, and Delivery
b. Relevant psychological information.

oped based on the person’s: 4.b.B. Ind. Service Planning, Design, and Delivery
3.B. Ind. Service Planning, Design, and Delivery c. Relevant social information.
a. Strengths. 4.c.B. Ind. Service Planning, Design, and Delivery
3.a.B. Ind. Service Planning, Design, and Delivery d. Available information on previous
b. Abilities. direct services and supports.
3.b.B. Ind. Service Planning, Design, and Delivery
c. Preferences. 4.d.B. Ind. Service Planning, Design, and Delivery
e. Other relevant assessments, when

d. Desired outcomes. available.

3.d.B. Ind. Service Planning, Design, and Delivery
e. Other issues, as identified 4.e.B. Ind. Service Planning, Design, and Delivery
Intent Statements
by the person served.
3.e.B. Ind. Service Planning, Design, and Delivery
In developing an individual service plan, all
Intent Statements relevant information is considered.
Plans are highly individualized, reflecting
Examples
the diversity of the persons served.
This standard does not require that each person
Examples have a physical or psychological evaluation.
When indicated through discussion with the per- The organization has a procedure in place to
son served that his or her desired outcomes of determine relevancy based on the individual’s
services are such that an individualized service situation and the scope of the services provided
plan is appropriate, plan development is begun. by the organization. The information may be
The organization may use consumer self- obtained from a previous provider, a family
assessments and/or person-centered planning member, or self-reported by an individual. The
as ways to obtain this information. Individual individual plans demonstrate that, when relevant,
service plans may be under the authority of a this information has been considered in the plan-
referral agency. In these cases, the organization ning process.
demonstrates how it accesses these plans and It is critical to understand the person’s skills, likes
how it uses them to achieve individualized ser- and dislikes, and desired outcomes. When those
vices and person-focused outcomes. Even when have been identified, it is helpful to understand
an external authority is responsible for plan the areas described above to ensure that there are
development, the organization must ensure that no inherent conflicts with the services and out-
plans meet all CARF standards. If necessary the comes desired by the individual.
program may need to develop an addendum to See Standard 2.B.5., which relates to the indi-
the plan to supplement missing items. vidual’s plan.
Staff notes and progress reviews indicate involve-
ment of and direction by the person served. 2.B. 5. A coordinated individualized service
Objectives reflect the desires and dreams of the plan:
persons, within the mission and values of the 5.B. Ind. Service Planning, Design, and Delivery
a. Is developed with the active involve-

organization, and are written using their lan-
ment of the person served.
guage. A good practice is to write individual 5.a.B. Ind. Service Planning, Design, and Delivery
plans using “I” language and to quote the person b. Identifies:

in the plan. (1) The person’s overall goals.

5.b.(1)B. Ind. Service Planning, Design, and Delivery
3.e. Other issues to be considered in service plan- (2) Specific measurable objectives.
ning may include, as identified by the specific

(3) Methods/techniques to be used review is essential to ensure goals are achievable

to achieve the objectives. and remain meaningful to the person served.
(4) Those responsible for Plans are essential for all members of the team to
implementation. perform their functions and to ensure continuity
(5) How and when progress on of services/supports when new staff members are
objectives will be regularly hired. The organization ensures that all persons
reviewed. involved understand the plans and their own
c. Is communicated in a manner that involvement in achieving the outcomes.

is understandable: Based on the scope of services, formalized service
planning may be less in-depth and less individu-
(1) To the person served.

5.c.(1)B. Ind. Service Planning, Design, and Delivery
(2) To the persons responsible for alized. For example, in a program that offers
implementing the plan. drop-in center services or senior centers, the plan
5.c.(2)B. Ind. Service Planning, Design, and Delivery
may take the form of a more generic agreement
d. Is reviewed on a regular basis with
such as a membership agreement, registration
respect to expected outcomes.
5.d.B. Ind. Service Planning, Design, and Delivery form, etc. Often these may be accredited as a
e. Is revised as appropriate based Community Integration program or a Home and
on the: Community Services program.
5.e.B. Ind. Service Planning, Design, and Delivery
(1) Changing needs of the

Active participation of the persons served in
person served.
5.e.(1)B. Ind. Service Planning, Design, and Delivery
setting goals and planning services may be dem-
(2) Satisfaction of the person served. onstrated through interviews, records, checklists,
5.e.(2)B. Ind. Service Planning, Design, and Delivery
f. Reflects timely transition planning etc. Persons served understand what is written in
when a person served moves: their plans and can communicate what it means.
5.f.B. Ind. Service Planning, Design, and Delivery
(1) From one level of services/ A good practice an organization may follow is to
supports or program to another provide copies of the service plan to the persons
within the organization. served and others who are responsible for imple-
menting the plan, unless applicable laws or
5.f.(1)B. Ind. Service Planning, Design, and Delivery
(2) Externally to another provider.

5.f.(2)B. Ind. Service Planning, Design, and Delivery
regulations prohibit doing so.

Intent Statements
The individual plan can be the source for mea-
The person served is an active participant giving
suring individual outcomes satisfaction.
direction in all aspects of the planning and revi-
sion processes. 5.b.(2) Specific measurable objectives are critical
to planning the steps that will lead to persons
NOTE: Even when an external agency is responsible
for plan development, the organization seeking being able to achieve their goals. Measurable
accreditation must ensure that the plans meet the objectives enable persons served and personnel
CARF standards. If necessary the program may to assess progress toward goal achievement. A
develop an addendum to the plan to supplement useful way of making goals and objectives more
missing items or address these in some other powerful and measurable is to use the SMART
manner to demonstrate conformance. mnemonic. While there are variants, SMART
usually stands for:
Examples
■ Specific.
Reasonable efforts and accommodations are
■ Measurable.
made to obtain the active participation and
understanding of the person served, including ■ Attainable.
the inclusion of an advocate if the person prefers, ■ Relevant.

or if it is necessary to interpret the person’s ■ Time-bound.
desires. An organization may choose to include
documentation in the plan of decisions made by There is a wealth of information available on
the individual. The organization establishes a the internet simply by searching for measurable
schedule for periodic review of the plan. The plan objectives.
focuses on outcomes and results, and regular

5.e.(2) The plan is revised to remain meaningful JAN’s trained consultants have access to a
to the person served. database of more than 200,000 previous accom-
modations to provide practical options. JAN can
Resources
be reached at: 1 (800) ADA-WORK or via email:
Information and tools that may be helpful in jan@jan.idci.wvu.edu.
developing plans and goals for persons served
The website www.mymdrc.org/assistive-tech/
can be found at www.lifecoursetools.com.
webinars.html has numerous webinars available
to assist providers and persons served with learn-
2.B. 6. When it has been determined that there ing about various technology and devices.
is a need, the following are addressed
in the plan:
 The website www.ap-toolkit.info provides
information and tools for procuring accessible
a. Assistive technology. technologies, training, and services.
b. Reasonable accommodations.
Intent Statements 2.B. 7. When applicable to the person and

In developing an individual service or support his or her goals and outcomes:
plan, these needs are considered, as appropriate, a. The person and/or family served
to maximize potential for achievement of goals. and/or their legal representatives
Examples are involved in:
The organization may provide assistive technol- (1) Assessing potential risks to
ogy, or it may be provided by referral to other each person’s health in the
local resources. Reasonable accommodations are community.
7.a.(1)B. Ind. Service Planning, Design, and Delivery
addressed when necessary to enable the person (2) Assessing potential risks to each
served to participate in the organization’s activi- person’s safety in the community.
ties and fully access services. When appropriate (3) Deciding whether to accept situ-
to the person’s needs, technology is addressed ations with inherent risks.
in the individual service plan. If a person needs (4) Identifying actions to be taken
services/supports that are not available from to minimize risks that have been
the organization, referrals to other services are identified.
suggested. 7.a.(4)B. Ind. Service Planning, Design, and Delivery
(5) Identifying individuals responsi-

Accommodations and technology may entail ble for those actions.
the use of communication devices, videos and
b. Risk assessment results are docu-

audio recordings, pictures, and materials in each mented in the individual service plan.
person’s primary language. Many modifications 7.b.B. Ind. Service Planning, Design, and Delivery
are simple and inexpensive. Intent Statements

When there are changes in the environment for
Some performance indicators of quality are that
the persons served and/or changes in a person’s
the organization provides education to service
health or functioning, consideration in planning
personnel on technology applications and
should include an assessment of risks for the indi-
incorporates knowledge and consideration of vidual. Risks are considered to be exposure to a
technology into assessment, evaluation, and predictable event or environment that could
training. result in serious physical or psychological injury
See the Glossary for the definitions of Assistive to the individual. A proactive approach in plan-
technology and Reasonable accommodations. ning that includes all relevant stakeholders can
help to reduce the potential for adverse
Resources
consequences.
The Job Accommodation Network (JAN), a
service of the President’s Committee on Examples
Employment of People with Disabilities, provides In recognition of the changing lifestyles and
information about workplace accommodations. choices of persons served and the wide variety

of opportunities for community inclusion and

access, this standard encourages the active par-
2.B. 8. The persons served are informed about
resources to assist them in securing and
ticipation of persons served to explore fully any
retaining related benefits for which they
risks inherent in their choices in terms of health,
are eligible.
safety, lifestyle, sexuality, and so forth, in order 8.B. Ind. Service Planning, Design, and Delivery
that persons are better able to make informed Intent Statements

choices. The staff members are knowledgeable about
The personal and professional opinions of staff requirements for obtaining and retaining bene-
members do not influence the information that is fits, due process, and time frames, or are able to
provided beyond what are known to be and what refer persons to authorities who are. The organi-
may possibly be expected benefits, risks, and zation provides information directly or through
responsibilities. referral about benefits and application proce-
dures to the persons and/or families served.
Examples of potential risks to a person’s health
might include a person who takes psychotropic Examples
medication being employed in a position that Providing persons with this information enables
requires working in extreme temperatures or a them to make more informed decisions about
person who takes seizure medications having to how choices could impact their ability to retain
wait for public transportation in hot weather. current benefits or acquire different benefits.
Examples of potential risks to a person’s safety Benefits may include, but are not limited to,
might include a person being placed in a sup- Supplemental Security Income, Social Security
ported apartment who does not know how to Administration income, Social Security Disabil-
contact appropriate emergency personnel if ity Insurance, Labor and Industry benefits,
needed, a person being placed in a job that employer insurance, unemployment insurance,
requires him or her to wait for public trans- food stamps, bus passes, public health services,
portation after dark, or a person who takes energy assistance, child care assistance, housing
psychotropic medication being employed in a assistance, and other governmental assistance
position that requires him or her to work with program benefits.
industrial machines.
These may include risk versus choice of different 2.B. 9. If a person served needs services/
treatment modalities such as aquatherapy or supports that are not available through
hippotherapy and may take into account where the organization, referrals to other pro-
services are provided, such as in a person’s home, viders or resources are suggested to the
in the community, or at a center. Other examples person served and/or referral source,
of things to consider regarding risk versus choice as appropriate.
are specific healthcare needs of the child, such as 9.B. Ind. Service Planning, Design, and Delivery
when a child uses a feeding tube or is susceptible Intent Statements

to infections and how often the playground The organization may not be able to provide all
equipment and toys are cleaned. After discussion services/supports a person may want or need. If
of such issues with the parents and child, the par- this is the case, the organization refers the person
ents’ choice might be documented in some way, to other services outside the organization.
such as on an informed consent form. Examples
When identifying actions to minimize risks, The organization maintains listings and demon-
always include consideration of the person’s strates knowledge of agencies and organizations
existing support system. to which it can refer individuals, if so requested
As part of an organization’s risk management, or needed. As a best practice, an organization
any health or safety risks identified during the would have a procedure in place to ensure that
planning process would be addressed to limit an individuals are satisfied with the services/
individual’s exposure to adverse consequences. supports they receive elsewhere as a result

of these referrals and that the agencies and Documentation Examples

organizations receiving its referrals are quality- The following are examples of the types of infor-
driven, person-centered services. mation you should have available to demonstrate
Some organizations also provide persons served your conformance to the standards in this sub-
with a handbook, which lists other community section. See Appendix A for more information
resources that could be used by a person to on required documentation.
enhance his or her quality of life. ■ Records of the persons served
■ Handbook and information regarding

2.B. 10. An exit summary report is prepared: responsibilities in services
a. On a timely basis. ■ Orientation checklist, information, etc.

b. For each person who leaves the ■ Individual service plans

organization’s services.
10.b.B. Ind. Service Planning, Design, and Delivery ■ Information demonstrating reasonable
c. That summarizes results of services
accommodations and assistive technology
received.
used, if applicable
Intent Statements ■ Documentation of advocacy training
The exit summary report serves as a tool to or curriculum
facilitate continuity of services/supports. ■ Referral information
NOTE: An exit summary report is not required for ■ Exit summary report
persons who leave services due to death, unless
this is relevant to the type of service provided.
For persons who “drop out” of services or exit
without notice, the summary indicates these
circumstances and may be very brief.
Examples
The report typically summarizes the results of
the services received by the person and makes
recommendations for future services to continue
the achievement of the person’s life goals. The
plan could suggest referrals to other services that
are not available through the organization, as
specified in Standard 2.B.9.

Section 2.C. Medication Monitoring and Management
C. Medication Monitoring 1.e.–f. Information on pertinent potential side

effects and/or drug interactions are those identi-
and Management fied by the prescriber, provided by the dispensing
pharmacy, and/or provided by support medical
or nursing staff. Program personnel are given
Applicable Standards access to resource materials.
■ If a program provides only medication
monitoring, Standards 2.C.1. and 2.C.2. 2.C. 2. The organization implements written
are applicable. (See the Glossary for the procedures that address:
2.C. MMM
definition of medication monitoring.) a. Storage, including handling of

■ If a program provides medication manage- medications requiring refrigeration
ment, all standards in this subsection are or protection from light.
2.a.C. MMM
applicable. (See the Glossary for the defini- b. Safe handling.

2.b.C. MMM
tion of medication management.) c. Packaging and labeling.

2.c.C. MMM
To clarify whether your program provides med- d. Safe disposal.

2.d.C. MMM
ication monitoring or management as defined e. Maintenance of an adequate supply

by CARF, contact your designated resource of medications for the persons
specialist. served.
2.e.C. MMM
f. Documentation of medication use.

1. An up-to-date individual record of all
2.f.C. MMM
2.C.
Intent Statements
medications, including prescription and
Documented procedures related to medications
nonprescription medications, used by
are an important aspect of an organization’s man-
the person served includes:
1.C. MMM agement of potential risk.
a. The name of the medication.
1.a.C. MMM
Examples
b. The dosage, including strength
or concentration. Guidance for an organization could come from
1.b.C. MMM
c. The frequency. licensing, contractual, funding, legal, or other

1.c.C. MMM
regulatory requirements.
d. Instructions for use, including
administration route. 2.a.–b. Written procedures for storage and safe
1.d.C. MMM
e. Potential side effects. handling include addressing limited/secure

1.e.C. MMM access and biohazard management.
f. Drug interactions.
1.f.C. MMM
2.d. Safe disposal of medications includes
g. For prescribed medications:
1.g.C. MMM addressing management of biohazards associated
(1) The prescribing professional with the use of medications.
and phone number.
1.g.(1)C. MMM 2.e. Efforts to ensure adequate supply would
(2) Dispensing pharmacy and
relate to the organization’s level of responsibility,
contact information.
1.g.(2)C. MMM
whether monitoring or management.
Intent Statements
The intent of this record is to have accurate 2.C. 3. As requested, the persons served or their
information typically provided by the pharmacy parents or guardians are provided with
or prescribing individual readily available for or given information about resources for:
appropriate personnel. 3.C. MMM
a. Advocacy and advocacy training to

Examples assist them in being actively involved
Guidance for an organization could come from in making decisions related to the use
State Professional Registration Practice Acts and of medications.
3.a.C. MMM
Statutes; licensing requirements; or other regula- b. Training and education regarding

tory requirements. medications.
3.b.C. MMM

Intent Statements ■ Instructions on self-administration, when

The active involvement of the persons served can applicable.
be demonstrated by evidence of their consent ■ The availability of financial supports and
and input regarding changes in medications. resources to assist the persons served with
The persons served and others, as appropriate, handling the costs associated with
are provided with information about medication medications.
management procedures and side effects.
Appropriate education and training provided
to the persons served and/or family members 2.C. 4. The organization documents that the use
identified by the persons served enables of all medications by the person served is
informed decisions. reviewed on at least an annual basis by a
single physician or qualified professional
In cases involving involuntary hospitalization and
the presence of court orders, there are rare situa- licensed to prescribe or dispense
tions in which medications are used involuntarily medications.
4.C. MMM
by the persons served. Intent Statements

Examples Organizations realize the importance to the
3.a. Advocacy training can include guidance health and safety of the person served that a reg-
ular systematic review of all medications being
given to the persons served/families about ques-
used is conducted by a qualified medical profes-
tions they might ask, such as “What are potential
sional to ensure that adverse reactions between
side effects of particular medications? What are
multiple medications are avoided and persons
the benefits of taking a particular medication?
are not overly medicated. To avoid replication of
What are the consequences of not taking the efforts, a program may obtain documentation
medication?” from another provider, family member, guardian,
3.b. This training and education may be provided etc. that this review of medications occurred.
by a medical or nursing licensed professional as
Examples
appropriate, and may include:
Review by a pharmacist, a healthcare professional
■ How the medication works.
who practices in the field of health sciences
■ The risks associated with each medication. focusing on safe and effective medication use,
■ The intended benefits. would meet the intent of this standard. Pharma-
■ Side effects. cists interpret and communicate this specialized
knowledge to patients, physicians, and other
■ Contraindications.
healthcare providers.
■ Appropriate knowledge of adverse interac-
Medication reviews typically address:
tions between multiple medications and food.
■ The appropriateness of each medication,
■ The importance of taking medications as
as determined by the needs and preferences
prescribed.
of each person served.
■ The need for laboratory monitoring.
■ The efficacy of the medication. (See the
■ The rationale for each medication.
Glossary for the definition of efficacy.)
■ Alternatives to the use of medications.
■ The presence of side effects, unusual effects,
■ Alternative medications. and contraindications.
■ Signs of nonadherence to medication ■ The use of multiple simultaneous
prescriptions. medications.
■ Potential drug reactions when combining ■ Medication interactions.
prescription and nonprescription medica-
The frequency of the reviews depends on:
tions, including alcohol, tobacco, caffeine,
■ The degree of severity of the person’s medical
illicit drugs, and alternative medications.
condition.

■ Whether multiple medications are provided ■ Prescribing errors.

and other contraindications exist. ■ Administration errors, including:
■ Guidelines related to the medication itself. – Medication omissions.
– Incorrect drug.
2.C. 5. An organization that manages – Incorrect rate or dose.
medications for persons served imple-
ments written procedures that address: – Incorrect route.
5.C. MMM
a. Purchase, if applicable, including – Incorrect timing.

processes for handling medication – Incorrect labeling.
shortages on weekends. – Incorrect identification of person served.
5.a.C. MMM
b. Transportation and delivery, if

■ Medication documentation errors.
applicable.
5.b.C. MMM
c. Off-site use, if applicable.

5.c.C. MMM 2.C. 6. An organization that manages medica-
d. Administration of medications tions for persons served implements
by personnel, including: written procedures regarding medica-
5.d.C. MMM
(1) Staff credentials and tions that provide for:

competencies. 6.C. MMM
a. Compliance with all applicable laws

5.d.(1)C. MMM
(2) Documentation of medication and regulations pertaining to medi-

administration. cations and controlled substances.
5.d.(2)C. MMM
(3) Documentation of the use and 6.a.C. MMM
b. Documentation or confirmation
benefits, or lack thereof, of of informed consent for each medica-
as needed (prn) doses. tion administered, when possible.
5.d.(3)C. MMM
6.b.C. MMM
Intent Statements c. Integrating any prescribed medica-

Documented procedures related to medications tions into a person’s overall plan,
are an important aspect of an organization’s including, if applicable, special
management of potential risk and its ability to dietary needs and restrictions associ-
administer medications on a consistent and ated with medication use.
6.c.C. MMM
safe basis. d. Identification, documentation, and

5.a.–c. If an organization has no role in purchase, required reporting, including to the
transportation, and/or off-site use of medications prescribing professional:
6.d.C. MMM
by the persons served, a written procedure is (1) Of any medication reactions

not required to address these aspects. experienced by the person
Examples served.
6.d.(1)C. MMM
5.c. Off-site use refers to administration or self- (2) Of medication errors, as

administration during time away, such as at appropriate.
6.d.(2)C. MMM
home, at school, at recreational activities, or at e. Review of medication errors and drug

work by persons served who normally receive reactions as part of the quality moni-
medications at the organization’s facilities and toring and improvement system.
6.e.C. MMM
programs, or the organization dispenses the f. Actions to follow in case of emergen-

medications for the person to self-administer cies related to the use of medications,
at home or elsewhere. including ready access to the tele-
5.d.(2) When examining medication manage- phone number of a poison control
ment errors as part of risk management, items center by:
6.f.C. MMM
to address may include: (1) The program personnel.

6.f.(1)C. MMM
■ Unauthorized drug use. (2) The persons served, as

appropriate.
■ Dispensing errors. 6.f.(2)C. MMM

g. Availability of medical resources Documentation Examples

for consultation during hours of The following are examples of the types of infor-
program operation. mation you should have available to demonstrate
6.g.C. MMM
h. Coordination as needed with the phy- your conformance to the standards in this sub-
sician providing primary care needs. section. See Appendix A for more information
6.h.C. MMM
Intent Statements
■ Policy on whether the organization has any
Documented procedures regarding medication
management helps to ensure that the use of role related to medications in the program
medications is addressed and integrated with seeking accreditation, and if so, clarifies the
other service strategies for each person served. extent of that role
■ Records of the persons served
Examples
■ Individual medication records for
6.b. It may not be possible to obtain informed
consent in situations where the person served persons served
is not coherent or competent, or is under a ■ Procedures regarding storage, safe handling,
court-ordered commitment for the purpose of packaging/labeling, and safe disposal

requiring medications. Evidence of consent for ■ List of educational and training
administering of medications may include formal resources for advocacy
signed consent forms reviewed at least annually, ■ Medication procedures regarding purchase,
and preferably with each medication change as transportation, inventory, off-site use, and
preferred by the person served and/or guardian; administration, if applicable
a notation by the prescribing individual in the
record of the person served that the medication
has been discussed and agreed upon; or medica- ■ Staff training records
tion to be administered listed on an individual ■ Documentation of training regarding medica-

plan actively developed with the person served. tion of persons served, if applicable
6.c. It is important that there be an initial review ■ Records of informed consent, if applicable
as soon as the person enters services of all medi- ■ Procedures related to medication reactions/
cations currently being taken and their efficacy, errors
potential side effects, and contraindications. Ser-
■ Actions to follow in case of medication
vice planning addresses the fact that the person is
emergencies
taking medication and integrates medication use
■ Written procedures regarding compliance
with the planning of services and supports for the
person served. with all laws/regulations pertaining
to medications
6.f. Identification of actions might also include in
addition to the number of a poison control center
ready access by program personnel and/or the
persons served to the telephone number of the
prescriber, physician, and/or support nursing
staff or of emergency medical services.
6.g. Consistent with licensure, physician assis-
tants, nurse practitioners, and clinical nurse
specialists may substitute for physician availabil-
ity. Consultation can be obtained through direct
employment, contract or consultant agreement,
or medical facility agreements. Organizations
may also use telemedicine as a method of
obtaining consultation.

Section 2.D. Employment Services Principle Standards
D. Employment Services ■ Person served obtains a job at minimum wage

or higher and maintains appropriate benefits.
Principle Standards ■ Person served maintains the job.
Description
An organization seeking CARF accreditation
in the area of employment services provides For information on the applicability of the stan-
individualized services and supports to achieve dards in this section to the services for which
identified employment outcomes. The array your organization is seeking accreditation,
of services and supports may include: please refer to the Applicable Standards state-
ments in the individual services in Section 3
■ Identification of employment opportunities
or to the grid beginning on page 126.
and resources in the local job market.
■ Development of viable work skills that match Services Design for Persons Served
workforce needs within the geographic area.
■ Development of realistic employment goals. 2.D. 1. The following information is considered
■ Establishment of service plans to achieve in developing the individual’s service
employment outcomes. plan for employment:
1.D. Emp Svcs
■ Identification of resources and supports to a. Self-reported interests and skills.

1.a.D. Emp Svcs
achieve and maintain employment. b. Work and volunteer history.

1.b.D. Emp Svcs
■ Coordination of and referral to employment- c. Previous training and education.

1.c.D. Emp Svcs
related services and supports. d. Benefits the person is receiving.

1.d.D. Emp Svcs
The organization maintains its strategic position- e. Availability to work, including hours.
1.e.D. Emp Svcs
ing in the employment sector of the community f. Transportation availability.

by designing and continually improving its ser-
1.f.D. Emp Svcs
g. Support needs.
vices based on input from the persons served and 1.g.D. Emp Svcs
h. Self-reported barriers to
from employers in the local job market, and employment.
managing results of the organization’s outcomes 1.h.D. Emp Svcs
i. Legal history.
management system. The provision of quality 1.i.D. Emp Svcs
employment services requires a continuous focus Intent Statements

on the persons served and the personnel needs of The program should become knowledgeable
employers in the organization’s local job market. about the person served in order to develop a
Some examples of the quality results desired by plan that identifies resources and supports to
the different stakeholders of these services and achieve the person’s goals.
supports include: Examples
■ Individualized, appropriate accommodations. 1.c. Consideration of previous education and
■ A flexible, interactive process that involves training may include computer and literacy skills.
the person. 1.g. Consideration of support needs includes
■ Increased independence. other support services being provided and the
■ Increased employment options.
availability of natural supports to support both
obtaining and maintaining employment.
■ Timely services and reports.
■ Persons served obtain and maintain employ-

ment consistent with their preferences,
strengths, and needs.

readily accessible information from the

2.D. 2. The person served is involved in community or other sources.
making informed employment-
related decisions, including: A comprehensive understanding of local
2.D. Emp Svcs
employment needs can lead to effective provision
a. The expected outcome for services.
2.a.D. Emp Svcs of services/supports, such as assistive technology;
b. His or her role and responsibilities the identification of employment objectives in
related to achieving desired services planning and coordination; the explor-
employment outcomes. ation of options of employment for students
2.b.D. Emp Svcs
Intent Statements transitioning from school to work, such as

Informed choice is reflected in the individual customized employment, the exploration of
planning process through full disclosure of interests in evaluation or actual work settings;
the capabilities of the organization to meet the and the development of individualized services
person’s outcomes expectations and the person’s to overcome barriers to achieving maximum
understanding of his/her responsibilities. employment outcomes.
Examples Sometimes there may be incremental steps
toward the desired outcome, when it is not quite
For persons with significant communication
in reach at the present time but can become
barriers, the program may assess the person’s
achievable with some intermediate efforts. For
interests, preferences, and input through other
example, a person may initially work part-time
means, such as observation or interviews with
hours to develop the stamina to handle a full-
family members, advocates of the person, or
time position.
staff who work with the person.
Decision making based on informed choice Services Design for Employers
may be reflected in: An employer may be an integrated business
■ The scope, duration, and expected outcomes in the community or it may be the organization
of the employment services. itself.
■ Employment choices, plans, and options.
■ Paid or unpaid work. 2.D. 4. Employment services provided reflect

■ Work settings. current needs of employers and trends
in the local job market.
■ Career development and/or training activities. 4.D. Emp Svcs
■ Career advancement opportunities.

Intent Statements
The provision of effective and cost-efficient
services requires an organization to maintain
2.D. 3. The person served is informed about
up-to-date knowledge of the opportunities in the
opportunities for employment in the
local job market. This knowledge is a reference
local community consistent with his
point for the setting of goals and the coordina-
or her desired outcome.
3.D. Emp Svcs
tion of resources to achieve the individual’s
Intent Statements desired service outcomes.
Current information on employment opportuni- By analyzing the employment opportunities
ties is vital to the individual planning process, in the local region, the organization can design
as well as to the continuous improvement of its services to be responsive to the personnel
the service delivery design. needs of employers and provide informed
choices to the persons served.
Examples
The organization changes its services as war-
Much of the information is accessible from gov-
ranted to meet employers’ needs and provides
ernmental or other public domain internet sites. supports and services to the persons served
This standard does not require an organization to to assist them in meeting the changing needs
develop this information on its own if it can use of the local job market.

Examples Successful employment services use input from

Obtaining and using stakeholder input in strate- these stakeholders to manage their performance
gic planning and positioning of the organization by measuring the satisfaction of employers and
helps to achieve optimum employment results. related key stakeholders. Further guidance can
The design and continuous improvement of be found in Section 1.M. Performance Measure-
employment services to meet the personnel ment and Management. The CARF publication
needs of employers are further supported Managing Outcomes, which is available on
through standards in Section 1 of this manual, request from your resource specialist, may also
including input, outcomes, and leadership. be helpful.
Some examples of input resources may include: 5.c. Partnering with employers may include pro-
viding opportunities such as job carving, job
■ Establishing business advisory councils or
shadowing, and internships, which may help the
maintaining membership in business
employer to meet diversity or recruiting goals.
associations.
An employment services organization can pro-
■ Participating in business forums.
vide leadership in its community by being a
■ Maintaining relationships with public and resource for the recruitment, education, and
private schools. successful development of employment opportu-
■ Person served or stakeholder feedback. nities for persons who are seeking employment.
See also Sections 1.D. Input from Persons Served Some examples may include:
and Other Stakeholders and 1.M. Performance ■ Assisting employers in the elimination of
Measurement and Management. architectural, procedural, instructional, com-
munication, and attitudinal barriers to the
2.D. 5. As appropriate to the services provided, employment and advancement of persons
employers are made aware of the follow- with employment challenges.
ing resources: ■ Educating employers about various disabili-
ties and resulting vocational implications,
5.D. Emp Svcs
a. Customer service/supports available

from the organization. assistive devices, job accommodations, and
5.a.D. Emp Svcs
b. Referrals of job applicants closely current disability-related legislation.

matched to the employers’ Follow-up and post-employment services may
requirements. include:
5.b.D. Emp Svcs
c. The organization’s ability to partner ■ Contact with the employed person and with
with employers to develop employ- the employer, when this is appropriate.
ment opportunities. ■ A documented system to provide organized
5.c.D. Emp Svcs
d. Tax credits that the employer may support contacts at regular intervals with the
secure as a result of hiring an eligible person served. As appropriate, contact at reg-
candidate. ular intervals is made with the employer and
5.d.D. Emp Svcs
Intent Statements significant others.

The success of employment services is based ■ The availability of appropriate personnel for
on meeting the needs of employers. the person served and/or employer during
and, if feasible, after regular working hours
Examples
to provide support services, if requested.
Not all aspects of this standard have to be pro-
■ The maintenance of contact for a reasonable
vided to every employer, but should be available
period of time to promote adequate job
upon request, either directly from the organiza-
adjustment and retention.
tion or through referral to and coordination with
■ The availability of services, including re-
other community resources.
placement, for persons who are unsuccessful
in maintaining employment.

Resources Measurement, modular arrangement of predeter-

A resource for organizations to use in establish- mined time standards (MODAPTS), etc.
ing successful employer partnerships is
Developing Effective Partnerships with Employers  Volunteer placements and unpaid placements are
considered acceptable closures in Canada.
as a Service Delivery Mechanism, which was This standard is linked to other standards related
published by Stout Vocational Rehabilitation to the organization’s compliance with laws and
Institute in June 1997. regulations and adherence to a written code of
ethical conduct related to its business and finan-
The Organization as Employer
cial practices.
NOTE: These standards apply only when the organi-
6.b. As changes are enacted such as Executive
zation has an employer-employee relationship with
Order 13658, “Establishing a Minimum Wage
the person served in the service being accredited.
for Contractors,” applicable to covered workers
(including workers whose wages are calculated in
2.D. 6. In an employer/employee relationship accordance with special certificates issued under
with a person served, the organization Section 14(c) of the Fair Labor Standards Act, the
complies with: organization has a process to ensure it complies
6.D. Emp Svcs
a. All applicable United States with changes applicable to its employment

Internal Revenue Service rules programs.
and regulations.
6.a.D. Emp Svcs Resources
b. Other applicable laws and
regulations. Further information can be obtained from
6.b.D. Emp Svcs
the U.S. Department of Labor (www.dol.gov),
c. Its own internal policies and
1-866-4-USA-DOL. TTY: 1-877-889-5627.
procedures.
6.c.D. Emp Svcs Employment and training questions: 1-877-
Intent Statements US-2JOBS. Wage and hour questions: 1-866-
Compliance with all applicable laws and regula- 4USWAGE. Workplace safety and health
tions is an integral part of the organization’s questions: 1-800-321-OSHA.
procedures. Changes in applicable laws and
regulations are integrated into the organization’s 2.D. 7. For U.S. organizations, when an individ-
system. ual receives less than the minimum
 Canadian organizations should be able
to demonstrate how they comply with their
wage, governmental requirements for
work measurement and wage payment
federal and provincial/territorial labor laws. are followed, including documentation
Examples of:
7.D. Emp Svcs
Some organizations have established a policy a. How the person’s disability affects
of paying at least minimum wage to persons his or her productivity.
7.a.D. Emp Svcs
served who are engaged in any paid work experi- b. Performance levels based on work
ences. See Section 3.H. Affirmative Business measurements.
7.b.D. Emp Svcs
Enterprise on page 240 for one model of services c. Commensurate wages paid.
7.c.D. Emp Svcs
that does so. d. Changes made based on annual

The organization is encouraged to develop its prevailing wage studies.
7.d.D. Emp Svcs
work measurement and payment system with Intent Statements

the assistance of regional or local wage and hour
For individuals receiving less than minimum
representatives.
wage, the organization should document how
 In Canada, such information can be obtained
from the provincial/territorial ministries of labor.
their disabilities impair their productivity.
Annual prevailing wage studies must be done.
The organization uses generally accepted tech- Wages are not simply based on minimum wage
niques such as time studies, Methods Time as the prevailing wage is frequently higher.

Examples payments are of a monetary nature and not

Some organizations have established a policy payments in kind.
of paying at least minimum wage to persons Hourly wage rates are based on acceptable time
served who are engaged in any paid work experi- study techniques unless the federal minimum
ences. See Section 3.H. Affirmative Business wage is paid.
Enterprise on page 240 for one model of services The productivity of those persons served who are
that does so. paid at an hourly rate that is less than minimum
The documentation regarding a person’s wage wage is measured at least every six months, with
rate is kept in the individual’s file. wages adjusted as indicated.
Governmental requirements include establishing A regular pay period is established and does not
the community wage rate for each type of job exceed the maximum number of days allowed
by contacting employers that have the work or under state law. Each person receives a written
closely approximate the work on which the wage statement for each pay period, which may take
rate is being based at least annually and docu- a variety of forms (e.g., a check stub, a written
menting that the wages paid to the persons statement inside the pay envelope, a notation on
served have been adjusted based on changes in the outside of the pay envelope, etc.) but complies
the prevailing wage survey. When the minimum with any applicable legal requirements, such as
wage increases, organizations should conduct indicating gross pay, hours worked, deductions,
prevailing wage surveys within 60 days and and net pay.
adjust wages accordingly. This information The Department of Labor requires full payment
includes: of wages for work performed within the pay
■ The prevailing wage for similar types of work. period. This standard is applicable even if the
■ The date obtained. organization desires to delay the payment of
■ The source of information.
wages based on the expected receipt of payment
for work performed by the organization.
■ Documentation that an entry-level wage
was not used. There is no charge to the persons served for
the privilege of employment.
Further information may be obtained from the
7.a. Organizations typically use documents such
U.S. Department of Labor and/or State Depart-
as case notes, performance evaluations, progress
ment of Labor.
notes, and training documents to capture infor-
A good system of work measurement: mation on how a particular disability impacts
■ Applies generally accepted work measure- an individual’s productivity. For example, an
ment techniques to specifically identified employee with a diagnosis of a developmental
work tasks. disability may require additional prompting to
■ Determines the level of performance required remember tasks during work due to diminished
for qualified, competent workers to accom- cognitive retention, thus causing him or her to
plish the prescribed task in a given situation. have lower productivity. Issues with quality may
also exist that would impact earning capacity.
■ Makes allowances for personal, fatigue, and
delay factors specific to each job. There has to be a relationship between the dis-
ability and the decreased productivity/quality,
■ Uses the same equipment, environment, and
and documentation should exist that outlines
methods as workers without disabilities. the specific areas that make the individual con-
Good practice would establish individual hourly sidered to have a disability for the work to be
wage rates within the first 30 calendar days of performed.
employment and every time an individual
changes jobs. Wage payments are based on a
system of individual performance rather than
on pooled and/or group wage payments. Wage

product/performance reliability, good communi-

2.D. 8. When persons make less than the cations, and written quality control procedures
minimum wage, they are:
8.D. Emp Svcs
specific to individual products and services
a. Informed at least semiannually (including inspection and testing requirements).
about how their productivity
When the organization is involved in prime man-
affects their wage.
8.a.D. Emp Svcs ufacturing and/or subcontract operations, files
b. Assisted to understand: on work methods, quality control, and produc-
8.b.D. Emp Svcs
(1) Their current rate of pay. tion scheduling are maintained and actively used
8.b.(1)D. Emp Svcs
(2) Ways to improve their earnings. by supervisory personnel. Written specifications

8.b.(2)D. Emp Svcs
Intent Statements
are maintained for each article produced.
Products are made in conformance to relevant
The organization should not only ensure fair
specifications and meet the standards of competi-
wages, it should also consider avenues for
tive products in the open market. Work methods
enhanced productivity and increased wages.
might include work station setup, steps in the
In some promising practices, organizations use production process, work flow, and equipment
job restructuring, assistive technology, and to be used. Production scheduling might include
natural supports to increase earning levels. production hours per job, shipping dates,
For additional information, see Section 3.Q. coordination with other jobs, and customer
Assistive Technology Supports and Services (AT). time frames.
Examples
The organization evaluates the equipment and 2.D. 10. For U.S. organizations, when the
techniques used in order to maximize the earn- organization bids for contract work
ing potential of persons served. In production or establishes prices for products
and training activities, it strives to use the tools, or services, it:
10.D. Emp Svcs
equipment, technology, and machinery to repli- a. Considers:

cate methods utilized by competitive industry,
10.a.D. Emp Svcs
(1) All direct costs.

which might open local job opportunities to the 10.a.(1)D. Emp Svcs
(2) All indirect costs applicable

persons served. This does not, however, preclude to each job.
individually tailored adaptive devices that may 10.a.(2)D. Emp Svcs
(3) Profit.
be used by persons to accomplish tasks which 10.a.(3)D. Emp Svcs
otherwise they could not do. (4) Fair market value.

10.a.(4)D. Emp Svcs
b. Reviews bids/prices at least annually.

10.b.D. Emp Svcs
2.D. 9. When the organization is producing a c. Revises bids/prices as necessary.

10.c.D. Emp Svcs
product or providing a service for busi- Intent Statements

nesses, it maintains a standardized The organization seeks business on a fair and
system of quality control. competitive basis. It does not engage in unfair
9.D. Emp Svcs
Intent Statements competition with other programs or commercial

organizations in selling its services and products.
The program maintains an organized system
To achieve financial stability, the organization
of quality control with responsibility vested in
knows its costs and bids competitively in the local
specified personnel to ensure that the quality
job market.
of products and services meets competitive
industrial standards. Examples
Examples When production of goods or contracted service
delivery is carried out by the organization, sound
Several elements characterize a quality control
program in standard commercial practices. and acceptable practices are observed in all busi-
The practices include use of a written policy ness and industrial activities, including purchase
of materials, sale of products, subcontracting,
assuring customers of quality commitment and

and pricing. See related standards in Section 1.F. Documentation Examples

Financial Planning and Management. The following are examples of the types of infor-
The bid price includes all direct and indirect mation you should have available to demonstrate
costs applicable to each job, product, or service. your conformance to the standards in this sub-
An overhead markup supported by a precise section. See Appendix A for more information
written analysis of production costs is charged. on required documentation.
The value of any services, equipment, or space ■ Individual employment service plans
provided by the organization for the contract
operation is included in the determination of this
■ Information on local job opportunities
markup. Indirect costs include staff salaries and
benefits, occupancy, depreciation, administrative and trends
costs, and all other costs which cannot be directly ■ Information regarding community services
identified with the job. All retooling, training, and resources used
and remodeling costs necessary to accomplish ■ U.S. Department of Labor Certificate,
the job are also calculated. All donated equip- if applicable
ment, materials, and services are included in the ■ Documentation related to U.S. Department
contract bid price at fair market value. of Labor laws, if applicable
Selling prices of the program’s products are based ■ IRS information, if in the U.S.
upon full cost reimbursement and are in line with
■ Canada Revenue Agency information,
the prevailing price range for such products in
the competitive market areas. if in Canada
■ Information related to applicable labor
The activities of analyzing costs may also include
reviewing methods for achieving optimal effi- laws and regulations
ciency in the work environment consistent with ■ Information on referrals made
the needs of the persons served. ■ Documentation of supports given to
This standard relates to the code of ethical employers, if applicable

conduct of business practices and marketing ■ Information regarding time studies and
activities referred to in Standard 1.A.6. and to wage payment practices
standards in Section 1.F. Financial Planning and ■ Information regarding prevailing wage studies
Management.
■ Information regarding bidding practices
■ Information demonstrating annual analysis

of products and services pricing

Section 2.E. Standards for Workforce Development Services
E. Standards for ■ Employment services that result in job reten-

tion and advancement in position, earnings,
Workforce and/or benefits.
Career development, including education
Development Services ■
and training, as desired.
Description
The design of workforce development services is Applicable Standards
results oriented and focused on the employment An organization choosing to add the enhance-
and career development goals of the person ment of workforce development services to an
served with consideration for sustaining the appropriate program/service in Section 3 must
resources needed to maintain the family unit. meet the standards in this section in addition
Services provide persons with information they to the applicable standards for that program/
can use to make informed choices and career service. Please refer to the Applicable Stan-
decisions. The services aim to break the cycle of dards statements in the individual services in
underemployment, unemployment, and public Section 3 or to the grid beginning on page 126.
assistance and to provide opportunities for skill, NOTE: Section 2.B. Individual-Centered Service Plan-
educational, and career development of persons ning, Design, and Delivery does not apply to
to become productive members of the workforce. Workforce Development Services. The planning ele-
Quality workforce development services have an ment for services that is contained within Section
individualized, customer focus. Services consider 2.E. will be reviewed as part of the on-site survey.
the individual’s needs and follow the referral plan
The term One-Stop Career Center (OSCC) used
of the One-Stop Career Center (OSCC). At pres-
in this section originates from the Workforce
ent in the U.S., workforce development contracts
Investment Act (WIA), subsequently updated by
usually emanate from the local OSCC. However,
the Workforce Innovation and Opportunity Act
the field is evolving and at this time CARF recog-
of 2014, which reaffirms the role of the public
nizes that these standards are also applicable to
workforce system and brings together and
contracts with related service initiatives, such as
enhances several key employment, education,
Welfare to Work programs, Department of Reha-
and training programs. The One-Stop delivery
bilitation, and the Veterans Administration.
system is a system where entities responsible for
The services are provided in a customer-friendly administering separate workforce investment,
environment using good business principles. The educational, and other human resource programs
person served is treated with respect as a valued and funding streams (referred to as One-Stop
customer. These services must also consider the partners) collaborate to create a seamless system
personnel needs of the employers in the local job of service delivery designed to enhance access to
market, the community resources available, and the programs’ services and improve long-term
the trends and economic considerations in the employment outcomes for individuals receiving
labor market. assistance. The local Workforce Investment
Some examples of the quality results desired by Board selects the operator of the One-Stop
the different stakeholders of these services Center. CARF also offers accreditation for One-
include: Stop Career Centers through the One-Stop Career
■ Employment in the local labor market with Center Standards Manual with Survey Prepara-
or without ongoing support. tion Questions. Information regarding OSCC
■ Employment that meets the individual’s
accreditation can be requested from your
desires and goals. designated resource specialist.
■ Wages, hours per week, employment
The standards in this subsection assert basic
schedules, and benefits at the level required principles that should be demonstrated by any
to maintain the family unit.

organization seeking accreditation in the area Intent Statements

of workforce development services. Written policies provide the basis for educating
staff about the expectations of the local referral
2.E. 1. A formal agreement is in place with the and funding entity.
One-Stop Career Center that clarifies Examples
common issues. These policies and procedures are available
1.E. Workforce Dev
Intent Statements for staff review and would be part of a new

A contract or memorandum of understanding employee’s orientation.
(MOU) is used to clarify the services arrange-
ments with local or state workforce development 2.E. 3. The organization’s administration uses
referral and funding sources. indicators of performance to maintain
Examples compliance with the agreement between
the One-Stop Career Center and the
At present in the U.S., workforce development
provider.
contracts or MOUs usually emanate from the 3.E. Workforce Dev
local One-Stop Career Center. However, CARF Intent Statements

also recognizes that these standards may be The organization uses the performance indicator
applicable to contracts with related service ini- reports to improve individual and organizational
tiatives, such as Welfare to Work programs. results.
Common issues that might be covered in the Examples
agreement include:
Typical performance indicator reporting includes
■ Common vision. effectiveness, efficiency, and satisfaction mea-
■ The fee/rate to be charged for services. surements. Performance indicators are used to:
■ Data sharing agreements. ■ Continuously monitor performance.
■ A conflict resolution process for issues ■ Identify any need for corrective action.
which may arise between the provider ■ Determine methods to improve services.
and the center.
■ Identify actions to take to improve services.
■ The use of appropriate release-of-
■ Evaluate the effectiveness of actions taken.
information forms.
■ Electronic networking (internal and external).
For further guidance, refer to Section 1.M.
■ Marketing and promotion of the organiza-
Networking with other organizations may give
tion’s services. guidance in determining methods to improve
services. Consider resources available through
■ Definition of the relationship between
the internet, such as Baldrige quality criteria.
the One-Stop Career Center and
the service provider.
2.E. 4. As requested, the organization provides
■ Criteria for eligibility of consumers.
information to the local One-Stop Career
■ Responsibility for provision of reasonable Center on the following:
accommodations. 4.E. Workforce Dev
a. Outcomes performance.
4.a.E. Workforce Dev
b. Service utilization.
2.E. 2. Policies and procedures that document 4.b.E. Workforce Dev
c. Customer satisfaction.
the relationship between the organi- 4.c.E. Workforce Dev
zation and the local One-Stop Career Intent Statements

Center are: The information reported to the referral source is
timely and provided in an understandable format.
2.E. Workforce Dev
a. Communicated to staff members.

b. Followed by staff members.

2.b.E. Workforce Dev

Examples Intent Statements

See related standards in Section 1 and Individual plans are created and implemented
Section 2.A. around the identified needs of the customer
served.
2.E. 5. The organization’s outreach efforts Examples
provide information: The organization ensures that all persons
5.E. Workforce Dev
a. About the services offered. involved understand the plans and their
b. About how services may be accessed. involvement in achieving the outcomes.

c. In a manner that reaches the target Reports are disseminated in a timely manner.
audience. No information specific to an individual is
5.c.E. Workforce Dev
disclosed unless the person has authorized it.

Intent Statements
An organization’s outreach efforts are not uni-
formly part of established relationships with 2.E. 7. The organization provides an orientation
One-Stops. Information should be conveyed to the services for the customer.
7.E. Workforce Dev
in such a way that it is understandable and Intent Statements

useful to the target audience.
The organization’s orientation gives each person
Examples an opportunity to learn about the services and
Outreach can be conducted in a variety of ways, to learn about service options and provides
including the use of promotional literature, a information for persons seeking services to
website, participation in community job club make informed choices.
activities, and public service announcements. Examples
Additionally, public information is shared A good practice an organization may follow is
with many stakeholders, such as: to put some of the common information in a
■ Customers and potential customers handbook, video, or audio recording. Informa-
of services. tion that might be covered includes:
■ Local government. ■ A review of the specific objectives for
■ Local and state workforce development

the services.
boards. ■ Identification of those staff members
■ Legislature.
responsible for the provision of services.
■ Rights of the person served.
■ Local community.
■ Responsibilities of the person served,
■ Funding and referral agencies.
including any conditions for maintaining
■ Regulatory agencies.
participation in services.
Examples include written annual reports, ■ Other information that would assist
brochures, web pages, videos, audio recordings, the person to achieve the objectives.
graphic illustrations, and charts.
The organization is responsive to the person
served and treats him or her with respect as
2.E. 6. The organization provides: a valued customer. Orientation is provided
6.E. Workforce Dev
a. Individualized services for the at a time and place convenient to the person.
customer per the guidelines of
the One-Stop Career Center.
2.E. 8. When a person is served from more than
b. Reports to the center, as requested, one entity designated by the One-Stop
concerning the person’s Career Center, the organization partici-
performance. pates as requested by the center in the
coordination of services.
8.E. Workforce Dev

Intent Statements Documentation Examples

The sharing of satisfaction of the persons served The following are examples of the types of infor-
with services with other entities focuses the mation you should have available to demonstrate
community on meeting the expectations of your conformance to the standards in this sub-
the persons and families served. section. See Appendix A for more information
Examples on required documentation.
Procedures are followed that ensure optimal ■ Written agreement with the One-Stop Career
services. No information specific to an individual Center, or in some circumstances contracts

is disclosed unless the person authorized it. with related service initiatives, such as Welfare
Service coordination may include activities to Work programs, Department of Rehabilita-
such as: tion, and the Veterans Administration
■ Data sharing policy
■ Planning of individual services.
■ Conflict resolution policy/procedure
■ Delivery of services.
■ Release-of-information form
■ Documentation of progress.
■ Eligibility criteria
■ Regular review of service objectives.
■ Information on performance indicators
■ Service revision, if needed.
■ Promotional literature, brochures, etc.
■ A procedure for sharing information about
the person served with all providers serving ■ Annual report
him or her. ■ Reports to the One-Stop Career Center
■ Formal evaluation of satisfaction with ■ Individual service plans

services by the person. ■ Handbook and information regarding
rights and responsibilities
2.E. 9. Policies and procedures are in place ■ Orientation checklist, information, etc.
to address at a minimum:
9.E. Workforce Dev ■ Procedure for sharing information when
a. Confidentiality of information. a participant receives services from other
b. Current employment-related additional providers

laws and regulations.
■ Evaluation of satisfaction by customers
c. Resources that ensure staff
■ Confidentiality of information policy/
development to support these
procedure
policies and procedures.
9.c.E. Workforce Dev
■ Informed consent policy/procedure
Intent Statements
■ Documentation showing staff training
The organization is knowledgeable of the
■ Curriculum of training areas
issues listed above, and its training and staff
development reflects this knowledge base.

Section 2.F. Community Services Principle Standards
F. Community Services 2.F. 1. The organization assists persons served

to enhance their quality of life as they
Principle Standards desire:
1.F. Comm Svcs Principle
a. By providing opportunities to
Applicable Standards maintain and/or increase:
1.a.F. Comm Svcs Principle
(1) Social contacts.

For information on the applicability of the stan- 1.a.(1)F. Comm Svcs Principle
dards in this section to the services for which (2) Personal relationships.
1.a.(2)F. Comm Svcs Principle
your organization is seeking accreditation, (3) Community networks.

please refer to the Applicable Standards state- (4) New supports.

ments in the individual services in Section 3 b. By facilitating exposure to new

or to the grid beginning on page 126. community experiences.
1.b.F. Comm Svcs Principle
c. By achieving desired or greater par-

Description ticipation in community activities.
1.c.F. Comm Svcs Principle
An organization seeking CARF accreditation in Intent Statements

the area of community services assists the per- Persons served have access to assistance as
sons and/or families served in obtaining access desired to address issues in community participa-
to the resources and services of their choice. The tion. There should be opportunities for personal
persons and/or families served are included in growth and development in the lives of persons
their communities to the degree they desire. This served.
may be accomplished by direct service provision
Examples
or linkages to existing opportunities and natural
supports in the community. Persons served have opportunities to engage
in their communities in ways that are age-
The organization obtains information from the
appropriate and consistent with their peers
persons and/or families served regarding
without disabilities.
resources and services they want or require that
will meet their identified needs, and offers an Some examples of life skills related to this stan-
array of services it arranges for or provides. The dard are interpersonal skills, which can include:
organization provides the persons and/or fami- ■ Make new friends.
lies served with information so that they may ■ Maintain old friendships.
make informed choices and decisions.
■ Act appropriately in response to how others
The services and supports are changed as neces- are feeling.
sary to meet the identified needs of the persons
■ Express dissatisfaction when mistreated.
and/or families served and other stakeholders.
Service designs address identified individual, 1.b. Persons served may have limited knowledge
family, socioeconomic, and cultural needs. of community activities. By the organization
Expected results from these services may include: facilitating initial exposure to new and varied
experiences, persons may then identify new
■ Increased or maintained inclusion in mean-
interests and activities for continued
ingful community activities. participation.
■ Increased or maintained ability to perform
The organization works with persons served
activities of daily living. to help them identify opportunities that are
■ Increased self-direction, self-determination, of interest to them.
and self-reliance.
■ Increased self-esteem. 2.F. 2. Individualized service plans identify
community inclusion activities,
as desired by the person served.

Intent Statements
2.F. 4. The organization:
The plan addresses objectives in accordance 4.F. Comm Svcs Principle
with expressed preferences or goals. a. Considers the individual preferences

of those served when selecting direct
Examples care staff.
Identifying opportunities for community inclu-
b. Addresses the input of persons

sion is a joint responsibility that is shared by the served on an ongoing basis.
organization and the persons and families served. 4.b.F. Comm Svcs Principle
Overcoming identified barriers may be beyond Intent Statements

the organization’s service delivery capability The agency and individual workers have the
or scope, but may be addressed by referrals skills and competencies to support participation
to other community agencies, organizations, effectively in this.
and resources. Examples
Persons served have opportunities for parti- This standard does not necessarily involve the
cipation beyond simply attending events. For service recipients in the organization’s hiring
example, in addition to attending church ser- practices, but it does suggest that some selection
vices, persons served may participate in their is possible among available qualified staff. It also
church community by joining a discussion group relates to standards in Section 2.B. with regard to
or helping with projects. plans, planning, and enhancing the self-direction
The organization provides opportunities for per- of services/supports, as well as to Standard 1.A.5.,
sons who are unable to verbalize their desires and referencing cultural competency planning, and
preferences to try out various activities in the Standard 1.K.4., referencing complaint resolution
community and gauges the response to help procedures.
determine the types of inclusion and activities 4.b. The person served could be involved in a
the person enjoys. variety of activities in which they participate in
the selection of direct care staff. Examples
2.F. 3. The organization supports persons include participating in the interviews of new
served to achieve participation in staff members, being introduced to the potential
community activities by developing staff member during a tour of the organization
skills and behaviors that: and being asked their input about the potential
a. Relate to the desired outcome. candidate, asking the person served during
intake about characteristics they would like or
b. Empower the persons served.
3.b.F. Comm Svcs Principle dislike and if they prefer a male or female to be
Examples their direct staff member, or giving the opportu-
3.a. A person might have an objective to increase nity to request a different group home when an
social skills by greeting others appropriately. This opening is available.
could be practiced in different settings and dur-
ing various activities and lead to increased 2.F. 5. When appropriate to services and the
opportunities for inclusion. population served, the program ensures
3.b. Learning to use public transportation may that:
help to empower persons served by increasing a. Personnel are knowledgeable about

their independence. early signs indicating possible
dementia and aging-related decline.

b. When early signs of possible Documentation Examples

dementia or aging-related decline The following are examples of the types of infor-
are identified: mation you should have available to demonstrate
5.b.F. Comm Svcs Principle
(1) Recommendation for further your conformance to the standards in this sub-
evaluation is made to the case section. See Appendix A for more information
manager responsible for the on required documentation.
person’s healthcare. ■ Records of the persons served
5.b.(1)F. Comm Svcs Principle
(2) When diagnosis is confirmed: ■ Progress notes

5.b.(2)F. Comm Svcs Principle
(a) If the scope of the program

can support the person to
■ Orientation information
remain and age in place, the
person-centered planning ■ Self-advocacy training information
process responds to the new ■ Conflict resolution information

needs. ■ Assistive technology and reasonable accom-
5.b.(2)(a)F. Comm Svcs Principle
(b) If the scope of the program modation information, if applicable

cannot support these new
■ Information regarding community resources
needs:
5.b.(2)(b)F. Comm Svcs Principle
utilized
(i) Appropriate transition
■ Procedures manual
planning is initiated.
5.b.(2)(b)(i)F. Comm Svcs Principle
(ii) Transfer of information

occurs to support suc-
cessful transition.
5.b.(2)(b)(ii)F. Comm Svcs Principle
Additional Resources
The CARF publication Using Individual-Centered
Planning for Self-Directed Services, which is avail-
able on request from your resource specialist,
provides an easy-to-understand guide of essential
elements, examples of planning procedures, sam-
ple plans, and a list of additional resources for
individual-centered planning of services based
on the preferences and needs of the persons
served.

Section 2.G. Children and Adolescents Specific Population Designation
G. Children and d. Culture/ethnicity, including

specific needs and preferences.
Adolescents Specific 1.d.G. CYS
1.e.G. CYS
e. School history.
f. Communication functioning,
Population Designation including:
1.f.G. CYS
(1) Speech.
Description 1.f.(1)G. CYS
(2) Hearing.
Children and Adolescents is a specific population 1.f.(2)G. CYS
(3) Language.
designation that can be added at the option of the 1.f.(3)G. CYS
organization to a community service being sur- g. Visual functioning.

1.g.G. CYS
veyed if children or adolescents are served and h. Learning style.

1.h.G. CYS
the organization desires this additional accredita- i. Intellectual functioning.

tion enhancement.
1.i.G. CYS
j. Family relationships.
1.j.G. CYS
Such services are tailored to the particular needs k. Interactions with peers.
and preferences of children and adolescents and 1.k.G. CYS
l. Environmental surroundings.
are provided in a setting that is both relevant to 1.l.G. CYS
m. History of use of alcohol, tobacco,

and comfortable for this population. or other drugs.
NOTE: Legal emancipation generally occurs through 1.m.G. CYS
n. Past exposure to trauma.

marriage, a court order, or specific rules of the 1.n.G. CYS
o. Assistive devices or technology,

Indian Child Welfare Act.
if used.
1.o.G. CYS
p. Coordinated information if dealing

Applicable Standards with multiple systems or other
If an organization chooses to add the Specific current service providers for the
Population Designation for Children and Ado- child/youth.
1.p.G. CYS
lescents to an appropriate service in Section 3, Intent Statements

the standards in this section must be applied Information concerning the individual’s needs,
in addition to the standards identified in the abilities, and health status is gathered and used
Applicable Standards statements in the to develop a personalized service plan, which is
individual services in Section 3. appropriate to the intensity of services provided
and identified in the program’s scope. The intent
2.G. 1. Information is gathered from families is to collect an adequate amount of information
about each child/youth served that to provide appropriate and safe services.
includes, as relevant to the scope of Examples
services provided:
1.G. CYS The organization establishes its protocol for gath-
a. Developmental history, such as ering, assessing, and synthesizing information for
developmental age factors. persons served. The information listed may be
1.a.G. CYS
b. Motor development and functioning. acquired from referral sources, affiliations,

1.b.G. CYS
c. Health history and status, including: associations, etc.

1.c.G. CYS
(1) Medical. 1.c.(5) Determination of the status of the child’s

1.c.(1)G. CYS
(2) Physical. immunization does not require a copy of the

immunization record. Organizations can note,
1.c.(2)G. CYS
(3) Mental.
1.c.(3)G. CYS
(4) Social/emotional. if appropriate to the scope of services provided,

1.c.(4)G. CYS
when children and adolescents are enrolled in
(5) Immunization record.
1.c.(5)G. CYS school settings where verification of immuniza-
(6) Prenatal exposure to alcohol, tion is legally required.
tobacco, or other drugs.
1.c.(6)G. CYS

c. Priorities.
2.G. 2. The methods used for gathering informa- 4.c.G. CYS
tion are appropriate with respect to the d. Expectations.

4.d.G. CYS
child’s or youth’s: e. Activities that might be beneficial.

4.e.G. CYS
2.G. CYS
a. Age. f. Concerns.
4.f.G. CYS
2.a.G. CYS
b. Development. g. Perceived barriers.

4.g.G. CYS
2.b.G. CYS
c. Culture. Intent Statements

2.c.G. CYS
d. Education. The organization obtains information from

2.d.G. CYS
e. Functional limitations, if applicable. the family regarding resources and services

2.e.G. CYS
f. Language/communication skills they want or require.

and abilities. Examples
2.f.G. CYS
Intent Statements Families may provide a wealth of information

The needs of the person served dictate the that drives the design and delivery of services/
methods by which information is gathered. supports. This information will be valuable to
the organization in providing services that satisfy
Examples the needs and desires of the persons and families
Methods and strategies for gathering information served.
are flexible and individualized to be appropriate
to the person served. The organization may 2.G. 5. Program staff identify with the family:
make use of input from select family members, 5.G. CYS
a. Family values to be considered in

authorities, and educational resources for the
services.
individual’s planning process. 5.a.G. CYS
b. The amount of involvement that the

family desires on an ongoing basis.
2.G. 3. Information gathered is shared with 5.b.G. CYS
families in understandable terms so Examples

they can make informed decisions. 5.b. Family desires regarding control/input may
3.G. CYS
Intent Statements
include identifying a primary decision-maker
or a specific contact person, if appropriate.
Families have the authority and are supported to
direct and manage their own services/supports
to the extent of their wishes. Information and 2.G. 6. Areas considered in identifying needs of
support are available to help families make each child/youth served, as relevant to
informed decisions. the scope of services provided, include:
6.G. CYS
a. Healthcare.
Examples 6.a.G. CYS
b. Nutrition.
In some instances, families may not have the 6.b.G. CYS
experience or sophistication necessary to make c. Physical activity.

6.c.G. CYS
informed decisions. In all cases, the organization d. Safety.

6.d.G. CYS
is a supportive partner in helping the families e. Education.

6.e.G. CYS
served to choose wisely. Families served are satis- f. Emotional/behavioral.

fied that the overall service design meets their 6.f.G. CYS
g. Mobility and functional

identified needs. Related areas may include input, independence.
accessibility, and performance management. 6.g.G. CYS
h. Child development.
6.h.G. CYS
i. Social and leisure.

2.G. 4. The program works with family members 6.i.G. CYS
j. Others, as identified.
to identify the following regarding the 6.j.G. CYS
development of their child or youth: Intent Statements

4.G. CYS
a. Strengths. Methods are established to identify and

4.a.G. CYS
b. Resources. respond to the individual’s needs.

4.b.G. CYS

Examples achieve results and personal outcomes

The organization may not provide services to satisfaction.
address all needs, but identified needs may be 7.a. Based on identified needs of the child or
addressed in planning and by referrals to other youth served, services may include the develop-
organizations. Also refer to Standards 2.B.1.–7. ment of skills for independence, social skills,
for additional planning guidelines. and social supports.
2.G. 7. As appropriate to the scope of services, 2.G. 8. Educational opportunities are available
individualized services are provided for the family to learn about:
based on: 8.G. CYS
a. Child development.
7.G. CYS
a. The identified needs of the child/ 8.a.G. CYS
b. Aspects of disability, as appropriate.

youth served. 8.b.G. CYS
c. Futures planning.
7.a.G. CYS
b. The desired outcomes of the family. 8.c.G. CYS
d. Community resources, including

7.b.G. CYS
c. Information gathered. availability of support groups.

7.c.G. CYS
d. Results from and responses to 8.d.G. CYS
e. Parenting skills.
previous services and supports, 8.e.G. CYS
if applicable. Intent Statements

7.d.G. CYS
Educational opportunities may be provided by

Intent Statements
the organization or made available to the family
Persons served are supported to direct and man- through appropriate referrals.
age services to achieve their outcomes. Programs
are developed based on the needs/desires of
the child/youth served and their family.
2.G. 9. Service personnel receive training that
covers, as appropriate to the scope of
Examples services:
9.G. CYS
The focus of the services is on the families, and a. Child growth and development.
the effectiveness of the services will ultimately 9.a.G. CYS
b. Behavior support skills.

be measured by how well the families use the 9.b.G. CYS
c. Learning styles.
resources of the organization and their commu- 9.c.G. CYS
d. Social and emotional needs.

nities. Their input into the service design is vital. 9.d.G. CYS
See also the standards in Section 2.B. relating to e. The effects of separation and
individual planning. placement on children.
9.e.G. CYS
Services may support development of mobility f. Health and nutrition.

9.f.G. CYS
and functional skills, communication skills, g. Applicable legal issues.

9.g.G. CYS
adaptive/self-care, and community living skills. h. Methods of communication.

9.h.G. CYS
Based on age and individual preferences and i. Crisis situations.

needs, services to support skill development may 9.i.G. CYS
j. Family support practices.

be identified in areas such as early childhood 9.j.G. CYS
k. Other specific needs.

development, family activities, physical activities, 9.k.G. CYS
social and recreational activities, school activi- Intent Statements

ties, vocational or work-related activities, and In order to achieve more successful outcomes in
independent living. services, service personnel are knowledgeable
The organization regularly looks at the needs of about a range of factors that may impact the
the child/youth served and provides services scope of services provided.
based on those needs. Services may change from Examples
time to time based on trends of those served and 9.a. Includes readiness to learn, brain develop-
their needs. Utilizing the data and demographics ment, and cognitive development.
from an organization’s performance management
system, the services are designed and delivered to

9.b. Includes dealing with aggressive or Examples

violent behaviors. Such arrangements could include:
9.d. Includes identifying and reporting ■ Use of a facility-based school.
child maltreatment. ■ Use of a private school at the organization.
9.h. May include sign language and assistive ■ Use of on-site educators from a local school
communication technology. system.
9.k. Additional needs could include issues ■ Coordination with home school services.
around attachment theory or specific issues
■ Coordination and monitoring of assignments.
to the child served such as medical or physical
needs or the use of assistive technology. ■ Coordination with the community school to
facilitate reintegration.
2.G. 10. If providing early intervention services,
the program provides guidance and/or 2.G. 12. Based on the needs and age of each
information to families to support their child/youth served, or as required by law,
child’s acquisition of: an educational professional or transition
10.G. CYS
a. Motor skills development. specialist is a member of the planning

10.a.G. CYS
team.
b. Physical health and development. 12.G. CYS
10.b.G. CYS
c. Physical fitness. Intent Statements

When applicable, the educational specialist
10.c.G. CYS
d. Social development.
10.d.G. CYS
e. Intellectual/cognitive development. assists in planning, implementing, and evaluating

10.e.G. CYS educational activities for the child or youth.
f. Speech and language development.
10.f.G. CYS
g. Creativity. Examples
10.g.G. CYS
h. Emotional development. The educational specialist or transition specialist

10.h.G. CYS
i. Safety. can be available when needed and is not required

10.i.G. CYS
to attend all planning team meetings.
j. Self care.
10.j.G. CYS
k. Identity development.
10.k.G. CYS 2.G. 13. If educational services are provided,
l. Proper nutrition and growth. they:
10.l.G. CYS
m. Independence and self- 13.G. CYS
a. Are appropriate to the child/youth

determination. served.
10.m.G. CYS
13.a.G. CYS
Intent Statements b. Meet applicable legal requirements.

13.b.G. CYS
When the organization is providing early inter-

Intent Statements
vention services, it is important that it provide
as much training as possible to parents as early Educational services should be individualized
as possible. This training should help parents and appropriate to the needs of each child
to further support development of their child. and youth served.
Examples
2.G. 11. When the services disrupt the child’s or Educational services may include provisions for
youth’s day-to-day educational environ- evaluation, group instruction, and/or individual
ment, the service provides or makes instruction, as appropriate.
arrangements for the continuity of There are a number of related standard areas that
his or her education. can provide direction in meeting this standard.
11.G. CYS
Intent Statements They include individualized planning, legal

Education services are provided without requirements, and analysis of data from an
undue disruption. organization’s outcomes system. By knowing
the needs of its customers and stakeholders,

services can be redesigned and the organization

strategically positioned to meet their needs.
2.G. 16. When a child/youth served moves to a
school or other community service, tran-
sition planning/information is provided
2.G. 14. If services are provided outside the in a timely manner:
home, the service environment is config- 16.G. CYS
a. To the family.
ured appropriately to meet the needs 16.a.G. CYS
of the child/youth served, including: b. To the new service provider, with

14.G. CYS
consent of the child/family.
a. The physical site. 16.b.G. CYS
Intent Statements
14.a.G. CYS
b. The furniture.
14.b.G. CYS
c. Any equipment used in services. Information and support are available to help
14.c.G. CYS
a person served and his or her family to make
d. Environmental factors.
14.d.G. CYS informed decisions and smooth transitions.
e. Assistive technology, if utilized.
14.e.G. CYS
Examples
Intent Statements
With a continued focus on the family and its role
The environment or setting is configured in a
in the child’s life, information about new services,
manner that is consistent with identified needs
alternative settings and strategies, etc., is
and capabilities of the persons served.
provided for the family’s use to assist in such
Examples transitions and to help give service continuity.
Considerations include the provision of:
■ Appropriately sized furniture. 2.G. 17. The organization conducts criminal
■ Recreational equipment.
background checks on all personnel
providing direct services to children
■ Age-appropriate reading materials and videos.
or youths.
17.G. CYS
Intent Statements
2.G. 15. The organization does not exclude chil-
dren or youths from services solely on Direct service personnel are appropriately
the basis of their juvenile justice status. screened before being allowed to provide ser-
15.G. CYS
vices. The provision of direct services includes
Intent Statements transportation.
Although specific behaviors may be identified by
a program as exclusionary admission criteria, chil-  In Canada, depending on provincial/territorial/
tribal requirements, a criminal record check and
dren or youths cannot be excluded from services a child welfare information system check would
solely because they are involved in the juvenile be required to meet this standard.
justice system. Individuals who need services but
are not eligible are linked to other resources. Examples
Background checks may include fingerprinting,
Examples
FBI criminal history checks, child abuse and
Children and youths cannot be excluded from neglect registry, sex offender registries, or other
services solely because they are involved in the appropriate methods available.
juvenile justice system, however, some of the
rights standards in Section 1.K. Rights of Persons Resources
Served may not be applicable. The Dru Sjodin National Sex Offender Public
Website (www.nsopw.gov), coordinated by the
U.S. Department of Justice, is a cooperative effort
between jurisdictions hosting public sex offender
registries (“Jurisdictions”) and the federal gov-
ernment and is offered free of charge to the
public. These Jurisdictions include the 50 states,
U.S. Territories, the District of Columbia, and

participating tribes. The website provides an quarters apart from adults and members of the
advanced search tool that allows a user to submit opposite sex. When family services are provided,
a single national query to obtain information the same sleeping areas may be appropriate. The
about sex offenders; a listing of public registry program considers social, emotional, develop-
websites by state, territory, and tribe; and mental, and cultural needs and actively addresses
information on sexual abuse education and the need to designate space for privacy.
prevention. The criteria for searching are limited Examples
to what each individual Jurisdiction may provide. 19.c. Other considerations may include a child
Also, because information is hosted by each
who sleep walks or has night terrors.
Jurisdiction and not by the federal government,
search results should be verified by the user in
the Jurisdiction where the information is posted. 2.G. 20. If residential services are provided, the
Users are advised to visit the corresponding in-home safety needs of the child/youth
Jurisdiction websites for further information served are addressed with respect to:
20.G. CYS
and/or guidance, as appropriate. a. Environmental risks.

20.a.G. CYS
b. Abuse and/or neglect inflicted by

2.G. 18. The program assists family members self or others.
20.b.G. CYS
to optimize resources and opportunities c. Self-protection skills.

20.c.G. CYS
as desired through: d. Medication management.

18.G. CYS 20.d.G. CYS
a. Community linkages.
18.a.G. CYS
b. Enhanced social support networks.

18.b.G. CYS
18.c.G. CYS
c. Outreach to encourage involvement. 2.G. 21. If residential services are provided, the
Intent Statements
organization provides opportunities for
visits, when appropriate and in compli-
ance with applicable laws and court
community and provides resource materials
orders, with:
to parents. 21.G. CYS
a. Family members and significant

Examples others.
18.b. Social support networks may include parent
21.a.G. CYS
b. Peers.
mentoring or support groups. 21.b.G. CYS
Applicable Standards Documentation Examples

Standards 19.–21. apply only if the service The following are examples of the types of infor-
provided is Community Housing, Supported mation you should have available to demonstrate
Living, Foster Family Services, or Host Family/ your conformance to the standards in this sub-
Shared Living Services. section. See Appendix A for more information
■ Records of the children and youths served
2.G. 19. If residential services are provided, there
are separate areas for beds for children/ ■ Individual service plans
youths served according to their: ■ Progress notes

19.G. CYS
a. Age. ■ Information provided to the families about

19.a.G. CYS
b. Gender. new services

19.b.G. CYS
c. Needs. ■ Procedures manual

19.c.G. CYS
Intent Statements
Because of the unique needs of children in resi-
dential settings, the program provides sleeping

Section 2.H. Older Adults and Older Adults/Dementia Care Specific Population Designations
H. Older Adults and Older longer and more productive lives. This extended
life expectancy also means that some of these
Adults/Dementia Care individuals experience an increased risk for
Alzheimer’s disease and related dementias
Specific Population (ADRD) as they age. ADRD are debilitating con-
ditions that impair memory, thought processes,
Designations and functioning, primarily among middle-aged
and older adults. The effects of these conditions
Description can be devastating for individuals with ADRD
Older adults (OA) is a specific population and their loved ones.
designation that can be added at the option of The National Task Group on Intellectual Disabili-
the organization to a service being surveyed if ties and Dementia Practices (NTG) cites research
specialized services are being provided to older confirming that, although dementia as experi-
adults with long-term disabilities, often diag- enced by adults with ID/DD “is generally similar
nosed in childhood, who are served to allow to that as experienced by other persons, there
them to remain in their own homes, day services, are exceptions. Some individuals with select con-
and communities of choice as long as possible ditions (Down syndrome, in particular) are more
and to promote aging in place. When appropriate at risk for dementia, experience earlier age of
to services being provided, the organization may onset, more rapid decline, and a briefer duration
choose to add this additional accreditation between diagnosis and death.”
enhancement. Persons served in this program
Services for OA/DC implement practices when
have typically been service/support recipients
appropriate to the persons served to promote
for most of their lifetime.
quality of care for individuals with ID/DD and
Services for older adults with disabilities and/or dementia. Services are provided based on current
their families may offer an array of options to assessments of the individual and person-
meet their social, vocational, residential/housing, centered care planning that considers the stage
psychological, recreational, cultural, legal, health, of the condition or cognitive decline and antici-
and physical needs with a specific focus on the pated needs. Information is provided to families/
impact of aging. Eligibility for services is defined caregivers about dementia and its progression.
in terms of each person’s functional needs, pref- Direct-care personnel are educated on dementia-
erences, and characteristics rather than specific care, and a personnel support system is
chronological age. available to reduce worker stress and manage
Options and choices are provided for the creation grief.
of individually tailored services that support Program and support options may be provided in
healthy aging, compensate to the extent possible various settings, including adult day services and
for any aging-related decline, educate on end-of- programs or services for persons who are living
life issues, and enable the persons served to in private homes with a caregiver, alone or with a
function as independently as possible for as long housemate, in a group residence, or a specialized
as possible. dementia-capable residence. Environments sup-
Older adults/dementia care (OA/DC) is a specific port the rights of persons served and promote
population designation that can be added at the their safety and security.
option of the organization to a service being sur- Some examples of the quality results desired by
veyed if specialized services are being provided the different stakeholders of these services
to older adults with long-term disabilities who include:
have the additional support requirements due
■ Safety and security.
to Alzheimer’s disease and related dementias
(ADRD). With advances in medicine and assis- ■ Slowing or mitigating of declines associated
tive technology, persons with intellectual or with normal aging.

developmental disabilities (ID/DD) are living

■ Ongoing assessment of individual’s

functioning.
2.H. 1. Persons served and/or their families
receive an array of individually tailored
■ Maintenance of self-care skills. services based on their individual needs
■ Health and wellness promoted. that include direct provision of or referral
■ Medical advocacy. for:
1.H. Older Adults
■ Physical health promoted. a. Supports to maintain community

involvement as desired.
■ Positive mental health status. 1.a.H. Older Adults
b. Advocacy for healthcare and

■ “Aging in place.”
increased support needs of the
■ Social functioning. persons served, including with
■ Active community involvement. funding resources.
1.b.H. Older Adults
■ Social inclusion. c. Coordination that provides the

■ Interpersonal relationships. persons served with access to
needed services.
■ Happiness and maintaining quality of life. 1.c.H. Older Adults
d. Advocacy to meet medical and

■ Retirement. psychological needs.
■ Mediating issues between family choice 1.d.H. Older Adults
e. Promoting continuity of care

and person-served choice. between different environments/
■ Group activities of choice. programs that are involved with
■ Grief counseling. the person.
1.e.H. Older Adults
■ Support with end-of-life issues. f. Support for caregivers, including

those who may themselves have
■ Education of persons served, families, and
special needs related to aging.
staff about options for end-of-life supports. 1.f.H. Older Adults
g. Education about end-of-life support

■ Transition planning.
services.
■ Preparation for hospice. 1.g.H. Older Adults
h. Supports to deal with grief and loss.

■ Access to palliative care. 1.h.H. Older Adults
Intent Statements
The organization ensures that the needs identi-
Applicable Standards fied are met either by providing the necessary
If an organization chooses to add the Specific services/supports or by arranging for linkages
Population Designation for Older Adults to an with an array of community services.
appropriate service or services in Section 3, Examples
Standards 1.–11. in this section must be applied 1.a. Persons served receive supports that allow
in addition to the applicable standards for the them to continue participation in valued life
individual services in Section 3. activities.
If the persons served by the program include Supports are individualized to ensure the pro-
any persons with Alzheimer’s disease or other gram is tailored to the individual rather than
forms of dementia, Standards 12.–17. in this persons served having to conform to a ready-
section must also be applied, which adds the made program.
Specific Population Designation for Older
Adults/Dementia Care to the program. The program collaborates with various agencies
in the community, providing education to staff
and support for persons served where needed.
1.c. Examples may include access to palliative
care or to behavioral health services that promote
optimal functioning across settings.

1.e. The program ensures that all involved receive Examples

the information needed to make informed deci- 3.a.(5) This would include areas such as leisure
sions regarding the individual’s care. and community participation, e.g., attending
1.g. The program provides support for the per- groups, clubs, church/spiritual activities.
sons served and families/caregivers. Education
about death, burial insurance, and life support 2.H. 4. The program provides activities that
systems are important parts of the individual’s promote wellness of persons served.
person-centered plan. 4.H. Older Adults
Intent Statements
Activities are individualized to the person served.
2.H. 2. As requested by persons served and/or Wellness includes maintenance of physical, men-
caregivers, the program provides assis-
tal, cognitive, and social well-being.
tance or information about resources
available to assist them in making: Examples
2.H. Older Adults
a. Legal decisions. The program provides a diverse range of activi-

2.a.H. Older Adults
b. Financial decisions. ties that meet the needs and interests of the
2.b.H. Older Adults
c. Residential decisions. persons served. Activities are designed to support

2.c.H. Older Adults persons served in improving or maintaining
d. Healthcare decisions.
2.d.H. Older Adults
their physical conditioning and capabilities,
e. Mental health related decisions. nutritional balance, mental health, hygiene, and
2.e.H. Older Adults
f. Other decisions. self-care. It could also include providing persons

2.f.H. Older Adults
Intent Statements and their families with information to promote

healthy aging, e.g. diet and nutrition guidelines,
This may include referrals to appropriate profes-
medications, exercise suggestions.
sionals for advice as needed.
Examples
2.H. 5. The service personnel are trained in:
2.f. May include decisions related to the individ- 5.H. Older Adults
a. The normal aging process.

ual’s care, end-of-life choices, hospice options, 5.a.H. Older Adults
b. Understanding the impact of age-

financial planning, and supports for family
related changes on the functioning
members to deal with guilt and decision-
of individuals with certain types of
making related to placing a loved one into care.
disabilities.
5.b.H. Older Adults
c. Recognizing changes that may be

2.H. 3. Personnel document periodic screen- early signs of Alzheimer’s disease
ings, observation, or review of each and other forms of dementia.
person served to identify: 5.c.H. Older Adults
3.H. Older Adults d. Signs of sensory impairment.

a. Functional changes in: 5.d.H. Older Adults
3.a.H. Older Adults e. Monitoring function.

(1) Activities of daily living. 5.e.H. Older Adults
3.a.(1)H. Older Adults
(2) Mobility. Intent Statements

(3) Cognition. The service personnel receive ongoing special-

ized training regarding the aging process, as well
(4) Communication and interaction
as information specific to aging in persons with
skills.
intellectual and developmental disabilities.
(5) Community participation.
Examples
b. Changes in behavior.
3.b.H. Older Adults
The organization provides or arranges for access
Intent Statements to relevant training based on the assessed needs
Assessment of changes indicates the need for of the service personnel and the ongoing needs of
revision of individual plans of persons served. the persons and families served. This standard is
linked to other standards in Section 1.I. as they

relate to job qualifications, experience, training,

and evaluation.
2.H. 8. The program demonstrates comprehen-
sive knowledge of and the ability to
5.a. Training includes information on typical identify and provide, or make arrange-
cognitive and physical changes that may occur ments with external resources to
as persons age. provide, care options and settings that
5.c. Service personnel are trained to recognize meet the needs of the persons served.
early indications of possible Alzheimer’s disease 8.H. Older Adults
Intent Statements
or other forms of dementia as well as other
underlying conditions that may have similar The organization demonstrates collaboration
symptoms and may be treatable. with other direct service providers, community
organizations, advocacy groups, governmental
entities, etc., to ensure that persons served and
2.H. 6. Services for persons served are provided their families have information about and access
under the supervision of a staff member to all services and funding sources available to
who has specific knowledge of and train- address their needs.
ing in aging with intellectual and
developmental disabilities.
6.H. Older Adults 2.H. 9. The organization promotes community
Intent Statements awareness of its specialized program
To ensure that the services address the wide for older adults as a resource for other
range of needs of older adults with disabilities agencies and professionals.
9.H. Older Adults
and their families, the supervisor has the qualifi-

Intent Statements
cations of a designated aging specialist or
equivalent specific knowledge and experience. The organization assists interested individuals
and organizations in accessing needed
Examples information.
An aging specialist is a qualified professional who Examples
possesses a knowledge and understanding of age-
This assistance may be achieved through the
related physical and psychological changes in
program’s publications and website, the activities
people with disabilities and possesses the skills to
of its staff and board members, and participation
work with older families in establishing future
in the community.
plans and promoting the autonomy of the person
served. Such a specialist would have knowledge Community libraries and website links can be
of community resources that provide support as educational tools to promote awareness.
well.
2.H. 10. Consistent with the scope of the pro-
2.H. 7. The program provides transition gram, end-of-life planning:
10.H. Older Adults
planning and supports for: a. Is directed by the wishes/desires of

7.H. Older Adults
a. Persons served as roles and the person served, power of attorney,

functioning change. and/or guardian.
10.a.H. Older Adults
b. Includes advocacy of hospice, pallia-

7.a.H. Older Adults
b. Families/caregivers providing
care to persons served. tive care, or other end-of-life choices.
10.b.H. Older Adults
7.b.H. Older Adults
c. Includes spiritual or religious ele-

Intent Statements
ments, if desired by the person
Transition planning would include changes in served.
residential situations, when these are anticipated 10.c.H. Older Adults
d. Includes the guidance of a medical

due to changes in functioning.
professional, if desired by the person
served.
10.d.H. Older Adults

e. Is submitted in the required format as

per specific jurisdiction to:
2.H. 11. When a person served dies, opportuni-
10.e.H. Older Adults ties are provided as needs are identified
(1) The primary healthcare provider. for peers, other persons in the program,
10.e.(1)H. Older Adults
(2) The hospital, if applicable. family/caregivers, and staff members to:

10.e.(2)H. Older Adults
f. Is shared with significant others, as 11.H. Older Adults
a. Express grief and remembrance.

determined by the person served. 11.a.H. Older Adults
b. Develop and participate in:

10.f.H. Older Adults
11.b.H. Older Adults
Intent Statements (1) Memorial service, if desired.

11.b.(1)H. Older Adults
Persons served, families/support systems, and (2) Memorial rituals and other forms
personnel have opportunities to talk about end- of grief expression, as desired.
of-life issues and the persons served are engaged 11.b.(2)H. Older Adults
in identifying their wishes. Intent Statements

Persons served, families/support systems, and
Examples personnel have opportunities to talk about
Numerous areas are considered in end-of-life end-of-life issues and participate in creating end-
planning, including medical and healthcare of-life protocols to assist in dealing with the loss.
issues, legal issues, financial and estate planning,
Examples
referral to resources for assistance in resolution
of family conflicts, spirituality, and family There may be the opportunity provided for
supports. others to remember the value and contributions
that the person served brought to others’ lives.
Advance directives may relate to organ donation
and orders not to resuscitate (DNR). Consider-
ations may include religion, legal parameters, Applicable Standards
how orders should be documented, and who is
Standards 12.–17. are applied if the persons
responsible for making a DNR decision.
served by the program include any persons
DNR orders are known and strictly adhered to. with Alzheimer’s disease or other forms of
Efforts are made to clarify issues related to an dementia.
individual’s end-of-life wishes to avoid any mis-
understanding on the part of personnel and/or
family/support systems.
2.H. 12. Assessments of the persons served are
conducted by qualified service personnel
10.b. Palliative care is the active total care of the or through referral and are documented:
person’s body, mind, and spirit, and also involves 12.H. Older Adults
a. Within 30 days of the initiation of

support for the family.
services.
Persons served and their families/support sys- 12.a.H. Older Adults
b. Ongoing at a frequency that is consis-

tems receive information about palliative care tent with the needs of the persons
options, including hospice. The program dem- served as determined by the service
onstrates an understanding of personal choice team.
and supports these choices. 12.b.H. Older Adults
c. In response to changes in care needs.

12.c.H. Older Adults
Resources d. In response to changes reported by

Resources and information to help people the family/caregiver.
with disabilities and others deal with serious
Intent Statements
health and/or end of life issues is available at
www.qualitymall.org in the Grief, Loss, and Assessments may be conducted by qualified
End-of-Life department (www.qualitymall.org/ service personnel or arranged through referral.
directory/dept1.asp?deptid=87).

Examples d. The choices and behaviors of the

For persons served who are exhibiting signs of person served that pose a risk to his
Alzheimer’s disease or other forms of dementia: or her health or safety or to the health
■ Initial and ongoing screenings/assessments
and safety of others.
identify: e. Identification of the preferences of

the person served for involvement
– Prior daily routines. of members of the family/support
– The preferences of the persons served. system.
13.e.H. Older Adults
– The choices of the persons served. f. The changing lifespan issues of

– The personal goals of the persons served. the person served.
13.f.H. Older Adults
■ May address the following areas: Intent Statements

– Behavior. This standard applies in conjunction with
– Cognition. Standard 2.B.5.
– Communication. Examples
– Dental. 13.b.(4) If residential services are provided,
there are many safety considerations that have
– Function.
added significance for older adults and older
– Health. adults affected by dementia.
– Medications.
– Nutrition. 2.H. 14. Person-centered care planning
– Pain management. considers:
14.H. Older Adults
– Physical. a. Stage of disease progression.

– Psychological. b. Anticipated needs of the person

served.
– Recreation and leisure. 14.b.H. Older Adults
c. End-of-life decisions and plans.

– Social. 14.c.H. Older Adults
– Spiritual. Intent Statements
– Others, as appropriate to the needs Person-centered care planning includes the

person served, family members, caregivers,
of the persons served.
and significant others as identified by the
person served.
2.H. 13. Based on current assessments, service
plans are implemented for the persons
2.H. 15. In response to evolving needs as persons
served that address:
13.H. Older Adults transition through stages, the program
a. Identified service needs to support revises plans and supports to address:
quality of life. 15.H. Older Adults
13.a.H. Older Adults a. Changes in:

b. Necessary: 15.a.H. Older Adults
13.b.H. Older Adults (1) Functional abilities.

(1) Interventions. 15.a.(1)H. Older Adults
13.b.(1)H. Older Adults (2) Cognitive abilities.

(2) Approaches. 15.a.(2)H. Older Adults
13.b.(2)H. Older Adults (3) Physical abilities.

(3) Supports. 15.a.(3)H. Older Adults
13.b.(3)H. Older Adults (4) Medical conditions.

(4) Environmental modifications. 15.a.(4)H. Older Adults
13.b.(4)H. Older Adults b. Support personnel’s needs.

c. The choices and behaviors of the per- 15.b.H. Older Adults
c. Families’/caregivers’ needs.
son served that relate to past history, 15.c.H. Older Adults
routines, and preferred activities Intent Statements

from earlier in life. The program supports the individuals in living
out their life as they wish or did wish and provides

them with quality and individualized supports manage behaviors can help to maintain the
and services as needs change. quality of services, ensure safety, and increase
Examples
job satisfaction.
As the cognitive incapacity of the person served 16.c. Personnel are trained to understand other
progresses, the program must rely on what the means persons may use to communicate likes
person expressed at an earlier point as his or her and dislikes, including body language.
wishes. 16.d. Personnel are also trained to modify their
communications to better meet the needs of
2.H. 16. Initially and annually, education is individuals.
provided for all service personnel on
dementia-specific topics, including: 2.H. 17. Information regarding the expected
16.H. Older Adults
a. Co-occurring conditions. progression of dementia and the impact

on the individual is available to families/
b. Stages of disease progression and
process. caregivers/support systems of the per-
16.b.H. Older Adults sons served.
c. Understanding the varying methods 17.H. Older Adults
of communication used by persons Intent Statements

served. Caregivers/support systems include persons who
d. Effective communication strategies. are not service personnel of the program.

e. Understanding dementia behaviors Examples

and how to relate and adapt to the Support systems may include respite providers
individual. and personal care providers.
16.e.H. Older Adults
Examples
16.b. One of the most difficult aspects of caring Additional Resources
for an individual with Alzheimer’s disease (or ■ Guidelines for Structuring Community Care
other forms of dementia) is dealing with the and Supports for People with Intellectual
behavioral and psychological symptoms. These Disabilities Affected by Dementia, developed
behaviors are often difficult for the caregiver to by The National Task Group on Intellectual
accept and may be upsetting. When such behav- Disabilities and Dementia Practices
iors occur (and may be perceived as dangerous, (http://aadmd.org/sites/default/files/NTG-
disruptive, or troubling), the response is usually communitycareguidelines-Final.pdf).
to try to get the individual to change the behav- ■ The National Task Group on Intellectual Dis-
ior. However, with dementia, it is often not abilities and Dementia Practices consensus
possible for persons to voluntarily change their recommendations for the evaluation and
behavior, as it is a result of the brain disease. The management of dementia in adults with intel-
behaviors can only be influenced by various lectual disabilities, available at
approaches, including how the individual is www.aadmd.org/ntg.
approached, by diversion, and by manipulating ■ California Department of Developmental Ser-
the environment. The service provider must vices: Thinking ahead: my way, my choice, my
accept the inevitable changes brought on by the life at the end. (www.dds.ca.gov/Consumer-
disease and adapt their style of directing and Corner/ThinkingAhead.cfm). This easy-to-
interacting with the person. When disruptive use workbook and companion videos
behaviors are present, it is useful to prevent or assist people in making decisions about the
manage them so that they are minimized. Man- end of their life.
aging such behaviors requires finding the cause,
■ Getting on with Cancer. (Donaghy, V., Bernal,
working around the behaviors, and acting in a
J., Tuffrey-Wijne, I., & Hollins, S. London:
way that maintains the individual’s dignity.
Books Beyond Words. 2002) Tells the story
Appropriate training to guide staff in how to
of a woman with Down Syndrome who has

cancer; designed to be used as a counselling Documentation Examples

tool by anyone working with people who have The following are examples of the types of infor-
both intellectual disabilities and cancer. mation you should have available to demonstrate
■ People planning ahead: A guide to communi- your conformance to the standards in this sub-
cating heath care and end-of-life wishes. section. See Appendix A for more information
Washington, DC: American Association on on required documentation.
Intellectual and Developmental Disabilities. ■ Records of the persons served
(aaidd.org/home)
■ Advance health care directives: An informa-
■ Progress notes
tional booklet on health care decisions for
■ Staff training information
individuals who have developmental disabili-
ties, their families, services providers and ■ Outreach and promotional materials
advocates on health care decisions. NYSARC, ■ Qualifications of supervisors

Inc. Delmar, N.Y. ■ Information regarding collaboration and par-
(www.nysarc.org/files/9713/2033/8415/ ticipation with other community providers
singlepage_Advance_Directives_no_act_no
■ Procedures manual, including policies and
w.pdf)
procedures related to aging in place, referral
■ When I die. Sunderland People First. out, transitions (e.g., moving locations),
(easyhealth.org.uk/sites/default/files/ monitoring change over time, and electronic
when_i_die_2_0.pdf) An example of a monitoring if used
person-centred approach to end-of-life
■ Assessments of persons served
planning for persons with intellectual or
developmental disabilities.

Section 2.I. Medically Fragile Specific Population Designation
I. Medically Fragile Some examples of the quality results desired

by the different stakeholders of these services
Specific Population include:
■ Development of an efficient and effective
Designation network of community support services
including access to therapies, medical sup-
Description ports, and guidance.
Medically Fragile is a specific population ■ Achievement of personal development in
designation that can be added at the option of health, education, and activities of daily
the organization to a service being surveyed if living.
it specializes in serving persons with a serious
■ Being able to choose and pursue meaningful
ongoing illness or a chronic health condition that
activities in the least restrictive environment
requires daily monitoring and ongoing medical
possible to achieve personal satisfaction in life
treatments and may include the routine use of a
activities.
medical device or assistive technology. Persons
■ Maintenance of health and well being.
with such needs require overall care planning to
achieve optimum health and developmental sta- ■ Restored or improved functioning.
tus and to achieve community integration to the ■ Enhanced quality of life.

maximum extent possible. Services augment and ■ Educational achievements.
support independence, empowerment, and dig-
■ Personal and family development.
nity of persons served through the provision of
flexible and efficient services. ■ Supported transitions between levels of care
A program specializing in serving persons with as needed.

medically specific needs assists the persons ■ End-of-life supports and care.
served in achieving or maintaining an optimal ■ Meaningful closures to end-of-life services

state of health through developmentally appro- and supports for the persons served and
priate care to have an enhanced quality of life others.
throughout their life span. This may include
achieving optimal functionality according to
their physical capacities. Applicable Standards
Service design is based on the needs, desires, If an organization chooses to add the Popula-
and expectations of the person served and tion Designation for Medically Fragile to an
includes consideration of age, medical acuity, appropriate service in Section 3, it must meet
medical stability, impairments, activity limita- standards 1.–19. in this section in addition to
tions, participation restrictions, psychological the standards identified in the Applicable Stan-
status, behavioral status, cultural diversity, dards statement for that service in Section 3 or
family/caregivers, and long-term outcomes on the grid beginning on page 126.
expectations. Appropriate medical consultation If the services are provided in a residential
occurs specific to each person served in addition setting, Standards 20.–24. in this section are
to medical consultation related to policies and also applied.
procedures. If the program specializes in serving children/
The services support transitions in a person’s life adolescents, the standards in Section 2.G.
and are changed as necessary to meet the identi- Children and Adolescents Specific Population
fied needs and desires of the persons served and Designation also must be applied.
their families/caregivers.

documents such as a program plan or marketing

2.I. 1. The program plan that guides the deliv- materials. An emphasis might be placed on maxi-
ery of the services includes:
1.Medically Fragile
mizing or maintaining independence of persons
a. A description of the program served, achieving community integration to the
including: maximum extent possible, and how changing
1.a.Medically Fragile
(1) The philosophy or mission state- acuity needs will be addressed.

ment of the program. 1.c. There are procedures in place that address
1.a.(1)Medically Fragile
(2) Program scope and goals. emergency medical needs and may include
b. Assurance that adequate resources behavioral crisis intervention procedures if

are available to deliver the services. applicable.
1.b.Medically Fragile
c. Procedures for providing or arrang-

ing for crisis intervention services. 2.I. 2. Services are managed by an individual
1.c.Medically Fragile
d. Procedures for coordinating and who has:

communicating with internal and
2.Medically Fragile
a. The education, training, and experi-

external service providers. ence needed to meet the needs of
1.d.Medically Fragile
e. A process for developing program persons with medically complex

policies and procedures that: needs.
1.e.Medically Fragile 2.a.Medically Fragile
(1) Identifies the medical and b. The competencies needed to manage

healthcare competencies the services.
required by program staff.
1.e.(1)Medically Fragile
Intent Statements
(2) Includes consultation with
The program identifies the background and com-
other medical and healthcare
petencies required based on the scope of services
professionals as needed. provided.
1.e.(2)Medically Fragile
f. A process for the plan to be regularly

reviewed and modified as needed. Examples
1.f.Medically Fragile
Based on the services provided, the individual’s

Intent Statements
education, training, and experience may be in
The program clearly defines, in writing, how ser- areas such as healthcare or nursing, health advo-
vice delivery is accomplished and demonstrates cacy, health aspects of developmental disability,
that it has the knowledge, facilities, space, materi- health problems commonly co-occurring with
als, partnerships, and staffing to provide the developmental disability, aging and elder care,
proper amount of care for the appropriate length
palliative care, or medication management.
of time based on the needs of the persons served.
Job descriptions identify qualifications needed
Examples and ensure compliance with applicable guidelines
The plan may be described in policy and proce- and legal requirements. Local, state/provincial/
dure manuals, a program handbook, brochures, territorial, or federal laws and national/
or other documentation. It may vary in length, professional organizations may be excellent
depending on the size of the organization and the resources for establishing qualifications.
complexity of services provided. The description
includes information such as the populations and 2.I. 3. Initial assessments of each person served
age groups served, relevant characteristics of the gather information as appropriate,
populations, schedule of operations, after hours’ including his or her:
contacts, and admission/transition criteria. 3.Medically Fragile
a. Developmental history, such as

This standard relates to Standard 2.A.1., which developmental age factors.
identifies additional parameters that the program 3.a.Medically Fragile
b. Motor development and functioning.

should document regarding its scope of services. 3.b.Medically Fragile
1.a.(1) The program’s philosophy may be

documented separately or included in other

c. Health history and status, including: 3.d. Cultural needs and preferences may include
areas such as religious background and practices,
(1) Medical.
3.c.(1)Medically Fragile
(2) Physical. dietary needs and preferences, and diversity.

(3) Mental. 3.n. Other relevant information may include

(4) Social/emotional. environmental needs and preferences, employ-

3.c.(4)Medically Fragile ment history, close personal relationships that are
d. Culture/ethnicity, including specific
important to the person, and personal interests
needs and preferences.
3.d.Medically Fragile and aptitudes.
e. Educational history.
3.e.Medically Fragile
f. Communication functioning, 2.I. 4. Assessments are appropriate with

including:
respect to the person’s:
(1) Speech. 4.Medically Fragile
3.f.(1)Medically Fragile
a. Age.
(2) Hearing. 4.a.Medically Fragile
b. Development, including physical
(3) Language. and cognitive ability.
g. Visual functioning. 4.b.Medically Fragile
c. Culture.
3.g.Medically Fragile
h. Learning style. 4.c.Medically Fragile
d. Education.
3.h.Medically Fragile
i. Intellectual functioning. 4.d.Medically Fragile
e. Functional limitations, if applicable.

3.i.Medically Fragile
j. Family relationships. 4.e.Medically Fragile
3.j.Medically Fragile Intent Statements

k. Interactions with:
3.k.Medically Fragile The needs of the person served dictate the
(1) Peers. methods by which information is gathered.
3.k.(1)Medically Fragile
(2) Sexual partner, if relevant.

3.k.(2)Medically Fragile
Examples
l. History of use of alcohol or other
drugs. Methods and strategies for gathering information
3.l.Medically Fragile
are flexible and individualized to be appropriate
m. Current use of assistive devices
to the person served. The organization may
or technology.
3.m.Medically Fragile make use of input from select family members,
n. Other information relevant to the authorities, and educational resources for the
person served, as applicable. individual’s planning process.
3.n.Medically Fragile
Intent Statements
Initial assessments are individualized and docu- 2.I. 5. The program implements written
ment the history and background of the person procedures to ensure that assessments
served as well as the present status of the person are updated:
served and family involvement. 5.Medically Fragile
a. At least annually.
Examples b. As needed:
Documentation of the person’s health, emotional (1) According to the specific needs
well being, and functioning may be derived from of an individual.
5.b.(1)Medically Fragile
referral information, persons served and family (2) Depending on changes in

observations, testing, staff recordings, and a person’s functioning.
mentor or volunteer input. The organization 5.b.(2)Medically Fragile
Intent Statements
establishes its protocol for gathering, assessing,
and synthesizing assessment information for Assessments are performed regularly for
persons served. all persons served including those whose status
does not appear to have changed. Procedures are
3.b. Medical/physical health history would
in writing and address the specific needs of the
include information such as immunization person served. Consideration is also given for
records, the need for sedation during treatment meeting the update requirements of funding
or procedures, and other service providers who and referral sources within a specific time frame.
are involved in the person’s care.

Examples b. Addresses:
Updated assessments may be recommended by (1) Emergent issues.

the service delivery team or external treatment 7.b.(1)Medically Fragile
(2) Ongoing issues.

providers, or they may be triggered by requests 7.b.(2)Medically Fragile
(3) Transitions in levels of care

for changes from the person served or the family as needs change, including
or caregivers. identifying the skills necessary
to be successful in the next
2.I. 6. Each person served and his or her family environment for:
or guardian, as appropriate, have 7.b.(3)Medically Fragile
(a) The person served.

decision-making roles in the following: 7.b.(3)(a)Medically Fragile
(b) Their families/caregivers.

6.Medically Fragile
a. Individual services planning, includ- 7.b.(3)(b)Medically Fragile
c. Ensures that, based on ongoing

ing planning for transition and/or assessments of the person served:
discharge if appropriate. 7.c.Medically Fragile
6.a.Medically Fragile (1) Treatments change as

b. Coordination of care. appropriate.
c. Referral to appropriate resources 7.c.(1)Medically Fragile
(2) Resource allocations change

based on the needs and preferences as appropriate.
of persons served and their families. 7.c.(2)Medically Fragile
6.c.Medically Fragile (3) Predicted outcomes change

d. Advance directives. as appropriate.
Intent Statements d. Considers the impact of changes on:

The individual and family as appropriate have (1) The person served and their
decision-making roles in all aspects of the individ- families/caregivers.
ual’s life and receive guidance and counseling as 7.d.(1)Medically Fragile
(2) The individual care plan of the

desired in making informed decisions, advance person served.
directives, and life planning. 7.d.(2)Medically Fragile
Intent Statements
Examples
The team responds to the preferences and needs
In recognition of continuous changes in the lives of the person served. The person served and their
of persons served and families, the organization family/caregivers are able to participate in all
fully and comprehensively explores changes and aspects of the team planning process as desired.
choices with the person served and his or her
family in daily living and services. Examples
6.d. Persons served and their families are The organization obtains information from the
involved in the development of advance direc- persons served regarding resources and services/
tives and in identifying the extent to which supports they want or require that will meet their
medical intervention is to be administered. identified needs, and offers an array of services/
supports it provides or arranges for. The organi-
zation provides the persons and families served
2.I. 7. The service delivery team for each with information so they can make informed
person served: choices and decisions. The services and supports
7.Medically Fragile
a. Provides services that are consistent are changed as necessary to meet the identified
with: needs of the persons served and other
(1) The needs and preferences of stakeholders.

the person served.
(2) The individual care plan.


b. That all changes are communicated

2.I. 8. The service delivery team for each to the entire team.
person served is designed and modified 9.b.Medically Fragile
as needed based on: c. Appropriate communications with:

8.Medically Fragile
a. The individual services planning (1) The primary care physician of

process. the person served.
b. Initial and ongoing assessments. (2) Other external stakeholders.

Intent Statements
Intent Statements
A designated individual monitors the implemen-
Based on ongoing assessments and a person-
tation of the individual plan for each person
centered planning process that ensures
served.
individual choice, the service delivery team is
modified as needed to ensure the level of support Examples
is adequate to meet the needs of the person Team member involvement can be accomplished
served. by a variety of methods such as conference calls;
Examples sending information via fax, email, messenger, or
Persons served participate in decisions about mail; and telephone calls or conversations
their service including how services will be deliv- between team members.
ered and possible alternatives for services within 9.c. Communications with external stakeholders
the organization and the community. might include, with the consent of the person
A primary care physician or rehabilitation physi- served, sharing information with doctors
cian should be an active team member when it is regarding a person’s reaction to treatments, or
determined that either or both should be part of informing a guardian about changes in the per-
the team. The program is able to show how the son’s plan.
physician has input into the ongoing direction of The primary care physician is informed of signif-
the plan, how the physician has input into review icant changes in the status of the person served,
of the progress of the person served, and how such as an acute illness that precipitates transfer
that input is incorporated into the team process. to another level of care or a fall that results in
The expectation is that the physician be involved significant injury.
in more than just signing orders.
Another option would be for a physician extend- 2.I. 10. Before the person served moves from
er to participate on the team as the physician’s the program to another service or
representative. The use of physician extenders another level of care, transition planning
must meet the legal requirements of the state/ is conducted and involves:
10.Medically Fragile
province/territory in which the program is a. The person served.

provided. 10.a.Medically Fragile
b. The family, as appropriate.

c. Service delivery team members.

2.I. 9. There is a designated care coordinator 10.c.Medically Fragile
d. Appropriate personnel from the next

for each person served who ensures: service, as available.
9.Medically Fragile
a. That all team members: 10.d.Medically Fragile
e. Consultation from the person’s

(1) Are aware of the plan of care for primary care physician and other
each person served. healthcare specialists, if applicable.
(2) Exchange information as

Intent Statements
appropriate.
Information and support are available to help a
(3) Implement the plan of care/
person and his or her family to make informed
supports for each person served. decisions and smooth transitions.

Intent Statements
2.I. 11. The program provides information to
The organization determines staff competencies
families/caregivers and the person
and provides or arranges for competency-based
served, as appropriate, about options
training in areas that reflect the specific needs of
as the person transitions through life the persons served.
stages.
Examples
Intent Statements
Staff training is an ongoing process. Compe-
Planning for a person with complex medical
tency-based training may include training that
issues and his or her family is life long. The organi-
is provided or recognized by a professional asso-
zation examines the individual life needs and
ciation, is part of a formal training curriculum,
updates services and shapes services and com-
or is acquired through continuing education.
munity resource linkages accordingly.
Training may be provided through in-services
Examples or access to external resources.
Transitions through life stages for persons with 12.i. Other specific needs depend on the specific
serious medical needs are complex and require persons or populations served and may include
provider organizations to consider many facets of areas such as medication monitoring and man-
persons’ needs and expectations. Often, mentors agement, training or information related to
who have “been there” can provide guidance and specific medical equipment or devices used, or
resource knowledge that can be shared with the training on aging or diversity issues.
family and caregivers. Some of the areas of con-
cern may include support for an aging caregiver,
2.I. 13. The program collaborates with the
medical and healthcare issues, and financial and healthcare providers who provide
estate planning.
specialized medical, psychological/
behavioral, and other therapeutic care
2.I. 12. As relevant to the needs of the persons to the person served.
served and the scope of the program, 13.Medically Fragile
Intent Statements
staff members demonstrate competency
in the following areas: The program shares information and planning
with other providers as needed to promote
a. The medical needs of the individuals
consistency and continuity of care.
served, including signs/symptoms
requiring immediate response and
appropriate actions. 2.I. 14. With the permission of the persons
b. Assistive technology, adaptive equip- served, the program provides advocacy

ment, and medical devices used by by sharing feedback from the person
the persons served. served regarding services the person has
received from other organizations and
c. Methods of communication.
12.c.Medically Fragile professionals providing ancillary
d. Positive behavior support skills. services.
e. Learning styles. 14.Medically Fragile
Intent Statements
f. Social, emotional, and sexual needs.
Sharing feedback from persons served and their
g. The effects of separation and place-
families helps focus the community healthcare
ment on children and families or as
system on meeting the needs and expectations
adults transition to different living of the persons served.
situations.
12.g.Medically Fragile
h. Grief and end-of-life support issues. Examples

12.h.Medically Fragile
i. Other specific needs of the persons Networks, partnerships, and referral arrange-
served. ments are maintained when the services meet
12.i.Medically Fragile
expectations of the persons served and their

families with regard to quality. When those schedule to ensure that equipment and devices
expectations are not met, feedback is shared with are working properly.
the provider and persons may be referred to Maintenance and calibration may be performed
other services. No information specific to an by an outside company that is contracted for its
individual is disclosed unless the person autho- expertise and is qualified to do so.
rizes it.
2.I. 17. If services are provided in the home, the
2.I. 15. The program assists families and program identifies in-home safety needs
caregivers to optimize resources and of the person served and addresses as
opportunities through involvement appropriate:
in support networks such as peer 17.Medically Fragile
a. Environmental risks.
support groups, local advocacy 17.a.Medically Fragile
b. Abuse and/or neglect by self or

groups, and self-help groups.
15.Medically Fragile others.
Intent Statements
c. Self-protection skills.
The program is knowledgeable of the community 17.c.Medically Fragile
Intent Statements
resources available and provides information to
families and caregivers to allow them to make Safety needs are determined on the basis of the
informed choices about resources and individual’s strengths and needs. Individual risk
opportunities. management in home settings considers health
and safety issues and steps to be taken to miti-
Examples gate the chances of the risk occurring.
Social support networks may include parent
Examples
mentors or support groups in the community.
The organization conducts assessments of poten-
tial risks to the person’s health and safety in their
2.I. 16. If the program is responsible for medical home environment, and implements strategies
equipment and devices used by persons
for mitigating the individual’s risk. Individual
served, it follows a written schedule
risk management is considered in the individual
according to manufacturers’ specifica-
assessment and planning process.
tions for maintenance and/or calibration
of the equipment.
2.I. 18. As appropriate to the scope of the pro-
Intent Statements gram, end-of-life planning:
The program ensures that equipment and 18.Medically Fragile
a. Is directed by the wishes/desires of

devices used by the persons served are in proper the person served and/or guardian.
working order. 18.a.Medically Fragile
b. Includes advocacy of hospice,

Medical equipment and devices includes adap- palliative care, or other end-of-life
tive and assistive technology equipment and choices as needed.
durable medical supplies such as wheelchairs, 18.b.Medically Fragile
c. Includes spiritual or religious

walkers, splints, etc.
elements, if desired by the person
Examples served.
Written schedules for maintenance and calibra- d. Includes the guidance of a medical
tion of medical equipment and devices are professional, if desired by the person
developed, and records of equipment checks served.
and maintenance performed are kept.
e. Is submitted to the hospital in the

Some equipment may require more frequent required format, if applicable.
maintenance than what is recommended by the

Intent Statements
manufacturer to maintain proper functioning.
Persons served, families/support systems,
The program may implement an inspection
and personnel have opportunities to talk about

end-of-life issues and participate in planning Intent Statements

memorial services. Persons served, families/support systems, and
Examples personnel have opportunities to talk about
end-of-life issues and participate in planning
Numerous areas are considered in end-of-life the memorial service and creating end-of-life
planning, including medical and healthcare protocols.
issues, legal issues, financial and estate planning,
referral to resources for assistance in resolution Resources
of family conflicts, spirituality, and family Resources and information to help people with
supports. disabilities and others deal with serious health
Advance directives may relate to organ donation and/or end of life issues are available at
and orders not to resuscitate (DNR). Consider- www.qualitymall.org in the Grief, Loss, and
ations may include religion, legal parameters, End-of-Life department (www.qualitymall.org/
how orders should be documented, and who is directory/dept1.asp?deptid=87).
responsible for making a DNR decision.
Community Residential Settings
DNR orders are known and strictly adhered to.
Efforts are made to clarify issues related to an
individual’s end-of-life wishes to avoid any mis- Applicable Standards
understanding on the part of personnel and/or
If the program provides services in a residential
family/support systems.
setting, Standards 20.–24. must also be met.
18.b. Palliative care is the active total care of the
person’s body, mind, and spirit, and also involves
2.I. 20. The living environment provided for
support for the family.
persons served is:
Persons served and their families/support sys- 20.Medically Fragile
a. Inclusive and integrated into the

tems receive information about palliative care community.
options, including hospice. The program dem- 20.a.Medically Fragile
b. Physically supportive to meet the

onstrates an understanding of personal choice
needs of the persons living in the
and supports these choices.
residence.
Resources
c. Psychologically supportive to meet

Resources and information to help people the emotional and social needs of
with disabilities and others deal with serious the persons served.
health and/or end of life issues is available at 20.c.Medically Fragile
Intent Statements
www.qualitymall.org in the Grief, Loss, and
End-of-Life department (www.qualitymall.org/ The program creates and supports a living envi-
directory/dept1.asp?deptid=87). ronment that is designed to assist the persons
served to achieve success in and satisfaction
with community living, as appropriate for and
2.I. 19. When a person served dies, opportuni- desired by the persons served.
ties are provided as appropriate to peers,
other persons in the program, family/ Examples
caregivers, and staff members to: Community housing is provided in partnership
a. Express grief and remembrance. with persons served. Residences are physically
b. Develop and participate in: integrated into the community and every effort
19.b.Medically Fragile is made to ensure that they approximate other
(1) Memorial services.
homes in their neighborhoods in terms of size
(2) Memorial rituals. and number of individuals. The services/
(3) Other forms of grief expression, supports are focused on home and community
as desired. integration. Community residential settings
enhance the dignity of persons served, support

personal choice, and provide privacy for the

person served.
2.I. 23. There are separate beds and sleeping
areas for persons served according to
20.b. The physical environment supports safe their:
and effective use of medical equipment and 23.Medically Fragile
a. Ages.
devices or other adaptive and assistive technol- 23.a.Medically Fragile
ogy used by the persons served. b. Genders.

c. Needs.
2.I. 21. On-site support is available to meet the Intent Statements

individual needs of the persons served. Each person served in a residential setting has his
Intent Statements or her own personal space that respects privacy

and promotes personal security, health, and emo-
Personnel are available on site based on
tional well being.
the needs of the persons served, as identified
in their individual plan. This standard does not require a separate room
for each resident, but it does suggest provision
Examples of a safe, secure, private location that meets the
The person’s plan is monitored and modifications needs and respects the preferences of persons
are made in on-site support as the needs and served. The program considers social, emotional,
circumstances of the person served change. developmental, and cultural needs as are impor-
Personnel have the experience and training tant to individuals.
needed to effectively address the needs of the
persons served. 2.I. 24. The program provides for visits, includ-
ing opportunities for privacy when
2.I. 22. Persons served have input regarding appropriate, with:
and access to: a. Family members and significant

others.
a. Nutritious meals and snacks or 24.a.Medically Fragile
enteral feedings. b. Friends.

22.a.Medically Fragile 24.b.Medically Fragile
b. Liquid refreshment on an ongoing

basis, as appropriate for the person
served.
Intent Statements
Persons served have choices and their individual
health and nutrition needs are met.
Examples
The program continually addresses the nutrition
needs and preferences of the persons served.
Medical and or nutritional consultants often pro-
vide guidance for the planning and delivery of
nourishment and snacks.
22.a. Meals and snacks are provided within
appropriate guidelines for the individual. Nutri-
tional needs are defined in the person’s individual
plan, if appropriate.

Section 2.J. Autism Spectrum Disorder Specific Population Designation (ASD)
Documentation Examples J. Autism Spectrum

mation you should have available to demonstrate Disorder Specific
Population Designation
on required documentation. (ASD)
■ Program plan, including scope of services
■ Records of the persons served Description

■ Assessments Autism Spectrum Disorder Specific Population
■ Individual service plans Designation may be applied as:
■ Progress notes ■ Children/Adolescents with Autism Spectrum
Disorder (ASD:C)
■ Staff training information
Individuals served under this designation
■ Outreach and promotional materials
generally range from birth to the age of
■ Qualifications of supervisors majority.
■ Information regarding collaboration and par- ■ Adults with Autism Spectrum Disorder
ticipation with other community providers (ASD:A)
■ Procedures manual Individuals served under this designation
are at the age of majority and older.
NOTE: CARF allows that there may be services pro-
vided to adolescent/adult persons technically in
a transitional range from one category to the other
and does not require strict adherence to the age cut-
offs above. This would be identified in a program’s
scope of service.
■ If an organization chooses to add the spe-
cific population designation for ASD:C to
an appropriate service in Section 3, it must
meet Standards 1.–17. in this section in
addition to the standards identified in the
Applicable Standards statement for that
service in Section 3 or on the grid beginning
on page 126.
■ If an organization chooses to add the spe-
cific population designation for ASD:A to
an appropriate service in Section 3, it must
meet Standards 1.–10. and 18.–22. in this
section in addition to the standards identi-
fied in the Applicable Standards statement
for that service in Section 3 or on the grid
beginning on page 126.

Principle Standards 2.J. 2. The program:

2.2.J. ASD
a. Acts as an informational resource for

2.J. 1. The program: community professionals regarding
1.2.J. ASD
a. Remains current with ASD research ASD.

findings.
2.a.2.J. ASD
1.a.2.J. ASD
b. Promotes community awareness of
b. Communicates identified benefits ASD that:
of research to staff and families, as
2.b.2.J. ASD
(1) Respects individuals with ASD.

appropriate. 2.b.(1)2.J. ASD
(2) Supports increased community

1.b.2.J. ASD
c. Bases education and services on integration and participation

reputable, evidence-based research of persons with ASD.
findings. 2.b.(2)2.J. ASD
c. Advocates for resources that are

1.c.2.J. ASD
d. Utilizes peer-reviewed and accepted knowledgeable about ASD.

practices to establish treatments that 2.c.2.J. ASD
Examples
are helpful to the person and family.
1.d.2.J. ASD
e. Monitors outcomes of services to 2.a. Community professionals may include

evaluate treatment efficacy and educators, therapists, and medical personnel.
monitor possible negative effects The organization provides opportunities for
of interventions. schools and teachers to receive training on
1.e.2.J. ASD
evidence-based practices in ASD, including:

Intent Statements
■ Strategies for teaching interdependence.
1.c. and 1.d. Reputable, evidence-based research
and peer-reviewed and accepted practices ■ Building on successes and rewards.
include research that has indicated successful ■ Establishing educational philosophies that
techniques and field recognition from profession- focus on the child and understanding the
als and advocacy organizations. family.
Through its active efforts the organization pro- ■ Resources for additional support/professional
motes increased community understanding and consultation.
opportunities for persons with ASD. Persons are
■ Generalization intervention methods across
part of the community and are included without
settings.
a label.
2.b. The organization promotes community
Resources
awareness, understanding, and acceptance of
The publication Evidence-Based Practices for ASD through education in its newsletter and
Children, Youth, and Young Adults with Autism other media publications, ability awareness
Spectrum Disorder (PDF file) can be found at celebrations, community trainings, public service
http://autismpdc.fpg.unc.edu/content/ebp- announcements, and other events.
update.
The organization promotes awareness of the
Google Scholar (http://scholar.google.com) is a contributions of individuals with ASD to their
good starting point for locating the latest, most communities and the workforce.
relevant information and abstracts.
Educational efforts can help move some focus
on “autistic traits” of individuals from the
negative to the positive; e.g., persons who are
nonverbal don’t have lengthy conversations
around the water cooler with coworkers. Efforts
could also include development of an inclusive-
community curriculum that addresses successful
transition planning from a student, parent, and
community perspective.

The US Centers for Disease Control and Preven- Intent Statements

tion (CDC) launched a campaign to make The organization identifies the extent of its
doctors and parents aware of the need for early services and the required expertise of personnel
diagnosis of autism. The CDC has distributed to support the population served.
posters and checklists to doctors that describe
developmental milestones for each age and also 2.J. 5. Strategies for reasonable accommoda-
developed a distribution kit to help volunteers tions include, as needed, the use of
to reach local media outlets. assistive technology or adaptations in:
5.2.J. ASD
a. Communications.
2.J. 3. Initial and ongoing training is provided 5.a.2.J. ASD
b. Environmental control.
for staff on: 5.b.2.J. ASD
3.2.J. ASD c. Mobility, orientation, or destination

a. Understanding ASD. training.
3.a.2.J. ASD
b. Evidence-based/generally accepted 5.c.2.J. ASD
d. Education and training.

interventions for ASD. 5.d.2.J. ASD
3.b.2.J. ASD
e. Activities of daily living.
c. Needs of families with children with 5.e.2.J. ASD
f. Employment.
ASD, when appropriate to the ages 5.f.2.J. ASD
served. g. Recreation.
5.g.2.J. ASD
3.c.2.J. ASD
d. Supports that are available for fami- h. Sensory needs.

5.h.2.J. ASD
lies as well as the person with ASD. i. Transportation.

5.i.2.J. ASD
3.d.2.J. ASD
e. Communication techniques. j. Other needs as identified by:

5.j.2.J. ASD
3.e.2.J. ASD
(1) The person/family served.

Intent Statements 5.j.(1)2.J. ASD
(2) Specialists working with the

Professionals should be knowledgeable about
person/family.
the range of treatment options and supports that 5.j.(2)2.J. ASD
may be offered in order to educate families about Intent Statements

evidence-based versus nonevidence-based Assistive technology and other reasonable
interventions. accommodations enable persons served to
Examples have increased access to or participation in
life, employment, education, and/or inclusion
3.a. and 3.e. Includes understanding of
in the community.
relationship-based models; sensory processing,
visual-spatial and language/auditory processing Examples
issues; and use of alternative means of Assistive technology is considered in all aspects
communication. of services, including:
3.b. The organization follows new research and ■ Diagnosis.
new interventions, staying up to date on what is ■ Treatments.
developing in the field and implementing new
■ Training.
approaches as evidence-based and accepted
interventions change. ■ Transition to school.
■ Education.
2.J. 4. Program personnel providing services ■ Life planning.

demonstrate required competency ■ Improving communication.
related to:
4.2.J. ASD The organization acts as a resource for parents to
a. The needs of persons with ASD.
4.a.2.J. ASD
understand available options and choose appro-
b. The requirements of the job. priate assistive technology based on research and
4.b.2.J. ASD
c. Training specific to the service advice from qualified assistive technology profes-
provided. sionals. In some instances, families may not have
4.c.2.J. ASD
the experience or knowledge necessary to make

informed decisions, and the organization helps Examples

the families served to choose wisely. 6.c. Includes consideration of adaptations other
Examples include communication devices, than technology that could work for families with
communication “books” and booklets, and sign limited budgets or funding.
language; sensory sensitivity accommodations; 6.d. Consideration of the environment and
handheld devices and computers; travel training; setting includes all functional environments
cellular phone communication; independent as appropriate to the person, such as the home,
living skills; supported and independent employ- childcare providers, preschool or other educa-
ment including micro-enterprise and part time tional settings, community activities, and
work; gym and sports activities; and public and vocational or employment settings.
other alternative opportunities for travel.
5.j. Might include providing tools for visual sup- 2.J. 7. Assistive technology and adaptations
ports, such as visual schedules, First Then Visual are considered in:
Schedule, etc. Visit www.autismspeaks.org/ 7.2.J. ASD
a. Treatments.
family-services/resource-library/visual-tools 7.a.2.J. ASD
b. Training.
for additional information and resources. 7.b.2.J. ASD
c. Transition to/from school, as

appropriate.
2.J. 6. If assistive technology services are 7.c.2.J. ASD
d. Education.
provided, the assistive technology: 7.d.2.J. ASD
6.2.J. ASD
e. Life planning, as relevant to the
a. Is based on a comprehensive evalua-
needs of the person served and the
tion that considers the person’s needs
scope of the program.
and preferences. 7.e.2.J. ASD
6.a.2.J. ASD
f. Improving communication.
b. Is individualized to the person. 7.f.2.J. ASD
6.b.2.J. ASD
c. Considers the principle of universal Intent Statements

design. The organization acts as a resource for families to
6.c.2.J. ASD
d. Is appropriate to the environment understand available options and choose appro-

and setting. priate assistive technology based on research and
6.d.2.J. ASD
advice from qualified assistive technology
e. Identifies resources and assists with
professionals.
financial planning.
6.e.2.J. ASD
f. Sets up training as needed. Examples

Leading organizations apply technology that is
6.f.2.J. ASD
g. Includes planning for allocation of

resources and related replacement available for everyday use to expand options for
costs. persons served. Today’s technology offers options
6.g.2.J. ASD
h. Identifies resources and contacts for to assist with cognition, communication, health,
repairs and troubleshooting. organization, and general living. Available tools
6.h.2.J. ASD
in the general marketplace help us stay con-
Intent Statements nected, work from anywhere, and be productive.
Assistive technology planning is individualized Computers and cell phones come loaded with
and considers the person’s interests, involves what was once considered “AT.”
the family in reviews of the home environment 7.c. Assistive technology services include coordi-
and other natural settings, and takes into account
nation of technology used at home, in the
long-term costs for servicing and potential
community, and at school to ensure consistency.
replacement. Planning also considers the nature
of the disability and factors such as changing
medical needs and changes in needs as the
person grows older.

Examples
2.J. 8. Based upon individual needs and
Information may include individual education
desires, the services facilitate connec-
plans, individual service plans, individual pro-
tions for persons and/or families served
gram plans, consultations, and allied health
to community resources that offer:
8.2.J. ASD service reports.
a. A variety of life experiences.
8.a.2.J. ASD
Information may be collected regularly through
b. Opportunities for community access.
8.b.2.J. ASD behavioral data collection and presentation at
c. Opportunities for community individual program plan meetings with the
inclusion. individual and other significant stakeholders.
8.c.2.J. ASD
Intent Statements Information includes the “must haves” in

The persons served have opportunities to the person’s life, e.g., sensory considerations such
develop or increase social contacts, new as low lighting or soft music and personal items
supports, and community networks. important to the person such as a favorite base-
ball cap.
Examples
The organization provides individualized ser-
vices and it supports community membership 2.J. 10. As appropriate to the services provided,
and inclusion as goals, but the extent is deter- the program provides or participates in
mined by the desires of each person served. transition planning for the persons
served.
10.2.J. ASD
2.J. 9. Information about the person is Intent Statements

obtained, maintained, and, with the Timely planning for transitions is a critical
consent of the person served, shared element to support persons when the environ-
with other providers or educators when ment is changing.
related to services the person is receiving Examples
or transition to other services, that
Preferred practices indicate that if transition-
includes:
9.2.J. ASD from-school planning begins at least by age
a. Strengths, abilities, and successes. fourteen, the likelihood of successful transition
9.a.2.J. ASD
b. Relevant medical information, as is enhanced. In general, transition planning may

available. be better beginning at an even earlier point based
9.b.2.J. ASD
c. Psychological information, as on individual needs. Families must also be

available. included in the planning process for transitions
9.c.2.J. ASD
d. Social information. as it can be as difficult for the family to transition

9.d.2.J. ASD
e. Successful strategies to support their young adult into adult services as it is for
learning, behavior, communication, the individual. This planning is further beneficial
and building social networks. at an earlier age because the waiting list for some
9.e.2.J. ASD
f. Person-specific situations that should services may be quite long.

be accommodated.
9.f.2.J. ASD
g. Key professionals involved in provid-

ing services to the individual.
9.g.2.J. ASD
Intent Statements
By sharing the successful experiences, service
approaches, and desires of the person served,
consistency and greater continuity of services
during transitions in the person’s life are possible.

Children/Adolescents with Autism medical, educational, mental health, disabil-

ity, and community services.
Spectrum Disorder (ASD:C)
■ Connecting to resources to identify and
treat medical or other conditions associated
Applicable Standards with ASD, as they are needed, to improve
Refer to the Applicable Standards listed on independence, family well-being, and
page 189 or to the grid beginning on page 126. adaptive behavior.
■ Gaining understanding of the core features
of ASD and associated conditions.
Description
■ Adjusting and adapting to the challenges
Early identification, intervention, treatment
of raising a child with ASD.
planning, and educational strategies for children
with autism spectrum disorder (ASD) remain a ■ Understanding the future opportunities,
challenge for families, their physicians, commu- services, and challenges that lay before them
nity supports, and educational systems. Early as they raise their child.
recognition of the condition allows families to ■ Planning for transition to/from school and life
receive advice and support to help them adjust to planning.
the child’s learning and development challenges ■ Building linkages within segments of school
and to mobilize resources to provide the best systems and across school systems to facilitate
early intervention services for the child. successful transitions between placements.
Services for children and adolescents with ASD ■ Providing outcomes information to schools to
are designed to provide to the child/adolescent enhance individualized education plans and
and family a variety of resources that reflect employment transition planning.
sound research. The family will have access to ■ Connecting with mentors and parent-
results-oriented therapies, education, advocacy, to-parent support groups or contacts.
and supports for their child’s optimal progress
and to establish a lifetime of positive learning and ■ Connecting with community organizations
behaviors. Services involve families, networks of and support groups dedicated to people
resources, and education and support communi- with ASD.
ties for adolescents transitioning to adulthood. ■ Becoming an advocate for policy changes,
Individuals served under this designation may as desired.
range from birth to the age of majority, although
sometimes services for adolescents transitioning 2.J. 11. The organization provides, arranges for,
to adulthood are provided by programs that also or has access to early diagnostic services
serve adults. Ages served would be identified in a for children with ASD that result in:
program’s scope of services. 11.2.J. ASD
a. A comprehensive evaluation that

Organizations with accredited services/supports provides diagnosis.
for children with ASD are a resource for families,
11.a.2.J. ASD
b. Identification of options and referrals

community services, and education. With the for appropriate treatment.
focus on continuous learning about ASD, the 11.b.2.J. ASD
Intent Statements
organization can assist parents with:
Comprehensive evaluations give service provid-
■ Obtaining early intervention screening.
ers information needed to ensure appropriate
■ Obtaining early intervention services. planning and services.
■ Obtaining an evaluation by clinicians experi-
enced in evaluating children with ASD to
improve treatment and outcomes.
■ Navigating the multiple and complex systems
that families need to coordinate, including

Examples g. Empowerment of the family to

Comprehensive evaluations give guidance for: make decisions.
12.g.2.J. ASD
■ Referrals to appropriate family support h. Opportunities for family members

services. and caregivers to learn and carry
over treatment techniques and learn
Family support services include providing
information and education in the basics about appropriate environments
for children with ASD.
of autism immediately upon diagnosis to 12.h.2.J. ASD
assist parents with understanding the Intent Statements

condition and preparing to make informed Information is available to assist parents and
decisions about treatment options and families in greater understanding to facilitate
choices. informed decision making and supporting their
■ Education plans for families and support child with ASD.
systems. Examples
Educational plans are developed with the 12.h. The family is an essential member of the
cooperation of the school district, whenever team, providing coaching and empowering fam-
possible, and the service provider takes an ily inclusion through communication, behavior,
active role in planning for transition to and environmental interventions.
school.
■ Developmental plans for therapy and
2.J. 13. Mentor services for families are offered
education. or referred, as available, for:
■ Medication management planning, if needed.
13.2.J. ASD
a. Training in advocacy.
■ Creation of collaborative teams for therapy
13.a.2.J. ASD
b. Accessing local community resources.

and support, including as needed dietary 13.b.2.J. ASD
c. Understanding the importance of

support and sensory integration support. certifications and training of support
■ Treatment planning and intervention for staff.
behavior redirection. 13.c.2.J. ASD
d. Creating a community of supports

Planning considers the needs of the child as and locating qualified service
well as the family/support system and encourage providers.
13.d.2.J. ASD
nonchemical therapeutic interventions. e. Understanding research findings

on ASD.
13.e.2.J. ASD
2.J. 12. Information is available to the family f. Connecting to parent and sibling
to promote: groups.
13.f.2.J. ASD
12.2.J. ASD
a. Increased awareness and under- Intent Statements

standing of ASD by parents and Mentors help parents and families understand
siblings. the active role they need to take in the imple-
12.a.2.J. ASD
b. Referral to and use of appropriate mentation of professional support services and

therapies. how to become effective advocates for their
12.b.2.J. ASD
c. Connections to educational and child with ASD.

medical resources. Examples
12.c.2.J. ASD
d. Communications with other families Mentors are individuals with expertise because
and persons with ASD. they have had the same or similar experience.
12.d.2.J. ASD
e. Identification of appropriate commu- Refer to the Section 3.T. Mentor Services (MS)
nity resources. for additional information and examples.
12.e.2.J. ASD
f. Involvement and adjustment of

family members.
12.f.2.J. ASD

Intent Statements
2.J. 14. The program:
14.2.J. ASD Family insight is important and valuable. Empha-
a. Promotes family-centered care. sis should be placed on developing a working
14.a.2.J. ASD
b. Provides or refers for family relationship between the family and the school
education programs on parenting system.
techniques and family well-being.
14.b.2.J. ASD Examples
c. Coordinates a system of supports
for family members. It is important to develop understanding among
14.c.2.J. ASD school staff about what will succeed with a spe-
d. Assists with planning for educational
cific child. The family can provide information
transition.
14.d.2.J. ASD
about the strengths and needs of the child; the
e. Promotes a life-span perspective family’s interests, priorities, and needs; current
on ASD needs and planning. behavioral and emotional goals; and specific
14.e.2.J. ASD
Examples behavioral interventions that work for the child.

The program is knowledgeable about state/
provincial ASD guidelines, if applicable, and 2.J. 16. When partnering with the education
IDEA services that are available for children from system, the program shares to the extent
birth through age 21. The program coordinates possible its knowledge of the child to
with and helps families advocate for those ser- give guidance to developing the most
vices to which their child is entitled. effective individual educational model,
14.c. Supports for family members may include including the effectiveness of treatment
networking opportunities, advocacy training, approaches and assistive technology
respite care services, support groups, mentor being used.
16.2.J. ASD
services to assist families with psychological Intent Statements

adjustment and coping with stress that may result The organization identifies the current scholastic
from an ASD diagnosis, and integrating various level and educational needs of the child,
services the family is receiving. including functional assessments of behavior,
14.d. The organization works with schools and communication, social skills, and family involve-
other organizations to develop collaborative ment, and works in cooperation with the family
training agendas for teachers and others who and school system to determine appropriate,
work with children with ASD. individualized learning models.
14.e. Promoting a life-span perspective on ASD Examples
may include assisting children with ASD, when If there are medical and psychological records,
they are old enough and depending on their level the program could assist the family to procure
of cognitive function, in understanding their these records from the entity that provided the
condition and learning effective techniques to services.
minimize its impact in their lives. Life-span
Learning models are developed to ensure ade-
issues may also include assisting parents with
quate levels of direct instruction and effective
planning for their long-term needs and the
behavioral interventions as needed to provide
challenges involved in having an adult child
educational benefit and improvement of social
with ASD.
and communication skills.
Considerations include:
2.J. 15. When a child begins school, services
■ The child’s strengths, needs, abilities, and
provide advocacy, if requested and with
family consent, to educational staff preferences.
about the family’s knowledge about ■ Successful environmental accommodations
their child. and adaptations.

15.2.J. ASD
■ Appropriate level placements.

■ Instructional adaptations. Adults with Autism Spectrum

■ Accommodations. Disorder (ASD:A)
■ Assistive technology.
■ Opportunities for the generalization of skills.
■ Language and learning strategies to improve
functional skills. Refer to the Applicable Standards listed on
page 189 or to the grid beginning on page 126.
■ Sensory issues and appropriate interventions
and supports, including ergonomics and body
mechanics as well as environmental issues. Description
Health and safety risks are also considered, and Supports for persons with autism spectrum
strategies to reduce such risks are implemented. disorder (ASD) enhance accessibility and
community membership opportunities for adults
with ASD. Education, employment, residential,
2.J. 17. Opportunities for education of the child’s social, and recreational opportunities; identifica-
peers, when appropriate and desired, are
tion from research of successful techniques to
provided.
17.2.J. ASD
apply to service provision including treatment
Intent Statements and intervention research; and lifelong planning
Educational opportunities for peers are individu- are means to achieve full inclusion and
alized and are based on the preferences of the participation.
family. Standards for ASD services and supports present
Examples a roadmap for successful outcomes in the lives
of persons with ASD by encouraging organiza-
Education may include understanding the social
tional values that focus on individualized,
and emotional needs of the child with ASD and
person-centered services for persons to achieve
learning strategies for developing friendships and
full inclusion and participation as desired in
supporting development of social skills. Educa-
their communities. Services involve families, net-
tion of parents and siblings of peers who befriend
works of resources, and education and support
the child with ASD may also be provided as
communities for older adolescents transitioning
appropriate.
to adulthood and adult persons with ASD.
The child’s parents are involved and give their
The standards in this section focus on planning
consent and input regarding information about
for transitions and development of supports as
the child to be shared with peers or others.
needed for persons with ASD, with the outcomes
Curriculum might include topics such as: of employment, further education, community
■ Learning about the strengths and difficulties living, and life planning.
of the child with ASD. Some of the quality results (outcomes) desired
■ How to become a mentor or friend. by the different stakeholders of ASD services
■ Understanding why the child with ASD needs may include:
accommodations. ■ Creating and supporting lifelong self-
■ Actual skills for peers to develop and use. advocacy skills.

■ Developing supports and community
resources for persons and families.
■ Enhancing quality of life by increasing social
contacts and support communities.
■ Encouraging service provider capacity
building by networking with governmental,
educational, business/employer, and other
community resources.

■ Recognizing and sharing reliable evidence- other families who have participated or are
based knowledge, innovations, interventions, participating in the program. Families often
and therapies with proven, research-based, benefit from parent-to-parent support that can
and peer-reviewed track records of getting be accessed from a family support network
results. component.
■ Planning for transition from school to suc- Based on the level and age of the person served,
cessful employment and community living there could be great variability in availability and
supports. involvement of the family or in the desire of the
■ Individualized, comprehensive life planning person served to have the family involved.
that is transferred to other service providers The organization could assist families served,
to ensure continuity of service planning and as desired, to:
supports. ■ Develop a personal circle of advocates.
■ Persons served moving toward: ■ Have opportunities for parent-parent
– Optimal use of natural supports. supports and networking.
– A social supports network. ■ Locate referral resources for specialized
– Self-help. and generic care.

– Greater self-sufficiency. Examples include developing natural supports
– Greater ability to make appropriate at an individual’s place of employment, signifi-
choices. cant relationships with staff, clergy, other family
members, and members of local chapters of
– Greater control of their lives.
advocacy organizations; e.g., Autism Society
– Increased participation in the community. of America, the Arc, Autism Society Canada
– Employment and/or continued education. (www.autismsocietycanada.ca), Autism Treat-
ment Services (www.autism.ca), and US Autism
2.J. 18. The services assist persons and/or fami- & Asperger Association (www.usautism.org).
lies served in enhancing their quality of The organization may link the family to an
life by providing or connecting them to appropriate community agency that can assist
opportunities to develop and/or increase with this.
as desired: State/provincial agency personnel may provide
information and training on community
18.2.J. ASD
a. Social networks.
18.a.2.J. ASD
b. Personal relationships. resources and benefits planning; funding and

18.b.2.J. ASD
program opportunities; foundation grants; refer-
c. Community supports.
18.c.2.J. ASD rals to insurance agencies, financial and estate
d. Supports from peer mentors, alumni planners, and allied health professional resources
from the program, or in the areas of speech, behavioral, occupational,
self-advocates with real life and physical therapies; and autism-specific
experiences. resources.
18.d.2.J. ASD
Intent Statements
The persons and/or families served are included 2.J. 19. The services provide information about
in their communities to the degree they desire. or referrals to community resources to
persons served, as desired, in the areas
Examples
of:
Opportunities are based on the unique learning 19.2.J. ASD
a. Educational development.
style of each individual and the need for individ- 19.a.2.J. ASD
ualized supports. Peer mentors add the b. Living skills development.

19.b.2.J. ASD
dimension of persons with ASD who understand c. Interpersonal relations.

19.c.2.J. ASD
the personal needs of a person with ASD. Fami- d. Recreation and leisure time
lies are provided with opportunities to meet with opportunities.
19.d.2.J. ASD

e. Vocational development, employ- 19.a. Services seek to address a problem identi-

ment, or career advancement. fied in professional journals that “Many students
on the autism spectrum are being admitted to
19.e.2.J. ASD
f. Access to generic community

resources. higher education, but they lack the social and
19.f.2.J. ASD
g. Housing. organizational skills to be successful.” (Van

19.g.2.J. ASD
Bergeijk, E., Kim, A., & Volkmar, F. (2008)
h. Transportation.
19.h.2.J. ASD Supporting more able students on the autism
Intent Statements spectrum: College and Beyond. Journal of Autism
Through providing information about or referrals and Developmental Disorders, 8.)
to supports, the organization facilitates growth 19.f. Generic community resources are resources
and development in the personal lives of persons in the community that are used by the general
served. Services enhance opportunities for inde- population without disabilities, and may include
pendent and productive living. local, state/provincial, or federal financial
Examples resources.
By addressing these areas, services seek to Resources
counter a problem identified in professional jour- A website offering some suggestions on risk
nals that “… completion of high school means management specific to the population with ASD
isolation and restricted social contexts for transi- is www.autismriskmanagement.com.
tioning youth and young adults on the autism
spectrum as they lose access to peer groups.”
(Crabtree, L., OT Practice, Volume 16, Issue 12.)
2.J. 20. Self-advocacy support services are
individualized to each person served
Information might be provided in different and his/her family and include:
ways, such as using an existing community 20.2.J. ASD
a. Self-advocacy skills training and

resource directory or a compilation by United
support systems.
Way. This information could give persons access 20.a.2.J. ASD
to supports as desired to enhance independent b. Developing new skills and supports

living skills, money management skills, commu- on an ongoing basis, including
nication skills, social interactions, exercise, self-determination.
20.b.2.J. ASD
community employment opportunities, house- Intent Statements

keeping activities, hygiene, food shopping, meal Support is given to persons and families served
preparation, reduction of maladaptive behaviors, for development of their advocacy skills.
and use of community resources, e.g., library or
gym. Examples
Providers are encouraged to offer safety-and-risk Quality of life is specific to and defined by each
life skills education early and often, suited to person and/or family served. Skills and supports
the person’s ability and learning styles. For some to enhance quality of life will be determined and
persons with ASD, learning how to disclose is their effectiveness reported by persons and fami-
a key to their personal safety during a high risk lies served.
situation, such as a sudden interaction with law Accessibility to forums of self-determination and
enforcement professionals. Without disclosure, decision making is key to meeting the needs of
accommodation would be difficult to get. persons with ASD.
Anticipating disruptive behaviors that might Support for advocacy activities may be provided
occur in the community can facilitate ensuring within the organization, through support for par-
prior training for staff members, an adequate ticipation in activities such as consumer councils,
ratio of personnel to persons served participating or support for self-facilitation of a person’s indi-
in the activity, and advance planning for an vidual planning meeting; or in the community,
emergency situation. through support for participation in activities
sponsored by advocacy groups; or support in

self-advocacy to access benefits, services, etc.

These examples of self-direction are not the only
2.J. 21. As relevant to the desires of the persons
served and the scope of the program, life
means by which support for advocacy may be
planning:
provided. 21.2.J. ASD
a. Is updated and adjusted:

An important first step is ensuring that persons 21.a.2.J. ASD
served feel safe in their environment before they (1) As the life of the person served
explore opportunities to enhance their advocacy changes.
21.a.(1)2.J. ASD
skills. There also must be a strong emphasis on (2) At least every two years.
21.a.(2)2.J. ASD
communication, including teaching how to b. Considers:

21.b.2.J. ASD
communicate, providing tools with which to (1) Concerns of the person and
communicate, and making sure that communica- family.
tion systems are part of every plan. Self-advocacy 21.b.(1)2.J. ASD
(2) Resources.
does little without the ability to communicate. 21.b.(2)2.J. ASD
(3) Priorities.
Likewise, due to prevalent dysfunction in choice- 21.b.(3)2.J. ASD
(4) Expectations.
making being one of the characteristics of autism, 21.b.(4)2.J. ASD
choice-making may have to be taught through (5) Beneficial activities.

21.b.(5)2.J. ASD
supports and experience. (6) Alternatives.

21.b.(6)2.J. ASD
For some persons who are not capable of partici- Intent Statements
pating themselves, this might include significant As ASD is considered to be a lifelong condition,
others, i.e., family, friends, or respite providers. some persons will need long-term support
This might include the concept of creating a sup- services. Life planning for these persons docu-
port circle, as many families are isolated and don’t ments future expectations for the person served
have anyone other than themselves to support the as they transition through life’s stages and the
individual with autism. family situation changes.
20.a. Examples of self-advocacy may include Examples
attending and participating in individual
A wealth of information is available on the inter-
program plan meetings, goal development,
net by searching “Life planning in ASD” or “ASD
employment opportunities, participating in
life planning.”
community meetings, attending human rights
conferences and trainings, membership on Based on the preferences and needs of the person
human rights committees and other organiza- served, life planning services may include:
tional boards, participating in group leisure ■ Direct guidance or participation to the extent
activities and travel, participating in political desired by the person served.
events and voting, and participating in safety ■ Outreach/facilitation to encourage the active
committees. Alternative methods, e.g., non- participation of the person served.
verbal communication, for self-advocacy may ■ Coordination of, or assistance with, crisis
be used. Depending on the persons served, intervention and stabilization services as
efforts may focus on very basic skills such as appropriate.
communication of basic wants and needs.
■ Assisting the person served to achieve goals
for independence as defined by the person.
■ Optimizing resources and opportunities
through community linkages and enhanced
social support networks.
■ Exploring living options reflective of the indi-
vidual desires of the person.

■ Exploring employment, career changes, or employment for both the individual served
educational activities, as desired and the employer.
by the person. ■ Referral to resources for assistance in resolu-
■ Planning for anticipated transitions as soon tion of family conflicts.
as the person enters services. ■ Implementing the life plan.
The life plan is individualized and person- The life planning process considers daily living
centered and may include long-term planning activities including, as appropriate:
considerations such as:
■ Communication.
■ Support for caregivers, including those who
■ Budgeting.
may themselves have special needs related to
■ Meal planning.
aging.
■ Personal care.
■ Medical and other healthcare issues.
■ Housekeeping and home maintenance.
Medicaid and Medicare in the United States,
provincial/territorial health insurance systems ■ Financial services.
in Canada, and private insurance are critical ■ Medical and dental needs.
life-planning concerns. ■ Community resources.
■ Financial and estate planning.
■ Social skills.
Wills and trusts and estate planning should ■ Recreational skills.
also be considered to protect the parent and
the child. Appropriate estate planning may be Recreation is an area that contributes to the
one that provides persons served with access health, well-being, and quality of life for each
to assets, while simultaneously protecting individual. Television, gym access, hobbies,
Supplemental Security Income (SSI) and travel, the arts, etc., all contribute to a healthy
Medicaid eligibility. Life insurance is an life plan.
essential part of a complete financial plan ■ Employment skills.
and ensures protection in case of the loss of ■ Educational opportunities.

a parent. ■ Use of community transportation.
■ Guardianship.
■ Spiritual or religious interests.
■ Family supports, including sibling supports
Developing a way of living and working that
if applicable. brings inner peace, humility, gratitude, joy,
■ Living arrangements, including social, recre- and maturity while enhancing the life process
ational, and community involvement. and social interactions can be an essential part
This may include real estate rental or pur- of the life plan.
chase, choice of group home, living with ■ Safety skills.
family, and residential staff supports.
Some organizations are assisting persons and
■ Career or educational development. families served to set up individual communities
Learning and development is a life-long proof supports for the person served as cooperatives.
cess. Higher education, community college, Considerations include:
vocational education, and individualized ■ Revenues and expenses.
training should be part of a life plan.
■ Financial trends.
Independent, competitive employment; sup-
■ Financial opportunities.
ported community employment; sheltered
■ Specifying the functions and responsibilities
workshops; natural supports; day activities;
etc., and all issues affecting life planning. of each party in the cooperative.
Impairment-related work expenses and
targeted tax credits are incentives for

■ Management information. Documentation Examples

■ Fiscal oversight and financial solvency, The following are examples of the types of infor-
including remediation plans when mation you should have available to demonstrate
appropriate. your conformance to the standards in this sub-
A benefits planning service can educate persons section. See Appendix A for more information
served and their families about long-term earn- on required documentation.
ings, long-range budgeting, tools, and resources ■ Records of persons served
for ongoing benefits management. ■ Individual service plans
Some persons may choose volunteerism over ■ Progress notes

employment, and life planning would also apply ■ Procedures manual
to this.
■ Organizational newsletters or other
Although the persons served are always involved, communications for parents
because the disability is one of deficits in both
■ Documented service strategies
socialization and communication and many can-
not express themselves and do not understand ■ Information about community resources/
complex or abstract concepts, the inclusion of networks

advocates and/or family is also important. ■ Advocacy training materials
■ Individual personal scrapbooks of

2.J. 22. The program ensures that individual persons served
benefits planning as desired by the ■ Life plans
person served is:
22.2.J. ASD
a. Reviewed to stay current with:

22.a.2.J. ASD
(1) Changes in the person’s life.

22.a.(1)2.J. ASD
(2) Changes in regulations.

22.a.(2)2.J. ASD
b. Updated accordingly.
22.b.2.J. ASD
Intent Statements
At the time of development of or modification to
a life plan, determinations are made for eligibility
for funding sources, entitlements, and benefits.
Examples
Considerations may include:
■ Diagnosis.
■ State/provincial agencies and services

provided.
■ Individual transition plan (residential,
vocational considerations).
■ Documentation (birth certificate, Social
Security (US) or Social Insurance Number
(Canada) card, medical diagnoses, allergies,
medications, and psychological/behavioral
evaluations).
■ Transportation.
■ Availability of community resources.

SECTION 3
Employment and Community Services
Description ■ Competitive employment.

An organization seeking CARF accreditation in ■ Employment at or above minimum wage.
the area of employment and community services ■ Economic self-sufficiency.
assists the persons served through an individual-
ized person-centered process to obtain access
to the services, supports, and resources of their ■ Career advancement.
choice to achieve their desired outcomes. This
may be accomplished by direct service provision, Selection of Services for Accreditation
linkages to existing generic opportunities and An organization is free to choose which of its
natural supports in the community, or any services it will seek to have accredited, but when
combination of these. The persons served are a service has been selected, all locations at which
included in their communities to the degree the service is provided must be included in the
they desire. survey. CARF will not accredit only a portion
The organization provides the persons served of a program or service. CARF does not consider
with information so that they may make the funding or referral entities or the populations
informed choices and decisions. Although served as differentiating a service so as to exclude
we use the phrase person served, this may also portions of it from being included in the survey.
include family served, as appropriate to the If the geographical service area is extensive,
service and the individual. however, CARF may choose to impose geograph-
The services and supports are arranged and ical limitations on the extent of a single survey in
changed as necessary to meet the identified order to ensure that the most meaningful survey
desires of the persons served. Service designs will be conducted.
address identified individual, family, socio-
economic, and cultural preferences.
Depending on the program’s scope of services,
expected results from these services/supports
may include:
■ Increased inclusion in community activities.
■ Increased or maintained ability to perform

activities of daily living.
■ Increased self-direction, self-determination,
and self-reliance
■ Self-esteem.
■ Housing opportunities.
■ Community citizenship.
■ Increased independence.
■ Meaningful activities.
■ Increased employment options.
■ Employment obtained and maintained.

Section 3.A. Employment Planning Services (EPS)
A. Employment Planning ■ Services are cost-effective.

■ Individuals served understand
Services (EPS) recommendations that are made.
■ Individuals served identify desired
Description employment outcomes.
Employment planning services are designed
to assist a person seeking employment to learn
about employment opportunities within the Applicable Standards
community and to make informed decisions. An organization seeking accreditation in
Employment planning services are individualized employment planning services must meet
to assist a person to choose employment out- the standards in this section and the
comes and/or career development opportunities standards in the following sections:
based on his or her preferences, strengths, ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
abilities, and needs. Services begin from a pre- optional
sumption of employability for all persons and ■ 2.A. Program/Service Structure, Standards
seek to provide meaningful information related 1.–13.
to planning effective programs for persons with
■ 2.B. Individual-Centered Service Planning,
intervention strategies needed to achieve the
goal of employment. Design, and Delivery, Standard 1.
■ 2.C. Medication Monitoring and Manage-
Employment planning uses some type of employ-
ment exploration model. This may involve one ment (as applicable; see page 148)
or more of the following: ■ 2.D. Employment Services Principle
■ Situational assessments.
Standards
■ 2.E. Workforce Development (optional)
■ Paid work trials.
■ 2.J. Autism Spectrum Disorder (ASD:A only,
■ Job tryouts (may be individual, crew,
enclave, cluster, etc.). optional)
■ Job shadowing.
3.A. 1. Employment exploration sites utilized
■ Community-based assessments.
for the person seeking employment
■ Simulated job sites. are appropriate to obtain desired
■ Staffing agencies/temporary employment information.
1.A. EPS
agencies. Intent Statements

■ Volunteer opportunities.
The assessment of employment sites in relation
■ Transitional employment. to the individual’s interests, needs, and functional
Some examples of quality outcomes desired abilities is critical to the individual making
by the different stakeholders of these services informed choices about his or her future
employment goals.
include:
■ Work interests are explored and identified. Examples
■ Recommendations for employment Information about a person served to be consid-
options are appropriate. ered in identifying suitable sites might include:
■ Employment planning reports lead to ■ Self-reported interests and experiences.
job goals. ■ Needs regarding safety and supervision.
■ Transferable work skills and employment ■ Needs regarding assistive technology

barriers are identified. and/or job accommodations.
■ Benefits planning is included. ■ Other considerations identified,
■ Services are timely in their delivery. as appropriate to the individual.

In conjunction with risk management strategies, Examples

an organization would want to consider the Assessments might include information
safety of any site before using it. Factors that about the person’s:
might be considered about individual sites ■ Learning style, which might include dem-
include: onstration, written, verbal, or modeling.
■ Adequacy of supervision.
■ Aptitudes, which might include mechanical
■ Safety or individual risk management or clerical.
concerns. ■ Modes of communication.
■ Specific work-site requirements.
■ Endurance/stamina.
■ Potential job accommodations.
2.d. Job accommodations may include the use
■ Accessibility.
of assistive technology.
■ Expectations for quality and quantity of work.
■ Job/task analysis. 3.A. 3. A person seeking employment is

■ Potential employment opportunities in the informed of job opportunities and
local job market. requirements in the employment market
consistent with his or her interests and
Resources
abilities.
Further information on creating accommoda- 3.A. EPS
tions at the potential work site can be found in Intent Statements

Section 3.Q. Assistive Technology Supports and Employment planning calls for a determination
Services (AT). The CARF publication CARF of realistic community employment opportuni-
Guide to Accessibility, which is available on ties in the local job market.
request from your resource specialist, may Examples
also be helpful. This planning is done within the context of the
The National Technical Assistance Partnership local job market and the geographic area accessi-
(NTAP) (www.gwcrcre.org/ntap/) provides ble to the persons served. The organization may
technical assistance (TA) in areas of national define in its promotional materials or orientation
need identified in consultation with the Rehabili- sessions with the persons which geographical
tation Services Administration (RSA) and the and labor market areas it serves.
Technical Assistance and Continuing Education Current information on local job opportunities
(TACE) Centers. is maintained. This information addresses not
only labor trends and employer needs, but also
3.A. 2. Employment exploration assesses the relevant community supports, services, and
person’s performance related to: transportation. The organization may make use
2.A. EPS
a. Job skills. of local employment studies, employment offices,

2.a.A. EPS
b. Interest in a particular job. internet connections, and other data-based

2.b.A. EPS
c. Work-related behaviors. methods for determining the nature of the local

2.c.A. EPS
labor market. Job carving or customized
d. Need for potential job
employment may be an important strategy
accommodations.
2.d.A. EPS to the development of job opportunities.
e. Other pertinent information related Self-employment may consist of several micro-
to the job seeker. enterprises that the person operates.
2.e.A. EPS
The standard may also form the basis for ques-

tions used on stakeholder satisfaction surveys
in the organization’s outcomes system. See related
standards in Section 1.M.

Related standards may be found in Section 2.B.

Individual-Centered Service Planning, Design,
3.A. 5. The person’s employment planning
report is:
and Delivery and in Section 3.D. Self- 5.A. EPS
Employment Services (SES). a. Shared in an understandable

manner with the person seeking
employment.
3.A. 4. A written employment planning report: 5.a.A. EPS
4.A. EPS b. Disseminated in a timely manner

a. Is completed for each person served.
4.a.A. EPS
to the referring agency individual
b. Addresses: responsible for implementing
4.b.A. EPS
(1) Employment exploration results. recommendations in the report.

4.b.(1)A. EPS
(2) The planned employment out-

5.b.A. EPS
Examples
come and/or plan to achieve the
desired employment outcome, 5.a. The report is shared in an understandable
including: manner with the person seeking employment.
4.b.(2)A. EPS
This may mean some additional explanations and
(a) Relevant jobs available in
supports are necessary for comprehension and
the employment market.
4.b.(2)(a)A. EPS retention ( e.g., the person might desire to have
(b) Strengths of the person evi- a personal advocate in attendance).
denced during explorations.
4.b.(2)(b)A. EPS 5.b. “Disseminated in a timely manner” implies
(c) Barriers to the achievement that the persons served and significant stakehold-
and maintenance of
ers were satisfied in the time it took to receive the
employment.
4.b.(2)(c)A. EPS
written report. Sharing the report with entities
(d) Transportation and other beyond the referring entity individual and the
support needs. person served would require written permission
4.b.(2)(d)A. EPS
c. Includes: of the person served.

4.c.A. EPS
(1) Self-evaluation by the person

of the employment exploration Documentation Examples
experience, if possible. The following are examples of the types of infor-
4.c.(1)A. EPS
(2) Individualized environmental, mation you should have available to demonstrate

assistive technology, or job-task your conformance to the standards in this sub-
accommodations used. section. See Appendix A for more information
4.c.(2)A. EPS
(3) Recommendations for commu-

nity resources and/or services, ■ Records of the persons served
as needed, to assist in addressing ■ Progress notes
employment barriers.
4.c.(3)A. EPS ■ Employment planning reports
Intent Statements ■ Referral information
This provides a blueprint guiding to desired ■ Guidelines/procedures for methods used
employment outcomes.
■ Information related to assessment of career
Examples exploration sites
The employment planning report clearly identi- ■ Information regarding local job opportunities
fies the next steps for a person to take to achieve
successful employment.
For people with significant disabilities, the need
for long-term supports and the likelihood of
developing natural supports is addressed.
4.b.(1) The exploration results capture a com-
prehensive summary of all information from
the assessment.

Section 3.B. Evaluation Services
B. Evaluation Services ■ Other appropriate evaluation tests,

depending on the individual.
Introduction ■ Analysis of prior work and/or volunteer
experience and transferable skills.
In this section two distinct programs are available
Some examples of the quality results desired
for accreditation. Although both programs offer
by the different stakeholders of these
services to assist persons to identify viable voca-
services include:
tional options, there are differences in scope.
An organization may seek accreditation in only ■ Realistic job opportunities are explored
one or in both, based on the scope of services and identified for individuals.
it provides and its desires for accreditation. ■ Employment barriers are identified and
■ Comprehensive Vocational Evaluation ways to overcome these are suggested.

Services (CVE)—page 207 ■ Assistive technology or other accommo-
■ Targeted Employment Screening (TES)— dations needed are identified.

page 213 ■ The evaluation is completed within the
authorization period.
Comprehensive Vocational ■ The person served understands the results.
Evaluation Services (CVE) ■ The cost per evaluation is acceptable.
■ Interests of the persons served are

Description thoroughly explored.
Comprehensive vocational evaluation services ■ Evaluation reports lead to job goals.
provide an individualized, timely, and systematic ■ Transferable skills are identified.
process by which a person seeking employment,
in partnership with an evaluator, learns to
identify viable vocational options and develop Applicable Standards
employment goals and objectives. A vocational An organization seeking accreditation in
evaluator or vocational specialist provides or comprehensive vocational evaluation services
supervises the services. must meet Standards 1.–11. in this section
An accredited comprehensive vocational evalua- and the standards in the following sections:
tion service is capable of examining a wide range ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
of employment alternatives. The following tech- optional
niques are used, as is appropriate to the person
■ 2.A. Program/Service Structure, Standards
being assessed, to provide comprehensive
1.–13.
vocational evaluation services:
■ 2.D. Employment Services Principle
■ Pre-evaluation assessment of assistive
Standards, Standards 1.–3.
technology needs.
■ Assessment of functional/occupational per-
formance in real or simulated environments.
■ Work samples.
3.B. 1. An individual evaluation plan is devel-
oped in a timely manner with each
■ Employment exploration model.
person served and is based on:
■ Psychometric testing.
1.B. Eval Svcs
a. Referral information.
■ Preference and interest inventories.
1.a.B. Eval Svcs
b. Referral questions to be answered.

1.b.B. Eval Svcs
■ Personality testing. c. Questions from the person served.

1.c.B. Eval Svcs
■ Extensive personal interviews. d. The initial interview.

1.d.B. Eval Svcs
e. The stated overall purpose of

the evaluation.
1.e.B. Eval Svcs

f. Pre-evaluation assessment of poten- Resources

tial modifications required to meet The National Technical Assistance Partnership
a person’s specific needs. (NTAP) (www.gwcrcre.org/ntap/) provides
1.f.B. Eval Svcs
Intent Statements technical assistance (TA) in areas of national

need identified in consultation with the Rehabili-
Timeliness (the development of the plan in a
tation Services Administration (RSA) and the
timely manner) is determined by the organization
Technical Assistance and Continuing Education
based on each person’s satisfaction with his or
her services, stakeholder input, funder or referral (TACE) Centers.
source rules and regulations, practical consider-
ations, or established professional protocols. 3.B. 2. The plan is prepared:
2.B. Eval Svcs
The organization is not required to have more a. By the person seeking employment
than one plan for each person. This standard and and the evaluator.
2.a.B. Eval Svcs
plan, rather than Section 2.B. Individual-Centered b. With input of the referral source or
Service Planning, Design, and Delivery, apply to other stakeholder, as appropriate.
CVE. 2.b.B. Eval Svcs
Intent Statements
Examples
The active participation of the person served
The information in the plan is often summarized is vital to a successful evaluation.
in the final vocational evaluation report. These
Examples
items often form the basis for the evaluation and
strategies used to learn about the individual’s Participation may be demonstrated by inter-
employment strengths and abilities. views, records, checklists, accommodations, etc.
The organization might indicate this mutual
1.f. The pre-evaluation assessment may include
participation by notes related to planning or by
reviewing referral information to determine if
having the plan signed by both the person served
technology needs are indicated and whether
and the evaluator.
there are functional limitations that may require
accommodations during the assessment. This The organization may address the quality of
can help to ensure that all test and instructional service planning with questions in its outcomes
materials that are likely to be used are available in measurement system about the satisfaction of the
appropriate formats and that the evaluation area persons served and other stakeholders. Informed
is completely accessible for individuals with choices and active participation exist in all phases
disabilities. It might be helpful to consult with of vocational evaluation.
technology specialists for cases where significant
assistive technology needs have already been 3.B. 3. The plan identifies:
noted. 3.B. Eval Svcs
a. How questions in the plan will be

In conducting the initial interview some helpful answered through the evaluation.
points to consider are:
3.a.B. Eval Svcs
b. Strategies to use assistive technol-

■ Determine if the individual uses or has used ogy when a need is identified.
3.b.B. Eval Svcs
any assistive devices. Intent Statements

■ Determine if there are any apparent func-
The plan identifies the questions to be answered
tional limitations that would suggest the during the evaluation and the methods to be
need for involving a technology specialist. used.
■ Determine what the person’s attitude is
Examples
toward using assistive technology
or workplace accommodations. If any Methods might include which evaluation tech-
reluctance is noted, explore this before niques, assessment tools, and procedures will
considering using assistive technology. be used to answer the questions documented
in the evaluation plan.

The plan is modified as necessary by the person

seeking employment and the evaluator.
3.B. 5. Comprehensive vocational evaluation
services including psychological testing
Considered in plan modification are the individ- are conducted:
ual’s interests, preferences, and choices; barriers; 5.B. Eval Svcs
a. By an evaluator who meets the

supports needed; etc.
qualifications defined by state or
Strategies to use assistive technology might provincial law, as applicable.
include: 5.a.B. Eval Svcs
b. Under the supervision requirements

■ Arrange for any consultation or other involve- of state or provincial law, as
ment of technology specialists if assistive applicable.
technology needs have been identified. 5.b.B. Eval Svcs
Intent Statements
■ If immediate need for assistive technology
Qualified personnel conduct the evaluation ser-
aids/devices was noted, arrange to obtain
vices in accordance with any applicable state or
the necessary equipment.
provincial laws and have the required credentials
■ If formats of tests and assessment activities as established by the organization.
may not be appropriate for the individual,
consider what other assessment instruments Examples
or alternate formats may be needed. Evaluators have the qualifications and super-
vision identified as necessary to conduct
For further information, refer to Section 3.Q.
evaluations using work samples, employment
Assistive Technology Supports and Services
career exploration, psychological/psychometric
(AT). The CARF publication CARF Guide to
testing, functional capacities assessments, or
Accessibility, which is available on request from
other methods.
your resource specialist, can also provide
guidance for creating accommodations at A psychological test is a systematic procedure
the potential work site. for observing behavior; i.e., interests, academic
achievement, intelligence, aptitudes, and person-
ality characteristics, with the aid of numerical
3.B. 4. When administering assessment scales or fixed categories.
tasks and activities, if an individual is
experiencing difficulties performing Psychological tests are categorized for adminis-
assessment tasks/activities, the evalua- trative qualification purposes into three levels:
tor modifies the task or activity to obtain A, B, and C. Levels A and B are objective tests
the optimal performance possible. and require the administrator/interpreter to have
4.B. Eval Svcs
a minimum of one course in tests and measure-
Intent Statements ments. Level C tests are subjective tests and
The focus is on the person’s ability to perform require that the interpretation of results be done
essential functions rather than on norms. by a professional who is certified by individual
Examples state or provincial requirements. The adminis-
tration, scoring, and reporting may be done
The evaluator may permit the individual to use
under the supervision/signature of a certified
any device necessary to complete the assessment.
professional. Please refer to the Standards for
Educational and Psychological Testing published
by the American Psychological Association
(APA).

3.B. 6. Evaluators using work samples to 3.B. 7. If career exploration activities are used:
provide assessments:
7.B. Eval Svcs
6.B. Eval Svcs

a. The focus is on interests and knowl-
a. Have knowledge and experience edge of the person.
with the work sample method/
7.a.B. Eval Svcs
b. Job analysis techniques identify

assessment. essential functions and explore ways
6.a.B. Eval Svcs
b. Follow written instructions to adapt the job and/or utilize devices

that specify: to compensate for loss of function.
6.b.B. Eval Svcs 7.b.B. Eval Svcs
(1) The materials used. c. Persons have opportunities to try

out and perform work tasks before
6.b.(1)B. Eval Svcs
(2) The equipment used.

6.b.(2)B. Eval Svcs
(3) The layout. vocational options are eliminated

6.b.(3)B. Eval Svcs
from consideration.
(4) Methods for administration. 7.c.B. Eval Svcs
6.b.(4)B. Eval Svcs
(5) Interpretation of scoring. Intent Statements

6.b.(5)B. Eval Svcs
Options and opportunities are not limited. Often

Intent Statements
vocational options that had been considered
Work sample methodology is documented not feasible, or perhaps not considered at all,
to ensure consistency in use. may become feasible through the use of assistive
Examples technology.
Best practices would use work samples that are
representative of realistic local job market oppor- 3.B. 8. Employment exploration sites that are
tunities. When there are some existing jobs that used for evaluations are assessed as to
the work samples do not replicate, attempts are their appropriateness for the person
made to access the related transferable skills. seeking employment with regard to:
8.B. Eval Svcs
Guidance can be found through the Department a. Adequacy of supervision.

of Labor’s Dictionary of Occupational Titles and
8.a.B. Eval Svcs
b. Safety.
related literature. In Canada, guidance can be 8.b.B. Eval Svcs
c. Specific work-site requirements.

found through job classifications set out by pro- 8.c.B. Eval Svcs
d. Potential job accommodations.

vincial/territorial ministries of labor. Career titles 8.d.B. Eval Svcs
can be found at www23.hrdc-drhc.gc.ca/ch/e/ e. Accessibility.

8.e.B. Eval Svcs
docs/ch_classification_structure.asp. To justify f. Expectations for quality and quantity

the development and use of particular work of work.
8.f.B. Eval Svcs
samples, the organization may make use of local g. Job/task analysis.

8.g.B. Eval Svcs
employment resources, employment offices, and h. Potential employment opportunity.

other methods of determining the nature of the 8.h.B. Eval Svcs
i. Other considerations identified as

local job market. appropriate to the individual.
Some work samples may require, depending on
8.i.B. Eval Svcs
Intent Statements
the person served, the use of assistive technology
or reasonable accommodations in the materials Employment exploration sites are assessed
and equipment used, methods for giving instruc- before placing a person there as part of a
program’s risk management.
tions, or safety precautions.
For additional guidance, see Section 3.Q. Examples
Assistive Technology Supports and Services Situational assessments can be accomplished
(AT). using simulated job stations or on-the-job evalu-
ations. Simulated job sites are located within the
organization. On-the-job evaluations are located
outside the organization. Both do not have to
be used unless the needs of a person served
are unmet with only one.

At on-the-job locations the person is given the e. Work and nonwork needs.
opportunity to experience the requirements
10.e.B. Eval Svcs
f. Intellectual capacities.
of the actual job, and the evaluation is often 10.f.B. Eval Svcs
g. Learning style, including ability

conducted by the job-site supervisor. The organi- to understand, recall, and respond
zation should ensure that Department of Labor to various types of instruction.
guidelines for paid work are followed. 10.g.B. Eval Svcs
h. Interests, aptitudes, and career

Related standards and supports may be found in aspirations.
Section 1.H. Health and Safety and Section 3.A. 10.h.B. Eval Svcs
i. Personal, social, and work-related

Employment Planning Services (EPS). behaviors.
10.i.B. Eval Svcs
j. Modes of communication.
3.B. 9. The evaluation report from a functional 10.j.B. Eval Svcs
k. Physical and psychomotor capacities.

capacities assessment identifies: 10.k.B. Eval Svcs
9.B. Eval Svcs l. Work skills and tolerances.

a. The person’s functional strengths 10.l.B. Eval Svcs
and needs. m. Job-seeking and job-keeping skills.

10.m.B. Eval Svcs
9.a.B. Eval Svcs
b. Accommodations/assistive technol- n. Knowledge of occupational

information.
ogy needed to enhance the person’s 10.n.B. Eval Svcs
capacities. o. Possible employment objectives,

9.b.B. Eval Svcs
c. Supports and resources available for including self-employment.

10.o.B. Eval Svcs
inclusion in the community. p. Customer service skills.

10.p.B. Eval Svcs
9.c.B. Eval Svcs
q. Attitude toward work.

Intent Statements 10.q.B. Eval Svcs
r. Understanding of work culture.

Functional assessments are comprehensive. 10.r.B. Eval Svcs
s. Identified health risks.

Examples 10.s.B. Eval Svcs
t. Identified safety risks.

To facilitate integration into the community, 10.t.B. Eval Svcs
Intent Statements
the report stresses abilities as well as strategies
to overcome barriers in order to enhance the The needs of each person served will dictate
person’s interdependence. the areas in which assessment is done.
These types of data elements are often collected Examples
in an organization’s demographic/characteristics Services do not have to assess every person’s
database. Analysis of these data may provide functioning in each of these areas.
information to modify or create services. Referral information may provide valuable
If a need for job accommodations seems insights to the evaluation process and results
apparent, information about the specific desired.
need is identified. Contracted services may be used to meet
the intent of the standard.
3.B. 10. Comprehensive vocational evaluation
services have the capability to assess 3.B. 11. The information in each evaluation
or obtain the following information: report:
10.B. Eval Svcs
a. Ability to learn about oneself as a 11.B. Eval Svcs
a. Answers the referral questions.

result of the information obtained 11.a.B. Eval Svcs
b. Includes recommendations, as
and furnished through the evaluation
appropriate, for training, employ-
experience.
10.a.B. Eval Svcs
ment, community resources, and
b. Assistive technology and reasonable job accommodations.
accommodations needed. 11.b.B. Eval Svcs
10.b.B. Eval Svcs c. Is shared in an understandable

c. Employment and community manner with the person seeking
supports needed. employment.
10.c.B. Eval Svcs
d. Environmental conditions needed. 11.c.B. Eval Svcs
10.d.B. Eval Svcs

d. Is disseminated in a timely manner Documentation Examples

to the referring agency individual The following are examples of the types of infor-
responsible for implementing the mation you should have available to demonstrate
report recommendations. your conformance to the standards in this sub-
11.d.B. Eval Svcs
e. Is relevant to the desired employ- section. See Appendix A for more information
ment outcome. on required documentation.
11.e.B. Eval Svcs
Intent Statements ■ Records of the persons served
The evaluation report identifies viable vocational ■ Evaluation plans and reports
options. ■ Testing results
Examples ■ Work sample written instructions
The evaluation report may include independent ■ Evidence of qualifications of the persons
living considerations; behavior observations; administering evaluation tests
proposed reasonable accommodations; recom- ■ Guidelines/procedures for techniques used
mendations for assistive technology; assessed
■ Policies and procedures for the evaluation
interests, aptitudes, and abilities; and specific
process
vocational recommendations or career options
based on the local job market.
11.b. When a specific job has been identified, if
necessary consult with an appropriate technology
specialist to identify specific worksite accommo-
dation strategies.
11.c. The report is shared in an understandable
manner with the person seeking employment.
This may mean some additional explanations and
supports are necessary for comprehension and
retention ( e.g., the person might desire to have a
personal advocate in attendance). When recom-
mendations are made for assistive technology
resources or services, exit interviews specifically
discuss use, maintenance/repair, and replacement
of assistive technology equipment. The responsi-
bilities of the employer, funders, and the person
to replace equipment over time are clarified.
An organization may consider asking in its out-
comes measurement system questions regarding
satisfaction with the outcomes of the items in this
standard. Follow-up may also provide insight
into the eventual result achieved by the person
seeking employment in comparison to the rec-
ommendations that were made.
11.d. “Disseminated in a timely manner” implies
that the persons served and significant stakehold-
ers were satisfied in the time it took to receive the
written report. Sharing the report with entities
beyond the referring entity individual and the
person served would require written permission
of the person served.

Targeted Employment Screening 3.B. 13. If an individual experiences difficulties

Services (TES) performing the tasks/activities,
the evaluator:
Description
13.B. Eval Svcs
a. Discusses the situation with the

The service model includes targeted personnel person served.
13.a.B. Eval Svcs
tests or samples of jobs designed to assess b. Identifies potential modifications

aptitudes/skills in a very specific, limited area required to meet a person’s
as identified by the employer/funder. Many specific needs.
organizations have contracts with funding 13.b.B. Eval Svcs
c. Implements strategies to use assistive

sources and/or community businesses that are technology or accommodation,
quite specific to the questions to be answered if possible, when a need is identified.
which will occur in a time-limited assessment 13.c.B. Eval Svcs
d. Documents any modification/

situation. The screening situation may be a adaptation and its effectiveness.
simulated business/work environment or specific 13.d.B. Eval Svcs
psychometrics per the community employment Intent Statements

opportunity. The focus is on the person’s ability to perform
essential functions rather than on norms.
Applicable Standards Examples
An organization seeking accreditation in The evaluator may permit the individual to use
targeted employment screening services any device necessary to complete the assessment.
must meet Standards 12.–17. in this section If technology needs or accommodations are indi-
and the standards in the following sections: cated due to functional limitations, it might be
helpful to consult with technology specialists.
■ 1.A. and 1.C.–1.N.; 1.B. Governance is
optional Resources
■ 2.A. Program/Service Structure, The Job Accommodation Network (JAN), a
Standards 1.–11. and 13. service of the President’s Committee on Employ-
ment of People with Disabilities, provides
Standards, Standard 5. only information about workplace accommodations.
JAN’s trained consultants have access to a
database of more than 200,000 previous accom-
modations to provide practical options. JAN can
3.B. 12. Targeted employment screening is based be reached at: 1-800-ADA-WORK or via email:
on the referral questions, including the jan@jan.idci.wvu.edu.
specific aptitudes/skills to be evaluated.
12.B. Eval Svcs
Intent Statements 3.B. 14. Personnel conducting psychometric

The needs of the referral source will dictate assessments meet the qualifications
the specific tests or work samples that would defined by state or provincial law,
be used to assess the person’s ability to perform as applicable.
14.B. Eval Svcs
the identified job. Intent Statements

Examples Qualified personnel conduct the evaluation
The screening service would inform the persons services in accordance with any applicable
seeking employment about the jobs for which it state or provincial laws and have the required
is conducting screening to ascertain the person’s credentials as established by the organization.
interest in screening for particular jobs and then Examples
would proceed accordingly. Evaluators have the qualifications and super-
vision identified as necessary to conduct

evaluations. Legal or regulatory requirements c. Modes of communication.

generally indicate that a vocational evaluator
16.c.B. Eval Svcs
d. Physical and psychomotor capacities.

or vocational specialist provides or supervises 16.d.B. Eval Svcs
e. Work skills and tolerances.

these assessments. 16.e.B. Eval Svcs
f.Customer service skills, attitude

toward work, and understanding
3.B. 15. Personnel administering work samples: of work culture.
15.B. Eval Svcs
a. Have knowledge and experience 16.f.B. Eval Svcs
g. Interpersonal and emotional aspects

with the work sample assessment. as observed in the assessment
15.a.B. Eval Svcs
b. Follow written instructions that process.

specify:
16.g.B. Eval Svcs
15.b.B. Eval Svcs Intent Statements

(1) The materials used.
15.b.(1)B. Eval Svcs The time-limited screening is designed and
(2) The equipment used. positioned to answer specific referral questions.
15.b.(2)B. Eval Svcs
(3) The layout.

Examples
(4) Methods for administration.
Service design is based on input from the referral
(5) Interpretation of scoring.
15.b.(5)B. Eval Svcs source. Often these referral sources might be
Intent Statements from special education departments or employ-
Work sample methodology is documented ment personnel departments.
to ensure consistency in use.
Examples 3.B. 17. The information gained from the
targeted employment screening:
Best practices would use work samples that are 17.B. Eval Svcs
representative of realistic local job market oppor- a. Answers the referral questions.
17.a.B. Eval Svcs
tunities. When there are some existing jobs that b. Is shared in an understandable
the work samples do not replicate, attempts are manner with the person served.
17.b.B. Eval Svcs
made to access the related transferable skills. c. Is relevant to the evaluation

Guidance can be found through the Department objective.
of Labor’s Dictionary of Occupational Titles and
17.c.B. Eval Svcs
d. Is shared with the funding source or

related literature. To justify the development and employer, as requested in the referral.
use of particular work samples, the organization 17.d.B. Eval Svcs
Intent Statements
may make use of local employment resources,
employment offices, and other methods of deter- The employment screening identifies
mining the nature of the local job market. viable vocational options.
Some work samples may require, depending on Examples
the person served, the use of assistive technology The screening may include behavior observa-
or reasonable accommodations in the materials tions; proposed reasonable accommodations;
and equipment used, methods for giving instruc- assessed interests, aptitudes, and abilities; and
tions, or safety precautions. specific vocational recommendations or career
options based on the local job market. When
3.B. 16. Based on the evaluation objective, tar- a specific job has been identified, if necessary
geted employment screening services consult with an appropriate technology specialist
can assess or obtain the following infor- to identify specific worksite accommodation
mation about a person: strategies.
16.B. Eval Svcs
a. Learning styles, including ability 17.b. The information is shared in an under-

to understand, recall, and respond standable manner with the person seeking
to various types of instruction. employment. This may mean some additional
explanations and supports are necessary for
16.a.B. Eval Svcs
b. Interests, aptitudes, and career

aspirations. comprehension and retention ( e.g., the person
16.b.B. Eval Svcs

Section 3.C. Community Employment Services
might desire to have a personal advocate in

attendance). When recommendations are made
C. Community
for assistive technology resources or services, exit Employment Services
interviews specifically discuss use, maintenance/
repair, and replacement of assistive technology Description
equipment. The responsibilities of the employer,
Community employment services assist persons
funders, and the person to replace equipment
to obtain successful community employment
over time are clarified.
opportunities that are responsive to their choices
17.c. An organization may consider asking in its and preferences. Through a strengths-based
outcomes measurement system questions regard- approach the program provides person-directed
ing satisfaction with the outcomes of the items in services/supports to individuals to choose,
this standard. Follow-up may also provide insight achieve, and maintain employment in integrated
into the result achieved by the person seeking community employment settings.
employment in comparison to the recommenda-
Work is a fundamental part of adult life. Individ-
tions that were made.
ually tailored job development, training, and
Documentation Examples support recognize each person’s employability
and potential contribution to the labor market.
The following are examples of the types of infor- Persons are supported as needed through an
mation you should have available to demonstrate individualized person-centered model of services
your conformance to the standards in this sub- to choose and obtain a successful employment
section. See Appendix A for more information opportunity consistent with their preferences,
on required documentation. keep the employment, and find new employment
■ Records of persons served if necessary or for purposes of career
■ Personnel records advancement.
■ Written instructions for work samples Such services may be described as individualized
■ Documentation related to results of
competitive employment, individual placements,
screenings contracted temporary personnel services, com-
petitive employment, supported employment,
transitional employment, mobile work crews,
contracted work groups in the community, com-
munity-based SourceAmerica® contracts, and
other business-based work groups in commu-
nity-integrated designs. In Canada, employment
in the form of bona fide volunteer placements is
possible.
Individuals may be paid by community employ-
ers or by the organization. Employment is in the
community.
The following service categories are available
under Community Employment Services (please
refer to the indicated page for program descrip-
tions and applicable standards):
■ Job Development (CES:JD)—page 216
■ Employment Supports (CES:ES)—page 222
NOTE: If an organization provides only Job Develop-

ment or Employment Supports, then it may be
accredited for only that service. If it is providing

both Job Development and Employment Supports, Job Development (CES:JD)

then it must seek accreditation for both.
In making the determination of what an organi- Description
zation is actually providing in comparison to Successful job development concurrently uses
these service descriptions, these factors are con- assessment information about the strengths and
sidered: the mission of the services, the program interests of the person seeking employment to
descriptions, brochures and marketing image for target the types of jobs available from potential
these services, and the outcomes of the services. employers in the local labor market. Typical job
If any clarification is needed, please contact your development activities include reviewing local
CARF resource specialist. There is no charge for employment opportunities and developing poten-
consultation. tial employers/customers through direct and
indirect promotional strategies. Job development
may include facilitating a hiring agreement
between an employer and a person seeking
employment. Some persons seeking employment
may want assistance at only a basic, informational
level, such as support for a self-directed job search.
Some examples of the quality outcomes desired
include:
■ Persons obtain community employment.
■ Persons obtain individualized competitive

employment.
■ Employment matches interests and desires
of persons.
■ Wages, benefits, and hours of employment
achieved as desired.
■ Average number of hours worked per week
increases.
■ Average number of hours worked per week
meets the desires of the person served.
■ Full-time employment with benefits.
■ Transition-age youth move directly from

their educational environment into
community employment.
■ Job retention/length of employment.
■ Potential for upward mobility.
■ Self-sufficiency.
■ Integration.
■ Responsive services.
■ Safe working conditions.
■ Cost-effective for placement achieved.
■ Reasonable length of time from referral

to placement.
■ Employers satisfied with the services.

Intent Statements
Applicable Standards Job placement services use an individualized,
An organization seeking accreditation for com- person-centered process to assist persons to
munity employment services: job development identify, obtain, and/or advance in employment.
must meet Standards 1.–5. in this section and Examples
the standards in the following sections:
Employment preparation services/supports
typically include:
optional
■ Assessing the appropriateness of the referral
■ 2.A. Program/Service Structure
for job placement services.
■ Analyzing pertinent findings from medical,
Design, and Delivery psychological, or prior vocational services
■ 2.C. Medication Monitoring and Manage- and/or work adjustment services and any
ment (as applicable; see page 148) special considerations such as using public
■ 2.D. Employment Services Principle transportation in order to maximize the
Standards person’s employment opportunities.
■ 2.E. Workforce Development (optional) ■ Counseling and/or teaching of individuals
■ 2.J. Autism Spectrum Disorder Specific Pop-

and/or groups techniques for obtaining and
ulation Designation (ASD:A only, optional) maintaining employment.
■ Assisting the persons served to become
NOTE: Standards 1.H.7., 1.H.13., and 1.H.14.
(Section 1.H. Health and Safety) are not applied to
knowledgeable about job duties, personnel
community sites where persons served are working. benefits, rates of pay, employment policies
These sites are not considered to be facilities of the and practices, and the job location prior to
program being used for service delivery, but rather job acceptance.
are employment sites of the person served. If any ■ Eliciting information about job preference,
clarification is needed, please contact a resource salary expectations and needs, insurance
specialist in the Employment and Community needs, transportation needs, and hours and
Services customer service unit. days that the person is available to work.
■ Assisting the person served to become knowl-
3.C. 1. Job development planning uses a edgeable regarding the impact of employment
strengths-based approach that consid- on disability and other benefits as well as pro-
ers, as appropriate to the person served: viding information on the means available to
1.C. CES
a. The person’s preferences. access such benefits. It is important that this

1.a.C. CES
b. Successful aspects of work history. information be provided by qualified person-

1.b.C. CES
c. Noted strengths and abilities from nel or external authorities. See also Section
volunteer experience or hobbies. 3.S. Comprehensive Benefits Planning (CBP).
Career counselors, job developers, and individual
1.c.C. CES
d. Successful aspects of previous train-

ing, education, and life experiences. job seekers can use formal and informal assess-
1.d.C. CES
e. The management and planning of ments for a variety of purposes:

benefits the person is receiving. ■ To clarify a job seeker’s likes and dislikes.
1.e.C. CES
f. Resources for career planning ■ To uncover individual strengths and talents.

and advancement. ■ To connect skills to interesting occupations.
1.f.C. CES
g. Transportation availability. ■ To identify which, if any, work accommoda-

1.g.C. CES
h. Availability of mentors and natural tions are needed.

supports. ■ To pinpoint the settings where target jobs
1.h.C. CES
i. Legal history, if applicable. occur and, more importantly, where the

1.i.C. CES
job seeker will be happiest.

Assessment activities provide the job developer b. Are tracked in a systematic manner
with invaluable material for matching a job to ensure ongoing monitoring until
seeker’s interests, skills, and abilities to the right employment is achieved.
job. Some examples of informal assessment
2.b.C. CES
c. Are revised periodically, as necessary.

activities that can help guide the job search are: 2.c.C. CES
Intent Statements
■ A “career autobiography”—a narrative
Individual plans are based on informed choices
description of the hobbies, interests, educa-
and input from the person served and are kept
tion, training, and volunteer and paid work
relevant. The person served is involved in plan-
experiences that make them who they are
ning and makes the decision about whether to
today. The skillful job developer will use the disclose his or her disability.
autobiography to identify themes recurring
throughout the person’s personal history Examples
that indicate the kinds of activities he or she Job development and placement services would
gravitates toward, enjoys, and excels at. include:
■ Quick “paper and pencil” checklists, available ■ Contacting employers to develop and/or
from a variety of sources, are useful for inter- identify job opportunities for persons seeking
acting with and getting to know job seekers. employment.
Look for ones covering a wide range of skills ■ Maintaining communication and coordina-
and abilities and that include a rating scale tion with other community agencies and
which job seekers can use to indicate the resources.
degree to which they have mastered each skill.
■ Maintaining an organized system of recording
If possible, complete skills inventories with
job openings including the names of employ-
candidates and use the opportunity to explain
ers, persons referred, and actions taken.
what is being asked and to prompt recall of
all relevant experiences. ■ Providing feedback of information to other
personnel regarding community employment
■ “Testimonials” about strengths, accomplish-
opportunities and labor market trends.
ments, and abilities gathered from peers,
teachers, parents, and past employers provide An individual service plan for a person served may:
external validation and help round out the ■ Integrate the results and/or recommendations
picture. from other services.
The job developer then synthesizes all of the ■ Contain the job objective(s) and the roles and
information collected through formal and infor- responsibilities of the individual providing
mal assessment activities and reflects back the placement and the person served.
important highlights and themes to job seekers ■ Consider career planning, including job
in an organized way. advancement and job changes.
Refer to related standards in Section 2.B. ■ Identify criteria for wage increases, including
Individual-Centered Service Planning, Design, productivity, longevity, and skill level.
and Delivery.
■ Specify short- and long-term goals and
objectives related to employment.
3.C. 2. Individual service plans for job develop- ■ Identify opportunities for integration and
ment are individualized to the person independence.
seeking employment and:
2.C. CES
■ Utilize generic integrated community
a. Involve his or her:
2.a.C. CES resources to meet nonwork needs.
(1) Input.
2.a.(1)C. CES ■ Identify short- and long-term support
(2) Approval. needed, including such supports as financial
2.a.(2)C. CES
resources, natural supports, and assistive

technology.

■ Consider ancillary support services, e. Assisting the job applicants in finding

if needed. jobs and employers well matched to
■ Specify the length of time for which follow-up their employment goals.
3.e.C. CES
contact will be maintained, primarily based f. Education and support in:

3.f.C. CES
on the person’s needs. (1) Self-directed job search,

It is a good practice to review the plans of persons when appropriate.
3.f.(1)C. CES
referred for job placement services who have not (2) ADA rights and EEOC.
3.f.(2)C. CES
been placed at least every 30 days. Consultation g. Disability awareness education to

occurs with the person, other appropriate profes- the employer, when indicated.
sional personnel, and/or the referral source to
3.g.C. CES
Intent Statements
determine if the placement plan should be
amended. Job developers maintain active relationships
with employers to promote employment
Individual job development plans for persons opportunities for persons.
seeking employment in crews, enclaves, etc.
consider the specific tasks to be performed Examples
and match the persons’ talents, interests, and The organization enhances relationships with
strengths to the opportunities available. Also the community employers by:
consider providing information on available ■ Providing for close cooperation between
job opportunities to persons who may currently the organization and community employers
be working in crews, enclaves, etc. through such mechanisms as a business
See also related standards in Section 2.B. advisory council, membership in community
Individual-Centered Service Planning, Design, employer associations, business forums,
and Delivery. and/or formal relationships with public
and private schools.
3.C. 3. Job development activities include, ■ Providing on-site job analysis, consultation,
depending on the needs of the and recommendations for work-site and job
individual served: modification and customized employment,
3.C. CES
a. Contacting employers and building when appropriate.

networks to develop and/or identify ■ Assisting employers to identify, modify,
job opportunities. and/or eliminate architectural, procedural,
instructional, communication, and/or
3.a.C. CES
b. Providing access to information

about current job openings. attitudinal barriers to employment.
3.b.C. CES
c. Work-site analysis, as needed. ■ Educating employers about various disabili-

3.c.C. CES
d. Supports that assist the person ties and resulting vocational implications,
served in an individual site, including: assistive technology devices, job accommoda-
3.d.C. CES
(1) Job-site consultation to identify tions, services provided by the organization,

or modify barriers to incentives to the employer, and current
employment. disability-related legislation affecting the
3.d.(1)C. CES
employer.
(2) Negotiating:
3.d.(2)C. CES
(a) Job carving. During job-site consultation, recommendations

3.d.(2)(a)C. CES
may be made for customized employment. This
(b) Job accommodations.
3.d.(2)(b)C. CES may include work-site and job modification
(c) Job sharing. and assisting employers to identify, modify,
3.d.(2)(c)C. CES
(3) Natural supports in the and eliminate barriers to the employment

workplace. and advancement of the persons served.
3.d.(3)C. CES
Best practices for contracted work groups and

other personnel designs for employers often

include clear guidelines in a written format

outlining the roles and responsibilities of the
3.C. 4. The services ensure that the new
employee is provided information:
community-based employer and the accredited 4.C. CES
organization. a. Needed to be appropriately oriented

to the:
3.a. Job developers in rural areas often are more 4.a.C. CES
successful through building face-to-face relation- (1) Job.

4.a.(1)C. CES
ships with employers so that when the employer (2) Work culture.
4.a.(2)C. CES
does have an opening, they are first to be con- b. As is available to all employees.
4.b.C. CES
tacted. Job developers in large urban areas may Intent Statements

also have success with random lead generation
Complete orientation of new employees helps
by cold calling and asking if the employer is
ensure success.
hiring and has the opening been posted yet.
Examples
Resources
Information provided directly by the developer
The National Technical Assistance Partnership
or the employer includes:
(NTAP) (www.gwcrcre.org/ntap/) provides
technical assistance (TA) in areas of national ■ The conditions of maintaining employment.
need identified in consultation with the Rehabili- ■ Job description.

tation Services Administration (RSA) and the ■ Responsibilities of the employee.
■ Wage payment practices.
(TACE) Centers.
■ Rate of pay.
The State Employment Leadership Network
■ Benefits provided by the business.
(SELN) (www.seln.org) is a multi-state technical
assistance collaborative established to improve ■ Work rules and customs.
employment outcomes for adults receiving devel- ■ Nondiscrimination practices.

opmental disabilities services in the U.S. Working ■ Conflict resolution procedures.
in partnership with the National Association of
■ Policies for transfer.
State Directors of Developmental Disabilities
Services and the Institute for Community Inclu- ■ Employee classifications in the business.
sion at the University of Massachusetts Boston as ■ Health and safety practices.

a community of practice, SELN assists states in ■ Union membership policies, if applicable.
developing effective employment systems by
■ Potential for career growth.
maximizing available state and federal resources
through improved rate and payment systems, ■ Job advancement.
using data to guide daily program management ■ Conditions for advancement.

and system performance, sharing resources of ■ Employment options available in the business.
both time and knowledge, and providing ongoing
■ Career opportunities and requirements.
technical assistance and training. Currently,
■ Job retention.
seventeen member states participate in SELN.
■ Improved benefits.
Another resource for establishing successful
employer partnerships is Developing Effective Information is given to the person served in a
Partnerships with Employers as a Service Delivery manner that is understandable to that person.
Mechanism, which was published by Stout These informational items may be given in a
Vocational Rehabilitation Institute in June 1997. variety of ways—classroom instruction, advocacy
groups, website listings, handbooks, etc.

Best practices include keeping records of persons To develop a successful business relationship and
who have been placed in outside employment reputation with local employers, the organization
that contain, at a minimum: must maintain an employer-responsive, cus-
■ Place of employment. tomer-designed service and partnership. This
creates a win-win situation for both the employer
■ Job title.
and the organization, thus opening the door for
■ Rate of pay and fringe benefits.
future placements.
■ Date on which employment commenced.
■ Employment status following Documentation Examples

commencement. The following are examples of the types of infor-
■ Name of the immediate supervisor, if mation you should have available to demonstrate
available, at the work site. your conformance to the standards in this sub-
See Section 2.B. Individual-Centered Service on required documentation.
Planning, Design, and Delivery for additional
■ Employment information or a handbook
guidance and related standards.
3.C. 5. If the person served has authorized dis- ■ Progress notes
closure, the organization provides the ■ Job development activity records

employer with information about or ■ Records of the persons served
access to resources as needed regarding:
5.C. CES ■ Systems for recording job openings
a. Job modifications and/or reasonable and contacts
accommodations.
5.a.C. CES ■ Assessment information
b. Federal, state, provincial, or employer
■ Local job market information
tax credits, if applicable.
■ Assessment of work sites
5.b.C. CES
c. Supports available from the organiza-

tion, including a staff contact person.
5.c.C. CES
Intent Statements
If authorized by the person, potential employers
are made aware of the resources the organization
can provide to support a continued successful
employment outcome.
Examples
Employers are provided with complete infor-
mation about supports and assistance that
can be provided by the organization and the
mechanisms to obtain the assistance, such
as the availability of job coach services.
The organization’s job development staff may
offer guidance on communication, simple
redirection, and positive reinforcement
suggestions for motivation.
The organization might inform or provide
a resource to the employer about tax credits
and disability-related legislation that may
affect the employer.

Employment Supports (CES:ES) ■ Increase in hours worked.

■ Increase in pay.
Description ■ Employment retention.
Employment support services are activities that ■ Full-time employment.
are employment-related to promote successful
training of a person to a new job, job adjustment,
retention, and advancement. These services are ■ Increase in natural supports from co-workers.
based on the individual employee with a focus ■ Persons served treated with respect.
on achieving long-term retention of the person ■ Increase in participation in the community.
in the job. ■ Minimize length of time for supports.
The level of employment support services ■ Type and amount of staff interaction
is individualized to each employee and the meets needs.
complexity of the job.
■ Job/career advancement.
Often supports are intensive for the initial
orientation and training of an employee with ■ Employer satisfaction.
the intent of leading to natural supports and/or ■ Satisfaction outcomes that reflect needs and
reduced external job coaching. However, some expectations of the employee are met.
persons may not require any employment sup- ■ Responsiveness to customers.
ports at the job site; others may require intensive ■ Job club to provide a forum for sharing
initial training with a quick decrease in supports, experiences.
while some will be most successful when long-
term supports are provided.
Supports can include assisting the employee with Applicable Standards
understanding the job culture, industry practices, An organization seeking accreditation for
and work behaviors expected by the employer. community employment services: employment
It may also include helping the employer and supports must meet Standards 6.–14. in this
coworkers to understand the support strategies section and the standards in the following
and accommodations needed by the worker. sections:
Supports are a critical element of the long-term ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
effectiveness of community employment. Sup- optional
port services address issues such as assistance in ■ 2.A. Program/Service Structure
training a person to complete new tasks, changes
in work schedule or work promotion, a decrease
in productivity of the person served, adjusting
to new supervisors, and managing changes in ■ 2.C. Medication Monitoring and Manage-
nonwork environments or other critical life activ- ment (as applicable; see page 148)
ities that may affect work performance. Routine ■ 2.D. Employment Services Principle
follow-up with the employer and the employee Standards
is crucial to continued job success. ■ 2.E. Workforce Development (optional)
Some examples of the quality outcomes desired ■ 2.J. Autism Spectrum Disorder Specific Pop-
by the different stakeholders of these services ulation Designation (ASD:A only, optional)
include:
NOTE: Standards 1.H.7., 1.H.13., and 1.H.14.
■ Performance level achieved meets require-
(Section 1.H. Health and Safety) are not applied to
ments of job or position. community sites where persons served are working.
■ Increase in skills. These sites are not considered to be facilities of the
■ Increase in hours worked independently.
program being used for service delivery, but rather
are employment sites of the person served. If any
■ Increase in productivity.
clarification is needed, please contact a resource

specialist in the Employment and Community process can help break down employment barri-
Services customer service unit. ers by encouraging individuals with disabilities to
take a more active role in planning and pursuing
3.C. 6. Training strategies include, as needed: their careers. Conducting mentoring programs
6.C. CES
a. On-site or off-site consultations. provides employers with access to new talent

6.a.C. CES
and an often underutilized workforce. It also
b. Decreasing the trainer’s presence
promotes greater awareness and understanding
on the job site.
6.b.C. CES of disabilities in the workplace.
c. Transferring training and support
to natural supports, when available. The length of participation in job-site training
6.c.C. CES is determined by the strengths, abilities, needs,
d. Mentoring.
6.d.C. CES
and preferences of the person served and may
e. Referral to support groups or be of unlimited duration.
employee assistance programs,
if appropriate and available.
6.e.C. CES 3.C. 7. When the organization provides supervi-
Intent Statements sion at the community employment site:
7.C. CES
Training strategies are individualized to the a. The support staff has sufficient
person and placement. knowledge of the industrial and
Examples programmatic aspects of the
assignment.
6.c. The design and implementation of the 7.a.C. CES
training plan to transfer: b. Backup contingency plans exist in the

event of the support staff’s absence
■ Facilitates integration at the work site through
or tardiness.
social interaction, physical proximity, partici- 7.b.C. CES
c. The support staff follows industry

pation in social activities available to all
and workplace practices.
employees, and opportunities for supervision 7.c.C. CES
by nonprogram personnel. d. The support staff is able to communi-

cate effectively with staff at all levels
■ Promotes the presence and participation
within the employment site.
of the person served in natural proportions 7.d.C. CES
in both work and nonwork activities. Intent Statements

■ Promotes opportunities for work site inte- The organization trains personnel to manage
gration during the organization’s marketing field-based services.
and job development activities within the Examples
industry.
Some staff training topics may include:
When appropriate, a plan to transfer supervision ■ Documentation and record keeping.
and/or support from the organization to the
■ Facilitation of use of natural supports.
employer is developed. Based on the strengths,
abilities, needs, and preferences of the person ■ Personal counseling.
served, the organization facilitates the develop- ■ Functional skills training.

ment of natural supports. ■ Medication management.
6.d. Mentoring is an on-the-job educational pro- ■ Incident reporting.
cess that provides opportunities for professional
■ Legal requirements and hiring practices
development, growth, and support for the person
(e.g., Americans with Disabilities Act
being mentored. Individuals receive information,
and Department of Labor).
encouragement, and advice from their mentors,
■ Legal requirements and hiring practices
who are experienced in the career field of the
person being mentored. set out by provincial/territorial ministries
of labor.
Individuals with disabilities continue to face atti-
■ Positive training and support.
tudinal barriers in employment. The mentoring

■ Prevention/reporting of neglect and abuse. ■ Financial management including techniques

■ Public relations and marketing for of purchasing, banking, handling taxes,
the organization. budgeting, and repaying debts.
■ Reasonable accommodation including ■ Functional academic skills.
assistive technology. ■ Health maintenance (e.g., personal hygiene,
■ Social skills training. exercise and fitness, nutrition and diet man-
agement, infection control, and use of medical
■ Work environments including negotiating
services and medicine).
skills, interacting with supervisors, under-
standing of employer needs and expectations, ■ Housekeeping and home maintenance skills.
and organized labor. ■ Human sexuality.
Workplace practices include such areas as dress, ■ Interpersonal relationships including those
grooming, appropriate identification, access to with the person’s spouse, family, and friends.
common areas, etc. ■ Life issues and transitions (e.g., leaving home,
See Sections 1.H. Health and Safety and 1.I. substance abuse, parenting, divorce, retire-
Human Resources and Standards 1.G.1. and ment, and death).
2.B.7. regarding risk management and ■ Management of personal and legal affairs.
assessment. ■ Menu planning and meal preparation.
■ Mobility and community transportation
3.C. 8. Any nonwork needs of the person served skills.
that may impact employment are:
8.C. CES ■ Recreational activities.
a. Identified.
8.a.C. CES ■ Safety practices including dealing with
b. Addressed through one of the
injuries and life-threatening situations.
following:
8.b.C. CES
■ Self-advocacy and assertiveness training.
(1) Referral to supportive services.
8.b.(1)C. CES
(2) The individual planning process. ■ Use of the telephone.

8.b.(2)C. CES
c. Monitored. ■ Utilization of community services

8.c.C. CES
and resources (e.g., laundromats, the library,
Intent Statements post office, and consumer affairs office).
The organization understands that nonwork
See Section 2.B. Individual-Centered Service
needs that affect employment potential must
Planning, Design, and Delivery.
be addressed.
Examples 3.C. 9. Individualized support services to main-
Based on the choices and needs of persons tain employment address, as needed:
served, the organization provides, arranges, or 9.C. CES
a. Knowledge of attendance and

refers the person for support and training in: punctuality expectations.
■ Daily living tasks.
9.a.C. CES
b. Demonstration of grooming skills,

■ Communication skills. appropriate hygiene, and appropri-
■ Consumer affairs and rights (e.g., familiarity
ate work attire.
9.b.C. CES
with warranties and policies and procedures c. Job-site safety practices.

9.c.C. CES
of governmental and community service d. On-the-job performance skills related

agencies). to quality and quantity of work.
9.d.C. CES
■ Contingency planning, problem solving, e. Work-related community skills such

decision making. as time management, mobility, and
■ Developing socially and age-appropriate
money management skills.
9.e.C. CES
behaviors. f. Work-related communication skills.

9.f.C. CES

g. Work ethics and job expectations. Specific education supports and services regard-
ing work-related skills are available based on the
9.g.C. CES
h. Health maintenance and medication

management. person’s needs and preferences. Supports and
9.h.C. CES
i. Corporate or work culture, including services should be flexible enough to meet the
things such as chain of command, need of the person at his/her functioning level
work relationships, and grievance and preferences and not require the person to
procedures. receive training in skills that are already achieved.
9.i.C. CES
j. Knowledge of governmental and Work-related community skills may include

community service agencies to sup- supports and services for such matters as how
port work success. the individual will plan for his/her lunches,
9.j.C. CES
k. Information related to how to access how to deal with transportation problems,

these services. and how to cash checks.
9.k.C. CES
l. Functional job-related literacy skills.

9.l.C. CES
m. Work-related academic skills.

3.C. 10. Individual support activities address,
9.m.C. CES as needed, integration into the
n. Knowledge of work practices. employment setting.
9.n.C. CES
o. Work-related technology. 10.C. CES
9.o.C. CES
p. Self-advocacy and assertiveness

skills.
9.p.C. CES 3.C. 11. Ongoing job support services to
Intent Statements retain employment are provided at
The services and supports provided by the times and locations suited to meet
organization cover a sufficient array of work- the needs and desires of the:
related skills and knowledge necessary to assist
11.C. CES
a. Person served.
persons to understand the meaning, value, 11.a.C. CES
b. Employer.
and demands of work, as well as how to access 11.b.C. CES
services and supports when necessary. The Intent Statements

individual support services related to maintaining Supports are convenient to all stakeholders.
employment should assist individuals served
to develop personal characteristics, attitudes, Examples
and work behaviors, and enhance functional The services/supports may be provided at the
capacities to continue success in employment. employment site itself or at another location
off-site if this better meets the person’s needs.
Examples
Supports to help those served to retain employ-
Ongoing individual input and preferences,
ment may be time limited or ongoing, and
coupled with the person’s strengths/skills, are
may be provided by the organization or through
essential to achieving employment goals and
affiliation, association, or other agreements
reaching maximum employment potential.
that enhance the success of the person served.
To ensure success, the person served is oriented
Support may be given to the employer’s person-
to the expectations of the employer and what is
nel as a strategy for transferring supervision from
required to maintain the job. Items covered in
the organization to the employer and reducing
this standard can be addressed in real paid work
the need for paid support services. Postemploy-
activities where the person served gets hands-on
ment and follow-up services are designed to
experience with the demands of the world of
promote adequate job adjustment and retention.
work, in a classroom-type setting, or an individ-
ual guidance session from staff. Literature and
contacts for other community services may be
of assistance to persons served.

When the organization provides supervision The staff is aware of persons’ progress and their
and training at the work site, the supervisor potential desire to advance or consider an alter-
or trainer is knowledgeable of: native career path. The organization is able to
■ The type of work performed in the assist persons in developing a plan to achieve
assignment. alternative career goals and assist them in such
pursuits if they desire. If the training that is
■ The rehabilitation techniques appropriate
required to reach new goals is outside the organi-
to the persons served to support them and
zation’s level of expertise, it may refer the person
promote adequate performance.
served to another resource. Documentation
supporting these activities may be found in
3.C. 12. For persons who are receiving long- the case record.
term services, there is review at least
semiannually of the level of ongoing
supports needed with the:
3.C. 14. The program provides or arranges for
12.C. CES employment crisis intervention services
a. Person served. when needed by a person served.
12.a.C. CES
b. Employer, as appropriate. 14.C. CES
12.b.C. CES
Intent Statements
Intent Statements
Individuals may have a need for crisis interven-
The level of support is individualized and tion services. The organization should ensure that
changes as needs change. these services can be accessed as necessary.
Examples Examples
A documented system is in place to provide Critical incidents may arise that require an
organized support contacts at regular intervals organization to assist the person served to resolve
with the persons served. As appropriate, contact a crisis that could disrupt the continuity of
at regular intervals is made with the employer. employment.
Follow-along supports would be documented. The program recognizes the value of crisis inter-
With the permission of the person served, per- vention services in supporting persons through
sonnel maintain communication with family recurring mental health issues or cycles. Based on
members and others who are likely to influence the person’s preferences, strengths, and needs, the
the probability of successful outcomes. employment service plan identifies the type of
crisis services that may be needed as well as the
3.C. 13. Based on the aspirations of the person action that may be necessary to resolve the crisis.
served, the program provides or refers The work plan would include, but not be limited
the person to resources for career to, emergency contacts, individual preference for
planning and advancement. psychiatric/medical care, and what works best
13.C. CES
for the individual during a crisis. Although each
Intent Statements crisis is different, it helps to have a general idea
The organization ensures that it has the availabil- of what level of intervention may be comfortable
ity of or linkages to other resources to improve and required for the individual.
the employment situation of persons served by If the person has an advance health care directive,
supporting them in additional training, educa-
it is available and used by the organization.
tion, and advocacy, according to the employment
service plan.
Examples
When an individual decides that an alternative
job or location is desirable, the organization
supports the person in the transfer process.

Section 3.D. Self-Employment Services (SES)
Documentation Examples D. Self-Employment

mation you should have available to demonstrate Services (SES)
section. See Appendix A for more information Description
on required documentation. Self-employment presents an opportunity for
■ Individual service plans persons with disabilities to gain financial equity
■ Information regarding community services often not available through wage employment in
and resources entry-level positions. Self-employment services
■ Documentation of services provided
provide supports that lead an individual toward
earning income directly from one’s own business,
■ Progress reports
trade, or profession, rather than as salary or
■ Staff training records wages from an employer. They may include
■ Training plans small business development, micro-enterprise,
■ Task analysis
or telecommuting. In order to achieve a desired
level of income, an individual may have several
■ Local job market information
enterprises.
■ Job development activity records
Some of the quality results desired by the differ-
■ Assessments of work sites ent stakeholders of these services may include:
■ Earnings.
■ Successful self-employment.
■ Increased self-esteem.
■ Independence.
■ Self-sufficiency.
■ Employment in the community.
An organization seeking accreditation in
self-employment services must meet the
standards in this section and the standards
in the following sections:
optional

ment (as applicable; see page 148)
■ 2.J. Autism Spectrum Disorder Specific

Population Designation (ASD:A only,
optional)

NOTE: Standards 1.H.7., 1.H.13., and 1.H.14. Examples

(Section 1.H. Health and Safety) are not applied to The business plan would address, at a minimum:
community sites where persons served are working.
■ The proposed service or product.
These sites are not considered to be facilities of the
program being used for service delivery, but rather ■ Analysis of the needs of present and potential
are employment sites of the person served. If any customers for the proposed service
clarification is needed, please contact a resource or product.
specialist in the Employment and Community ■ Assessment of the person’s capabilities to
Services customer service unit. deliver the proposed business.
■ Mission statement and business goals.
3.D. 1. Informed choice of a person served who ■ Description of the market area to be served.
expresses interest in self-employment is
■ Customer profile.
facilitated through discussion with him
or her of at least the following: ■ Identification of competitors.
1.D. SES
a. Feasibility. ■ Potential impacts of changes and trends in

1.a.D. SES
b. The potential market. the business environment (risk analysis).

■ Ongoing supports (consideration for business
1.b.D. SES
c. Financial considerations.
1.c.D. SES
d. The potential impact on the administration, bookkeeping, and sales and

person’s benefits. marketing).
■ Operating and control systems.
1.d.D. SES
e. Economic goals.
■ Break-even analysis.
1.e.D. SES
Intent Statements
■ Start up costs.
Self-employment is not for everyone. Before
beginning, the organization ensures that the ■ Cash flow analysis.
person has thoroughly explored his or her ■ Potential networking opportunities.

responsibilities regarding self-employment ■ Establishment of a distinct business identity.
services and has made an informed choice.
The organization would establish procedures
Examples for evaluating the self-employment plan. A small
Some things to consider include the set of values business consultant may be a valuable resource
that motivates the person, the issue of isolation in the planning and implementation of the self-
versus integration, who the self-employment employment plan. An appeal process may need
benefits, the availability and quality of supports, to be established if the person served does not
financial benefits planning, and the potential agree with the decisions. Best practices suggest
of the business idea. policies and procedures that detail the responsi-
bilities of the person served and the business
3.D. 2. The organization assists the person consultant are critical to success.
served directly or through referral Resources
to develop a business plan.
2.D. SES The Small Business and Self-Employment Service
Intent Statements (SBSES) can provide comprehensive information,
Development of a business plan is a critical counseling, and referrals about self-employment
component when a choice has been made and small business ownership opportunities
to pursue self-employment. for persons with disabilities. The SBSES can
answer questions about starting a business or
self-employment practice from persons with
disabilities, service providers, and anyone else
with an interest in promoting these as career
choices for persons with disabilities. The SBSES
can also provide information and referrals about

managing a business and disability issues.

Another resource that might be helpful is the
3.D. 4. The organization assists the person
seeking self-employment directly
CARF publication, The Self-Employment Option:
or by referral in the implementation
An Introductory Guide to Microenterprise for
of the plan.
Individuals with Disabilities, which is available 4.D. SES
on request from your CARF resource specialist. Intent Statements

The organization ensures that the person
3.D. 3. The organization assists the person receives needed supports.
to develop a self-employment plan Examples
of implementation, which includes:
3.D. SES A number of community resources may be
a. Setting priorities. considered. Among them are small business
3.a.D. SES
b. Addressing needs of doing business development councils, service corps of retired

such as required business practices, executives, women’s business centers, and other
equipment, physical plant, communi- small business consultants such as Association
cations, and staff/supports. of Enterprise Opportunities.
3.b.D. SES
c. The budget for implementation Small business consultant means a qualified per-
of the self-employment plan. son who, by education, training, and experience,
3.c.D. SES
d. Startup costs. is knowledgeable about factors that contribute

3.d.D. SES
e. Operating and control systems. to successful and profitable small businesses.

3.e.D. SES
f. Cash flow analysis. Ongoing supports may be needed in the

3.f.D. SES
g. Ongoing supports, including: implementation of the plan. Among them may

3.g.D. SES
(1) Business administration. be considerations such as arranging audits or

3.g.(1)D. SES
(2) Bookkeeping. improving advertising or marketing.

3.g.(2)D. SES
(3) Sales and marketing. Additional Resources

3.g.(3)D. SES
Intent Statements The CARF publication The Self-Employment

The organization provides support in developing Option: An Introductory Guide to Microenterprise
all aspects of the plan. for Individuals with Disabilities, which is available
Examples
on request from your CARF resource specialist,
may provide additional information regarding
Marketing aspects of the business include: practice in the field. This publication hits the
■ Identifying the target audience. high points of small business ownership strate-
■ Messages and methods for reaching gies for prospective business owners and their
these target audiences. supporters. This guide is for those who focus
■ Marketing costs.
on the possibilities for success instead of the
risk for failure. Self-employment presents an
■ Responsibilities for plan implementation.
opportunity for persons with disabilities to gain
The needs of doing business may consider: financial equity often not available through wage
tools and equipment, initial stock and supplies, employment or through working in the ubiqui-
advertising, modification to real property, rent tous string of entry-level positions assigned to
on equipment, insurances, bookkeeping services persons with disabilities. Includes actual case
(reporting and paying sales and payroll taxes), examples, a sample business plan, forms to
vehicle purchase or modification, business cards, organize your development process, and answers
and repairs to equipment. to frequently asked questions.

Section 3.E. Employee Development Services (EDS)
Documentation Examples E. Employee Development

mation you should have available to demonstrate Services (EDS)
on required documentation. Employee development services are individual-
■ Business plans for micro-enterprises ized services/supports that assist persons seeking
of persons served employment to develop or reestablish skills, atti-
■ Marketing information tudes, personal characteristics, interpersonal
■ Individual service plan
skills, work behaviors, functional capacities, etc.,
to achieve positive employment outcomes.
■ Business records
Such services/supports are time limited and
can be provided directly to persons seeking
employment or indirectly through corporate
employer/employee support programs. These
services/supports can be provided at community
job sites, within formal and organized training
and educational settings, through coaching, by
tutorial services, or within the organization.
These services may be offered in a free-standing
unit or as a functional piece of other services.
include:
■ Person served obtains employment.
■ Person served moves to a training program

or better employment.
■ Person served retains his or her job.
■ Person served obtains improved benefits.
■ Increased wages.
■ Increased skills.
■ Increased work hours.
■ Movement to individualized competitive

employment.
■ Employment in an integrated environment.
■ Job advancement potential increases.
■ Job-seeking skills are developed.
■ Job-keeping skills are developed.
■ Career growth and development.
■ Level of support needed is reduced.
■ Exposure to and availability of a variety

of jobs.
■ Program is kept at capacity.
■ Services are cost-effective for the results

achieved.

■ Responsiveness (days from referral to Resources

starting services). The National Technical Assistance Partnership
(NTAP) (www.gwcrcre.org/ntap/) provides
technical assistance (TA) in areas of national
Applicable Standards need identified in consultation with the Rehabili-
An organization seeking accreditation in tation Services Administration (RSA) and the
employment development services must Technical Assistance and Continuing Education
meet the standards in this section and the (TACE) Centers.
standards in the following sections:
■ 1.A. and 1.C.–1.N.; 1.B. Governance is 3.E. 2. When indicated as needed in a person’s
optional individual plan, services/supports are
■ 2.A. Program/Service Structure provided to address:
2.E. EDS
■ 2.B. Individual-Centered Service Planning, a. Attendance and punctuality.

2.a.E. EDS
Design, and Delivery b. Grooming skills, hygiene, and

■ 2.C. Medication Monitoring and Manage- appropriate work attire.
2.b.E. EDS
ment (as applicable; see page 148) c. Job-seeking skills such as interview-
ing, completing applications, and
Standards developing and using job-finding
networks and resources.
■ 2.E. Workforce Development (optional) 2.c.E. EDS
d. On-the-job performance skills related

to quality and quantity of work.
Population Designation (ASD:A only, 2.d.E. EDS
e. Work-related skills such as time

optional)
management, mobility, and money
management skills.
3.E. 1. Individualized employee development 2.e.E. EDS
f. Functional literacy skills.

services: 2.f.E. EDS
1.E. EDS g. Knowledge of work practices such

a. Identify the employment objective
as payroll deductions, insurance, ben-
of each person seeking employment,
efits, safety, unions, and retirement.
if this has not been completed prior 2.g.E. EDS
to entering the service. h. Work-related academic skills.

2.h.E. EDS
1.a.E. EDS
b. Identify the supports/services i. Work-related communication skills.

2.i.E. EDS
needed by the person to progress j. Work-related interpersonal skills,

toward the desired employment including conflict resolution and
outcome. anger management.
2.j.E. EDS
1.b.E. EDS
c. Reflect the progress of the person k. Work ethics.

2.k.E. EDS
over time toward achieving the l. Corporate or work culture, including

identified employment outcomes. things such as chain of command,
1.c.E. EDS
work relationships, and grievance

Intent Statements
procedures.
The design of services is specific to the 2.l.E. EDS
m. Customer service.
employment objective of the person seeking 2.m.E. EDS
employment. Intent Statements
Examples Services/supports are individualized to the per-

son’s needs. Corporate and community cultures
Services will vary and be influenced by cultural should also be considered in services design.
diversity, customs of the local job market, and
the specific employer/work-site culture. Examples
The organization may provide or arrange for
these services/supports. It is not required that

all of these services/supports be provided for Documentation Examples

every person; each person is provided with only The following are examples of the types of infor-
the services/supports that will help him or her mation you should have available to demonstrate
to achieve the desired employment outcomes. your conformance to the standards in this sub-
Referrals or contracted services are provided, as section. See Appendix A for more information
appropriate, that address barriers to the person’s on required documentation.
employment goals. Some resources may include: ■ Records of the persons served
■ Access to governmental and community ■ Individual service plans
services agencies.
■ Progress notes
■ Resources for legal affairs/tax matters.
■ Results of service—placements, additional
■ Resources for transportation needs. training, and movement
■ Resources for nonwork-related needs, ■ Training course description, if the program
including housing and child care. provides
Use of assistive technology and/or reasonable
accommodations may reduce or eliminate
barriers to successful employment outcomes.
Related standards in Section 2.B. Individual-
Centered Service Planning, Design, and Delivery
may provide additional guidance.
3.E. 3. When an employee development

training course is provided:
3.E. EDS
a. The course description specifies the:

3.a.E. EDS
(1) Job-related work competencies/

skills that are addressed in the
course.
3.a.(1)E. EDS
(2) Methods of instruction.

3.a.(2)E. EDS
(3) Course objectives in

measurable terms.
3.a.(3)E. EDS
b. Course content is:

3.b.E. EDS
(1) Reviewed at least annually.

3.b.(1)E. EDS
(2) Updated as needed to ensure

continuing relevance to the
potential labor market.
3.b.(2)E. EDS
Intent Statements
A written course description or curriculum
identifies everything to know about the course.
Examples
The list of topics covered is maintained and
refined using the organization’s outcomes man-
agement system to guide and improve services.

Section 3.F. Employment Skills Training Services (EST)
F. Employment Skills 3.F. 1. An employment skills training course is

designed to meet the workforce needs
Training Services (EST) identified by employers within regional
industry sectors.
Description 1.F. EST
Examples
Employment skills training services are organized
formal training services that assist a person seek- The skills training course is based on the com-
ing employment to acquire the skills necessary munity’s personnel needs. In the United States,
for specific jobs or families of jobs. Such services these potential jobs are usually categorized by
can be provided at job sites in the form of appren- the Department of Labor into specific families
ticeships, on-the-job training, and/or volunteer of jobs or categories of occupations. In Canada,
situations; within formal and organized training job classifications are set out by provincial/
and educational settings (such as community territorial ministries of labor.
colleges and trade and technical schools); or Resources
within the organization. The National Technical Assistance Partnership
Some examples of the quality outcomes desired (NTAP) (www.gwcrcre.org/ntap/) provides
by the different stakeholders of these services technical assistance (TA) in areas of national
include: need identified in consultation with the Rehabili-
■ Persons show improvement in skill level. tation Services Administration (RSA) and the
■ Specific marketable skills are developed.
(TACE) Centers.
■ Persons served achieve employment in
the area of training.
3.F. 2. Each course description/curriculum
■ Persons secure employment with benefits.
includes:
■ Persons retain employment. 2.F. EST
a. The planned length of the course

■ Training is completed in a timely manner. and the course schedule.
2.a.F. EST
■ Training is cost-effective for the results b. The sequence of topics or areas

produced. to be covered.
2.b.F. EST
c. The materials, equipment, and tools

relevant to the job that will be used.
Applicable Standards 2.c.F. EST
d. Methods of instruction.
An organization seeking accreditation in 2.d.F. EST
e. Education or certification require-

employment skills training services must
ments for course instructors, if
meet the standards in this section and the
applicable.
standards in the following sections: 2.e.F. EST
f. Minimum requirements necessary

to participate in the course.
optional 2.f.F. EST
g. Training objectives relative to:

■ 2.A. Program/Service Structure 2.g.F. EST
(1) Skills.
■ 2.B. Individual-Centered Service Planning, 2.g.(1)F. EST
(2) Work place competencies.

Design, and Delivery 2.g.(2)F. EST
(3) Knowledge.
■ 2.C. Medication Monitoring and Manage- 2.g.(3)F. EST
h. Requirements for course completion.

ment (as applicable; see page 148) 2.h.F. EST
i. Jobs or job titles held by a person

completing the course.
Standards 2.i.F. EST
j. Credentials or certifications recog-

nized by employer that are received
■ 2.J. Autism Spectrum Disorder Specific Pop- upon completion, if applicable.
ulation Designation (ASD:A only, optional) 2.j.F. EST

Intent Statements k. Corporate or work culture.

4.k.F. EST
A written course description or curriculum l. Customer service.

identifies everything to know about the course. 4.l.F. EST
Intent Statements
Examples The skills training program is designed and con-
2.a. Course schedules indicate whether the train- tinually enhanced with input from an employer
ing offers open enrollment or has a set schedule. association, educational entity, or specific
The list of topics covered is maintained and employer. Soft skill requirements as listed in this
refined using the organization’s outcomes man- standard may vary from employer to employer.
agement system to guide and improve services. The purpose of this standard is to ensure pro-
vision of resources or linkages to encourage
successful employee behaviors in persons served.
3.F. 3. Realistic information is provided about:
3.F. EST
Examples
a. Availability of similar jobs in the
local industry sector. 4.c. Job-seeking skills include skills such as inter-
3.a.F. EST
b. Potential career pathways and viewing, completing applications, and developing

advancement opportunities. and using job-finding networks and resources.
3.b.F. EST
c. Typical pay ranges. 4.e. Functional literacy skills include skills such
3.c.F. EST
d. Benefits typically available. as time management, mobility, and money

3.d.F. EST management skills.
Intent Statements 4.f. Knowledge of work practices includes items
The organization provides accurate information such as payroll deductions, insurance, benefits,
that relates courses to jobs in the local area. safety, unions, and retirement.
Examples 4.i. Work-related interpersonal skills include
In order to be informed, make choices, and be conflict resolution and anger management.
involved, the persons served should be able to 4.k. Corporate or work culture includes areas
get accurate and current information about the such as chain of command, work relationships,
organization’s results of services and its potential and grievance procedures.
to deliver services/supports relevant to their
needs and desires. Information is provided about 3.F. 5. When the skills training program is an
the variety of service options available, or support industry-based apprenticeship:
approaches to a service need. 5.F. EST
a. The design and implementation of

the program is based on input from
3.F. 4. In addition to technical skills, courses relevant stakeholders, including:
address, as needed: 5.a.F. EST
(1) Employers.
4.F. EST
a. Attendance and punctuality. 5.a.(1)F. EST
(2) Unions, if applicable.

4.a.F. EST
b. Grooming skills, hygiene, and 5.a.(2)F. EST
b. Staff members are knowledgeable

appropriate work attire. in the requirements of the industry.
4.b.F. EST
c. Job-seeking skills. 5.b.F. EST
c. There is a clear description of the role

4.c.F. EST
d. On-the-job performance skills related and function of program staff mem-

to quality and quantity of work. bers assigned to the apprenticeship
4.d.F. EST
e. Functional literacy skills. site.

4.e.F. EST 5.c.F. EST
f. Knowledge of work practices. d. Lines of communication between

4.f.F. EST
g. Work-related academic skills. staff members and appropriate

4.g.F. EST
h. Work-related communications skills. individuals at the apprenticeship

4.h.F. EST
i. Work-related interpersonal skills. site are clearly defined.

5.d.F. EST
4.i.F. EST
j. Work ethics.
4.j.F. EST

e. If program staff provide work site e. Satisfaction of other stakeholders,

supervision: if applicable.
5.e.F. EST 6.e.F. EST
(1) The supervisor is qualified in f. Performance outcomes analysis.

the industrial and programmatic
6.f.F. EST
Intent Statements
aspects of the assignment.
5.e.(1)F. EST
The training is continually designed to meet
(2) Contingency plans for super-
industrial and business needs and overall
vision when the supervisor is stakeholder satisfaction.
late or absent are:
5.e.(2)F. EST
(a) In place. Examples

5.e.(2)(a)F. EST
(b) Communicated to all A review of the course examines the currency

appropriate parties. and relevance of the curriculum content,
5.e.(2)(b)F. EST
materials, and equipment. Information on the
f. Written procedures and techniques
satisfaction of the persons served and employers
specific to the services provided and
the location where they occur are can also be used to guide curriculum revisions.
shared with all appropriate parties. A promising practice for planning and continu-
5.f.F. EST
g. Provisions are in place to cover: ously improving a skills training program is to

5.g.F. EST
consider the impact of changing population
(1) Workers’ compensation.
5.g.(1)F. EST characteristics and demographics in the service
(2) Other potential liability issues area such as new immigrant populations,
specific to the industry, if relocation data, aging, etc.
applicable.
5.g.(2)F. EST Conformance to this standard may be
h. Employers are informed about con- determined by comparing the results of job
fidentiality requirements regarding
development/job placement to the curriculum
persons served in the program.
5.h.F. EST
and the local job market.
i. Ensuring periodic feedback to and
The organization’s outcomes management system
assessment of the trainee is part of
can provide valuable information on planning
the program’s responsibilities.
5.i.F. EST and continuously improving the design and
Intent Statements delivery of employment training services.
The program is designed to meet the personnel See related standards in Section 1.C. Strategic
needs of employers and achieve employment Planning, 1.D. Input from Persons Served and
outcomes success for persons served. Other Stakeholders, and 1.N. Performance
Examples Improvement.
5.b. Industry knowledge includes regulations, Resources
practices, procedures, conduct, and any other The CARF publication Strategic Positioning and
requirements specific to the industry. Planning in the 21st Century, which is available
on request from your resource specialist, pro-
3.F. 6. The services are expanded, modified, vides assistance in designing services to meet
or discontinued based on: customer needs and responding to environmen-
6.F. EST
a. Local industry sector information. tal considerations.

6.a.F. EST
b. Labor market trends/forecasts

and industry expectations.
6.b.F. EST
c. Satisfaction of and input from

the person served.
6.c.F. EST
d. Satisfaction of and input from

employers.
6.d.F. EST

Section 3.G. Organizational Employment Services (OES)
Documentation Examples G. Organizational

mation you should have available to demonstrate Employment Services
(OES)
Description
■ A course description
Organizational employment services are
■ A formal training curriculum
designed to provide paid work to the persons
served in locations owned, leased, rented, or
■ Progress notes managed by the service provider. A critical com-
■ Records of the persons served ponent and value of organizational employment
services is to use the capacity of the organization’s
employment and training service design to create
opportunities for persons to achieve desired
employment outcomes in their community of
choice, including individualized competitive
employment.
Service models are flexible and may include a
variety of enterprises and business designs,
including organization-owned businesses such
as retail stores, restaurants, shops, franchises, etc.
include:
■ Movement to individualized competitive
employment.
■ Movement to an integrated environment.
■ Increased wages.
■ Pay at or above minimum wage.
■ Increased work hours.
■ Minimized downtime with meaningful

activities available.
■ Exposure to and availability of a variety
of jobs.
■ Increased ability to interact with others as
part of a professional team and to resolve
interpersonal issues appropriately.

p. Opportunities for training on

Applicable Standards other jobs.
1.p.G. OES
An organization seeking accreditation in q. How the individual can move to

organizational employment services must community integrated employment.
meet the standards in this section and the 1.q.G. OES
Intent Statements
Persons served are given complete information
related to their employment, as would be
optional available to all employees.
Examples
Design, and Delivery Strategies include posting information from enti-
ties such as the Equal Employment Opportunity
Commission; Occupational Health and Safety
ment (as applicable; see page 148) Administration; Department of Labor; and other
■ 2.D. Employment Services Principle governmental and regulatory agencies on bulletin
Standards boards, and providing it in electronic formats, in
■ 2.H. Older Adults Specific Population handbooks, and at regular informational discus-
Designation (optional) sions at employee-management meetings.
■ 2.J. Autism Spectrum Disorder Specific Pop- 1.e.–f. When appropriate, a parent, guardian, or
ulation Designation (ASD:A only, optional) advocate should be informed of the organization’s
pay practices when the person is paid less than
3.G. 1. The following information is provided the minimum wage.
to the person served: 1.i. The organization provides information
1.G. OES
a. The conditions of maintaining to persons served about voting rights and

employment. opportunities.
1.a.G. OES
b. Benefits provided by the

organization. 3.G. 2. Training activities address, as needed:
2.G. OES
a. Job performance and progress.

1.b.G. OES
c. Responsibilities of the organization. 2.a.G. OES
b. Increasing individual performance.

1.c.G. OES
d. Responsibilities of the person served. 2.b.G. OES
c. Work-site job modifications, if

1.d.G. OES
e. Wage payment practices.

1.e.G. OES
f. Rate of pay, including: needed.

2.c.G. OES
1.f.G. OES
(1) Methods of performance d. Strategies for resolving job-related

measurement. issues.
2.d.G. OES
1.f.(1)G. OES
(2) Methods to increase earnings. e. Safe workplace practices.

2.e.G. OES
1.f.(2)G. OES
g. Work rules and customs. Intent Statements

1.g.G. OES
h. Nondiscrimination practices. A systematic plan of instruction and/or support

in work skills and behaviors to be acquired is
1.h.G. OES
i. Civil rights practices.

1.i.G. OES
j. Policies for transfer. developed.

1.j.G. OES
k. Employee classifications in Examples

the organization. A plan to develop appropriate social and inter-
1.k.G. OES
l. Health and safety practices. personal skills necessary to retain employment

1.l.G. OES
m. Potential for advancement may also need to be considered.

opportunities. Support in the use of available transportation
1.m.G. OES
n. Conditions for advancement. is provided as needed.

1.n.G. OES
o. Employment options available See Section 2.B. Individual-Centered Service

in the organization. Planning, Design, and Delivery.
1.o.G. OES

appropriate to the needs and desires of the

3.G. 3. Based on the needs and choices of the person served.
person served, the organization provides
or refers the person to resources for 3.q. Community services and resources may
addressing, as relevant to job support: include laundromats, libraries, post offices,
3.G. OES
consumer affairs offices, etc.
a. Basic academic skills.
3.a.G. OES
b. Basic self-care skills. 3.s. If left unaddressed, nonwork needs may

3.b.G. OES negatively affect employment potential. Based
c. Communication skills.
3.c.G. OES
on the choices and needs of persons served, the
d. Work attitudes. organization may provide, arrange, or refer the
3.d.G. OES
e. Tools and equipment related person for support and training in:
to the person’s job. ■ Daily living tasks.
3.e.G. OES
f. Mobility and travel training.

3.f.G. OES
■ Communication skills.
g. Interpersonal relationships
■ Consumer affairs and rights (e.g., familiarity
with coworkers.
3.g.G. OES with warranties, policies, and procedures
h. Job-site safety practices. of governmental and community service
3.h.G. OES
i. Career planning. agencies).

3.i.G. OES
j. Problem-solving and decision- ■ Contingency planning, problem solving,

making skills. and decision making.
3.j.G. OES
k. Health maintenance and medication ■ Developing socially appropriate and

management. age-appropriate behaviors.
3.k.G. OES
l. Knowledge of governmental and

■ Financial management including purchasing,
community service agencies.
3.l.G. OES
banking, handling taxes, budgeting, and
m. Management of legal affairs. repaying debts.
3.m.G. OES
n. Management of benefits and ■ Functional academic skills.

financial resources.
3.n.G. OES ■ Health maintenance (e.g., personal hygiene,
o. Recreational and leisure time
exercise and fitness, nutrition and diet man-
activities.
3.o.G. OES
agement, infection control, and use of medical
p. Use of phone and computer services and medicine).
resources.
3.p.G. OES ■ Housekeeping and home maintenance skills.
q. Use of community services and
■ Human sexuality.
resources.
■ Interpersonal relationships including those
3.q.G. OES
r. Accommodations or assistive
technology needs, if identified. with the person’s spouse, family, and friends.
■ Life issues and transitions (e.g., leaving home,
3.r.G. OES
s. Other issues or barriers to success,

as identified. substance abuse, parenting, divorce, retire-
3.s.G. OES
ment, and death).
Intent Statements
■ Management of personal and legal affairs.
Development of a person’s competencies in
■ Menu planning and meal preparation.
related areas can impact the person’s job success
and opportunity for career advancement. ■ Mobility and community transportation
skills.
Examples
■ Recreational activities.
It is not required that every person served receive
■ Safety practices including dealing with
all the services/supports available. Each person
receives only those services that will help the per- injuries and life-threatening situations.
son meet his or her employment goals. However, ■ Self-advocacy and assertiveness training.
the organization has the capability in place to ■ Use of the telephone.

address each area listed in this standard, as is

■ Utilization of community services and

resources (e.g., laundromats, the library,
3.G. 5. Relevant training activities are available
during periods of reduced work activity.
post office, and consumer affairs office). 5.G. OES
■ Work attitudes and skill exploration. Intent Statements

The persons served are engaged in meaningful,
3.G. 4. At the request of the person served and age-appropriate activities that are supportive
at least annually, persons are provided of their goals, even when work is low.
informed choices for exploration of Examples
other work opportunities, as desired: Training opportunities might include computer
4.G. OES
a. Within the organization. lab activities, job exploration, simulated work

4.a.G. OES
b. In the community. activities to improve or develop new skills, and

volunteer experiences in the community. Train-
4.b.G. OES
Intent Statements
ing activities might also include areas identified
Informed choice is vital in conforming to this in Standard 3., as relevant to a person’s individual
standard. Persons served frequently lack knowl- plans.
edge about existing community employment
opportunities. Many people with developmental Documentation Examples
disabilities may not be able to exercise informed
choice until and unless they have been provided The following are examples of the types of infor-
with opportunities to explore something mation you should have available to demonstrate
different. your conformance to the standards in this sub-
Examples on required documentation.
All persons served should be given experiential ■ Records of the persons served
opportunities to explore community employ-
■ Employment information or a handbook
ment options to ensure that choice is truly
informed. Some organizations facilitate visits ■ Individual service plans
for persons served to community employment ■ Progress notes

sites including those that employ persons served
who may have been previous coworkers in the
organizational employment setting.
The persons served and appropriate staff mem-
bers or partnership agencies are involved in
the assessment of opportunities for community
employment. If indicated, a person served is
referred for other services either within the
organization or to external services. Clear
reasons are documented in the assessment
explaining why a person was not referred to
other services.
Related standards to consider are in Section 1.D.
Input from Persons Served and Other
Stakeholders; 1.L. Accessibility; 1.M.
Performance Measurement and Management;
1.N. Performance Improvement; and 2.B.
Individual-Centered Service Planning, Design,
and Delivery.

Section 3.H. Affirmative Business Enterprise (ABE)
H. Affirmative Business 3.H. 1. The affirmative business enterprise

develops a business plan that addresses:
Enterprise (ABE) 1.H. ABE
a. The proposed service or product.

1.a.H. ABE
b. A customer-needs analysis.
Description 1.b.H. ABE
c. Assessment of the organization’s

Affirmative business enterprises (ABE) are
capabilities to deliver the service
designed to provide significant economic benefits
or product.
to their employees in a businesslike, integrated 1.c.H. ABE
setting. Wages are at or above minimum wage and d. Establishment of a distinct business
a benefits package is provided for all employees. identity or brand.
1.d.H. ABE
Business enterprises may be provided as many e. A mission statement.

1.e.H. ABE
different business models, including franchises, f. A description of the market area

manufacturing settings, and community busi- to be served.
1.f.H. ABE
nesses such as stores, restaurants, and other g. A customer profile.

commercial or social enterprises. 1.g.H. ABE
h. Identification of competitors.
In order for a program to seek accreditation as
1.h.H. ABE
i. Marketing plan.
an ABE, all employees must be paid minimum 1.i.H. ABE
j. Potential impacts of changes and

wage or higher. trends in the business environment.
Some examples of the quality results desired 1.j.H. ABE
k. Break-even analysis.
by the different stakeholders of these services 1.k.H. ABE
l. Business goals and objectives.

include: 1.l.H. ABE
m. An operating budget.
■ Employment. 1.m.H. ABE
n. Potential networking opportunities.

■ Earnings and benefits. 1.n.H. ABE
o. Startup costs.
1.o.H. ABE
p. Cash flow analysis.

■ Career development.
1.p.H. ABE
q. Ongoing administrative supports.

■ Employment in an integrated environment.
1.q.H. ABE
Intent Statements
■ Meaningful work.
An affirmative business enterprise establishes
■ Opportunities to feel valued. and continuously improves its business plan to
strategically position its organization to the
needs of its community and its employees.
Examples
An organization seeking accreditation as an
affirmative business enterprise must: In today’s challenging, constantly changing
business environment, a dynamic business plan
■ Pay wages at or above minimum wage.
provides a vision and a sense of purpose for the
■ Meet the standards in this section and the
affirmative business enterprise. Some important
standards in the following sections: aspects of the planning process include identify-
– 1.A. and 1.C.–1.N.; 1.B. Governance is ing the potential customer base and the potential
optional benefits of the business to these customers;
– 2.C. Medication Monitoring and Manage- involving all stakeholders in the planning pro-
ment (as applicable; see page 148) cess; conducting an internal analysis of the
– 2.E. Workforce Development (optional) organization’s strengths, needs, opportunities,
and threats; positioning the business within the
– 2.J. Autism Spectrum Disorder Specific context of environmental trends; implementing
Population Designation (ASD:A only, new ways of working and managing that allow
optional) the business to respond strategically

to environmental changes, priorities, and

necessary internal changes.
3.H. 3. An affirmative business enterprise:
3.H. ABE
a. Maintains an integrated employment

Resources workforce as deemed by funding
The CARF publication Strategic Positioning and sources, if applicable, or its own
Planning in the 21st Century, which is available established goals.
on request from your CARF resource specialist, 3.a.H. ABE
b. Provides a benefits package for

provides additional information related to all employees.
establishing and positioning the organization’s 3.b.H. ABE
c. Has a written job description for each

affirmative business. position that is reviewed annually
and updated as needed.
3.H. 2. The affirmative business enterprise 3.c.H. ABE
d. Posts promotion guidelines.

develops a marketing plan that includes: 3.d.H. ABE
2.H. ABE
e. Follows its job posting guidelines.
a. Market demographics and size. 3.e.H. ABE
2.a.H. ABE
f. Conducts performance evaluations
b. Services or product differentiation for all personnel employed by the
between it and its competitors. affirmative business enterprise
2.b.H. ABE
c. Competitive analysis. that are:

2.c.H. ABE
3.f.H. ABE
d. Target or segmented markets. (1) Based on job functions and

2.d.H. ABE
e. Addressing the requirements competencies identified.

3.f.(1)H. ABE
of doing business. (2) Evident in personnel files.

2.e.H. ABE
3.f.(2)H. ABE
f. Business objectives. (3) Conducted in collaboration

2.f.H. ABE
g. Marketing strategy to promote with the direct supervisor with

the business. evidence of input from the
2.g.H. ABE
h. An operating budget. personnel being evaluated.

3.f.(3)H. ABE
2.h.H. ABE
(4) Used to:

Intent Statements 3.f.(4)H. ABE
(a) Assess performance related

A written marketing plan is developed based on
to objectives established in
the results of the organization’s business analysis
the last evaluation period.
and its mission in the community. 3.f.(4)(a)H. ABE
(b) Establish measurable per-

Examples formance objectives for
A marketing plan is often customized to the the next year.
unique needs of job seekers and the community. 3.f.(4)(b)H. ABE
(5) Performed annually.

Keeping in mind its mission, an organization’s 3.f.(5)H. ABE
plan should present an action plan to accomplish Intent Statements

its business objectives, including any modifica- Affirmative business enterprises are designed
tions in program, staffing, pricing, and physical to provide significant economic benefits to their
plant; specification of the target audience; and employees. In the U.S., the benefits package
a communication plan, including the messages includes at a minimum workers’ compensation
to be communicated and the vehicles for and FICA.
communication. Examples
ments of each position. Job descriptions are
updated and revised, as needed, to maintain their
currency. Personnel are evaluated at least annu-
ally based on their activities/skills that are related
to their job performances as defined in the job
descriptions. The evaluation includes goals that
will lead to employee development and will

further support the organization’s values and of products and services meets competitive
mission. industrial standards.
Surveyors will review some personnel records Examples
of persons employed in the affirmative business Several elements characterize a quality control
while on-site to verify that procedures in the program in standard commercial practices. The
standards and pertinent legal requirements are practices include use of a written policy assuring
being followed. The organization demonstrates customers of quality commitment and product/
compliance with legal requirements pertaining performance reliability, good communications,
to personnel records. and written quality control procedures specific
The organization has clear procedures for posting to individual products and services (including
available jobs, and personnel understand how inspection and testing requirements).
promotions occur in the organization. If a job is When the organization is involved in prime
available, personnel know where it will be posted manufacturing and/or subcontract operations,
and are clear on whether there is a possibility of files on work methods, quality control, and pro-
promotion from within the organization. duction scheduling are maintained and actively
used by supervisory personnel. Written specifi-
3.H. 4. When appropriate to the business, cations are maintained for each article produced.
the affirmative business enterprise Products are made in conformance to relevant
uses industrial grade tools, equipment, specifications and meet the standards of competi-
and machinery. tive products in the open market. Work methods
4.H. ABE
Intent Statements
might include work station setup, steps in the
production process, work flow, and equipment
When the organization provides equipment to
to be used. Production scheduling might include
be used by the persons served, the equipment
production hours per job, shipping dates,
should:
coordination with other jobs, and customer time
■ Replicate the tools and methods required
frames.
by competitive industry.
■ Be suitable to the local job opportunities
3.H. 6. When the affirmative business enterprise
available to the persons served.
bids for contract work or establishes
Examples prices for products or services, it
The use of equipment should not be based on includes:
6.H. ABE
one’s readiness. Fulfillment of this standard a. All direct costs.

reflects an organization’s efforts to develop skills
6.a.H. ABE
b. All indirect costs applicable to each

of persons that will increase their employability. service or job.
6.b.H. ABE
Related standards and information can also c. Profit.

be found in Section 3.Q. Assistive Technology 6.c.H. ABE
d. Consideration of fair market value.

Supports and Services (AT). 6.d.H. ABE
Intent Statements
The organization seeks business on a fair and
3.H. 5. When the affirmative business enterprise
competitive basis. To achieve financial stability,
is producing a product or providing a
the organization knows its costs and bids
service for business, it maintains an
competitively in the local job market.
organized system of quality control.
Examples
5.H. ABE
Intent Statements
When production of goods or contracted service
The program maintains an organized system
delivery is carried out by the organization, sound
of quality control with responsibility vested in
and acceptable practices are observed in all busi-
specified personnel to ensure that the quality
ness and industrial activities, including purchase
of materials, sale of products, subcontracting,

and pricing. See related standards in Section 1.F.

Financial Planning and Management.
3.H. 9. The following information is provided
to each employee/person served:
The bid price includes all direct and indirect 9.H. ABE
a. Employee classifications in the

costs applicable to each job, product, or service.
business enterprise.
An overhead markup supported by a precise 9.a.H. ABE
written analysis of production costs is charged. b. Responsibilities of the affirmative

The value of any services, equipment, or space business.
9.b.H. ABE
provided by the organization for the contract c. Benefits provided by the affirmative
operation is included in the determination of business.
9.c.H. ABE
this markup. Indirect costs include staff salaries d. Wage payment practices.
9.d.H. ABE
and benefits, occupancy, depreciation, and e. Rate of pay.

administrative costs. All retooling, training, and 9.e.H. ABE
f. Work rules and customs.

remodeling costs necessary to accomplish the job 9.f.H. ABE
g. Nondiscrimination practices.
are also calculated. All donated equipment, mate- 9.g.H. ABE
h. Civil rights practices.

rials, and services are included in the contract bid 9.h.H. ABE
price at fair market value. i. Health and safety practices.

9.i.H. ABE
Selling prices of the program’s products are based j. Responsibilities of the employee.
9.j.H. ABE
upon full cost reimbursement and are in line with k. Corporate or work culture, including
the prevailing price range for such products in things such as chain of command,
the competitive market areas. work relationships, and grievance
procedures.
This standard relates to the code of ethical 9.k.H. ABE
conduct of business practices and marketing l. Potential for advancement

activities referred to in Standard 1.A.6.a. opportunities.
9.l.H. ABE
m. Conditions for advancement.

9.m.H. ABE
3.H. 7. The prices of products and services n. Employment options available

are analyzed at least annually. in the organization.
9.n.H. ABE
7.H. ABE
o. Opportunities for training on

Intent Statements
other jobs.
The prices are analyzed annually to ensure 9.o.H. ABE
p. Policies for transfer.

that they remain fair and competitive. 9.p.H. ABE
q. Union membership policies,

Examples if applicable.
The activities of analyzing costs may also include
9.q.H. ABE
r. Other job opportunities in the

reviewing methods for achieving optimal effi- local area consistent with his
ciency in the work environment consistent with or her interests.
the needs of the persons served. 9.r.H. ABE
s. Career path opportunities relative

See related standards in Section 1.F. Financial to the person’s goals and abilities.
Planning and Management. 9.s.H. ABE
Intent Statements
Persons served are given complete information
3.H. 8. The following information is gathered, related to their employment, as would be avail-
as appropriate, for each person seeking able to all employees. Although persons served
employment with the affirmative are considered full employees of the affirmative
enterprise business: business enterprise, all standards in Section 1.D.
8.H. ABE
a. Performance information or refer- Input from Persons Served and Other Stakehold-
ences from previous employment. ers and Section 1.K. Rights of Persons Served are
8.a.H. ABE
b. Self-reported interests. still applicable to them.

8.b.H. ABE
c. Other pertinent information.

8.c.H. ABE


The information provided is based on the Effective and efficient outcomes are achieved
input and expectations of the organization, through continuous improvement of the
its stakeholders, and entities such as the Equal resources used. The resources used are based
Employment Opportunity Commission, Occu- on the individuals’ expectations, location of
pational Health and Safety Administration, services not available through the organization,
Department of Labor, and other local, county, employers’ requirements for resources and
state, provincial, and federal agencies. Strategies support, and the input of the persons served
include posting such information on bulletin and other stakeholders.
boards, electronic formats, handbooks, and Examples
informational discussions at employee- The organization may refer or contract for
management meetings. such services.
10.j.(4) Job-related community skills may
3.H. 10. As needed, the employee/person served include time management, mobility, and
receives educational resources on: money management skills.
10.H. ABE
a. Safety precautions and the preven- 10.j.(6) Knowledge of work practices may
tion of injuries and occupational include payroll deductions, insurance, benefits,
diseases. safety, unions, and retirement.
10.a.H. ABE
b. Appropriate medical or behavioral

health resources/options.
10.b.H. ABE 3.H. 11. Based on the needs and choices of the
c. Medications and their potential employee, the organization provides
effects on employment performance. or refers the employee to resources for
10.c.H. ABE
d. Assistive technology. addressing, as relevant to employment

10.d.H. ABE
e. Reasonable accommodations. and career advancement:

10.e.H. ABE 11.H. ABE
f. Employee assistance services a. Basic academic skills.

and resources.
11.a.H. ABE
10.f.H. ABE
b. Basic self-care skills.
g. Managing the impact of earned
11.b.H. ABE
c. Communication skills.
income on government or 11.c.H. ABE
d. Interpersonal relationships
insurance benefits. with coworkers.
10.g.H. ABE
h. Career development. 11.d.H. ABE
e. Salary and benefits negotiations.

10.h.H. ABE
i. Self-advocacy. 11.e.H. ABE
f. Work attitudes.
10.i.H. ABE
j. Soft skills training related to: 11.f.H. ABE
g. Tools and equipment related

10.j.H. ABE
(1) Attendance and punctuality. to the person’s job.

10.j.(1)H. ABE
(2) Grooming skills, hygiene,

11.g.H. ABE
h. Mobility and travel training.

and appropriate work attire. 11.h.H. ABE
i. Job-site safety practices.

10.j.(2)H. ABE
(3) On-the-job performance skills 11.i.H. ABE
j. Self-advocacy and assertiveness

related to quality and quantity skills.
of work. 11.j.H. ABE
10.j.(3)H. ABE k. Career planning.

(4) Job-related community skills. 11.k.H. ABE
10.j.(4)H. ABE l. Problem solving and decision-

(5) Functional literacy skills. making skills.
10.j.(5)H. ABE
(6) Knowledge of work practices. 11.l.H. ABE
m. Health maintenance and

10.j.(6)H. ABE
(7) Work-related academic skills. medication management.

10.j.(7)H. ABE
(8) Corporate culture.

11.m.H. ABE
10.j.(8)H. ABE
n. Knowledge of governmental and
k. Other issues identified for community service agencies.
the individual.
11.n.H. ABE
10.k.H. ABE
o. Management of legal affairs.
11.o.H. ABE

p. Management of benefits Legal terminology may vary from state to state

and financial resources. or province to province; i.e., healthcare power
11.p.H. ABE
q. Use of technology. of attorney, power of attorney, and guardianship.

11.q.H. ABE
The program/service should be able to discuss
r. Use of community services
how it addresses the issue of the legal decision-
and resources.
11.r.H. ABE making authority of the persons served.
Intent Statements 12.b. Any limitation on a person’s legal decision-
Development of a person’s competencies in making authority should be continued only as
related areas can impact the person’s job success. long as is appropriate and necessary. The pro-
gram/service assists the person served and his
Examples
or her family members/support system to access
Job support services are provided according to resources, such as attorneys with expertise in
the individual plan and include the following: this area, who can assist with facilitating changes,
the performance standards against which the if appropriate, in legal autonomy status.
person’s progress will be assessed, methods of
Examples
assessment, the methods of instruction, and
the requirements for completion of supports A provider could demonstrate knowledge of legal
or extension of supports. decision-making authority through policies that
11.k. Career planning may include persons inter- outline levels of legal autonomy, inservices on
issues of legal decision-making authority, and
ested in moving to individualized competitive
materials for personnel and the persons served
employment or advancement within the affirma-
tive business enterprise. that explain legal decision-making authority,
such as guardianship and how it might relate
11.r. Community services and resources include to services.
laundromats, the library, post office, consumer
affairs office, etc. Documentation Examples
It is not required that every person served receive The following are examples of the types of infor-
all the services/supports available. Each person mation you should have available to demonstrate
receives only those services/supports that will your conformance to the standards in this sub-
help the person meet his or her employment section. See Appendix A for more information
goals. However, the organization has the capa- on required documentation.
bility in place to address each area listed in this
■ Business plan
standard, as is appropriate to the needs and
■ Mission statement
desires of the person served.
■ Business objectives
3.H. 12. The program/service demonstrates: ■ Marketing budget

12.H. ABE
a. Knowledge of the legal decision- ■ Marketing plan

making authority of the ■ Business records
persons served.
12.a.H. ABE ■ Employee handbook
b. When applicable, the provision of
■ Employee personnel files
information to the persons served
regarding resources related to legal ■ Employee evaluations
decision-making authority. ■ Employee training records

12.b.H. ABE
Intent Statements ■ Personnel policies
The person served may not have the capacity ■ Job descriptions
or be of the age to make decisions in his or her ■ Contract bids

own best interests. An individual may need to be ■ Educational resources on various topics
assigned to make decisions regarding healthcare
choices, financial decisions, or life care planning.

Section 3.I. Child and Youth Services (CYS)
I. Child and Youth ■ 2.F. Community Services Principle

Services (CYS) ■ 2.I. Medically Fragile Specific Population
Designation (optional)
Description ■ 2.J. Autism Spectrum Disorder Specific Pop-
Child and youth services provide one or more ulation Designation (ASD:C only, optional)
services, such as prenatal counseling, service
coordination, early intervention, prevention, 3.I. 1. Information is gathered from families
preschool programs, and after-school programs. about each child/youth served that
These services/supports may be provided in includes, as relevant to the scope of
any of a variety of settings, such as a family’s services provided:
private home, the organization’s facility, and 1.I. CYS

community settings such as parks, recreation developmental age factors.
areas, preschools, or child day care programs 1.a.I. CYS
b. Motor development and functioning.

not operated by the organization. 1.b.I. CYS
c. Health history and status, including:

In all cases, the physical settings, equipment, 1.c.I. CYS
(1) Medical.
and environments meet the identified needs of 1.c.(1)I. CYS
the children and youth served and their families. (2) Physical.
1.c.(2)I. CYS
Families are the primary decision makers in the (3) Mental.

1.c.(3)I. CYS
process of identifying needs and services and (4) Social/emotional.

play a critical role, along with team members,
1.c.(4)I. CYS
(5) Immunization record.

in the process. 1.c.(5)I. CYS
(6) Prenatal exposure to alcohol,

Some examples of the quality results desired tobacco, or other drugs.
by the different stakeholders of these services 1.c.(6)I. CYS
d. Culture/ethnicity, including specific

include: needs and preferences.
■ Services individualized to needs and
1.d.I. CYS
e. School history.
desired outcomes. 1.e.I. CYS
f. Communication functioning,
■ Collection and use of information including:
regarding development and function 1.f.I. CYS
(1) Speech.
as relevant to services. 1.f.(1)I. CYS
(2) Hearing.
■ Children/youths developing new skills.
1.f.(2)I. CYS
(3) Language.
■ Collaborative approach involves family
1.f.(3)I. CYS
g. Visual functioning.
members in services. 1.g.I. CYS
h. Learning style.
1.h.I. CYS
i. Intellectual functioning.
1.i.I. CYS
Applicable Standards j. Family relationships.

1.j.I. CYS
An organization seeking accreditation in child k. Interactions with peers.

1.k.I. CYS
and youth services must meet the standards in l. Environmental surroundings.

this section and the standards in the following 1.l.I. CYS
m. History of use of alcohol, tobacco,

sections: or other drugs.
1.m.I. CYS
■ 1.A. and 1.C.–1.N.; 1.B. Governance is n. Past exposure to trauma.

optional 1.n.I. CYS
o. Assistive devices or technology,

■ 2.A. Program/Service Structure if used.
1.o.I. CYS
■ 2.B. Individual-Centered Service Planning, p. Coordinated information if dealing

Design, and Delivery with multiple systems or other
■ 2.C. Medication Monitoring and Manage- current service providers for the
ment (as applicable; see page 148) child/youth.
1.p.I. CYS

Intent Statements to the extent of their wishes. Information

Information concerning the individual’s needs, and support are available to help families
abilities, and health status is gathered and used make informed decisions.
to develop a personalized service plan. Examples
Examples In some instances, families may not have the
The organization establishes its protocol for experience or sophistication necessary to make
gathering, assessing, and synthesizing informa- informed decisions. In all cases, the organization
tion for persons served. The information listed is a supportive partner in helping the families
may be acquired from referral sources, affilia- served to choose wisely. Families served are satis-
tions, associations, etc. fied that the overall service design meets their
1.c.(5) Determination of the status of the child’s identified needs. Related areas may include input,
immunization does not require a copy of the accessibility, and performance management.
immunization record. Organizations can note,
if appropriate to the scope of services provided, 3.I. 4. The program works with family members
when children and adolescents are enrolled in to identify the following regarding the
school settings where verification of immuniza- development of their child or youth:
4.I. CYS
tion is legally required. a. Strengths.

4.a.I. CYS
b. Resources.
2. The methods used for gathering informa-
4.b.I. CYS
3.I. c. Priorities.
tion are appropriate with respect to the 4.c.I. CYS
d. Expectations.
child’s or youth’s: 4.d.I. CYS
2.I. CYS
e. Activities that might be beneficial.
a. Age. 4.e.I. CYS
2.a.I. CYS
f. Concerns.
b. Development. 4.f.I. CYS
2.b.I. CYS
g. Perceived barriers.
c. Culture. 4.g.I. CYS
2.c.I. CYS
Intent Statements
d. Education.
2.d.I. CYS
The organization obtains information from
e. Functional limitations, if applicable.
2.e.I. CYS the family regarding resources and services
f. Language/communication skills they want or require.
and abilities.
2.f.I. CYS
Examples
Intent Statements
Families may provide a wealth of information
The needs of the person served dictate the that drives the design and delivery of services/
methods by which information is gathered.
supports. This information will be valuable to
Examples the organization in providing services that satisfy
Methods and strategies for gathering information the needs and desires of the persons and families
are flexible and individualized to be appropriate served.
to the person served. The organization may
make use of input from select family members, 3.I. 5. Program staff identify with the family:
authorities, and educational resources for the
5.I. CYS
a. Family values to be considered in

individual’s planning process. services.
5.a.I. CYS
b. The amount of involvement that the

3.I. 3. Information gathered is shared with family desires on an ongoing basis.
families in understandable terms so 5.b.I. CYS
Examples
they can make informed decisions.
3.I. CYS
5.b. Family desires regarding control/input may
Intent Statements include identifying a primary decision-maker
Families have the authority and are supported to or a specific contact person, if appropriate.
direct and manage their own services/supports

communities. Their input into the service design

3.I. 6. Areas considered in identifying needs of is vital. See also the standards in Section 2.B.
each child/youth served, as relevant to
relating to individual planning.
the scope of services provided, include:
6.I. CYS
Services may support development of mobility
a. Healthcare.
6.a.I. CYS and functional skills, communication skills,
b. Nutrition. adaptive/self-care, and community living skills.
6.b.I. CYS
c. Physical activity. Based on age and individual preferences and

6.c.I. CYS
d. Safety. needs, services to support skill development may

6.d.I. CYS
e. Education. be identified in areas such as early childhood

6.e.I. CYS
f. Emotional/behavioral. development, family activities, physical activities,

6.f.I. CYS
g. Mobility and functional social and recreational activities, school activi-

ties, vocational or work-related activities, and
independence.
6.g.I. CYS independent living.
h. Child development.
6.h.I. CYS
The organization regularly looks at the needs
i. Social and leisure.
6.i.I. CYS of the child/youth served and provides services
j. Others, as identified. based on those needs. Services may change from
6.j.I. CYS
Intent Statements time to time based on trends of those served and

Methods are established to identify and their needs. Utilizing the data and demographics
respond to the individual’s needs. from an organization’s performance management
system, the services are designed and delivered
Examples to achieve results and personal outcomes
The organization may not provide services to satisfaction.
address all needs, but identified needs may be 7.a. Based on identified needs of the child or
addressed in planning and by referrals to other youth served, services may include the develop-
organizations. Also refer to Standards 2.B.1.–7. ment of skills for independence, social skills,
for additional planning guidelines. and social supports.
3.I. 7. As appropriate to the scope of services, 3.I. 8. Based on the identified needs of the
individualized services are provided child or youth served, services include
based on: the development of:
7.I. CYS
a. The identified needs of the child/ 8.I. CYS
a. Skills for independence.

youth served. 8.a.I. CYS
7.a.I. CYS b. Social skills.

b. The desired outcomes of the family. 8.b.I. CYS
7.b.I. CYS c. Social supports.

c. Information gathered. 8.c.I. CYS
7.c.I. CYS
d. Results from and responses to Intent Statements

previous services and supports, The persons served have access to an array
if applicable. of services/supports for development.
7.d.I. CYS
Intent Statements Examples

Persons served are supported to direct and Services support development of mobility and
manage services to achieve their outcomes. functional skills, communication skills, adaptive/
Programs are developed based on the needs/ self-care, and community living skills. Based
desires of the child/youth served and their family. on age and individual preferences and needs,
services to support skill development may be
Examples
identified in areas such as early childhood devel-
The focus of the services is on the families, and opment, family activities, physical activities,
the effectiveness of the services will ultimately social and recreational activities, school activi-
be measured by how well the families use ties, vocational or work-related activities, and
the resources of the organization and their independent living.

The organization regularly looks at the needs Examples

of the child/youth served and provides services 10.a. Includes readiness to learn, brain
based on those needs. Services may change from development, and cognitive development.
time to time based on trends of those served and 10.b. Includes dealing with aggressive or
their needs. Utilizing the data and demographics violent behaviors.
from an organization’s performance management
10.d. Includes identifying and reporting
system, the services are designed and delivered
child maltreatment.
to achieve results and personal outcomes
satisfaction. 10.h. May include sign language and assistive
communication technology.
3.I. 9. Educational opportunities are available 10.k. Additional needs could include issues
for the family to learn about: around attachment theory or specific issues
9.I. CYS
a. Child development. to the child served such as medical or physical

9.a.I. CYS
needs or the use of assistive technology.
b. Aspects of disability, as appropriate.
9.b.I. CYS
c. Futures planning.
9.c.I. CYS 3.I. 11. If providing early intervention services,
d. Community resources, including
the program provides guidance and/or
availability of support groups.
9.d.I. CYS
information to families to support their
e. Parenting skills. child’s acquisition of:
9.e.I. CYS
11.I. CYS
Intent Statements a. Motor skills development.

11.a.I. CYS
Educational opportunities may be provided b. Physical health and development.

11.b.I. CYS
by the organization or made available to c. Physical fitness.

the family through appropriate referrals. 11.c.I. CYS
d. Social development.
11.d.I. CYS
e. Intellectual/cognitive development.
3.I. 10. Service personnel receive training 11.e.I. CYS
f. Speech and language development.

that covers, as appropriate to the 11.f.I. CYS
g. Creativity.
scope of services: 11.g.I. CYS
10.I. CYS
h. Emotional development.
a. Child growth and development. 11.h.I. CYS
10.a.I. CYS
i. Safety.
b. Behavior support skills. 11.i.I. CYS
10.b.I. CYS
j. Self care.
c. Learning styles. 11.j.I. CYS
10.c.I. CYS
k. Identity development.
d. Social and emotional needs. 11.k.I. CYS
10.d.I. CYS
l. Proper nutrition and growth.
e. The effects of separation and 11.l.I. CYS
placement on children. m. Independence and self-

10.e.I. CYS
determination.
f. Health and nutrition. 11.m.I. CYS
10.f.I. CYS
g. Applicable legal issues. Intent Statements

10.g.I. CYS
h. Methods of communication. When the organization is providing early inter-

10.h.I. CYS
i. Crisis situations. vention services, it is important that it provide

10.i.I. CYS
as much training as possible to parents as early
j. Family support practices.
10.j.I. CYS
as possible. This training should help parents
k. Other specific needs. to further support development of their child.
10.k.I. CYS
Intent Statements
In order to achieve more successful outcomes 3.I. 12. When the services disrupt the child’s
in services, service personnel are knowledgeable or youth’s day-to-day educational
about a range of factors that may impact the environment, the service provides or
scope of services provided. makes arrangements for the continuity
of his or her education.
12.I. CYS

Intent Statements requirements, and analysis of data from an

Education services are provided without organization’s outcomes system. By knowing
undue disruption. the needs of its customers and stakeholders,
services can be redesigned and the organization
Examples
strategically positioned to meet their needs.
Such arrangements could include:
■ Use of a facility-based school.
3.I. 15. If services are provided outside the
■ Use of a private school at the organization. home, the service environment is config-
■ Use of on-site educators from a local ured appropriately to meet the needs
school system. of the child/youth served, including:
15.I. CYS
■ Coordination with home school services. a. The physical site.

15.a.I. CYS
■ Coordination and monitoring of assignments.

b. The furniture.
15.b.I. CYS
■ Coordination with the community school

c. Any equipment used in services.
15.c.I. CYS
to facilitate reintegration. d. Environmental factors.

15.d.I. CYS
e. Assistive technology, if utilized.

15.e.I. CYS
3.I. 13. Based on the needs and age of each Intent Statements
child/youth served, or as required by law, The environment or setting is configured in a
an educational professional or transition manner that is consistent with identified needs
specialist is a member of the planning and capabilities of the persons served.
team.
13.I. CYS
Examples
Intent Statements
Considerations include the provision of:
When applicable, the educational specialist
■ Appropriately sized furniture.
assists in planning, implementing, and evaluating
educational activities for the child or youth. ■ Recreational equipment.
■ Age-appropriate reading materials and videos.

Examples
The educational specialist or transition specialist
can be available when needed and is not required 3.I. 16. The organization does not exclude chil-
to attend all planning team meetings. dren or youths from services solely on
the basis of their juvenile justice status.
16.I. CYS
3.I. 14. If educational services are provided, Intent Statements

they: Although specific behaviors may be identified
by a program as exclusionary admission criteria,
14.I. CYS
a. Are appropriate to the child/youth

served. children or youths cannot be excluded from
14.a.I. CYS
services solely because they are involved in the
b. Meet applicable legal requirements.
14.b.I. CYS juvenile justice system. Individuals who need
Intent Statements services but are not eligible are linked to other
Educational services should be individualized resources.
and appropriate to the needs of each child Examples
and youth served.
Children and youths cannot be excluded from
Examples services solely because they are involved in the
Educational services may include provisions for juvenile justice system, however, some of the
evaluation, group instruction, and/or individual rights standards in Section 1.K. Rights of Persons
instruction, as appropriate. Served may not be applicable.
There are a number of related standard areas that
can provide direction in meeting this standard.
They include individualized planning, legal

participating tribes. The website provides an

3.I. 17. When a child/youth served moves to advanced search tool that allows a user to submit
a school or other community service,
a single national query to obtain information
transition planning/information is
about sex offenders; a listing of public registry
provided in a timely manner:
17.I. CYS
websites by state, territory, and tribe; and
a. To the family. information on sexual abuse education and
17.a.I. CYS
b. To the new service provider, with prevention. The criteria for searching are limited
consent of the child/family. to what each individual Jurisdiction may provide.
17.b.I. CYS
Intent Statements Also, because information is hosted by each

Jurisdiction and not by the federal government,
Information and support are available to help
search results should be verified by the user in
a person served and his or her family to make
the Jurisdiction where the information is posted.
informed decisions and smooth transitions.
Users are advised to visit the corresponding
Examples Jurisdiction websites for further information
With a continued focus on the family and its and/or guidance, as appropriate.
role in the child’s life, information about new
services, alternative settings and strategies, etc., 3.I. 19. The program assists family members
is provided for the family’s use to assist in such to optimize resources and opportunities
transitions and to help give service continuity. as desired through:
19.I. CYS
a. Community linkages.
3.I. 18. The organization conducts criminal 19.a.I. CYS
b. Enhanced social support networks.

background checks on all personnel 19.b.I. CYS
c. Outreach to encourage involvement.

providing direct services to children 19.c.I. CYS
or youths. Intent Statements

18.I. CYS

Intent Statements
community and provides resource materials
Direct service personnel are appropriately to parents.
screened before being allowed to provide ser-
vices. The provision of direct services includes Examples
transportation. 19.b. Social support networks may include parent
mentoring or support groups.
 In Canada, depending on provincial/territorial/
tribal requirements, a criminal record check
and a child welfare information system check Documentation Examples
would be required to meet this standard. The following are examples of the types of infor-
Examples mation you should have available to demonstrate
Background checks may include fingerprinting,
FBI criminal history checks, child abuse and
neglect registry, sex offender registries, or
■ Records of the children and youths served
other appropriate methods available.
Resources
■ Progress notes
The Dru Sjodin National Sex Offender Public
■ Information provided to the families
Website (www.nsopw.gov), coordinated by the
U.S. Department of Justice, is a cooperative effort about new services
between jurisdictions hosting public sex offender ■ Procedures manual
registries (“Jurisdictions”) and the federal gov-
ernment and is offered free of charge to the
public. These Jurisdictions include the 50 states,
U.S. Territories, the District of Columbia, and

Section 3.J. Family-Based/Shared Living Supports
J. Family-Based/Shared ■ 2.F. Community Services Principle Standards

■ 2.G. Children and Adolescents Specific
Living Supports Population Designation (optional)
In this section three distinct programs are ■ 2.H. Older Adults Specific Population
available for accreditation: Designation (optional)
■ Family Services—page 252 ■ 2.I. Medically Fragile Specific Population
■ Foster Family Services—page 253
■ Host Family/Shared Living Services—
page 258 Population Designation (ASD:A and/or
ASD:C, optional)
An organization may seek accreditation in
any one or multiple program categories based
3.J. 1. Planning:
on the services provided and its desires for 1.J. FBSLS
accreditation. a. Is person- and family-centered.

1.a.J. FBSLS
b. Recognizes family expertise.

1.b.J. FBSLS
Family Services (FS) c. Considers family values.

1.c.J. FBSLS
d. Supports individual and family

Description relationships.
1.d.J. FBSLS
Family services are provided to persons served e. Enhances lifespan planning.

1.e.J. FBSLS
and/or their families, either to enable the person f. Addresses contingency planning
and the family to stay together or to enable the in the event of loss of the primary
person served to remain involved with his or her caregiver.
1.f.J. FBSLS
family. Families, including the persons served,

are the key decision makers in identifying the
services/supports needed and in choosing how 3.J. 2. The organization provides or refers the
those services/supports will be delivered. family to desired support services.
Some examples of the quality results desired 2.J. FBSLS

include:
3.J. 3. The organization provides to the person
■ Resources to support family stability.
served/family:
■ Availability of respite services.
3.J. FBSLS
a. Information on community resources,

■ Emergency response system for family relief. including how to access these.
3.a.J. FBSLS
■ Families remaining together. b. Referral sources for specialized

care needs.
3.b.J. FBSLS
Applicable Standards Intent Statements
An organization seeking accreditation in In order to make informed choices about

family services must meet Standards 1.–5. appropriate services and providers, the families
in this section and the standards in the (including the persons served) have a wide
variety of options from which to choose.
following sections:
■ 1.A. and 1.C.–1.N.; 1.B. Governance is Examples
optional Information provided is responsive to identified
■ 2.A. Program/Service Structure, Standards needs and goals and so may suggest new or
1.–19. different services and strategies.

3.J. 4. The program collaborates, as appropri- Foster Family Services (FFS)

ate to identified needs, with other
programs in planning service delivery. Description
4.J. FBSLS
Foster family services are provided under a con-

tract or agreement for the temporary placement
of an individual, regardless of age, in a family
3.J. 5. The organization assists families with setting outside the birth or adoptive family home.
development of a plan for relief, Foster family services are provided to a foster
including: family provider to establish and maintain a home
5.J. FBSLS
a. A 24-hour emergency response on a temporary basis for the person served.

system. The courts may be involved in establishing
5.a.J. FBSLS
b. Respite services and supports, this relationship.

if needed. Foster family services are comprehensive and
5.b.J. FBSLS
Intent Statements establish a system of supports and services for the

Families often need respite-type services individual, the family of origin when appropriate,
that are not necessarily regularly scheduled, and the foster family provider. These services
in order to deal with emergencies and the focus on establishing stability in the life of the
pressures of caregiving. person served.
Examples
In this program description and these standards,
provider refers to the individual(s) supporting the
Emergency services can be provided by the person served. Although the “home” is generally
organization or by another provider. Review the provider’s home or residence, it may also be
Section 3.M. for a description of respite services. the home of the person served.
Documentation Examples Some examples of the quality results desired
by the different stakeholders of these services/
supports include:
■ Temporary placements for persons.
section. See Appendix A for more information ■ Stability in a person’s life.
on required documentation. ■ Appropriate matches of persons with
■ Records of the persons served foster families.
■ Individual service plans ■ Safe placements.
■ Progress notes
■ Information regarding relief and emergency Applicable Standards

response systems
An organization seeking accreditation in foster
■ Procedures manual family services must meet Standards 6.–17. in
this section and the standards in the following
sections:
optional
NOTE:
– Standard 1.H.7. (Section 1.H. Health and
Safety) is not applied to any foster family
home.
– Standards 1.H.13.–1.H.14. are applied
to the foster family home only when
the organization owns the home.

If any clarification is needed, please

contact a resource specialist in the
3.J. 7. Foster family providers receive training
to meet the identified needs of the
Employment and Community Service
persons served that covers:
customer service unit. 7.J. FBSLS
a. Human growth and development

and how to best support it.
■ 2.B. Individual-Centered Service Planning, 7.a.J. FBSLS
b. Behavior supports.
Design, and Delivery 7.b.J. FBSLS
c. Learning styles.
■ 2.C. Medication Management and Monitor- 7.c.J. FBSLS
d. Cultural diversity.
ing (as indicated by the guidelines in this 7.d.J. FBSLS
section, 2.C. is applicable to the organiza- e. Applicable legal issues.

7.e.J. FBSLS
tion if the provider has a responsibility for f. Methods of communication.

7.f.J. FBSLS
medications for persons served) g. Physical limitations and accom-

■ 2.F. Community Services Principle Standards modations needed, if applicable.
7.g.J. FBSLS
■ 2.G. Children and Adolescents Specific h. Parenting skills, when needed.

7.h.J. FBSLS
Population Designation (optional) i. Medication management, when

applicable for the person served.
■ 2.H. Older Adults Specific Population 7.i.J. FBSLS
Designation (optional) j. Other specific needs.

7.j.J. FBSLS
■ 2.I. Medically Fragile Specific Population Examples

Designation (optional) 7.i. When family responsibilities include medica-
■ 2.J. Autism Spectrum Disorder Specific tion administration to persons served, ensuring
Population Designation (ASD:A and/or appropriate training (as per Standards 3.J.12.c.
ASD:C, optional) and 3.J.7.i.) is an important aspect of organiza-
tional risk management and safety of persons
3.J. 6. Services reflect the active participation served. Guidance for an organization could come
of the: from licensing, contractual, funding, legal, or
6.J. FBSLS
other regulatory requirements.
a. Person served.
6.a.J. FBSLS
7.j. Other specific needs could include issues
b. Family of origin, if appropriate.
6.b.J. FBSLS around attachment theory, medical or physical
c. Foster family provider.
6.c.J. FBSLS
needs, or the use of assistive technology.
d. Placement agency.
6.d.J. FBSLS
e. Others, as appropriate. 3.J. 8. The organization advocates on behalf of:

6.e.J. FBSLS
8.J. FBSLS
Intent Statements a. The person served.

8.a.J. FBSLS
Persons served are supported to direct b. The foster family provider.

and manage their services. 8.b.J. FBSLS
Examples
Examples This advocacy may relate to the outcomes of
It is important that the organization’s services these services, including adoption or returning to
strive to allow as much participation of all parties family of origin, if appropriate. (See the following
as possible. This is to ensure that all the parties standard.)
are working together with a common focus on
the interests of the person served.

Examples
3.J. 9. Advocacy for the persons served
This planning is sometimes referred to as
addresses the following areas,
concurrent planning, in that several different
as appropriate:
9.J. FBSLS possible outcomes may occur, and they may
a. Assurance of basic needs not all be evident at the start of the process.
being addressed. Flexibility and close monitoring of the situation
9.a.J. FBSLS
b. Basic rights protection for are possible key indicators of conformance.

the persons served.
9.b.J. FBSLS
c. A permanent living arrangement 3.J. 11. Foster family services reflect planning
for the person. in the following ways:
9.c.J. FBSLS
d. Legal oversight. 11.J. FBSLS
a. Persons served are afforded opportu-

9.d.J. FBSLS
e. Adoption coordination, if needed. nities and supports so that whenever

9.e.J. FBSLS
f. Developmental needs. feasible they return to their families

9.f.J. FBSLS
g. Exploitation awareness. of origin.

11.a.J. FBSLS
9.g.J. FBSLS
h. Health and safety needs. b. When out-of-home placements are

9.h.J. FBSLS
i. Education. necessary, services are provided to

9.i.J. FBSLS
the families of origin and foster
j. Surrogate parent, if applicable.
9.j.J. FBSLS family providers to support the
Intent Statements opportunity for family reunification.
11.b.J. FBSLS
Persons served are informed of and supported c. When persons served are released for
to exercise their rights. adoption, they receive the supports
Examples they need.
11.c.J. FBSLS
9.e. Adoption coordination may include all d. When family reunification or adop-
aspects of coordination surrounding the legal tion is not feasible, persons served
process of adoption as specified by national, have the opportunity for long-term
state, or local regulations. inclusion in a typical family environ-
ment or another living arrangement
that meets their needs or desires.
3.J. 10. Action planning addresses: 11.d.J. FBSLS
10.J. FBSLS e. When persons served cannot be

a. A range of possible living opportuni- maintained in a foster family envi-
ties, as available. ronment, they experience the most
10.a.J. FBSLS
b. Permanency and stability in the life culturally similar residential, educa-

of the person served. tional, and social opportunities
10.b.J. FBSLS
c. Time lines of services. possible while efforts are made

10.c.J. FBSLS
d. Activities to meet the time lines. to secure a stable environment.

10.d.J. FBSLS 11.e.J. FBSLS
e. Persons responsible for the Intent Statements

activities/time lines. Persons served have continued access to
10.e.J. FBSLS
f. Temporary or ongoing supports assistance as needed to obtain and coordinate

needed to execute the action plan. services promptly.
10.f.J. FBSLS
g. Monitoring of action plans.

10.g.J. FBSLS Examples
h. Follow-up as needed.
10.h.J. FBSLS These concepts indicate that a sense of perma-
Intent Statements nency is established in the life of the person
Information is gathered and used in developing served. Advocacy for each person served is
a personalized plan. critical in all instances, and particularly when
reunification with the family of origin is not
possible or is not in the best interest of the
person served.

3.J. 12. The organization, in collaboration with 3.J. 14. The organization assists foster family
the court system, when applicable: providers with development of a
plan for relief, including:
12.J. FBSLS
a. Recruits foster family providers. 14.J. FBSLS
a. A 24-hour emergency response

12.a.J. FBSLS
b. Screens foster family providers.

12.b.J. FBSLS
c. Trains foster family providers. system.

14.a.J. FBSLS
12.c.J. FBSLS
d. Monitors the performance of foster b. Respite services and supports,

family providers. if needed.
14.b.J. FBSLS
12.d.J. FBSLS
e. Reviews foster family providers’ Intent Statements

performance. Respite services and access to emergency
12.e.J. FBSLS
f. Provides support services as needed assistance are readily available.

or requested.
12.f.J. FBSLS
Examples
Intent Statements For more information on respite services,
There are sufficient qualified agency and please refer to Section 3.M.
individual providers to meet the needs of
persons served in their communities. 3.J. 15. Each foster family provider has a
Examples signed agreement that:
15.J. FBSLS
CARF is not accrediting the foster family units, a. Identifies the following for
but rather the services provided by the organi- each involved party:
15.a.J. FBSLS
zation that make foster family placement (1) Role.

successful.
15.a.(1)J. FBSLS
(2) Responsibilities.
15.a.(2)J. FBSLS
12.c. Although Standard 1.H.7. (tests of emer- (3) Specific needs.

gency procedures) is not applied to foster family 15.a.(3)J. FBSLS
b. Identifies the:
homes, safety authorities advise regular practice 15.b.J. FBSLS
(1) Performance monitoring process.

of testing emergency procedures in all homes. 15.b.(1)J. FBSLS
(2) Legal rules/regulations that

This may be an area an organization would
are applicable.
want to include in its training for foster family 15.b.(2)J. FBSLS
providers. c. Is shared with all parties in an

understandable manner.
15.c.J. FBSLS
3.J. 13. Each person served is involved with Intent Statements

the selection of his or her foster family, Clarification of the relationship between the
as is appropriate to age and ability. organization and the foster family provider and
the roles and responsibilities of each promotes
13.J. FBSLS
Intent Statements
delivery of services and supports in an effective
Persons served are supported to direct and manner that will respond to changing needs.
manage their services.
Examples
Examples
Agreements in simple written form minimize
The selection of a specific foster family setting misunderstandings, allow for modification as
is not made based solely on availability. needs change, and provide the basis for successful
partnerships.
15.a.(2) When family responsibilities include
medication administration to persons served,
ensuring appropriate training (as per Standards
3.J.7.i. and 3.J.12.c.) is an important aspect of
organizational risk management and safety of
persons served. Guidance for an organization

could come from licensing, contractual, funding, Examples

legal, or other regulatory requirements. This standard extends the active participation
called for in Standard 3.J.6. to the movement
3.J. 16. Foster family services address the needs of the person served to a new or different setting
of each person served in the following or service. Required time frames are established
areas: by the organization and/or state guidelines.
16.J. FBSLS
a. Healthcare.
16.a.J. FBSLS
b. Safety.
16.b.J. FBSLS
c. Education/vocational, as appropriate.
16.c.J. FBSLS mation you should have available to demonstrate
d. Emotional/behavioral. your conformance to the standards in this sub-
16.d.J. FBSLS
e. Social and community activities. section. See Appendix A for more information
16.e.J. FBSLS
f. Religious, spiritual, and cultural. on required documentation.

16.f.J. FBSLS
g. Transition from foster care to adult ■ Records of the persons served

services, including identifying and ■ Progress notes
addressing guardianship issues.
16.g.J. FBSLS
h. Others, as identified.
16.h.J. FBSLS
Intent Statements
■ Information regarding relief and emergency
It is the responsibility of the organization to response systems
ensure that these needs are being met by the
■ Information regarding foster family
foster family provider.
arrangement
Examples
■ Assessment information
Services are always individualized. The organi-
■ Information regarding recruitment,
zation should be able to demonstrate that it can
screening, training, and monitoring
provide services either through its own resources
or through contractors, partnerships, or referrals
as needed to meet the needs of the persons
served.
3.J. 17. As a person served moves to a different

service or setting, pertinent information
is provided within a reasonable time
frame to the:
17.J. FBSLS
a. Family of origin, as appropriate.

17.a.J. FBSLS
b. Foster family provider, as

appropriate.
17.b.J. FBSLS
c. Person served.
17.c.J. FBSLS
d. New provider of service or new

setting.
17.d.J. FBSLS
e. Referral/funding source.
17.e.J. FBSLS
f. Any other provider working

with the individual.
17.f.J. FBSLS
Intent Statements
Information and support is available to help
persons served make informed decisions.

Host Family/Shared Living Services Some examples of the quality results desired
(HF/SLS) and supports include:
■ Quality of life as identified by the
Description
person served is enhanced.
Host family/shared living services assist a person
served to find a shared living situation in which
he/she is a valued person in the home and has ■ Increased community access.
supports as desired to be a participating member ■ Persons served choose whom they

of the community. An organization may call will live with and where.
these services a variety of names, such as host ■ Participation of the persons in the
family services, shared living services or sup- community.
ports, alternative family living, structured family
■ Community membership.
care giving, family care, or home share.
■ Support for personal relationships.
Getting the person in the right match is a
critical component to successful host family/ ■ Increased natural supports.
shared living services. The organization begins ■ Strengthened personal networks.

by exploring with the person served what con- ■ Supports accommodate individual needs.
stitutes quality of life for him/her and identifies
■ Persons feel safe.
applicant providers who are a potential match
with the person’s identified criteria. The person ■ Persons feel that the supports they need/want
served makes the final decision of selecting his are available.

or her host family/shared living provider. ■ Persons decide where they live.
Safety, responsibility, and respect between or ■ Persons feel valued.

amongst all people in the home are guiding prin- ■ Persons have meaningful relationships.
ciples in these services. Persons are supported
■ Persons develop natural supports.
to have meaningful reciprocal relationships both
■ Persons participate in their community.
within the home, where they contribute to deci-
sion making, and the community. The service
provider helps the person served to develop
natural supports and strengthen existing net-
works. Relationships with the family of origin An organization seeking accreditation in
or extended family are maintained as desired host family/shared living services must meet
by the person served. The provider supports Standards 18.–25. In this section and the
the emotional, physical, and personal well-being standards in the following sections:
of the person. ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
Persons develop their personal lifestyle and optional

modify the level of support over time, if they – Standard 1.H.7. (Section 1.H. Health and
so choose. The provider encourages and Safety) is not applied to any host family/
supports the person served to make his or shared living provider.
her own decisions and choices. – Standards 1.H.13.–1.H.14. are applied to
The host family/shared living provider does the provider only when the organization
not necessarily have to be a family, as it could owns the home.
be an individual supporting the person. In this If any clarification is needed, please
program description and these standards, pro- contact a resource specialist in the
vider refers to the individual(s) supporting the Employment and Community Service
person served. Although the “home” is generally customer service unit.
the provider’s home or residence, it may also be ■ 2.A. Program/Service Structure
the home of the person served.

■ 2.B. Individual-Centered Service Planning, (2) Other individuals living in

Design, and Delivery. the home.
19.e.(2)J. FBSLS
■ 2.C. Medication Management and Monitor- Examples

ing (as indicated by the guidelines in this
19.a. May include criminal background checks,
section, 2.C. is applicable to the organiza- drug testing, verification of immunizations, or
tion if the provider has a responsibility for
other checks that may be relevant for the individ-
medications for persons served)
ual/family or to the person served.
2.F. Community Services Principle Standards
 The organization complies with all required
■
■ 2.G. Children and Adolescents Specific background checks, as applicable, including the
Population Designation (optional) Federal Exclusions List. The Office of Inspector
■ 2.H. Older Adults Specific Population General has the authority to exclude individuals
Designation (optional) and entities from federally funded healthcare
■ 2.I. Medically Fragile Specific Population programs and maintains a current List of
Designation (applicable when indicated by Excluded Individuals and Entities (LEIE).
the support needs of the person served) Anyone who hires an individual or entity
on the LEIE may be subject to civil monetary
penalties. For more information, refer to
Population Designation (ASD:A and/or
oig.hhs.gov/exclusions/index.asp.
ASD:C, optional)
19.c.(1) This might include information such
as household relationships and dynamics and
3.J. 18. The organization actively recruits considerations related to the external environ-
providers.
18.J. FBSLS ment, neighborhood where the home is located,
Intent Statements surrounding areas, etc.
Services are available in a timely manner. 19.e.(1)(a) The potential provider may indicate
limitations on the scope of supports they are
3.J. 19. The organization implements a screen- willing or able to effectively provide due to
ing process for individuals and/or factors such as physical or medical complexities,
families to be service providers, gender, age, cognitive development levels, or
which includes: communication abilities.
19.J. FBSLS
a. Background checks for all adults

in the home. 3.J. 20. As part of the screening process, the
19.a.J. FBSLS
b. Drivers’ records. organization:

20.J. FBSLS
19.b.J. FBSLS
c. A home study to gather information a. Identifies the expectations from

about: the person served of what is desired
19.c.J. FBSLS
(1) The home environment. in a shared living situation, which

19.c.(1)J. FBSLS
includes:
(2) Who lives in the home. 20.a.J. FBSLS
19.c.(2)J. FBSLS
(1) Lifestyle desired.
d. Character reference checks on 20.a.(1)J. FBSLS
the potential provider. (2) Indicators of quality of life

19.d.J. FBSLS
to the person.
e. Interviews with: 20.a.(2)J. FBSLS
19.e.J. FBSLS
(3) Interests.
(1) The potential provider to: 20.a.(3)J. FBSLS
19.e.(1)J. FBSLS
(4) Transportation requirements.
(a) Explore the provider’s 20.a.(4)J. FBSLS
expectations. (5) Cultural/spiritual considerations.

20.a.(5)J. FBSLS
19.e.(1)(a)J. FBSLS
(b) Identify the demographics (6) Living space requirement.

20.a.(6)J. FBSLS
and characteristics of per- (7) Others identified.

20.a.(7)J. FBSLS
sons whom he/she feels

able to support.
19.e.(1)(b)J. FBSLS

b. Gathers information as relevant c. Ensures that individuals have choice

to the needs of the person served, regarding:
including:
21.c.J. FBSLS
20.b.J. FBSLS
(1) Where they live.
(1) Health status.
21.c.(1)J. FBSLS
20.b.(1)J. FBSLS
(2) With whom they live.
(2) Medical conditions.
21.c.(2)J. FBSLS
20.b.(2)J. FBSLS
d. Sets a time frame for decision making
(3) Cognitive abilities. that allows adequate time
for the person to explore choices.
20.b.(3)J. FBSLS
(4) Behavioral challenges. 21.d.J. FBSLS
e. Supports a transition to move in,

20.b.(4)J. FBSLS
Intent Statements
if that is the choice.
It is the person served who should be asked 21.e.J. FBSLS
to answer “What is important in my life…” If Intent Statements

the person served cannot identify this due to a Getting the right person in the right match is a
communication barrier, significant individuals/ critical component to success. The organization
advocates in the person’s life who know him/her manages a process that will lead to a decision
and would be able to do so should be involved. and ensures that a person moves to a home only
The program gathers sufficient information to when the full process has been completed.
suggest potential matches with well-suited pro- When matching individuals with potential provid-
viders. Information is gathered from secondary ers, information from the screening process is
sources as needed and available to help ensure shared with both.
a compatible setting.
Examples
Examples Satisfaction of persons with these services greatly
Personal priorities of the person are identified to depends on a match that meets their identified
assist with the screening and matching process. strengths, needs, and preferences. There will be
Friendships and relationship considerations at least one but may be more meetings between
that may be important to the person served are an individual and a potential provider to allow
addressed. Some questions you may want to ask time for them to determine whether it is a good
the person to help identify lifestyle and quality fit. If the decision of either is that the match is not
of life indicators are: What’s your best week day desired, then the process is repeated with another
like? What is your worst week day like? What’s potential provider. Information gleaned from
your best weekend day like? What would give an unsuccessful match may inform additional
you more better days? criteria to use in identification of another
20.a.(3) Includes hobbies and activities that potential provider.
are important to the person served.
20.b. Secondary sources, including referral 3.J. 22. The organization requires providers
documentation, assessments such as the Support to participate in competency-based
Intensity Scale, information gathered from family training that addresses:
22.J. FBSLS
and previous providers, may be sources for infor- a. Implementation of program values.
22.a.J. FBSLS
mation not available directly from the person b. First aid.

served.
22.b.J. FBSLS
c. Basic healthcare expectations.

22.c.J. FBSLS
d. Documentation practices.
3.J. 21. In matching individuals with potential 22.d.J. FBSLS
e. Medication management, when

providers, the organization: applicable for the person served.
21.J. FBSLS
a. Provides an opportunity for them

22.e.J. FBSLS
f. Other specific areas as applicable

to meet and know one another. to the person served.
21.a.J. FBSLS
b. Ensures that each has information 22.f.J. FBSLS
Examples
about the other to enable both
to exercise informed choice. Although Standard 1.H.7. (tests of emergency
21.b.J. FBSLS
procedures) is not applied to the home, safety

authorities advise regular practice of testing Examples

emergency procedures in all homes. This may Agreements in simple written form minimize
be an area an organization would want to include misunderstandings, allow for modification as
in its training for providers. needs change, and provide the basis for successful
22.c. Includes regular visits to a doctor and other partnerships.
healthcare professionals as needed. An organization may also give specific guidance
22.f. May include training on interpersonal skills, regarding responsibilities in a procedures manual
communication styles, or positive behavioral that is separate from the agreement itself.
supports, when applicable. 23.a.(1)–(2) When responsibilities include
medication administration to persons served,
3.J. 23. The organization has a written agree- ensuring appropriate training (as per Standard
ment with each provider that: 22.e.) is an important aspect of organizational
23.J. FBSLS
a. Includes: risk management and safety of persons served.

23.a.J. FBSLS
Guidance for an organization could come from
(1) Their respective responsibilities.
23.a.(1)J. FBSLS licensing, contractual, funding, legal, or other
(2) Legal rules and regulations that regulatory requirements.
are applicable.
23.a.(2)J. FBSLS
23.a.(3) Communication with providers allows
(3) Mechanisms for communication
two-way dialogue between the organization and
between the organization and
providers. As the service needs of a person served
the provider.
23.a.(3)J. FBSLS change, the provider may be the first to see the
(4) Identification of who has what signs and to suggest modifications to service
authority over decisions regard- planning and delivery.
ing the individual’s:
23.a.(4)J. FBSLS 23.a.(7)–(8) Includes processes for and condi-
(a) Health care. tions that may lead to transition of the person
23.a.(4)(a)J. FBSLS
(b) Finances. served to a different home and termination of

23.a.(4)(b)J. FBSLS
(c) Legal status. the agreement/contract.

23.a.(4)(c)J. FBSLS
(5) Identification of roles for han-

dling a crisis situation involving 3.J. 24. The organization implements a proce-
the person served should one dure for monitoring the performance
arise. expectations of the provider that:
23.a.(5)J. FBSLS
(6) Performance expectations for

24.J. FBSLS
a. Takes place:
the provider. 24.a.J. FBSLS
(1) Initially at:

23.a.(6)J. FBSLS
(7) Performance monitoring process. 24.a.(1)J. FBSLS
(a) 30 days.
23.a.(7)J. FBSLS
(8) Process for resolution if the 24.a.(1)(a)J. FBSLS
(b) 90 days.
organization and/or individual 24.a.(1)(b)J. FBSLS
(2) Quarterly for the rest of the

is not satisfied with the provider
first year.
or home life conditions. 24.a.(2)J. FBSLS
23.a.(8)J. FBSLS
(3) Subsequently every six months,
b. Is shared with all parties in an
unless the individual situation
understandable manner.
23.b.J. FBSLS merits more frequently.
24.a.(3)J. FBSLS
Intent Statements b. Includes individual discussions with:

Clarification of the relationship between the
24.b.J. FBSLS
(1) The person served.

organization and the provider and the roles 24.b.(1)J. FBSLS
(2) The provider.

and responsibilities of each promotes delivery 24.b.(2)J. FBSLS
of services and supports in an effective manner (3) Others, as appropriate.

24.b.(3)J. FBSLS
that will respond to changing needs. c. Ensures:

24.c.J. FBSLS
(1) Implementation of program

values.
24.c.(1)J. FBSLS

Section 3.K. Community Housing (CH)
(2) The individual rights of the

person served in the home
K. Community Housing
24.c.(2)J. FBSLS
are respected. (CH)
(3) Protection of the person served
from any form of exploitation. Description
24.c.(3)J. FBSLS
(4) Provider is facilitating linkages Community housing addresses the desires,

of the person to the community. goals, strengths, abilities, needs, health, safety,
24.c.(4)J. FBSLS
d. Includes documenting the results and life span issues of the persons served, regard-
of monitoring visits. less of the home in which they live and/or the
24.d.J. FBSLS
e. Addresses performance improve- scope, duration, and intensity of the services

ment as needed. they receive. The residences in which services/
24.e.J. FBSLS
supports are provided are typically owned,

Examples
rented, leased, or operated directly by the organi-
24.d. Results of monitoring visits include find- zation, or may be owned, rented, or leased by a
ings as well as any actions taken to address issues third party, such as a governmental entity. Pro-
or problems discovered during the process. viders exercise control over these sites in terms
of having direct or indirect responsibility for
3.J. 25. The organization ensures that the the physical conditions of the facility.
provider has a plan for: Community housing is provided in partnership
25.J. FBSLS
a. Respite or relief to address continuity with individuals. These services/supports are

of support. designed to assist the persons served to achieve
25.a.J. FBSLS
b. Emergency response. success in and satisfaction with community liv-

25.b.J. FBSLS
ing. They may be temporary or long-term in

Intent Statements
nature. The services/supports are focused on
Respite services and access to emergency home and community integration and engage-
assistance are readily available. ment in productive activities. Community
Examples housing enhances the independence, dignity,
Providers have the same needs for supports personal choice, and privacy of the persons
and service access as do families of origin. served. For persons in alcohol and other drug
For more information on respite services, programs, these services/supports are focused
please refer to Section 3.M. on providing sober living environments to
increase the likelihood of sobriety and abstinence
Documentation Examples and to decrease the potential for relapse.
The following are examples of the types of infor- Community housing programs may be referred
mation you should have available to demonstrate to as group homes, halfway houses, three-quarter
your conformance to the standards in this sub- way houses, recovery residences, sober housing,
section. See Appendix A for more information domestic violence or homeless shelters, and safe
on required documentation. houses. These programs may be located in rural
or urban settings and in houses, apartments,
townhouses, or other residential settings owned,
rented, leased, or operated by the organization.
■ Progress notes They may include congregate living facilities
■ Information regarding recruitment, and clustered homes/apartments in multiple-unit
screening, training, and monitoring settings. These residences are often physically
■ Contract information
integrated into the community, and every effort
is made to ensure that they approximate other
homes in their neighborhoods in terms of size
■ Information regarding relief and and number of individuals.
emergency response systems

Community housing may include either or both ■ Persons having freedom and support to
of the following: control their schedules and activities.
■ Transitional living that provides interim sup- ■ Settings that are physically accessible to
ports and services for persons who are at risk the individuals.
of institutional placement, persons transition-
ing from institutional settings, or persons who
are homeless. Transitional living is typically Applicable Standards
provided for six to twelve months and can An organization seeking accreditation in
be offered in congregate settings that may community housing must meet the standards
be larger than residences typically found in this section and the standards in the follow-
in the community. ing sections:
■ Long-term housing that provides stable, ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
supported community living or assists the optional
persons served to obtain and maintain safe, ■ 2.A. Program/Service Structure
affordable, accessible, and stable housing.
The residences in which Community Housing Design, and Delivery
services are provided must be identified in the ■ 2.C. Medication Monitoring and Manage-
survey application. These sites will be visited ment (as applicable; see page 148)
during the survey process and identified in the
■ 2.F. Community Services Principle Standards
survey report and accreditation decision as a site
at which the organization provides a Community ■ 2.G. Children and Adolescents Specific
Housing program. Population Designation (optional)

NOTE: The term home is used in the following stan- ■ 2.H. Older Adults Specific Population
dards to refer to the dwelling of the person served, Designation (optional)

however CARF accreditation is awarded based on ■ 2.I. Medically Fragile Specific Population
the services/supports provided. This is not intended Designation (optional)
to be certification, licensing, or inspection of a site. ■ 2.J. Autism Spectrum Disorder Specific
Some examples of the quality results desired Population Designation (ASD:A and/or
by the different stakeholders of these services/ ASD:C, optional)
supports include:
■ Safe housing. 3.K. 1. Each person served is in a residential
■ Persons choosing where they live. setting with his or her own personal
■ Persons choosing with whom they will live. space that:
1.K. CH
■ Persons having privacy in their homes.

a. Respects privacy.
1.a.K. CH
■ Persons increasing independent living skills.

b. Promotes personal security.
1.b.K. CH
c. Promotes safety.
■ Persons having access to the benefits of 1.c.K. CH
community living. Intent Statements

■ Persons having the opportunity to receive Persons served have a right to personal,
services in the most integrated setting. private space.
■ Persons’ rights to privacy, dignity, respect, Examples
and freedom from coercion and restraint 1.a. This standard does not require a separate
are ensured. room for each resident, but it does suggest the
■ Persons having the freedom to furnish and provision of a safe, secure, private location
decorate their sleeping or living units as that can be thought of by the person served
they choose. as his or her own. Even when a person shares

a bedroom with a roommate, there is still Examples

privacy available. 2.a. These meetings could be community
1.b. A program might consider units with lock- meetings or meetings for the purpose of
able entrance doors, with the persons served collaboratively discussing issues such as:
and appropriate staff having keys as needed. ■ Program operations.
1.c. Safety needs are determined on the basis ■ Problems.

of the individuals’ strengths and needs. See also ■ Plans.
standards in Section 1.H. Health and Safety
■ The use of program resources.
for all sites owned, leased, or operated by the
organization. 2.b. The program encourages all persons served
to take increasing responsibility for cooperative
3.K. 2. The organization provides the following operation of the household. Activities may
community living components: include the preparation of food and the perfor-
2.K. CH
mance of daily household duties.
a. Regular meetings between the
persons served and staff. 2.d. Persons served have the freedom to furnish
2.a.K. CH
b. Opportunities to participate in and decorate their sleeping or living areas.

typical home activities. 2.e. Organizations might consider that persons
2.b.K. CH
c. Appropriate linkage when health- served have access to food at any time unless
care needs of the persons served there are special dietary concerns identified in
are identified. a person’s individualized service plan. As part of
2.c.K. CH
a person’s participation in household activities,
d. A personalized setting.
2.d.K. CH one role might be cleaning and slicing fresh fruit
e. Daily access to nutritious or vegetables to provide healthy snacks being
meals and snacks. available at all times for housemates.
2.e.K. CH
f. The opportunity for expression

2.f. Depending on the program structure and
of choice by the persons served in
the needs of the persons served, there may be
regard to rooms and housemates.
2.f.K. CH procedures for maintaining separate sleeping
g. Based on the choice of the persons areas in accordance with the genders, ages,
served, opportunities to access: and developmental level of the persons served.
2.g.K. CH
(1) Community activities. Whenever possible, each person served has

2.g.(1)K. CH
(2) Cultural activities. the choice of a private room or the opportunity

to participate in the selection of his or her
2.g.(2)K. CH
(3) Social activities.

2.g.(3)K. CH
(4) Recreational activities. roommate.

2.g.(4)K. CH
(5) Spiritual activities. 2.g. Persons served have freedom and support to
2.g.(5)K. CH
(6) Employment/income generation control their schedules and activities as identified

activities. in their plans.
2.g.(6)K. CH
(7) Necessary transportation. 2.g.(8) Activities could include meetings of

2.g.(7)K. CH
12-step and other self-help groups.
(8) Self-help groups.
2.g.(8)K. CH
(9) Other activities as identified

in the person’s plan. 3.K. 3. In-home safety needs of persons served
2.g.(9)K. CH
are addressed with respect to:
h. Guidelines related to: 3.K. CH
2.h.K. CH
(1) Visitors or guests. 3.a.K. CH
2.h.(1)K. CH
b. Abuse and/or neglect inflicted
(2) Pets.
2.h.(2)K. CH by self or others.
3.b.K. CH
Intent Statements c. Self-protection skills.

Persons served have choice in services/supports.
3.c.K. CH
d. Medication management.
3.d.K. CH


Safety needs are determined on the basis The safety and security of the living arrange-
of the individuals’ strengths and needs. ments of the persons served are assessed, risk
factors and accessibility issues are identified,
Examples
and modifications are made to make the housing
See also standards in Section 1.H. Health and choices acceptable.
Safety for all sites owned, leased, or operated
by the organization. Examples
Successful transition of a person served to safe
3.K. 4. When possible, persons served have and affordable new housing requires the organi-
options to make changes in their zation to establish organizational procedures
living arrangements: based on input from a variety of customers and
4.K. CH
stakeholders. Planning considerations should
a. At their request.
4.a.K. CH include the strengths, desires, and needs of the
b. At the request of their families, persons served, as well as areas of organizational
when applicable. consideration and resources that will need to be
4.b.K. CH
c. In transitional living, on a periodic addressed. Those areas include accessibility plans

basis when initiated by the and resources budgeted to remove barriers,
organization. appropriate review of health and safety factors
4.c.K. CH
d. Based on informed choice. as defined by local authorities, and the various

aspects of risk management, and are all part
4.d.K. CH
Intent Statements
of the individual services and organizational
Residential services and supports are flexible planning necessary to secure new housing.
and fluid, as the needs and desires of the
persons served change.
3.K. 6. Each person served receives:
Examples 6.K. CH
a. Skill development necessary to live

The preference for a different living situation as independently as possible.
is typically addressed at the person’s annual 6.a.K. CH
b. Ongoing support/services as they

planning meeting. explore changes in their living
Knowledge of existing and planned services is arrangements.
important for the persons served so that they can 6.b.K. CH
Intent Statements
make informed choices about alternative living
arrangements. Alternative living arrangements The person served has continuous access to
may be provided by the organization or other services and support. The person’s plan is con-
providers. The term living arrangements refers tinuously monitored, and modifications are
to the service model and not the residence or made in the plan as the needs and circumstance
home itself. of the person served change.
6.b. The person served may need confidence
and courage to try alternative living arrange-
3.K. 5. Based on the needs of persons tran- ments. It is the responsibility of the provider
sitioning to other housing, there are
organization to attempt to minimize risks of try-
procedures in place to assist them ing alternative living arrangements. See also the
in securing housing that is: related Standard 2.B.7. in Section 2.B. Individual-
5.K. CH
a. Safe. Centered Service Planning, Design, and Delivery

5.a.K. CH
b. Affordable. related to assessment of risk for persons served.

5.b.K. CH
c. Accessible. Examples
5.c.K. CH
d. Acceptable. Often, the development of a professional team

5.d.K. CH
and a circle of support and friends can be helpful

in encouraging persons served to try alternative Intent Statements

living arrangements. When housing is shared by two or more individuals,
the program actively addresses the need to desig-
Resources
nate space for privacy and individual interests.
A number of resources can be helpful to the
planning of delivery of services/supports. Examples
These include the CARF publication Using 9.c. Opportunities for visitors are flexible
Individual-Centered Planning for Self-Directed with consideration also given to the rights
Services, which is available on request from your of all residents.
resource specialist, as well as related standards
regarding accessibility, health and safety, and 3.K. 10. The organization assists the person
fiscal management in Section 1 of this manual. served to identify and utilize available
Additional guidance may also be found in modes of transportation.
Section 3.L. Supported Living (SL). 10.K. CH
Intent Statements
3.K. 7. Personnel are on site based on the When transportation cannot be accessed
independently by the persons served, the
needs of the persons served, as
organization coordinates transportation
identified in their individual plans.
7.K. CH to other relevant services and activities.
Intent Statements
Examples
Personnel have the experience/training
The development of natural supports also can
needed to effectively deal with the needs
of the persons served. be effective in enabling persons to participate
in more community activities.
Examples
If the program serves persons with autism spec- 3.K. 11. The organization demonstrates efforts
trum disorder (ASD), personnel have experience to maintain a person’s residence as long
and training in this area. An organization serving as possible during temporary medical,
persons with ASD may add a specific population legal, or personal absences.
designation to its accreditation by selecting to 11.K. CH
include this on its survey. See Section 2.J. Autism Examples

Spectrum Disorder Specific Population Designa- If tenant laws do not apply, an organization might
tion (ASD). consider putting a residency agreement or other
written agreement in place that could provide
3.K. 8. There is a system for the on-call protections to residents and appeals comparable
availability of designated personnel to those provided under the jurisdiction’s land-
24 hours a day, 7 days a week. lord tenant law.
8.K. CH
3.K. 9. In congregate housing, provisions are mation you should have available to demonstrate
made to address the need for: your conformance to the standards in this sub-
9.K. CH
a. Smoking or nonsmoking areas. section. See Appendix A for more information

9.a.K. CH
b. Quiet areas. on required documentation.

9.b.K. CH
c. Areas for visits. ■ Records of the persons served

9.c.K. CH
d. Other issues, as identified ■ Individual service plans

by the residents. ■ Progress notes
9.d.K. CH
■ Health and safety information

Section 3.L. Supported Living (SL)
L. Supported Living (SL) Some examples of the quality results desired

by the different stakeholders of these services/
supports include:
Description
■ Persons served achieving choice of housing,
Supported living addresses the desires, goals, either rent or ownership.
strengths, abilities, needs, health, safety, and life
■ Persons served choosing whom they will
span issues of persons usually living in their own
homes (apartments, townhouses, or other resi- live with, if anyone.
dential settings). Supported living services are ■ Minimizing individual risks.
generally long-term in nature but may change ■ Persons served have access to the benefits
in scope, duration, intensity, or location as the of community living.
needs and preferences of individuals change ■ Persons served have autonomy and indepen-
over time. dence in making life choices.
Supported living refers to the support services
provided to the person served, not the residence
in which these services are provided. A sampling Applicable Standards
of people receiving services/supports in these An organization seeking accreditation in
sites will be visited as part of the interview pro- supported living must meet the standards
cess. Although the residence will generally be in this section and the standards in the
owned, rented, or leased by the person who lives following sections:
there, the organization may occasionally rent or ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
lease an apartment when the person served is optional
unable to do so. Typically, in this situation the
NOTE:
organization would co-sign or in other ways
guarantee the lease or rental agreement; however, – Standard 1.H.7. (Section 1.H. Health and
the person served would be identified as the Safety) is not applied to supported living
tenant. residences.
Supported living programs may be referred to – Standards 1.H.13.–1.H.14. are applied
as supported living services, independent living, to the supported living residence only
supportive living, semi-independent living, and when the organization owns the home.
apartment living; and services/supports may If any clarification is needed, please
include home health aide and personal care contact a resource specialist in the
attendant services. Typically there would not be Employment and Community Service
more than two or three persons served living in customer service unit.
a residence, no house rules or structure would ■ 2.A. Program/Service Structure
be applied to the living situation by the organi- ■ 2.B. Individual-Centered Service Planning,
zation, and persons served can come and go as Design, and Delivery
they please. Service planning often identifies the
number of hours and types of support services ■ 2.C. Medication Monitoring and Manage-
provided. ment (as applicable; see page 148)
The home or individual apartment of the person ■ 2.F. Community Services Principle Standards
served, even when the organization holds the ■ 2.G. Children and Adolescents Specific
lease or rental agreement on behalf of the person Population Designation (optional)
served, is not included in the survey application ■ 2.H. Older Adults Specific Population
or identified as a site on the accreditation Designation (optional)
outcome.

■ 2.I. Medically Fragile Specific Population Examples

Designation (optional) Health and safety risks may be greater in this type
■ 2.J. Autism Spectrum Disorder Specific of residential support service. This standard
Population Designation (ASD:A and/or amplifies those in Section 1.H., and should be
ASD:C, optional) considered in their context. Although Standard
1.H.7. (tests of emergency procedures) is not
3.L. 1. Based on the needs of the persons applied to supported living residences, safety
served, assistance is offered in securing authorities advise regular practice of testing
or maintaining housing that is: emergency procedures in all homes. This may
1.L. SL
be an area an organization would want to include
a. Safe.
1.a.L. SL in its training for persons receiving supported
b. Affordable. living services.
1.b.L. SL
c. Accessible. Outcomes and quality indicators for these

1.c.L. SL
d. Chosen by the individual. services/supports may include the service pro-

1.d.L. SL
Intent Statements vider having a procedure for assessing potential

Information and support is available to help per- risks involved in making choices. Staff, persons
sons served make informed choices. Although served, and others as appropriate are trained in
these services/supports are provided to persons this process.
in their own home or apartment, it may at some
time be necessary for the provider to offer assis- 3.L. 3. Persons served have input into:
tance to the individual in locating a different, 3.L. SL
a. Where they live.

more appropriate living situation. 3.a.L. SL
b. With whom they live.

3.b.L. SL
Examples
Intent Statements
Outcomes and quality indicators for these Persons served are supported to direct and
services/supports may include: manage their own services/supports.
■ Persons are safe in their home and
Examples
neighborhood.
These elements of interdependence and self-
■ Persons have the information and opportu-
determination are fundamental to the concepts
nity to look at different living arrangements
of supported living, and will enhance consumer
in order to make a choice that makes sense
satisfaction results demonstrated as conformance
for them.
to the standards in Section 1.M. Performance
■ Agencies assist persons in finding and secur-
Measurement and Management.
ing their own home as needed or requested.
Outcomes and quality indicators for these
services/supports may include:
3.L. 2. In-home safety needs of persons served
■ Persons choosing where to live and with
are addressed with respect to:
2.L. SL whom and they control what happens in
a. Environmental risks. their homes.
2.a.L. SL
b. Abuse and/or neglect inflicted by self

■ Persons having a key to their own homes
or others.
2.b.L. SL
and deciding who else has a key and who
c. Self-protection skills. may enter into their homes.
2.c.L. SL
d. Medication management. ■ The agency mission, strategic plan, policies

2.d.L. SL
Intent Statements and procedures all reflecting consistent values

Risk and safety considerations are assessed about choice.
and potential intervention identified to promote ■ Persons making their own everyday choices
health, independence, and safety. as well as planning for the future.

Examples
3.L. 4. Persons served determine the décor
Outcomes and quality indicators for these
in their homes.
4.L. SL services/supports may include:
Intent Statements ■ Persons are supported to communicate their
Persons self-direct and provide input regarding preferences, choices, and needs.
decor in the home.
■ Staff are trained in assisting persons to use
Examples their support system in making choices.
Persons served have opportunities to access the ■ Persons have family, friends, or neighbors
community to purchase decorative items for their who support them in typical ways or as
home. Staff may provide assistance and counsel paid help.
regarding budgeting for long-range planning. ■ The individual and his or her circle of support
work together as a team with the supported
3.L. 5. Support personnel are available, based living agency and others to share the responsi-
on the needs of the person served, as bility for his or her well-being.
identified in the individual plan.
5.L. SL
Intent Statements 3.L. 7. A system is in place to provide access to

Direct service personnel possess the skills, needed services/supports 24 hours a
competencies, and qualifications to support day, 7 days a week.
7.L. SL
the persons served. Intent Statements

Examples Refer to Standard 5. The extent of service support
Supported living services may be up to 24/7/365 is determined by the needs of the individuals,
based on their program plans and regulations.
support, depending on local regulatory require-
ments and definitions. This is individualized to
each person’s specific needs. 3.L. 8. Based on the needs and desires of the
Outcomes and quality indicators for these persons served, support is offered in
services/supports may include: the following areas:
8.L. SL
a. Healthy lifestyles.
■ Services/supports are provided in the person’s 8.a.L. SL
home and in the community at times that b. Personal care.

8.b.L. SL
make sense for the individual and when c. Home maintenance.

8.c.L. SL
preferred. d. Their role as a tenant, when

■ Persons direct the services/supports they applicable.
8.d.L. SL
receive and have a choice of agencies and staff. e. Effective self-advocacy and decision
making.
8.e.L. SL
3.L. 6. Support personnel collaborate with the f. Family contact, if desired.

8.f.L. SL
person’s support network, as directed g. Social life and friendships/

by the person served. relationships.
6.L. SL 8.g.L. SL
Intent Statements h. Community membership and social

networks.
This standard defines the amount of control the 8.h.L. SL
person served has over the living supports. i. Financial stability.

8.i.L. SL
j. Other identified needs.

8.j.L. SL
Intent Statements
Supported living services may be more inclusive
of life needs than traditional residential support
for basic food and shelter requirements.

Examples Examples
Outcomes and quality indicators for these Outcomes and quality indicators for these
services/supports may include: services may include:
■ Persons are secure in their home and do not ■ The person fully participates in the
have to move if their needs change. mainstream of community life according
■ Support of self-advocacy for the persons to personal choice and preference.
served empowers the persons to advocate ■ He or she has opportunities to join clubs,
on behalf of themselves. groups, organizations, and religious groups
■ Organizations have a method for changing and to use local community resources.
individual services as service/support needs ■ Support staff are knowledgeable about local
change. community and generic services.
■ Persons have opportunities and support for ■ Staff are trained in building community
building and maintaining relationships with connections and ways to help individuals in
family, friends, and community members. locating and accessing mental and physical
■ Persons have opportunities to learn about health resources.
relationships, including how to protect them-
selves against abuse and exploitation and Additional Resources
developing and maintaining friendships and The CARF publication Using Individual-Centered
relationships. Planning for Self-Directed Services, which is avail-
■ Persons have access to generic community
services and supports. provides an easy-to-understand guide of essential
elements, examples of planning procedures, sam-
■ The organization maintains a directory of
ple plans, and a list of additional resources for
local community and generic services.
individual-centered planning of services based
■ Persons are supported in locating and access- on the preferences and needs of the persons
ing mental and physical resources. served.
■ Individual support plans show adequate plan-
ning for health and safety needs and include Documentation Examples
plans for possible emergencies and disasters. The following are examples of the types of infor-
3.L. 9. Persons served are provided opportuni- your conformance to the standards in this sub-
ties to choose and access: section. See Appendix A for more information
9.L. SL
a. Community activities. on required documentation.

9.a.L. SL
b. Cultural activities.
9.b.L. SL
c. Social activities. ■ Individual service plans

9.c.L. SL
d. Recreational activities. ■ Progress notes

9.d.L. SL
e. Spiritual activities. ■ Health and safety information

9.e.L. SL
f. Employment/income generation ■ Procedures manual

activities.
9.f.L. SL
g. Transportation, when necessary.

9.g.L. SL
h. Other.
9.h.L. SL

Section 3.M. Respite Services (RS)
M. Respite Services (RS) 3.M. 1. Before services begin, the persons

served and their families communicate
Description their:
1.M. RS
Respite services facilitate access to time-limited, a. Preferences.

1.a.M. RS
temporary relief from the ongoing responsibility b. Needs.

of service delivery for the persons served, fami-
1.b.M. RS
c. Expectations.
lies, and/or organizations. Respite services may 1.c.M. RS
be provided in the home, in the community, or Intent Statements

at other sites, as appropriate. An organization The services/supports reflect the needs of
providing respite services actively works to each person and family served.
ensure the availability of an adequate number Examples
of direct service personnel. Continuing two-way communication with
Some examples of the quality results desired the service provider is essential to achieve out-
by the different stakeholders of these services/ comes that are successful in terms of stakeholder
supports include: satisfaction.
■ Services/supports are responsive to the
family’s needs. 3.M. 2. Respite services accommodate:
■ Services/supports are safe for persons.
2.M. RS
a. The needs of the person served.

2.a.M. RS
■ Services/supports accommodate medical b. The needs of each family.

needs. 2.b.M. RS
Intent Statements
This standard amplifies and defines the partner-
Applicable Standards ship between the person served and his or her
An organization seeking accreditation in family and the service provider.
respite services must meet the standards in
this section and the standards in the following 3.M. 3. The preferences and needs of each family
sections: determine the specific respite services
received by the family.
3.M. RS
optional Intent Statements

■ 2.A. Program/Service Structure Family preferences make these services/supports
■ 2.C. Medication Monitoring and Manage- unique to the families receiving them.
ment (when services are provided in an Examples
organization site and exceed seven con-
Ongoing communication between the organiza-
secutive days duration for an individual,
tion and providers helps to identify the specific
Standards 1.–2. and 5.– 6.)
respite needs of each family.
■ 2.F. Community Services Principle
Standards, Standard 4.
3.M. 4. Family members assist with respite
■ 2.G. Children and Adolescents Specific training, as appropriate.
Population Designation (optional) 4.M. RS
Intent Statements
■ 2.H. Older Adults Specific Population
Designation (optional) Persons served are supported to direct and
manage their own services.
■ 2.I. Medically Fragile Specific Population
Designation (optional) Examples
■ 2.J. Autism Spectrum Disorder Specific Generally families know best what the person
Population Designation (ASD:A and/or served needs and can be helpful in training
ASD:C, optional) others.

Section 3.M. Respite Services (RS)
Intent Statements
3.M. 5. The individual respite site is matched
The health and safety of persons served are
to the identified needs of each person
supported in the service environment.
and family served.
5.M. RS
Intent Statements Documentation Examples

The location of service delivery is an important The following are examples of the types of infor-
part of the family’s service needs and plan. mation you should have available to demonstrate
Examples
The organization attempts to provide services/ on required documentation.
supports when and where the person served
chooses.
■ Progress notes
Individuals’ satisfaction with services, cost
effectiveness, accessibility, and reasonable ■ Procedures manual
accommodations are considered in determining ■ Intake information

the locations used to provide respite services/
supports.
3.M. 6. When other needs of the person served

are observed during provision of respite,
communication to the family includes:
6.M. RS
a. Information about resources that are

available and how to access these.
6.a.M. RS
b. Recommendations for additional

services.
6.b.M. RS
Intent Statements
Persons served have access to an array of
services/supports.
Examples
As a basis of the partnership between the organi-
zation and the family, the organization has an
equal responsibility to convey its observations
regarding the services/supports needed to the
family and the person served for their
consideration.
3.M. 7. When applicable, the following accom-

pany the person served or are available
at the service site:
7.M. RS
a. Necessary medications.
7.a.M. RS
b. Needed medical and/or adaptive/

assistive technology equipment.
7.b.M. RS
c. Instructions for:
7.c.M. RS
(1) Medical care.

7.c.(1)M. RS
(2) Special needs.

7.c.(2)M. RS
(3) Emergencies.
7.c.(3)M. RS

Section 3.N. Services Coordination (SC)
N. Services Coordination Applicable Standards

(SC) An organization seeking accreditation in
services coordination must meet the standards
Description in this section and the standards in the follow-
ing sections:
Services coordination programs provide goal-
oriented and individualized supports focusing on ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
improved self-sufficiency for the persons served optional

through assessment, planning, linkage, advocacy, ■ 2.A. Program/Service Structure
coordination, and monitoring activities. Success- ■ 2.B. Individual-Centered Service Planning,
ful services coordination results in community Design, and Delivery
opportunities and increased independence for
the persons served. Programs may provide
occasional supportive counseling and crisis
intervention services, when allowed by regula-
tory or funding authorities. Standards*
Services coordination may be provided by an
organization as part of its individual service ■ 2.G. Children and Adolescents Specific
planning and delivery, by a department or divi- Population Designation (optional)

sion within the organization that works with ■ 2.H. Older Adults Specific Population
individuals who are internal and/or external to Designation (optional)
the organization, or by an organization with the ■ 2.I. Medically Fragile Specific Population
sole purpose of providing community services Designation (optional)
coordination. Such programs are typically pro-
vided by qualified services coordinators or by
case management teams. Population Designation (ASD:A and/or
ASD:C, optional)
Organizations performing services coordination
as a routine function of other services or pro- * For employment services coordination, these
grams are not required to apply these standards standards are applied as relevant to the scope
unless they are specifically seeking accreditation of employment-focused services.
for this program.
Some examples of the quality results desired 3.N. 1. The persons served are linked to services
by the different stakeholders of these services and resources as identified in their indi-
include: vidual plans.
1.N. SC
■ Access to a variety of services/supports. Intent Statements

■ Access to choices of services. Persons are provided with the necessary level
■ Individualized services to meet needs.
of assistance to afford them equal access to
community services and resources.
■ Persons achieving goals.
Examples
■ Persons achieving independence.
■ Access to vocational training.

For optimal results and satisfaction of the per-
sons served with their services, the organization
■ Persons achieving employment.
assesses the availability, costs, and effectiveness
■ Access to career development. of such services; establishes an efficient referral
mechanism; and facilitates the process.
Quality service coordinators maintain contacts
and arrangements with community resources to
enable the development of the individual plans

as noted in the standards in Section 2.B., in Many organizations keep other agency brochures
which the preferences, needs, and desired and referral forms available to facilitate smooth
outcomes of the persons served are addressed. linkages to services.
Ties to standards in Section 1.M. Performance
Measurement and Management and Section 1.N. 3.N. 3. Based on the needs of the persons
Performance Improvement are apparent. The served, services coordination includes:
CARF publication Managing Outcomes, which
3.N. SC
a. Activities carried out in collaboration

is available on request from your resource with the persons served and/or their
specialist, includes practical examples of families, as appropriate.
customer-driven outcomes systems. 3.a.N. SC
b. Outreach/facilitation to encourage
participation of the persons served.
3.N. 2. Services coordination personnel 3.b.N. SC
c. Coordination of, or assistance with,

maintain a working knowledge of: crisis intervention and stabilization
2.N. SC
a. Services/resources that are appropri- services, as appropriate.

ate for the needs of the persons 3.c.N. SC
d. Assisting the persons served to

served. achieve goals for independence as
2.a.N. SC
b. Support systems that are relevant defined by the persons served.

to the lives of the persons served. 3.d.N. SC
e. Optimizing resources and opportuni-

2.b.N. SC
c. Funding issues pertinent to the ties through:

referral process. 3.e.N. SC
(1) Community linkages.

2.c.N. SC
3.e.(1)N. SC
Intent Statements (2) Enhanced social support

The organization demonstrates the ability to networks.
3.e.(2)N. SC
provide services and supports in an effective f. Assistance with:

3.f.N. SC
and efficient manner. (1) Accessing transportation.

3.f.(1)N. SC
Examples (2) Securing safe housing that is

The service coordinator need not know all the reflective of the:
3.f.(2)N. SC
answers, but knows where and how to find the (a) Abilities of the persons
resources and services desired to support the served.
3.f.(2)(a)N. SC
persons served. (b) Preferences of the persons

In order to provide the linkages, coordination, served.
3.f.(2)(b)N. SC
and support needed by the persons served, the (c) Needs of the persons served.
3.f.(2)(c)N. SC
services coordinators are able to demonstrate (3) Exploring employment or other

knowledge of healthcare, social services, employ- meaningful activities.
ment, housing, recreational opportunities, and 3.f.(3)N. SC
(4) Accessing employment training.

other services and systems available in the 3.f.(4)N. SC
(5) Job seeking.

community. 3.f.(5)N. SC
(6) Career development and

Service coordinators would identify community advancement.
services and community resources, establish 3.f.(6)N. SC
g. Provision of, or linkages to, skill

relationships with these community resources/ development services needed to
services, maintain current contact information,
enable the person served to perform
and partner to coordinate services for a person
daily living activities, including, but
as needed. not limited to:
The internet, local United Way guides, etc. can 3.g.N. SC
(1) Budgeting.
be used to address individualized needs. 3.g.(1)N. SC
(2) Meal planning.

3.g.(2)N. SC
(3) Personal care.

3.g.(3)N. SC

(4) Housekeeping and home 3.b. In some programs, such as Healthy Families
maintenance. America, guidelines specify a variety of positive
outreach methods and are used to build trust,
3.g.(4)N. SC
(5) Other identified needs.

3.g.(5)N. SC
h. Evidence of linkages with necessary engage the person served in services, and main-
and appropriate: tain ongoing involvement.
3.h.N. SC
(1) Financial services. 3.h.(2) Medical or other healthcare includes

3.h.(1)N. SC
(2) Medical or other healthcare. the coordination of the healthcare of the persons
3.h.(2)N. SC
served. Often individuals are seeing a variety
(3) Other community services.
3.h.(3)N. SC
of healthcare professionals and using a variety
(4) Assistive technology assessment. of medications that need to be monitored and
3.h.(4)N. SC
Intent Statements coordinated. When working with infants or

Services coordination meets the needs of the children, healthcare includes immunizations.
person served in their communities directly
or through linkages to qualified providers. 3.N. 4. The organization provides services
coordination activities at times and
Examples
in locations that meet the needs of
These services coordination activities are carried the persons served.
out in partnership and collaboration with the 4.N. SC
persons served. All the elements listed in this Intent Statements

standard should be available directly or through Persons served have access to assistance as
referral. needed in any setting that provides the best
Not all services available are provided to every access.
person served. The services identified for any Examples
individual relate to the input and outcomes Services such as assessment, planning, coordi-
expectations as identified in the plan of the nation, and monitoring can be provided in
person served. See related standards in Sections any setting that provides the best access to
1.D., 1.M., 1.N., and 2.B. the persons served and is preferred by the
Services/supports that may be provided include: persons served.
■ Coordinating crisis assistance and supports. Such locations may include residences, correc-
■ Facilitating linkages to community resources. tional settings, shelters, community resource
■ Coordinating and documenting of overall
sites, hospitals, schools, medical, or other
service delivery plans. service sites.
■ Obtaining services necessary to meet basic
human needs ( e.g., food and shelter). 3.N. 5. The intensity of services coordination
is based on the needs of the person
■ Supports to prevent homelessness.
as identified in his or her individual
■ Assisting the person served to connect to person-centered plan.
employment services leading to a job. 5.N. SC
Intent Statements
■ Assisting the persons served in increasing
social support networks in the community. Persons served have authority and are supported
to direct and manage their services to the extent
■ Assisting the persons served in accessing
they wish. The intensity of services coordination
their financial rights and benefits. and the frequency of contact are individualized
■ Assessing the needs for personal advocacy and clearly defined.
and making recommendations where
Examples
appropriate.
There is wide variability among types of case
■ Facilitating certain activities of medical or
management. Many programs provide intensive
behavioral health services coordination. services coordination to a small, select group

of individuals, and other programs provide Additional details for establishing and managing
services only periodically. However, there is a quality outcomes can be located in Section 1.M.
clear relationship between how often persons Performance Measurement and Management
are served and their specific needs. and Section 1.N. Performance Improvement, as
Some programs, such as Healthy Families Amer- well as in the Managing Outcomes publication,
ica, have clearly defined criteria for increasing/ which is available on request from your CARF
decreasing the intensity of services. resource specialist.
3.N. 6. When multiple services coordinators
exist: The following are examples of the types of infor-
6.N. SC
a. A primary service coordinator
is identified.
6.a.N. SC section. See Appendix A for more information
b. There is coordination to: on required documentation.
6.b.N. SC
(1) Facilitate continuity of care.

6.b.(1)N. SC
(2) Reduce duplication of services.
6.b.(2)N. SC ■ Person-centered plans for the persons served
Intent Statements ■ Progress notes
The person served has access to assistance as ■ Information regarding the types of services
needed to obtain services promptly. and resources provided
Examples ■ Consumer satisfaction information
By referencing the individual’s service plan ■ Signed forms authorizing release of
and utilizing the personal outcomes satisfaction information on service satisfaction
measurements, services coordination results
in effective and efficient service delivery.
■ Procedures for coordination of services
■ Authorization of persons served to share

3.N. 7. With the permission of the persons
served, personnel provide advocacy satisfaction information
by sharing feedback regarding the ser-
vices received with the agencies and
organizations providing the services.
7.N. SC
Intent Statements
Persons served have an active role in program
design, performance appraisal and quality
improvement activities. The sharing of perfor-
mance analysis reports and satisfaction surveys
with stakeholders focuses the community on
meeting the expectations of the persons served.
Examples
Networks, partnerships, and referral arrange-
ments are maintained when the services meet
the expectations of the persons served with
regard to quality. Persons are referred to different
community services when those expectations
are not met.
No information specific to an individual is
disclosed unless the person has authorized it.

Section 3.O. Transition Services (TS)
O. Transition Services (TS) Applicable Standards

An organization seeking accreditation in
Description
employment transition services must the meet
Transition services are integrated, community- standards in this section and the standards in
oriented, systematic services for students/ the following sections:
transition-age youth and their families provided
through a jointly planned approach, involving
optional
broad-based community collaboration, linkages,
advocacy, and natural supports.
Transition services/supports are planned and
coordinated for multiple outcomes for youths Design, and Delivery
leaving school, including post-secondary ■ 2.C. Medication Monitoring and Manage-
education, supported education, vocational ment (as applicable; see page 148)
assessments and targeted training, community ■ 2.E. Workforce Development (optional)
employment (including supported employment ■ 2.F. Community Services Principle
and volunteer placement), independent or sup- Standards, Standard 2.F.4.
ported living, and community participation.
■ 2.J. Autism Spectrum Disorder Specific Pop-
The organization demonstrates early active out-
reach to and connection and partnership with ulation Designation (ASD:A only, optional)
school districts to address the transition needs
of students and their families. The purpose of 3.O. 1. Outreach is provided to students/
this collaboration and early planning is focused transition-age youth and their
on ensuring that transition-age youth are not families to:
1.O. TS
“missed” as they move from one system to a. Inform them of their options
another. before they transition from school
Some examples of the quality results desired to community services, including
by the different stakeholders of these services post-secondary education or
include: employment, when appropriate.
1.a.O. TS
■ Community-oriented services.
b. Inform them of the process to
follow to obtain access to funding
■ Post-secondary education.
for desired services.
■ Transition-age youth move directly 1.b.O. TS
c. Allow them opportunity to become

from their educational environment acquainted with service options
into community employment. of interest.
■ Transition-age youth explore alternative
1.c.O. TS
d. Enable them to make informed deci-

community employment situations. sions about their future participation.
■ Access to targeted vocational training
1.d.O. TS
Intent Statements
or apprenticeships.
In order to make informed choices, students/
■ Independent or supported living.
transition-age youth and their families need as
■ Community participation. much information as possible about the options
■ Employment. available to them as adults in their communities.
■ Volunteer placement. Examples
■ Connections to community resources. With a continued focus on the family and its
■ Appropriate benefits/supports as lifelong role in the child’s life, information about
persons leave school. new services, alternative settings and strategies,
etc., is provided for the family’s use to assist in
such transitions and to help give continuity to

Section 3.O. Transition Services (TS)
services. This could include information about services to adult community services by focusing
sources of funding, employment, community liv- on opportunities, during the final years and
ing services, and service provider organizations months of educational services, to connect the
in the community. See also Standard 2.A.1. student and his or her family with local commu-
In order to make informed choices about appro- nity supports and services.
priate services and providers, the families and Collaboration is needed to coordinate the two
transition-age youth are given information about plans. Collaboration means bringing the various
the various options from which to choose. The participants in the planning process—i.e., the
array may also suggest new or different services youth in transition, family members, school per-
and strategies more appropriate to their identi- sonnel, community service providers—together
fied needs and goals. for discussion and ongoing planning.
1.c. Best practices include providing oppor- See the Intent Statements and Examples for plan-
tunities for students/transition-age youth to ning, under Standards 2.B.1.–7., which concern
experience or try out various service options to comprehensive plans.
help determine interest and appropriateness.
1.d. Informed choice is vital in conforming to 3.O. 3. The plan for transition from school to
this standard. Persons served frequently lack community services identifies, as
awareness of and the necessary knowledge about appropriate:
community opportunities to be able to make an
3.O. TS
a. The person’s options for future

informed choice. They are limited in exercising employment.
informed choice until and unless they have been 3.a.O. TS
b. Potential future residential settings.

provided with experiential opportunities to 3.b.O. TS
c. Community resources available.

explore community options to ensure that 3.c.O. TS
choice is truly informed. d. Existing family supports.

3.d.O. TS
e. The availability of transportation.

This is especially important for persons con- 3.e.O. TS
sidering employment. The persons served f. Training/educational opportunities.

3.f.O. TS
and appropriate staff members or partnership g. Social and recreational opportunities/

agencies should be involved in the assessment involvement.
3.g.O. TS
of opportunities for community employment. h. Unique supports needed for the

If indicated, a person served is referred for persons served.
external services to fully explore community
3.h.O. TS
i. Funding resources.
employment before other alternatives are 3.i.O. TS
j. Health and healthcare

considered. considerations.
3.j.O. TS
k. Other information identified by

3.O. 2. Each person’s plan for transition from the person and/or the family.
school to community services is coordi- 3.k.O. TS
nated to ensure accurate information Intent Statements

when the individual education plan is The plan for each student is tailored to his or
developed. her specific expectations and to the services/
2.O. TS
supports available locally.
Intent Statements
Examples
The plan communicates the student’s expecta-
tions and outcomes. The organization and school Linkages and supports from the local community
closely work together to develop an accurate are keys to the development and implementation
transition plan. of a successful plan for transition to adult com-
munity services.
Examples
Information about community-based providers
Transition planning enhances the effectiveness
is shared with the students and their families
and efficiency of the transition from school
at critical times in the development of the

Section 3.P. Community Integration (COI)
individual education plans or transition plans.

By beginning the process early, the students and
P. Community Integration
families served have the opportunity to learn (COI)
about local service providers, enroll with the
appropriate adult agencies, and examine and plan Description
to address barriers to the achievement of their
Community integration is designed to help
expected outcomes.
persons to optimize their personal, social, and
3.a. For youths considering employment, indi- vocational competency to live successfully in
vidually tailored job development, training, and the community. Persons served are active part-
support recognize each person’s employability ners in determining the activities they desire
and potential contribution to the labor market. to participate in. Therefore, the settings can be
Persons are supported as needed through an informal to reduce barriers between staff mem-
individualized person-centered model of services bers and persons served. An activity center, a day
to explore community employment options. program, a clubhouse, and a drop-in center are
Resources examples of community integration services.
Information and tools that may be helpful in Consumer-run programs are also included.
developing plans and goals for persons served Community integration provides opportunities
can be found at www.lifecoursetools.com. for the community participation of the persons
served. The organization defines the scope of
Documentation Examples these services and supports based on the identi-
The following are examples of the types of infor- fied needs and desires of the persons served. This
mation you should have available to demonstrate may include services for persons who without
your conformance to the standards in this sub- this option are at risk of receiving services full-
section. See Appendix A for more information time in more restrictive environments with
on required documentation. intensive levels of supports such as hospitali-
zation or nursing home care. A person may
participate in a variety of community life
■ Individual transition plans experiences or interactions that may include,
■ Progress notes but are not limited to:
■ Assessment information ■ Leisure or recreational activities.
■ Documentation of connections with school ■ Communication activities.

districts or community-based employment ■ Spiritual activities.
services providers
■ Cultural activities.
■ Pre-vocational experiences.
■ Vocational pursuits.
■ Volunteerism in the community.
■ Educational and training activities.
■ Development of living skills.
■ Health and wellness promotion.
■ Orientation, mobility, and destination

training.
■ Access and utilization of public
transportation.
■ Interacting with volunteers from the
community in program activities.

■ Community collaborations and social ■ 2.I. Medically Fragile Specific Population

connections developed by the program Designation (optional)
(partnerships with community entities ■ 2.J. Autism Spectrum Disorder Specific
such as senior centers, arts councils, etc.). Population Designation (ASD:A and/or
NOTE: The use of the term persons served in ASD:C, optional)
Community Integration may include members,
attendees, or participants, as appropriate. 3.P. 1. The persons participating in services/
Some examples of the quality results desired activities move toward:
1.P. COI
a. Optimal use of:

include: 1.a.P. COI
(1) Natural supports.

■ Community participation.
1.a.(1)P. COI
(2) Self-help.
1.a.(2)P. COI
b. Greater self-sufficiency or a slowing

■ Increased interdependence. of the declines associated with aging.
1.b.P. COI
■ Greater quality of life. c. Greater choice.

1.c.P. COI
■ Skill development. d. Greater control of their lives.

1.d.P. COI
■ Slowing of decline associated with aging.

e. Participation in the community.
1.e.P. COI
■ Volunteer placement. Intent Statements

■ Movement to employment. Services and supports lead to positive outcomes
for persons served. The organization considers
■ Center-based socialization activities during
the demographics of the population it serves,
the day that enable persons to remain in
including such things as medical risk factors,
their community residence.
travel concerns, family aspirations, and age of
■ Activity alternatives to avoid or reduce time persons served. Outcomes prevent fallback to
spent in more restrictive environments, such government institutions and maintain the indi-
as hospitalization or nursing home care. vidual’s participation level in defined community
settings.
Applicable Standards Examples

An organization seeking accreditation in com- These services are designed and delivered in such
munity integration must meet the standards in a manner as to enhance the interdependence of
this section and the standards in the following the persons served, their self-concept, and their
sections: social adaptations. These services are flexible in
satisfying the needs and desires of the persons
served.
optional
Community integration of the medically fragile
can include activities at a center or across campus
from their typical home environment. If the per-
Design, and Delivery son served is medically fragile and unable to
■ 2.C. Medication Monitoring and Manage- attend activities in the community, the organiza-
ment (as applicable; see page 148) tion may consider different methods of reverse
■ 2.F. Community Services Principle Standards integration such as a religious group providing
church services at the organization one day a
Population Designation (optional) week, or the person served being adopted by a
foster grandparent or a college student for one-
on-one activities. Another example of reverse
Designation (optional) integration would be pet therapy where an indi-
vidual with a certified pet therapy animal visits

the organization to allow the persons served Some quality of life indicators would be:
to interact with the pet. ■ Social Well-Being
– I have friends who care about me

3.P. 2. Services and activities are organized – I have an active social life
around:
2.P. COI
– I feel comfortable in social situations
a. The stated goals of the
persons served. – My recreational activities often involve
2.a.P. COI
b. The identified preferences of interacting with others

the persons served. ■ Occupational/Career Development
Well-Being
2.b.P. COI
c. The identified needs of the

persons served. – I am satisfied with my job options
2.c.P. COI
d. Improving the ability of the persons – I am satisfied with my job skills

served to understand their needs. – I am satisfied with my employment
2.d.P. COI
e. Assisting the persons served to situation

achieve their goals of choice in
■ Material Well-Being
the following areas:
2.e.P. COI
(1) Community living skills – I can afford decent housing

development. – I can afford decent clothing
2.e.(1)P. COI
(2) Interpersonal relations. – I feel good about my financial future

2.e.(2)P. COI
(3) Recreation/use of leisure time

2.e.(3)P. COI
opportunities. 3.P. 3. Services are provided at times and
(4) Vocational development or locations that meet the needs of the
employment. persons served.
2.e.(4)P. COI 3.P. COI
(5) Educational development. Intent Statements

2.e.(5)P. COI
(6) Self-advocacy. The program demonstrates the ability to provide

2.e.(6)P. COI
(7) Access to nondisability related services in an effective and efficient manner

social resources. and takes the needs of persons served into
consideration.
2.e.(7)P. COI
Intent Statements
Persons served have an active role in program Examples
design and redesigning the program. The program’s services and hours of operation,
including evenings, weekends, and holidays, are
Examples
evaluated periodically to ensure that the services
The organization demonstrates that a range are available and accessible to meet the needs
of basic services/supports is provided. These and interests of the persons served.
services/supports could be arranged within a
psychosocial clubhouse, an activity center, or a
day program, but the common services consist 3.P. 4. Personnel are available to meet with
of providing assistance with independent living persons served to discuss matters of
skills and the other activities as desired by the interest or concern.
4.P. COI
persons served and described in this standard. Intent Statements

2.e.(1) The program assists the person served to Personnel are accessible to persons served.
develop the skills needed to live as independently
as possible in the community.
2.e.(4) Paid or volunteer work may be a compo-
nent of these services.

Examples assistance may include, but are not limited to,

Individual or group meetings can include Supplemental Security Income, Social Security
regularly scheduled meetings or meetings for Disability Insurance, food stamps, bus passes,
the purpose of discussing issues such as: public health services, and local, county, and state
■ Program operations and activities.
or provincial assistance.
■ Hours of operation.
3.P. 6. The program’s outreach to and follow-up
■ Problems.
procedures for the persons served are
■ Plans. directed to:
6.P. COI
a. Those who drop out of services.

6.a.P. COI
b. Those who have been admitted to

3.P. 5. The organization provides information a treatment, institutional, or other
or referral to assist the persons served setting.
in securing assistance to meet their
6.b.P. COI
Intent Statements
basic needs.
5.P. COI
The intent of this standard is that the program
Intent Statements adopt procedures that describe how the program
Agency and direct support personnel possess will coordinate services and referrals to reduce
the skills, competencies, and qualifications to disruption to the services for the persons served.
support the persons served.
Examples
Examples Each program is encouraged to work coopera-
Overcoming identified barriers or meeting tively with other agencies in the community
specific needs may be beyond the organization’s to develop a seamless continuum of services
service delivery capability but may be addressed and to reduce all barriers to access.
by referrals to other community agencies, organi-
zations, and resources. Documentation Examples
This may include any of the following based on The following are examples of the types of infor-
the needs of the person served: mation you should have available to demonstrate
■ Income maintenance.
■ Benefits.
■ Food, clothing, and household goods.
■ Short-term or emergency shelter.
■ Housing subsidies, including long-term
■ Progress notes
housing.
■ Medical and healthcare.
■ Meeting schedules and notes
■ Information on the impact of employment
on securing and accessing future benefits.
■ Transportation.
■ Other community supports.
The organization provides information about

public assistance and application procedures
to the persons and/or families served. The staff
members are knowledgeable about requirements
to obtain and retain public assistance, due
process, and time frames or are able to refer
persons to authorities who are. Sources of public

Section 3.Q. Assistive Technology Supports and Services (AT)
Q. Assistive Technology purpose of providing assistive technology ser-

vices. Services are provided by personnel who
Supports and Services practice only in their area(s) of competency.
Some examples of the quality results desired
(AT) by the different stakeholders of these services
and supports include:
Description
By providing an array of assistive technology
■ Increased community access.
services, which may be specialized to a specific
■ Participation of the persons in the
population, an organization assists the persons
served in making informed decisions and choices community.
to increase access to or participation in employ- ■ Increased employment options.
ment options, education, independent living, ■ Increased wages.

interdependence, and/or inclusion in the com- ■ A flexible, interactive process that involves
munity. Services reflect the latest knowledge in the person served.
the field.
■ Individualized, appropriate accommodations.
Services and supports may include assisting
■ Decreased family or caregiver support.
persons served in the assessment, evaluation,
selection, acquisition, use, support, design and ■ Timely services and reports.
fabrication, follow along or follow up, modifica-

tion, or maintenance of an assistive technology
device; providing or arranging for training; Applicable Standards
providing information about referrals for and An organization seeking accreditation in
observations and trials of assistive technology assistive technology supports and services
devices; and/ or exploring alternative strategies. must meet the standards in this section and
Training is an important component of services the standards in the following sections:
and supports because assistive technology is ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
often abandoned if persons have not been optional
properly trained in its use. ■ 2.A. Program/Service Structure, Standards
Strategies for accommodation may include the 1.–13.
use of assistive technology applications in: ■ 2.E. Workforce Development (optional)
■ Communication
■ Community living Population Designation (optional)
■ Employment ■ 2.H. Older Adults Specific Population
■ Environmental control Designation (optional)

■ Mobility, orientation, or destination training ■ 2.I. Medically Fragile Specific Population
■ Education and training

■ Activities of daily living/independent living
Population Designation (ASD:A and/or
■ Recreation
ASD:C, optional)
■ Transportation
■ Meeting other needs as defined by the 3.Q. 1. The organization continually promotes
persons served universal design principles across all
Assistive technology services and supports may services.
1.Q. Assistive Technology
be provided by an organization as part of its ser-

vice delivery program, by a department within an
organization, or by an organization with the sole


The organization advocates for implementation Information is provided about the variety of
of universal design to facilitate access of all available service options or support approaches
persons to the community at large. to a service need and the volume of services an
Examples organization can support, which may include
the number of persons served and geographical
There are many facets to an organization’s
coverage. The organization presents information
promotion of assistive technology and its
about its ethical practices, which directly relate to
enhancement of persons’ lives in areas such as:
its divulging potential conflicts of interest, if any.
■ Early interventions. The information is presented in an understand-
■ Education. able manner and before persons served agree to
■ Employment. participate in the service.
■ Community services. This standard is part of the organization’s public
information activity. Organizations have the
■ Communication.
responsibility to respond to all requests from the
■ Housing.
public concerning their accredited services. This
■ Recreation. responsibility includes providing information
■ Promotion of assistive technology and defined by some CARF standards, information
universal design in the community. defined by the organization as important, and
■ Public facilities.
information in response to questions from the
public.
■ Transportation.
The organization serves as a community resource
■ Telecommunications.
for assistive technology.
■ Software and hardware.
■ Health care. 3.Q. 3. Persons and/or families served partici-

pate in making informed decisions about
3.Q. 2. Information about the program: their assistive technology services,
a. Includes: including:
2.a.Q. Assistive Technology
(1) Responsibilities of the person a. Expected results of services for

served, including financial persons served.
responsibility. b. How the design of services meets

2.a.(1)Q. Assistive Technology
(2) Affiliations of the organization identified needs.

3.b.Q. Assistive Technology
and staff members. c. Off-the-shelf technology resources,

(3) Availability of equipment, includ- as appropriate.

3.c.Q. Assistive Technology
ing expected wait time for it. d. How services will be delivered.
2.a.(3)Q. Assistive Technology 3.d.Q. Assistive Technology
(4) Potential for conflicts of interest, e. Expected time lines of services.

3.e.Q. Assistive Technology
if any. f. Possible alternatives for services.

3.f.Q. Assistive Technology
b. Is provided in an understandable g. How results will be evaluated.

format to the person served. 3.g.Q. Assistive Technology
h. Full disclosure to persons served

c. Is updated as necessary to reflect and funders about future:

changes in information provided. 3.h.Q. Assistive Technology
(1) Technology benefits.

3.h.(1)Q. Assistive Technology
Intent Statements (2) Maintenance.

To be informed, make choices, and be involved, (3) Expected costs.

persons and/or families served should get

accurate and current information about the
organization’s potential to deliver services
relevant to their needs and preferences.

(4) Expected responsibilities. ■ Considering methods for long-term use

of technology through modification
(5) Technology changes.

i. Other aspects about the service and/or upgrading.

design, as requested. ■ Financial or resource/benefits planning
3.i.Q. Assistive Technology
for replacement or repair of the assistive

Intent Statements
technology.
Persons served are given information about
■ Establishment of a recycling program.
all aspects of services and participate in making
informed decisions. Resources
Examples 3.c. The website www.mymdrc.org/assistive-
In some instances, persons and/or families served tech/webinars.html has numerous webinars
may not have the experience or knowledge neces- available to assist providers and persons served
sary to make informed decisions. In all cases, the with learning about various technology and
organization helps persons and families served devices.
choose wisely.
This is not a one time event—services also use 3.Q. 4. Services enable the persons and/or
a holistic approach. Service/support planning families served:
looks at the person’s interests, may involve the a. Greater access to their communities.
family in the assessment, reviews the home envi- b. Opportunities to enhance their
ronment, and considers sustainability and/or a quality of life.
business plan that includes long-term servicing Intent Statements

and potential replacement costs. The plan con-
Community access is sometimes limited by
siders the nature of the disability and factors
the lack of appropriate assistive technology
such as aging and changes in medical needs.
application and services. These limitations can
Assistive technology services establish pro- be addressed by assistive technology devices
cedures for education and planning for the and strategies.
person served, including:
■ An initial screening to identify technology 3.Q. 5. The community environment is con-
needs. sidered when developing services.
■ Incorporation of technology in evaluations,
Intent Statements
interviews, administration of tasks and activi-
ties, assessment of functional capabilities, and The likelihood of success can be enhanced
by thoroughly considering all environmental
planning.
factors that might affect strategies for using
■ Suggestions for prescribing and introducing
such technology.
assistive technology in services to meet the
person’s outcomes expectations.
3.Q. 6. The individual service plan identifies
■ Suggested approaches for implementation of
each person’s desired outcomes from
assistive technology in services and supports. using assistive technology.
■ Strategies for creating supports, learning
Intent Statements
about related technology, utilizing mentors,
and becoming a peer technology mentor. Services are developed around the preferences
and needs of the persons served, including con-
■ Universal design and the use of assistive tech-
sideration of long-term implications of growth,
nology in other activities of daily living. aging, disability management, and medications;
■ Evaluation of the “fit” of the prescribed assis- availability of service repairs; and “fit.”
tive technology approach in the services.
■ Reviewing the outcome satisfaction with the
assistive technology.

Examples Knowledge about previous experience with

Providing effective and cost-efficient services assistive technology can help identify potential
requires an organization to maintain up-to-date problems.
knowledge of assistive technology. This knowl- Transition times are a key consideration in plan-
edge is a reference point for informally assessing ning assistive technology, i.e., the child moving
needs and preferences of the persons served, set- from the home situation to the school environ-
ting goals, and coordinating resources to achieve ment and later from school to adult activities.
the individual’s desired service outcomes. The The use of assistive technology can level the play-
organization can design its services to respond to ing field, especially in school. Family members
the needs of the persons served and provide them need to be educated to what assistive technology
with information to make informed choices. services and supports can provide.
3.Q. 7. The individual service plan: 3.Q. 8. Assistive technology services and train-
a. Identifies functional limitations to ing are integrated into other services

opportunities of the person served. offered by the organization, if applicable.
7.a.Q. Assistive Technology 8.Q. Assistive Technology
b. Addresses potential for Intent Statements

accommodations.
All needs of the persons served are considered,
c. Integrates accommodations includ- and the individual planning is comprehensive
ing, if applicable, into the current and coordinated.
employment situation.
Examples
d. Addresses previous assistive tech-
nology services, if applicable. If other services are offered, staff will receive
7.d.Q. Assistive Technology
in-service training about available assistive tech-
e. Addresses the dynamic nature of
nology services.
the disability, as appropriate.
f. Addresses anticipated changes All services received are contained in a single

in employment, environment, plan whenever possible and the services are
or living situation, as appropriate. integrated as much as possible, although funding
requirements may sometimes require separate
g. Addresses, as appropriate to services
plans.
for the person served:
7.g.Q. Assistive Technology
(1) Safety risks.

7.g.(1)Q. Assistive Technology 3.Q. 9. The assistive technology planning pro-
(2) Health risks. cess demonstrates collaboration with
7.g.(2)Q. Assistive Technology
Intent Statements available community agencies, organiza-

When barriers to the person’s goals are identified, tions, funding sources, and networks,
assistive technology services and strategies are as appropriate for the persons served.
used to address these limitations to a person’s Intent Statements

opportunities in a comprehensive manner for
Individualized service planning provides infor-
the present and future.
mation and linkages to services that enable the
Examples persons served to achieve their objectives.
Barriers are addressed by a coordinated indi- Examples
vidualized service plan and by the provision of
Linkages and partnerships with other com-
services in locations consistent with preferences
munity agencies are an important strategy for
and needs. Addressing the barriers may include
meeting the needs of the persons served. By
services within the organization, the use of assis-
knowing the expectations of the persons served,
tive technology, reasonable accommodations,
the organization can strategically plan to promote
referral to other agencies, or collaborative part-
opportunities for the person in the community,
nerships with other community resources.
configure staffing patterns or contracted services,

and provide services in locations convenient

to the person.
3.Q. 12. When a person exits services, a summary
report contains:
To promote community accessibility and create 12.Q. Assistive Technology
a. A description of the assistive

efficient services, the organization establishes
technology services provided and
and maintains partnerships, networks, and coor-
approximate training time.
dination with other agencies. Many organizations 12.a.Q. Assistive Technology
consider cost-effectiveness and satisfaction of the b. Identification of potential future

persons served in designing and maintaining assistive technology needs and rec-
these networks and partnerships and include ommended implementation plan.
these data in the organization’s outcomes man- c. Maintenance, troubleshooting,

agement report. and repair source(s).
Organizations often establish social media Intent Statements

groups or online discussion boards to: Before leaving services, a person served is
■ Help persons served find one another given a summary of services.
and share experiences, mentoring, etc. Examples
■ Build informal community networks
An organization might give a copy of the sum-
among users of assistive technology. mary report to the person who received services
■ Share information about resources. to ensure that subsequent providers are informed
■ Provide resources for recycling of equipment. of potential identified needs.
3.Q. 10. The time frame for services is established 3.Q. 13. On request, employers are provided
based on input from: with:
a. Persons served. a. Educational resources.

b. Families served. b. Reasonable accommodations

c. Funders. resources.
d. Employers, if applicable. c. Ongoing technical assistance.

10.d.Q. Assistive Technology
e. Service providers. d. Support in developing employment

opportunities.
f. Other stakeholders, as appropriate. 13.d.Q. Assistive Technology

e. Other resources, as requested.
Intent Statements 13.e.Q. Assistive Technology
Intent Statements
The persons served, employers, and funders
are involved in establishing time frames for Service providers have a community role as
the services. resources.
Timeliness is a critical factor and one that Not all aspects of this standard have to be pro-
may be included as a performance indicator vided to every employer, but the information
in organizational performance analysis. should be available on request, either directly
from the organization or through referral to and
coordination with other community resources.
3.Q. 11. If additional assistive technology
needs are identified, referrals/ Examples
recommendations are based on: Employment service providers successfully use
a. Specialized knowledge and/or employer advisory groups—usually referred

experience in the field. to as Business Advisory Councils (BACs)—in
b. Knowledge of referral/funding many ways. Training programs and placement

processes. initiatives, such as many with Projects with
Industry (PWI) programs, may form advisory
Intent Statements councils consisting of the employers and busi-
Services reflect the latest knowledge in the field. nesses that these programs were formed to serve.

This mechanism has been very effective in Documentation Examples

developing employee training that specifically The following are examples of the types of infor-
addresses employers’ skill needs, which helps mation you should have available to demonstrate
provide a ready supply of workers with the abili- your conformance to the standards in this sub-
ties and work attitudes needed for success. section. See Appendix A for more information
Assistive technology service components could on required documentation.
become involved with existing BAC efforts or
form advisory councils if none are in place.
■ List of community resources and agencies
Employers often have only limited awareness of
used regularly
assistive technology and workplace accommoda-
■ Disclosure information
tions and may have misconceptions about costs
and adverse impact of accommodations in their ■ Satisfaction information from persons served,
work settings. Participating in BAC efforts can families, and funders

improve the employer’s understanding of assis- ■ Exit summary reports
tive technology. Possible interaction might ■ Procedures manual
include:
■ Working with placement and employer liaison
specialists to ensure that assistive technology
resources and accommodations are included
as part of the information and materials that
outline services rehabilitation can provide.
■ Making presentations or displaying pictures
of accommodations that have worked well at
business-after-hours events, often hosted by
local Chambers of Commerce.
■ Encouraging representatives from assistive
technology service components to become a
regular part of existing BACs.
■ Utilizing technology specialists to handle
specific questions on assistive technology.
Additional Resources
The CARF publication Using Individual-Centered
provides an easy-to-understand guide of essential
elements, examples of planning procedures,
sample plans, and additional resources for indi-
vidual-centered service planning based on the
preferences and needs of the persons served.
The website www.mymdrc.org/assistive-tech/
webinars.html has numerous webinars available
to assist providers and persons served with learn-
ing about various technology and devices.

Section 3.R. Behavioral Consultation Services (BCS)
R. Behavioral 3.R. 1. The behavioral consultation service’s

personnel:
Consultation Services 1.R. Behavioral Consultation
a. Demonstrate skill, knowledge,

(BCS) and application of:
1.a.R. Behavioral Consultation
(1) Behavioral strategies and

Description techniques.
1.a.(1)R. Behavioral Consultation
The focus of the service is to increase the person’s (2) Applicable evidence-based
ability to express more effective and acceptable practices.
behaviors. Behavioral strategies are identified b. Provide to those involved with

and used to teach the person better ways to deal the person served:
1.b.R. Behavioral Consultation
with the environment and personal stressors to (1) Support.

ensure that targeted behaviors are discouraged 1.b.(1)R. Behavioral Consultation
(2) Training.
and positive behaviors are learned and main- 1.b.(2)R. Behavioral Consultation
tained. Through redirection of a targeted Examples

behavior to a more socially and culturally 1.b.(2) Behavioral consultants provide training
acceptable behavior, persons are able to achieve to the person’s support team that includes:
increased participation in mainstream commu- ■ Theory, as applicable.
nity activities. This includes services to persons ■ A review of written behavioral strategies/
to address targeted behaviors in the home or instructions.
community, such as eating disorders, disruptive
■ An application of the strategies/instructions
behaviors, or self-injurious behaviors.
using:
– Written/verbal scenarios.
Applicable Standards – Role play.
An organization seeking accreditation – Training with the person in real-life
in behavioral consultation services must settings, as appropriate.
meet the standards n this section and the
3.R. 2. The direct services staff involved in
the person’s life are trained on specific
optional behavioral change strategies/
■ 2.A. Program/Service Structure techniques.
2.R. Behavioral Consultation

Design, and Delivery, Standards 1. and 2.
■ 2.C. Medication Monitoring and Manage- 3.R. 3. The behavioral consultation plan is
ment (as applicable; see page 148) modeled for all involved with the intent
■ 2.G. Children and Adolescents Specific to extinguish targeted behaviors as soon
Population Designation (optional) as possible, based on the needs of the
person served.
Population Designation (ASD:A and/or 3.R. 4. The behavioral consultation service facil-
ASD:C, optional) itates monthly team meetings with all
involved in the person’s individual plan.
Intent Statements
Although team members are expected to meet
monthly, information may be shared by external

contact with others involved in the plan devel- (3) Define immediate antecedents
oped through behavioral consultation services. for occurrences and nonoccur-
rences of the targeted behavior.
3.R. 5. Behavioral strategies are consistent (4) Identify the consequences or out-
across a variety of environments familiar comes of the targeted behaviors.
to the person served. (5) Identify functional alternative

Examples behaviors to the targeted

behavior.
The service demonstrates efforts to ensure 8.a.(5)R. Behavioral Consultation
the consistent implementation of behavioral (6) Identify the primary ways the
strategies in applicable settings, such as: person served communicates
with other individuals.
■ Family environment. 8.a.(6)R. Behavioral Consultation
(7) Identify actions that support

■ School/educational environments.
what the person served should
■ Work environments. and should not do.
■ Community environments important to (8) Identify reinforcers.

the person served.
(9) Identify the history of the tar-

geted behavior, the approaches
3.R. 6. Contact occurs with the person that have been attempted to
and/or family served: decrease or eliminate it, and the
a. Through: effects of those approaches.

(1) Formal involvement. (10) Develop summary statements

(2) Direct observation. for each major predictor and/or

6.a.(2)R. Behavioral Consultation consequence.
b. To ensure that progress is made. 8.a.(10)R. Behavioral Consultation
6.b.R. Behavioral Consultation b. Include results that are incorporated

into the development of behavioral
strategies.
3.R. 7. Behavioral assessments are completed 8.b.R. Behavioral Consultation
and include input, as appropriate, from:

a. The person served.

3.R. 9. The consultation service takes into
b. The parent(s) or caregiver of consideration the following needs of
the person served. the person served, as appropriate:
c. The person’s teacher(s) or other 9.R. Behavioral Consultation
a. Health.
staff members. 9.a.R. Behavioral Consultation
7.c.R. Behavioral Consultation

b. Safety.
d. The extended family that is involved 9.b.R. Behavioral Consultation
c. Educational.
in the life of the person served. 9.c.R. Behavioral Consultation
7.d.R. Behavioral Consultation d. Emotional.

e. Other stakeholders that are involved 9.d.R. Behavioral Consultation
in the person’s life. e. Physical.

9.e.R. Behavioral Consultation

f. Social.
9.f.R. Behavioral Consultation
g. Leisure.
9.g.R. Behavioral Consultation
h. Spiritual/cultural.
3.R. 8. When dealing with targeted behaviors, 9.h.R. Behavioral Consultation
functional assessments: i. Others, as identified.

9.i.R. Behavioral Consultation
a. Are conducted and:

(1) Describe the targeted behavior.

(2) Define potential environmental

or setting events.

3.R. 10. Behavioral strategies and training are 3.R. 12. Behavioral consultants demonstrate
provided to the person served, family, ongoing, formal monitoring of the
and support persons, as needed and implemented strategies by:
appropriate:

a. Regularly collecting, summarizing,
a. Prior to the implementation of and reviewing empirical data.
the behavioral strategies.

b. Sharing data summaries with team
b. In the following areas: members.
10.b.R. Behavioral Consultation 12.b.R. Behavioral Consultation
(1) Motor skills. c. Being available for consultation and

to directly observe implementation
10.b.(1)R. Behavioral Consultation
(2) Physical skills and fitness.

(3) Academic skills. of the behavioral strategies.

(4) Social skills. d. Regularly meeting with team

members.
(5) Intellectual development. 12.d.R. Behavioral Consultation

e. Problem solving to resolve barriers
(6) Communication skills, including
to the effective implementation
language development.
10.b.(6)R. Behavioral Consultation of behavioral strategies.
(7) Creative skills. 12.e.R. Behavioral Consultation
10.b.(7)R. Behavioral Consultation f. Revising behavioral strategies,

(8) Daily living skills. when needed, to maximize their
(9) Community awareness. effectiveness.

(10) Safety skills. 12.f.R. Behavioral Consultation
10.b.(10)R. Behavioral Consultation Intent Statements

(11) Self care skills.
10.b.(11)R. Behavioral Consultation 12.a. Collection of data will provide direction
(12) Identity development. on strategies used in the plan.
3.R. 13. Written procedures address the use

3.R. 11. Written behavioral strategies: of behavioral strategies, including:
a. Are developed with involvement a. The appropriate use of reward

from key persons in the person’s life. or positive incentive systems.
b. Include: b. Acceptable/unacceptable
(1) Consents. interventions.

11.b.(1)R. Behavioral Consultation 13.b.R. Behavioral Consultation
(2) A rationale for the use of c. Prohibition of punishment.

the strategies.
Intent Statements
(3) A definition of the targeted
Procedures reflect the language from established
behavior(s). ethical guidelines on the use of behavioral
(4) Clearly stated, measurable strategies.

behavioral goals.
(5) A summary of baseline data, 3.R. 14. If consultation in Early Intensive Behav-
where applicable. ior Intervention (EIBI) is provided, the
(6) A list of materials or resources program:

needed to implement the 14.R. Behavioral Consultation
a. Continually develops a curriculum to

strategies. meet the needs of the person and/or
(7) Procedural instructions for family served.

implementing the strategies. 14.a.R. Behavioral Consultation
b. Provides curriculum training to:

(8) Clarification of roles. 14.b.R. Behavioral Consultation
(1) Families.
(9) Formal data collection methods. 14.b.(1)R. Behavioral Consultation
(2) Intervention workers.

(3) Other applicable individuals.


c. Oversees the implementation ■ The internet.

of a formalized curriculum. ■ Resource listings.
d. Monitors progress on curriculum

Education may also be provided through other
goals.
14.d.R. Behavioral Consultation
resources and may include assisting the person or
e. Works directly with the person family served to access information on their own.
served.
f. Reassesses the person served 3.R. 18. Written procedures specify that the
at regular intervals. consultation service provides or arranges
14.f.R. Behavioral Consultation
g. Trains interveners in behavioral for crisis intervention services.

learning theory and practical skills. 18.R. Behavioral Consultation
14.g.R. Behavioral Consultation

Examples
NOTE: Standard 14. is applicable only to programs
serving children under age five and using an early, The organization may have its own on-call or
intensive behavioral intervention approach to direct crisis response service. It may also contract
services. or collaborate with area providers that offer crisis
intervention services.
3.R. 15. In a medically supervised program, there
is a medical director who is a physician. 3.R. 19. The organization has a plan for the
supervision of direct service personnel,
including:
a. Staff members.
3.R. 16. The program receives appropriate 19.a.R. Behavioral Consultation
medical consultation regarding any b. Volunteers.

medically related policies or procedures c. Trainees.

developed by the program. d. Interns.

16.R. Behavioral Consultation 19.d.R. Behavioral Consultation
Intent Statements e. Contracted personnel.

Medical consultation is typically provided by a

medical director who is a physician. However,
there may be circumstances in which the con- 3.R. 20. When applicable, ongoing supervision
sultation is provided by a licensed physician’s of direct service personnel addresses:
assistant or nurse practitioner. The consultation 20.R. Behavioral Consultation
a. The appropriateness of the strategies

does not have to be provided by a staff member used relative to the specific needs of
but can be connected through a contract or a each person and/or family served.
consulting or voluntary agreement. 20.a.R. Behavioral Consultation
b. Service effectiveness as reflected by

the person served meeting his or her
3.R. 17. The consultation service ensures that individual goals.
information and education relevant 20.b.R. Behavioral Consultation
c. The provision of feedback that

to the needs of the person and family
enhances the skills of direct service
served are provided as needed.
17.R. Behavioral Consultation personnel.
Examples d. Accuracy of assessment and referral

Information may be provided that focuses skills, when applicable.
on relationships, mental health or behavioral e. Issues of ethics and boundaries.

issues, parenting, or life skills. Education 20.e.R. Behavioral Consultation
Intent Statements
may be provided through:
The intent of this standard is to ensure that
■ Individual and group sessions.
all direct service personnel are provided with
■ Group education. appropriate supervision and direction.
■ Peer-to-peer or family support.
■ Audio/video or written materials.

Examples Documentation Examples

Supervision may occur through the supervisor’s The following are examples of the types of infor-
participation in service planning meetings, mation you should have available to demonstrate
organizational staff meetings, side-by-side your conformance to the standards in this sub-
sessions with the person served, or one-to-one section. See Appendix A for more information
meetings between the supervisor and personnel. on required documentation.
20.c. May include information on best practices, ■ Records of persons served
or identify areas for needed professional growth. ■ Individual service plans
■ Progress notes
3.R. 21. When applicable, training in the use
of adaptive devices and equipment
is provided to: ■ Staff training records
■ Behavioral assessments
a. Personnel.
b. The person served. ■ Functional assessments

c. The family. ■ Written behavioral strategies

d. Caregivers. ■ Written plan for supervision of direct service

personnel
■ Forms authorizing release of confidential
3.R. 22. When needed, assistive technology is information

used and reasonable accommodations
are made in:
a. The development of services and

supports.
b. The ongoing provision of services.

Examples
The organization may provide assistive technol-
ogy, or it may be provided by referral to other
local resources. Reasonable accommodations are
necessary to fully access services and enable the
person served to participate in the organization’s
activities. Technology needs may be addressed in
an individual service plan. If a person needs ser-
vices that are not available from the organization,
referrals to other services are suggested.
The organization considers reasonable accom-
modations and uses assistive technology to
convey information about services. Accommo-
dations and technology may entail the use of
communication devices, video and audio record-
ings, pictures, and materials in each person’s
and/or family’s primary language. Many modifi-
cations are simple and inexpensive. When
necessary, the program also provides education
on technology applications.

Section 3.S. Comprehensive Benefits Planning (CBP)
S. Comprehensive ■ Tax credits

■ Transportation assistance
Benefits Planning (CBP) ■ Private insurance (short- and long-term
disability policies)
Description
Some examples of quality results desired by the
A comprehensive benefits planning organization different stakeholders of these services include:
creates and continuously improves its services
■ Access
and staff competencies to enhance the economic
standing, well-being, and self-sufficiency of per- – Information presented in understandable
sons served. Through trained and professional format or manner.
benefits planning specialists, comprehensive – Individual disability or employment
individual and family benefits planning enhances challenges are met.
lives, provides support in learning what resources – Service locations are accessible.
are available and how to advocate for benefits,
– Benefits planning meetings use effective
and provides support in learning how and when
mediums such as face-to-face meetings,
to access needed resources. Benefits planning
phone conferences, email, and video
demonstrates a willingness to revise planning as
conferencing.
the consumer of services grows, changes, experi-
ences change, and has new goals. ■ Effectiveness
Benefits planning that is comprehensive assists – Persons served are able to identify specific
individuals through collaboration and coordina- benefits applicable to their work and living
tion with a wide range of potential resources and situations.
agencies. There is a network of resources that fill – Advocacy skills are developed for specific
in the many aspects of daily living. The following benefits issues.
is not an exhaustive list, but suggests some exam- – Informed choices are made with regard
ples of these: to employment and benefits planning.
■ Social Security Disability Insurance (SSDI)
– Self-sufficiency in personal resource
(SSA) management is achieved.
■ Supplemental Security Income (SSI) (SSA)
– Skills for resource planning are achieved.
■ Vocational Rehabilitation Services
– Enhanced economic well-being of the
■ Work Incentives Planning and Assistance person served is achieved.
(WIPA) – Asset building potential of persons served
■ Workers Compensation expanded.
■ Unemployment compensation ■ Efficiency
■ Veterans Benefits – The time from intake to referral is
■ Medicare and Medicaid (CMS) minimized.
■ Provincial/territorial health insurance – A comprehensive and individualized plan
systems is developed in minimal time.
■ Provincial/territorial social services disability – Benefits planning reports are returned
benefits/Canada Pension Plan (CPP)— to referral authorities and persons served
Disability Benefits within designated times.
■ Housing assistance – The caseload of benefits planning
■ Energy assistance specialists is maintained at the level
of “break-even” efficiency.
■ Food stamps
■ Temporary Assistance for Needy Families

(TANF)

■ Person Served Satisfaction

3.S. 1. The Comprehensive Benefits Planning
– Persons served express satisfaction in: (CBP) program designs its services by:
- The knowledge they gained about 1.S. Benefits Planning
a. Identifying the needs of its

benefits and community resources. customer base.
- The reduction of their fears regarding
1.a.S. Benefits Planning
b. Conducting regular analysis of

the potential loss of benefits. environmental trends.
1.b.S. Benefits Planning
- Trust and confidence of the benefits c. Assessing the organization’s capacity

planning process and its result. and developing new strategies for
- The personal and employment choices service delivery.
1.c.S. Benefits Planning
made based on quality benefits d. Identifying what services it can

information. provide.
1.d.S. Benefits Planning
■ Stakeholder Satisfaction e. Collaboration with and outreach

to other community resources.
– Family members and other stakeholders: 1.e.S. Benefits Planning
- Gain knowledge to help with benefits Intent Statements

management and return-to-work As benefits guidelines and the needs and
economic support strategies. demographics of persons served change, the
- Express reduced fear of losing benefits. CBP makes changes in its service processes
and business structures.
- Identify methods for “navigating the
system” and connecting to resources. Examples
- View benefits as tools to help youths A CBP service, whether part or a unit of a larger
transitioning from school reach their organization or a freestanding service, establishes
employment and community living a routine for assessing customer and stakeholder
goals. quality expectations. Based on this customer-
design input, organizations and/or their service
units will often reflect upon their mission, ser-
Applicable Standards vices, environmental threats, and opportunities.
An organization seeking accreditation in The result is a strategic plan that is established
comprehensive benefits planning must to help position the CBP business, including the
meet the standards in this section and creation of collaborations and partnerships.
the standards in the following sections: Resources
■ 1.A. and 1.C.–1.N.; 1.B. Governance is Related information can be found in the CARF
optional publication Strategic Positioning and Planning
■ 2.A. Program/Service Structure, Standards in the 21st Century, which is available on request
1.–19. from your resource specialist.
Design, and Delivery 3.S. 2. Information provided to the public
■ 2.G. Children and Adolescents Specific describes the CBP’s services, including:
2.S. Benefits Planning
Population Designation (optional) a. Roles and responsibilities of benefits

■ 2.J. Autism Spectrum Disorder Specific planning specialists.
Population Designation (ASD:A and/or b. Confidentiality of all personal infor-

ASD:C, optional) mation related to services.
c. Guidelines directing ethical decision

making, including protection of
persons served from financial
exploitation.

d. Guidelines for private pay. supports that create the outcomes sought by
persons served.
e. Internal controls for managing

conflicts of interest.
4. The organization has a process estab-
2.e.S. Benefits Planning
3.S.
Intent Statements
lished to keep personnel current on
Information is provided so that persons can
all benefits planning guidelines.
make informed decisions about the suitability 4.S. Benefits Planning
of services for them. Intent Statements

Examples Benefits/legislative changes often occur annually
or even more frequently. It is critical for personnel
Formal outreach may be conducted with poten-
to be aware of current guidelines.
tial service recipients and with other service
providers to inform them of services that are The business supports provided by the organi-
available. Information might be provided in zation are important to ensure stable and
responsive services/supports and accuracy
brochures or other handouts, on the company
of information provided.
website, disseminated through staff presenta-
tions, etc.
3.S. 5. For continuous quality improvement,
the program establishes internal quality
3.S. 3. The CBP trains new benefits planning
controls for individual case planning.
specialists on competency in: 5.S. Benefits Planning
a. Technology options.
b. Service provision ethics.

c. Disability-specific concerns.
3.S. 6. Service provision is responsive to
3.c.S. Benefits Planning the person’s:
d. Legislation related to benefits. 6.S. Benefits Planning
3.d.S. Benefits Planning a. Level of technical ability.

e. Services. 6.a.S. Benefits Planning
3.e.S. Benefits Planning b. Ability to access the physical

f. State/provincial and federal location of service provision.
programs. 6.b.S. Benefits Planning
3.f.S. Benefits Planning
g. Informed choices about work.

3.g.S. Benefits Planning
h. Work incentives programs.

3.h.S. Benefits Planning 3.S. 7. The program educates persons served
i. Health benefits from government
about:
and employers. 7.S. Benefits Planning
3.i.S. Benefits Planning a. Long-term earning potential.

j. Resources available for tax-related 7.a.S. Benefits Planning
questions or issues. b. Long-range economics budgeting

3.j.S. Benefits Planning and employment planning related
Intent Statements to disability/disadvantagement.
Services are delivered by a trained benefit c. Tools and resources for ongoing
specialist. benefits management.
Examples d. Resources that could be of value

There are three critical aspects of direct service in addressing identified needs.
a CBP provider must consider: the outcomes Intent Statements

desired by the person served, the direct services Education is an ongoing process and provides
by the organization staff, and the business sup- work incentives planning and assistance in
ports provided by the organization to ensure employment efforts.
stable and responsive services/supports. By
knowing the characteristics and service/support Examples
needs of persons served, the organization will Life planning considers not only the long-range
continually train its staff in issues and services/ economics for budgeting and employment, but
also short-term barriers and/or transitional

financial issues that will be encountered as the Documentation Examples

participant is working toward long-term earning The following are examples of the types of infor-
potential. It considers the total picture of family mation you should have available to demonstrate
assets, family supports, and the costs and com- your conformance to the standards in this sub-
plications of aging with disabilities. section. See Appendix A for more information
3.S. 8. When the program provides contact ■ Records of persons served
information to the person served for
■ Individual benefits analysis
community resources in response to
■ Progress notes
requests from and/or identified needs,
it conducts follow up with the person ■ Procedures manual
regarding his or her accessing these ■ Documented staff training

resources.
Intent Statements
Information is continually updated and made
available for the person served as life circum-
stances and the needs of the person served
change.
Examples
A CBP may provide information in a number
of ways, such as a packet of information, website
connections, or linkages. Resources that persons
might want access to include:
■ Financial planners
■ Attorneys/legal services
■ Tax consultants
■ Private insurance policies
■ Protection and advocacy
■ Estate planning
■ Trusts
■ Wills and directives
■ Educational loans, stipends, and scholarships
■ Retirement plans
■ Medical bills
■ Employment services
■ Understanding employee benefits
■ Housing services

Section 3.T. Mentor Services (MS)
T. Mentor Services (MS) ■ 2.G. Children and Adolescents Specific

Population Designation (optional)
Description ■ 2.H. Older Adults Specific Population
Mentor services are designed for and dedicated
to the recruitment, training, and support of ■ 2.I. Medically Fragile Specific Population
community supports and volunteers who provide Designation (optional)
coaching, community activities, and networks to ■ 2.J. Autism Spectrum Disorder Specific Pop-
assist persons with disabilities and/or disadvan- ulation Designation (ASD:A and/or ASD:C,
tages to achieve goals as desired in education, optional)
employment, and/or self sufficiency in life.
Some examples of the quality results desired 3.T. 1. Based on the scope of mentor services,
by the different stakeholders of these services the organization:
1.T. Mentor Services
and supports include: a. Recruits mentors.

1.a.T. Mentor Services
■ Successful life transitions, including complet- b. Matches mentors to persons served,

ing school, adjusting to disability, overcoming considering:
1.b.T. Mentor Services
personal or family crisis, loss, and aging. (1) The desired goals of the
■ Completion of academic, career, and person served.
1.b.(1)T. Mentor Services
personal goals. (2) The mentor’s qualifications.

1.b.(2)T. Mentor Services
■ Achieving and maintaining employment. Intent Statements

■ Self sufficiency. Mentors are recruited from many diverse walks
■ Increased community access and of life to enable good matches that will meet
independence. various needs of persons served. The closeness
■ Increased social capital.
of the match is often key to success in mentor
relationships.
■ Building confidence and self-esteem.
Examples
■ Support in self-advocacy.
Information obtained from analyzing the demo-
■ Economic improvement.
graphic data collected on persons served during
■ Tax benefit to the community.
intake and service delivery can help the mentor
■ Housing. service to target its recruitment and training
■ Network of supports in the local community. efforts.
■ Reduction in negative encounters with There are mentors with a variety of backgrounds
legal systems. and experiences from which a person served can
■ Respite and resources for families.
find a suitable match.
The organization can use many ways to find
suitable a match between a person served and
Applicable Standards a mentor. Some ideas include the creation of
An organization seeking accreditation in profiles or resumes and hosting get-acquainted
mentor services must meet the standards meetings or informal social functions, such as
in this section and the standards in the a morning coffee break, to let persons served
following sections: and mentors get to know each other.
optional


3.T. 2. A competency-based training process for 3.T. 3. Mentor activities:

mentors is designed and continuously
a. Are planned with the involvement

improved to match the needs of the: of the persons served.
a. Persons served.

b. Support persons in achieving
b. Mentors. their goals.
2.b.T. Mentor Services 3.b.T. Mentor Services

Competency training is aligned to meet the Persons served learn to advocate for supports
outcomes expectations of the persons served. to meet their goals.
Examples Examples
Training might include as applicable to the When persons served are oriented to the services,
population served: insights into their roles, rights, and responsi-
■ Communication skills bilities in the program can be shared. This
information can also be presented in handbooks,
■ Employment knowledge
websites, and other communication mediums
■ Disability awareness
such as newsletters.
■ Accessibility awareness
■ Assistive technology 3.T. 4. Accommodations are individualized to

■ Transition from school the persons served as needed to facili-
■ Problem solving
tate success in achieving their goals.
■ Listening skills Intent Statements

■ Knowledge of community resources Mentor services emphasize individualized service
and supports design.
■ Relationship building
■ Setting boundaries as to mentoring Examples
■ Sensitivity awareness
Utilizing reasonable accommodations, including
assistive technology, can assist persons to achieve
■ Cultural diversity
success with their life goals.
■ Family dynamics
As appropriate and desired by the person served,
■ Risk management, including personal liability community activities may include leisure, educa-
■ Managing time and expenses tion, and ongoing recovery supports.
■ Emergency and off-hours supports
■ Role and relationships with families 3.T. 5. Orientation to mentor services is pro-
■ Self-determination in individual planning
vided to the person served regarding:
and budgeting a. The purpose of the service.

■ Confidentiality of persons served and their

b. The role and commitment expected
families of the person served.
■ Control of infectious diseases

c. Incentives to participate in mentor
services.
■ Crisis de-escalation 5.c.T. Mentor Services
d. Methods for scheduling time with

■ Respect, dignity, and rights
the mentor.
■ Understanding recovery goals
5.d.T. Mentor Services
Intent Statements
■ Self-advocacy skills
Orientation is a learning and teaching strategy
that clarifies the services and mission of the
organization.

Examples
3.T. 8. The organization provides opportunities
Orientation activities provide an opportunity to
for mentors to network with other
inform persons served about the benefits, goals,
mentors.
and services/supports of the mentor program. 8.T. Mentor Services
This will also provide the opportunity to encour- Intent Statements

age the persons served to establish their role in Mentors networking allows sharing of insights,
services and to identify past positive achieve- resources, and problem solving strategies.
ments and the goals they desire to achieve.
Examples
5.d. This would specifically include boundary
Mentor networking can occur in many ways,
setting.
such as meetings, electronic connections, and
informal social gatherings.
3.T. 6. Mentors provide access to information
for persons served on community
3.T. 9. Mechanisms are in place to address
resources including, as appropriate to
the personal security of mentors.
the scope of services: 9.T. Mentor Services
a. Medical, life, and disability insurance.

b. Public benefits.
3.T. 10. The program implements strategies
c. Housing.
6.c.T. Mentor Services to promote:
d. Banking and financial services. 10.T. Mentor Services
6.d.T. Mentor Services a. Self-confidence of the persons

e. Problem solving. served.
6.e.T. Mentor Services
f. Government services. 10.a.T. Mentor Services
b. Self-sustaining supports for the

6.f.T. Mentor Services
g. Local advocacy and self-help groups. persons served, as appropriate.

6.g.T. Mentor Services

Mentors assist persons served to achieve self suf- A community of support for the person served
ficiency in their lives emphasizing development can be a resource to assist in planning for and
of community connections and supports. navigating the many stages of life transitions.
Examples Examples
Areas dealing with government assistance, bene- Many organizations set up clubs, social events,
fits, and legal and financial services can be quite and email connections for persons served to
complex. The mentor and the organization usu- “stay in touch” and to continually promote
ally develop reference materials for coaching and the mentor services. These may be supported
assistance to establish contacts within the com- through alumni networking, event fund raising,
munity’s generic and governmental resources. and networking with other clubs or supports
such as advocacy.
3.T. 7. Community networks are identified to A program might use a website to:
meet the goals of the persons served. ■ Provide information.
Intent Statements ■ Receive input from persons served, funding

The organization seeks new resources and con- sources, and community resources.
tacts in the community for partnering to ensure ■ Facilitate networking of mentors and persons
it is meeting needs and achieving outcomes served.
desired by the persons served.
■ Provide an opportunity for sharing of
Examples thoughts and ideas to facilitate successful
Networks of collaborative resources are estab- employment and living outcomes.
lished based on the needs of the persons served
and the strengths of each resource.

Section 3.U. Personal Supports Services (PSS)
Documentation Examples U. Personal Supports

mation you should have available to demonstrate Services (PSS)
on required documentation. Personal supports services are designed to pro-
■ Records of persons served vide instrumental assistance to persons and/or
■ Individual service plans families served. They may also support or facili-
■ Progress notes
tate the provision of services or the participation
of the person in other services/programs, such
as employment or community integration ser-
■ Recruitment materials for mentors vices. The services are primarily delivered in the
■ Orientation materials for persons served home or community and typically do not require
■ Brochures or materials describing services
individualized or in-depth service planning.
■ Business planning documentation
Services can include direct personal care sup-
ports such as personal care attendants and
■ Outcomes reports
housekeeping and meal preparation services;
services that do not involve direct personal care
supports such as transporting persons served,
information and referral services, translation
services, programs offering advocacy and assis-
tance by professional volunteers (such as legal
or financial services), training or educational
activities (such as English language services),
mobile meal services; or other support services,
such as supervising visitation between family
members and parent aides.
A variety of persons may provide these services/
supports other than a program’s staff, such as
volunteers and subcontractors.

e. As appropriate to the service pro-

Applicable Standards vided, safety training that includes:
2.e.U. Personal Supports Services
An organization seeking accreditation in per- (1) First aid/CPR.

sonal supports services must meet Standards 2.e.(1)U. Personal Supports Services
(2) Biohazards.
1.–7. in this section and the standards in the 2.e.(2)U. Personal Supports Services
(3) Physical hazards.

following sections: 2.e.(3)U. Personal Supports Services
(4) Body mechanics.

■ 1.A. and 1.C.–1.N.; 1.B. Governance is 2.e.(4)U. Personal Supports Services
f. If transportation is provided:
optional 2.f.U. Personal Supports Services
(1) Proper seat restraints or car seat

installation when children are
■ 2.B. Individual-Centered Service Planning, served.
Design, and Delivery, Standards 1. and 2. 2.f.(1)U. Personal Supports Services
(2) Wheelchair tie-downs,

■ 2.C. Medication Monitoring and Manage- when applicable.
ment (as applicable; see page 148) 2.f.(2)U. Personal Supports Services
(3) Safe driving techniques.

2.f.(3)U. Personal Supports Services
Standards, Standard 4.
■ 2.F. Community Services Principle Stan-
3.U. 3. When direct personal care supports are
dards, Standard 5. if the program includes provided, the program implements a
providing direct care personal attendant plan and written procedures for:
services 3.U. Personal Supports Services
a. The supervision of personnel, includ-

■ 2.G. Children and Adolescents Specific ing provision of timely feedback to
Population Designation (optional) enhance skills.
3.a.U. Personal Supports Services
■ 2.H. Older Adults Specific Population b. Addressing unplanned absences to

Designation (optional) ensure continuity of supports.
3.b.U. Personal Supports Services
■ 2.I. Medically Fragile Specific Population

Intent Statements
The intent of this standard is to ensure that all
■ 2.J. Autism Spectrum Disorder Specific personnel used by an organization to provide
Population Designation (ASD:A and/or personal care supports receive appropriate
ASD:C, optional) supervision or direction. In addition to staff mem-
bers and contracted personnel, personnel may
3.U. 1. The program clearly identifies the sup- include volunteers, trainees, and interns. Stan-
ports and services provided. dard 2.F.5. applies to direct personal care
supports.
Examples
3.U. 2. Personnel receive training that includes: Supervision may occur through the supervisor’s
a. Promoting consumer-directed participation in service planning meetings,

supports. organizational staff meetings, side-by-side
b. Advocating for the needs of sessions with the person served, or one-to-one
persons served. meetings between the supervisor and personnel.
c. Guidelines for participating in the 3.a. May include information on best practices or
service planning for persons served, identify areas for improvement.
when applicable.
2.c.U. Personal Supports Services
d. Where appropriate, supportive

therapeutic techniques.
2.d.U. Personal Supports Services

3.U. 4. When applicable, training in the use 3.U. 6. If the personal supports service provides
of adaptive devices and equipment training or an educational activity for the
is provided to: persons served, the program includes a
written description for each offering that
a. Personnel.
b. The person served. includes:

c. The family. a. Focus on the needs of the trainees.

d. Caregivers. b. Requirements for participation, if any.

c. Objectives for the activity.

Examples 6.c.U. Personal Supports Services
d. Instructional methods and materials.

Adaptive devices and equipment use would 6.d.U. Personal Supports Services
e. The sequence and hours of

be dependent on the type of service supports
instruction.
provided and the population served. Some 6.e.U. Personal Supports Services
examples are wheelchairs, lifts, breathing devices, f. Regular review and revision/updates
and feeding devices. as needed.
6.f.U. Personal Supports Services
Examples
3.U. 5. When needed, assistive technology is Activities might include offerings such as English
used and reasonable accommodations language services; fitness classes; craft classes;
are made in: computer classes; classes on financial planning
a. The development of services and or tax preparation; information/education

supports. regarding caregiver resources in the community;
b. The ongoing provision of services. health-specific topics such as diabetes, heart

health, and osteoporosis; healthy nutrition and
Examples physical exercise; stress management; elder abuse
When assistive technology/reasonable accommo- issues; falls prevention; and literacy programs.
dations are identified as needed, the organization
may directly provide the assistive technology, 3.U. 7. If information and referral services are
or it may be provided by referral to other local provided, the program demonstrates:
resources. Reasonable accommodations may be 7.U. Personal Supports Services
a. Knowledge of available services/

necessary to fully access services and enable the
resources.
person served to participate in the organization’s 7.a.U. Personal Supports Services
activities. If a person needs services that are not b. Knowledge of support systems that
available from the organization, referrals to other are relevant to the persons served.
services are suggested. c. Facilitation of access to available

The organization considers reasonable accom- services/resources.
modations and uses assistive technology to d. Availability at times and locations

convey information about services when needed. convenient to the persons served.
Accommodations and technology may entail the

use of communication devices, video and audio
recordings, pictures, and materials in each per-
son’s and/or family’s primary language. Many
modifications are simple and inexpensive. When
necessary, the program also provides education
on technology applications.

Short-Term Immigration Support b. Greater self-sufficiency.

Services (ISS) c. Increased participation in the

community.
Description Intent Statements

Immigration Support Services (ISS) encompass a Services and supports lead to positive outcomes
range of services that promote integration, inde- for persons served. Outcomes prevent fallback
pendence, and active participation for persons in to government institutions and maintain the indi-
their new land. ISS assist persons to feel at home vidual’s participation level in the community.
in their new community and integrate into soci- Outcomes for immigration support services could
ety, while being respectful of the culture from relate to persons served securing employment,
which they came. Preferably services are offered housing, and developing personal/social support
when the organization is able in the first language networks.
of the person served by multilingual and cultur- Examples
ally diverse staff. Services include provision of
information and orientation to the new culture of These services are designed and delivered in such
the person, community referrals, and support. a manner as to enhance the interdependence of
Workshops may be offered on a variety of topics the persons served, their self-sufficiency, and
such as general advocacy, legal advocacy, com- their successful integration into their community.
munity supports, and cultural awareness. Other Services are flexible in satisfying the needs and
services may include employment supports pro- desires of the persons served.
vided at drop-in resource sites, outreach services,
and English acquisition services. Interpretation 3.U. 9. Program design and services/activities
and translation services may be offered to help are developed based on information
limit language and communication barriers. gathered from the persons served and
Services provided under this subcategory are considers:
generally short term. Persons with more exten- a. The desired outcomes from services.
sive needs are given appropriate referrals to other b. The identified preferences of the
programs, which may be within the organization persons served.
or another service in the community. c. The identified needs of the

persons served.
d. Improving the ability of the persons

served to understand their needs.
An organization seeking accreditation in 9.d.U. Personal Supports Services
e. Assisting the persons served to

short-term immigration support services
achieve desired outcomes, as appro-
must meet Standards 1.–12. in this section
priate to the individual, in the
and the standards in the following sections:
following areas:
■ 1.A. and 1.C.–1.N.; 1.B. Governance is 9.e.U. Personal Supports Services
(1) Integration into the community.

optional 9.e.(1)U. Personal Supports Services
(2) Interpersonal relations.

■ 2.A. Program/Service Structure 9.e.(2)U. Personal Supports Services
(3) Recreation/use of leisure time

■ 2.B. Individual-Centered Service Planning, opportunities.
Design, and Delivery, Standard 1. only 9.e.(3)U. Personal Supports Services
(4) Vocational development or

employment.
3.U. 8. The persons participating in services/ 9.e.(4)U. Personal Supports Services
(5) Educational development.

activities move toward: 9.e.(5)U. Personal Supports Services
(6) Self-advocacy.
a. Optimal use of: 9.e.(6)U. Personal Supports Services
(7) Access to nondisability related

(1) Natural supports. social resources.

8.a.(1)U. Personal Supports Services
(2) Self-help. 9.e.(7)U. Personal Supports Services
8.a.(2)U. Personal Supports Services

Intent Statements ■ Problems.

Persons served have an active role in program ■ Plans.
design and redesigning the program to remain
relevant to their needs and desires.
Examples 3.U. 12. The organization provides information
The organization demonstrates that a range or referral to assist the persons served
of basic services/supports is provided. These in securing assistance to meet their
services/supports could be arranged within a basic needs.
one-stop resource office or other setting, but 12.U. Personal Supports Services
Intent Statements
the common services consist of providing assis-
tance or basic supports to enable individuals to Agency and direct support personnel possess
function fully within their communities, and the the skills, competencies, and qualifications to
other activities as desired by the persons served support the persons served.
and described in this standard. Examples
9.e.(1) The program assists the person served to Overcoming identified barriers or meeting spe-
develop skills and connections to their commu- cific needs may be beyond the organization’s
nity and integrate into society. service delivery capability but may be addressed
by referrals to other community agencies, organi-
3.U. 10. Services are provided at times and loca- zations, and resources.
tions that meet the needs of the persons This may include any of the following based on
served. the needs of the person served:
Intent Statements ■ Income maintenance.
The program demonstrates the ability to provide ■ Benefits.
services in an effective and efficient manner and ■ Food, clothing, and household goods.
takes the needs of persons served into ■ Short-term or emergency shelter.
consideration.
Examples housing.
The program’s services and hours of operation, ■ Medical and healthcare.
evaluated periodically to ensure that the services
are available and accessible to meet the needs and
■ Transportation.
interests of the persons served.
3.U. 11. Personnel are available to meet with per- The organization provides information about
sons served to discuss matters of mutual public assistance and application procedures to
interest or concern. the persons and/or families served. The staff
Intent Statements
members are knowledgeable about requirements
to obtain and retain public assistance, due pro-
Personnel are accessible to persons served.
cess, and time frames or are able to refer persons
Examples to authorities who are. Sources of public assis-
Individual or group meetings can include tance may include, but are not limited to,
regularly scheduled meetings or meetings Supplemental Security Income, Social Security
for the purpose of collaboratively discussing Disability Insurance, food stamps, bus passes,
issues such as: public health services, and local, county, and state
or provincial assistance.
■ Hours of operation.

Section 3.V. Self-Directed Community Supports and Services (SDCSS)
Documentation Examples V. Self-Directed

mation you should have available to demonstrate Community Supports
and Services (SDCSS)
Description
■ Identification of supports and services
provided Many community organizations, in partnership
with individuals, families, and funding sources,
■ Records of persons served, if applicable
are redesigning their resources to embrace a
to the service provided
self-directed community supports and services
■ Individual service plans, if applicable
approach. For many individuals, this is one
to the service provided more significant and evolutionary step away
■ Progress notes from institutional settings. This customer-
■ Procedures manual designed and delivered approach utilizes an
■ Documented staff training
individually controlled budget. The budget is
developed according to guidelines from the
■ Curriculum for training/education courses
funding source. Through the development
provided and management of individualized community
■ Forms authorizing release of confidential support options, individuals take an active role
information in the decisions that affect their lives.
■ Plan and written procedures for supervision Due to budgetary constraints, at times the indi-
of direct service personnel vidual budget development process may need
to separate wants from needs for treatment and
support. Some important objectives include:
■ Identifying an individual’s needs.
■ Selecting supports and services within

an approved context that best address those
needs.
■ Determining the amount of supports or
services necessary to adequately address
each identified need.
■ Determining a cost or amount to reimburse
providers.
■ Integrating supports and services within
the set individual budget plan.
■ Establishing policies and procedures for filing
claims and receiving reimbursement.
■ Establishing policies and procedures for deal-
ing with government tax reports and filings
for employers and employees.
■ Providing policies and procedures for risk
management, notably in the areas of
corporate compliance to prevent fraud, waste,
and abuse of government funds.
■ Continuously improving the local service pro-
vider accredited in Self-Directed Community

Supports and Services based on decision

making and true participation of persons Applicable Standards
served in service and organizational design. An organization seeking accreditation in self-
Self-directed supports and services are based on directed community supports and services:
the assumption that individuals receiving sup- flexible supports planning (FSP) must meet
port have the authority to determine the role the standards 1.–12. in this section and the stan-
provider will play in their lives and that personal dards in the following sections:
preferences for supports should drive, or at least ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
heavily influence, the planning process. optional

Some examples of the quality results desired ■ 2.A. Program/Service Structure, Standards
by the different stakeholders include: 1.–13.

■ Persons lead the planning process and have An organization seeking accreditation in self-
support of their choosing to do so. directed community supports and services:
■ Persons decide which supports and employer of record support services (EOR)
services to direct. must meet standards 13.–24. in this section
■ Persons get help as desired to direct their
and the standards in the following sections:
supports and services. ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
■ Persons direct how their supports and

optional
services are provided, including their nature. ■ 2.A. Program/Service Structure,
■ Persons have a budget over which they have

Standards 1.–13.
control.
■ Persons have free choice among providers,
within funding guidelines.
■ Persons get help as desired in finding
■ Persons select, hire, fire, and manage
the workers who provide their supports
and services.
■ Persons make decisions to redirect funds
among supports and services as desired.
There are two program categories in which
an organization can seek accreditation in Self-
Directed Community Supports and Services:
■ Flexible Supports Planning (FSP) allows
an organization to manage the assessment,
development, and planning of services to
help persons served gain access to supports
as needed.
■ Employer of Record for Support Services
(EOR) work with persons served as the man-
aging employer, ensures that governmental
payroll requirements are met, and often acts
as a human resource consultant.

Flexible Supports Planning (FSP) to hire, fire, and manage individuals providing
their supports and services.
Flexible Supports Planning services provide
information and assistance for persons served By examining the individual plans and outcome
to plan and direct their individual budgets for expectations of persons served and keeping
supports and services. When an organization is abreast of legislative changes, the organization
accredited in both Flexible Supports Planning can assess its capacity and develop strategies for
and Employer of Record for Support Services, creating the kinds of services that will meet the
consideration is made for dealing with potential needs of its community. In addition, the organi-
conflicts of interest. zation may use consumer satisfaction surveys to
gather information on services offered.
The organization may also regularly meet with
Applicable Standards funding sources and a committee of consumers
An organization seeking accreditation in self- and their representatives/guardians to develop
directed community supports and services: or modify existing services.
flexible supports planning (FSP) must meet
standards 1.–12. in this section and the stan- 3.V. 2. The individual plans of the persons
dards in the following sections: served drive the system of supports
■ 1.A. and 1.C.–1.N.; 1.B. Governance is and services.
2.V. SDCSS
optional
Intent Statements
■ 2.A. Program/Service Structure,
The business and service functions of the organi-
Standards 1.–13. zation are designed based on the input, outcome
expectations, and outcome satisfaction of per-
3.V. 1. The program establishes with stake- sons served. Individual and aggregate data from
holder input its mission and philosophy the individual service plans of persons served
for person- or self-directed community provide the basis for developing and changing
support services. organizational service designs.
1.V. SDCSS

Input from persons served and other stakehold- Organizations can demonstrate in different ways
ers is used to design the self-directed supports how they incorporate aggregated data from out-
program, align business practices, and continu- come expectations of persons served into their
ally improve services. planning process for ongoing development and
improvement of supports. This might be tied
Examples
to an indicator identified in its performance
When an organization establishes a self-directed analysis.
support service, it involves all stakeholders in
the planning process, which can include local
(county/provincial) human services and health 3.V. 3. Persons served:
3.V. SDCSS
officials, the state department of human services, a. Choose their support team.
3.a.V. SDCSS
persons expected to be served by the service, b. Prioritize the supports/services they

their representatives/guardians (if applicable), want, within guidelines established
case managers, and the organization itself. The by the funding source.
3.b.V. SDCSS
planning process includes aligning business prac- Examples

tices and developing a vision for what the agency
will provide. The organization uses input from 3.a. Persons direct their services and choose
these stakeholder meetings to develop a set of those who work with them.
core values and a mission statement that includes Customer service representatives for the persons
the roles and options of the persons served to served may be available. The organization may
direct the services provided, including the ability have staff from many different backgrounds and

experiences, including direct support, super- health, welfare, and community participation
vising others in a human services setting, and as desired.
developing support and services programs. Examples
Employees who are experienced in hiring and in
Persons served may identify advocates, if desired,
person-centered planning may also be beneficial
in understanding the situations of the persons to assist them in participating fully in plan and
budget development.
served.
A handbook is often used to provide all stake-
3.b. Local funding sources may have different
guidelines for self-directed supports and services. holders with a clear understanding of roles and
responsibilities in the creation and implementa-
The accredited program establishes and main-
tion of self-directed budgets. The handbook may
tains its services and business designs to meet the
needs of the persons served while ensuring that include information about the process of hiring
and supervising staff, explanations and samples
all applicable guidelines are met and maintained.
of forms, and the responsibilities of the persons
The organization may track the impact of ser- served including how to work with funding
vices delivered on outcomes in order to provide sources to create an individual budget. The hand-
feedback to the funding sources for changes book may also include responsibilities of the
and enhancements in their funding guidelines. organization providing fiscal support services
Through the use of standardized reporting pro- such as staff payment, labor compliance, and
cesses, an organization can track funds used in budgetary monitoring.
various service areas within the individually
4.a.(2) Some persons may choose to find an
approved budgets.
established community provider for particular
aspects of their plan. In this case the self-directed
3.V. 4. Persons served are provided with supports and services program provides informa-
information and full participation tion about qualified community providers from
to the extent desired in the areas of: whom the person can make an informed choice
4.V. SDCSS
a. Home and community supports and how the person selecting a provider can have
and services, including: input in the selection of employees of the organi-
4.a.V. SDCSS
(1) Choice of supports/services. zation who provide their supports/services.

4.a.(1)V. SDCSS
(2) Choice of providers. 4.d. Persons served may be assisted in the hiring
4.a.(2)V. SDCSS
b. Available resources from funding process through a handbook that describes typi-
sources. cal service and support staff qualifications and
4.b.V. SDCSS
c. Establishing an individual budget. provides information on writing a job descrip-

4.c.V. SDCSS
d. Resources and informational tool tion, performing evaluations, establishing work

kits to help manage services. schedules, and training employees about their
4.d.V. SDCSS
needs.
e. Their responsibilities for addressing
their personal health, welfare, and A comprehensive website that is frequently
safety needs. updated by the organization can be an excellent
4.e.V. SDCSS
way to keep all participants and users of self-
f. A participation agreement for
directed budget services informed. Websites can
person- or self-directed supports
include updated procedures and forms, real-time
and services.
4.f.V. SDCSS account balances, legislative updates, and provide
Intent Statements a mechanism for feedback on service design.
Persons participate as desired in all aspects of 4.f. A support service planning agreement is
their services. Full disclosure, education, and an excellent way for the person served to be
supports are provided to the persons served informed of the services available to them and
to support them in the establishment of an to choose needed and desired services. Services
individual budget that will provide reasonable offered by the support services planner may
choices and access to services that support include organizing person-centered meetings

to review goals, revising health and safety plans, Intent Statements

assisting in the recruitment of staff, facilitating Persons have the right to freedom from abuse,
background checks, providing staff training, and neglect, and exploitation. Acceptance of the
providing information about technology options. rights of self-directed supports and services
comes with the knowledge that the person
3.V. 5. Persons served are informed of: served and the organization are accountable
5.V. SDCSS
for tracking funds and determining and over-
a. The supports/services that
seeing how funds are used and reported.
they are eligible to purchase.
5.a.V. SDCSS
b. Terms and conditions for Examples

the use of funds. The organization may inform and educate per-
5.b.V. SDCSS
c. Required documentation sons served and their support staff about their
of fund expenditures. rights and the methods for reporting abuse,
5.c.V. SDCSS
d. Consequences for abuse or neglect, or financial exploitation through its

fraudulent use of self-directed initial orientation procedures. The organization
funds, supports, and services. can also provide information to persons served
5.d.V. SDCSS
and their support staff in a handbook or on a
Intent Statements website that defines and gives examples of abuse,
The self-directed supports and services initiative neglect, and financial exploitation and provides
is designed and managed to ensure that all clear instructions on how to report any violations
stakeholders’ concerns are addressed and that or suspected violations.
corporate compliance is in place to assure tax- The organization provides its staff with training
payers that the funds are used for approved about how to report budgetary issues to the
means within government guidelines.
funding sources and the persons served. The
Examples organization also provides corporate compliance
Risk management policies and procedures, training to staff that includes understanding and
with an emphasis on corporate compliance, are recognizing abuse and exploitation. The training
excellent ways to assure the funding sources and provides the organization’s employees with the
taxpayers that the funds for self-directed services foundation for effectively implementing proce-
are being used in accordance with approved dures to address violations of rights or misuse
guidelines. of funds. Through training, the organization’s
employees understand the process of document-
An organization providing fiscal support services
ing any suspected abuse, neglect, or fraud and
may have a handbook or website that informs the
how to report such violations.
persons served of services they are eligible to
purchase and the terms and conditions for the
use of the funding. The handbook or website can 3.V. 7. Individual budgets for home- and
also provide information on fraud and outline community-based supports:
7.V. SDCSS
the consequences of using funding in a fraudu- a. Are under the control and direction
lent manner. of persons served and/or legal guard-
ians as appropriate.
7.a.V. SDCSS
3.V. 6. Persons served and their supports and b. Are developed based on input of
services providers are informed of: the person served.
7.b.V. SDCSS
6.V. SDCSS
a. What might constitute abuse, c. Are based on reliable costs and/or

neglect, and exploitation. supports and services utilization.
7.c.V. SDCSS
d. Are sustainable while considering

6.a.V. SDCSS
b. Procedures to follow if they

encounter cases of abuse, neglect, the health and welfare of the
exploitation, or fraudulent use of person served.
7.d.V. SDCSS
funds.
6.b.V. SDCSS

e. Include a process for making adjust- Examples

ments in the individual budget with The organization has a process that allows the
involvement of the person served. persons served to request contact with their
7.e.V. SDCSS
f. Move with the person served, within funding source to adjust or make modifications
applicable guidelines. to their individual budget during the fiscal year.
7.f.V. SDCSS
g. Are shared in an understandable While the funding source may have the final
manner with the person served, authority on budget issues, information and out-
family, team members, and other comes of the person served can be used to clearly
stakeholders: advocate for adjustments that are needed to the
7.g.V. SDCSS
(1) With the person served being individual’s service design. The process includes
informed of the amount autho- feedback and input from the persons served and
rized to be self-directed. may also include input from the person’s case
7.g.(1)V. SDCSS
manager and support coordinator.
(2) With any governmental funding
protocols clearly identified. Adjustments to the individual’s budget may
7.g.(2)V. SDCSS
include moving funds from one category in the
h. Are reviewed and monitored accord-
budget to another or providing additional train-
ing to a determined method and
frequency. ing to the person’s supports and service staff as
7.h.V. SDCSS the person’s situation changes. Other changes
i. Include a procedure for moving
may include a request for financial services if
money within the budget categories.
7.i.V. SDCSS
changes in the person’s ability to manage the
j. Include a procedure to evaluate budget occur, or additional funds to modify a
and inform the person served home or vehicle to meet changing needs.
of over and under expenditures
7.j. The organization provides its staff with train-
in his/her budget.
7.j.V. SDCSS ing about overspending and underspending.
k. Include, as appropriate to the
person served:
7.k.V. SDCSS 3.V. 8. Persons served are provided with
(1) Flexible supports planning.
7.k.(1)V. SDCSS
assistance, as they desire, to:
(2) Treatment and training. 8.V. SDCSS
7.k.(2)V. SDCSS
a. Identify and plan for support
(3) Environmental modifications services, including:
and provisions. 8.a.V. SDCSS
7.k.(3)V. SDCSS
(1) Finding qualified providers.
(4) Assistive technology. 8.a.(1)V. SDCSS
7.k.(4)V. SDCSS
(2) Reviewing the individual plan
(5) Assessments, including: implementation.
7.k.(5)V. SDCSS
(a) Initial assessment. 8.a.(2)V. SDCSS
b. Identify, access, arrange for, and

7.k.(5)(a)V. SDCSS
(b) Subsequent assessment. manage use of generic community

7.k.(5)(b)V. SDCSS
(6) Self-directed support activities. resources that:

7.k.(6)V. SDCSS 8.b.V. SDCSS
(7) Community inclusion. (1) Meet their support needs.

7.k.(7)V. SDCSS 8.b.(1)V. SDCSS
(8) Supported employment. (2) Are provided in accordance

with their choices as determined
7.k.(8)V. SDCSS
Intent Statements
through a person-centered
7.a. When the person served is a child, these planning process.
are under the control of the parent or guardian. 8.b.(2)V. SDCSS
Authorized amounts of money for authorized Intent Statements

supports and services are based on assessment The support service planner provides informed
of the needs and desires of the person served. choice and assists the persons served to direct
There is a process for making adjustments in the their budgets to products and services that are
individual budget in a fiscal year, as well as subse- approved through the person-centered planning
quent years, based on considerations of health, process.
welfare, and changing needs.

Examples
3.V. 10. The support service planner:
Planning for successful flexible supports is 10.V. SDCSS
focused on individual outcomes while balancing a. Helps persons served to gain access
the needs and desires of the person served. Using to services as needed regardless of
the outcomes desired and within the funding the funding source, as appropriate.
10.a.V. SDCSS
guidelines, the flexible supports planner contin- b. Assists persons served in developing
uously searches for and maintains information a personal budget based on the
on providers and other generic community individual plan.
10.b.V. SDCSS
resources, such as recreational events and educa- c. Identifies the time line for the
tional opportunities, that can meet the needs individual plan implementation
of the person served. Advocacy and educational with the individual.
10.c.V. SDCSS
efforts may assist the persons served in accessing d. Identifies supports necessary to
services they choose under self-directed budgets. ensure the individual’s health and
safety.
10.d.V. SDCSS
3.V. 9. The support service planner helps e. Facilitates the development and
persons served to: expansion of community resources
9.V. SDCSS
a. Identify an informal support and providers.

10.e.V. SDCSS
network of family, friends, f. Assists in verifying that providers

and associates. are qualified to deliver services.
9.a.V. SDCSS 10.f.V. SDCSS
b. Build and/or sustain established g. Monitors on an ongoing basis the

networks. provision of services included in
9.b.V. SDCSS
the individual’s plan.

Intent Statements 10.g.V. SDCSS
h. Initiates and oversees the process

Self-directed services are often enhanced by
of assessing and reassessing the
the bonds and shared experiences of friends
individual’s level of support needed,
and colleagues. Support networks often result
in more community opportunities and increased as appropriate.
10.h.V. SDCSS
independence for the persons served. Intent Statements

Examples Support service planners continuously maintain
knowledge and understanding of the needs and
Based on the needs of and outcomes desired by
outcomes desired by the persons served, identify
the persons served, the support service planner
providers who are qualified to deliver services,
may link persons served with mentors who have
and encourage the providers to design and posi-
experience in managing self-directed services,
tion their services to meet the person’s needs.
or who may be willing to share insights or infor-
mation about generic resources to enhance Examples
community activities and experiences. Support The intensity of support service planning is based
networks often help with accessing services, on the needs of the person served as identified in
adjusting to new communities, coping with his or her individual plan. Service provision is
changes in life, and sharing of resources. Exam- not only monitored for outcome satisfaction;
ples include social gatherings designed for the support service planner also facilitates the
individuals with disabilities, community organi- creation and development of other community
zations that provide recreational opportunities, resources and providers that will meet the ever-
and faith-based organizations with counseling changing needs of persons served.
and other support services. Communities can provide many assets to meet
the diverse needs of persons served. Informal and
formal networks may address the support needs
and provide opportunities for meaningful partic-
ipation in the collective life of the community.

and is continually analyzed and integrated into

3.V. 11. When individual budget management the business practices of the organization. A con-
is provided, it includes, as appropriate:
11.V. SDCSS
sumer satisfaction survey conducted at least once
a. Monitoring to ensure that expendi- a year can also be used to gather information on
tures do not exceed the approved overall consumer satisfaction and ascertain any
plan. concerns of the persons served or their represen-
11.a.V. SDCSS
b. Resolving issues if the person served tatives/guardians. This information may also be
is not staying within the plan. shared with funding sources for use in planning.
11.b.V. SDCSS
c. Helping to return funds not used The information noted in this standard helps the
according to the plan guidelines. funding source and the organization better meet
the needs of the persons served, offer other ser-
11.c.V. SDCSS
d. Dealing with conflicts of interest,

fraud, waste, and abuse of govern- vices or products that are more relevant to the
ment funds. persons served, and identify any changes in
11.d.V. SDCSS
organizational planning that should occur.
Intent Statements
The organization establishes and maintains
policies and procedures to help assure stake-
holders that funds are used appropriately
and within guidelines.
Examples
The organization’s corporate compliance policies
and procedures address the expectations of
individual budget management. Specifically,
corporate compliance is the sum of all actions,
policies, procedures, reviews, audits, prevention
strategies, corrective actions, modifications, staff
training efforts, reporting systems, etc. that are
developed and implemented by the organization
and its employees to prevent and detect illegal or
unethical activity and/or fraud, waste, and abuse.
3.V. 12. Regular reporting is provided to the

appropriate oversight agency or
organization and includes:
12.V. SDCSS
a. Satisfaction of the persons served.

12.a.V. SDCSS
b. Service utilization information.

12.b.V. SDCSS
c. Budget analysis.
12.c.V. SDCSS
d. Transition and/or discharge

summary information.
12.d.V. SDCSS
Intent Statements
For optimal results and the satisfaction of the per-
sons served, the flexible supports planner reports
accurate figures on services used, budget status,
and completion of services.
Examples
Service satisfaction is often measured at the time
of individual planning sessions or at discharge

Employer of Record for Support provided with information to be appropriately

approved and oriented to the job of providing
Services (EOR) supports and services to the person.
The person served is the managing employer— 13.a. Information provided may include:
responsible for hiring, firing, and managing
■ The conditions of maintaining employment.
details surrounding employment of their sup-
port workers, such as duties, work hours, and ■ Job description.
performance expectations. The provider is the ■ Responsibilities of the employee.

employer of record that supports the person ■ Wage payment practices.
served in ensuring that governmental payroll
■ Rate of pay.
requirements are met. In some cases, the person
served may be considered the employer of record ■ Benefits provided by the business.
and contract or hire the organization as a fiscal ■ Work rules and customs.
agent to be responsible for payroll and related ■ Nondiscrimination practices.
governmental reporting.
■ Conflict resolution procedures.
■ Policies for transfer.

Applicable Standards ■ Employee classifications in the business.
An organization seeking accreditation in self- ■ Health and safety practices.
directed community supports and services: ■ Union membership policies, if applicable.
employer of record support services (EOR)
■ Job retention.
must meet standards 13.–24. in this section
and the standards in the following sections: ■ Potential for career growth.
■ 1.A. and 1.C.–1.N.; 1.B. Governance is ■ Training on vulnerable adults including the
optional identification and reporting of maltreatment,

neglect, and exploitation.
Standards 1.–13. ■ Training on the Child Protection Act and
other applicable regulations.
3.V. 13. The employer of record for support ■ Training on the organization’s mission.
services: ■ Training on blood-borne pathogens and

13.V. SDCSS
a. Provides employment information. communicable diseases.

13.a.V. SDCSS
b. Conducts or arranges for background ■ Training on the Emergency Planning and

checks of support workers chosen by Community Right to Know Act (EPCRA) and
the person served. the handling of hazardous substances.
13.b.V. SDCSS
c. Provides complete payroll service, ■ Training on recognizing and reporting fraud.

including tax withholding, workers’ ■ The organization’s method for reporting
compensation, and liability employee injury on the job.
insurance.
13.c.V. SDCSS
13.b. The organization conducts background
Intent Statements checks and makes a list of disqualifiers to evalu-
The organization creates business policies and ate negative information. The organization has in
procedures that provide funding, payroll, and place a procedure for subsequent steps should a
accounting back-office support for employees potential employee be disqualified from employ-
chosen to provide services and supports for ment as a caregiver.
persons served.
Examples
The employer of record ensures that new
employees hired by the persons served are

structure such as a flat fee per month based on

3.V. 14. If the organization also provides flexible total budget allocation. Included in this fee struc-
supports planning services, written
ture is usually a cost for every transaction, such
guidelines exist to avoid conflicts of
as processing W2s, tax filing, new-hire setup, and
interest.
14.V. SDCSS
report creation. An annual handbook or pricing
Intent Statements list given to persons served when persons inquire
The organization adopts and enforces conflict about services is an excellent way to ensure that
of interest guidelines tailored to its specific needs the persons served are informed of fees for ser-
and consistent with laws in its state or province. vices. The total billing for an individual depends
on the level of service the person elects to receive.
Examples
Some persons use employer of record services
Few actions undermine the credibility of an just to process payrolls for their employees, while
organization more than having its funds not others use employer of record services to handle
used exclusively for purposes designated by the every aspect of human resource management.
stakeholders. Adhering to well-defined conflict The key element to employer of record service
of interest guidelines helps to prevent even the pricing is that it is structured to offset reasonable
perception that funds may be being used for per- costs of paying individuals and/or other vendors
sonal gain by the managers or board members. to perform the functions and ensure compliance
Many states/provinces have laws that govern con- with legal requirements while empowering per-
flict of interest situations. For example, in many sons to implement self-directed services that
states an individual seeking services cannot uti- meet their needs and desires.
lize the same organization for flexible supports
planning and employer of record services due to
conflict of interest issues. An organization should
3.V. 16. Brochures or other informational
materials are provided to the persons
consult laws applicable in its locale.
served that identify the employer of
Conflict of interest guidelines may: record’s:
■ Define conflict of interest.
16.V. SDCSS
a. Approach to self-directed services.

16.a.V. SDCSS
■ Specify the persons who are covered b. Services provided.

by the policy. 16.b.V. SDCSS
c. Geographical area served.

■ Require regular disclosure of information
16.c.V. SDCSS
Intent Statements
related to conflicts of interest.
Brochures and other informational materials
■ Specify procedures for handling potential
clarify to the persons served the organization’s
or actual conflicts of interest when they philosophy, purposes, approach to services
arise and provide examples. provided, and how their outcome expectations
■ Specify training for new staff members may be met.
on identifying possible conflict of
Examples
interest situations.
Information can be provided in a variety of ways,
including printed and electronic. The organiza-
3.V. 15. A fee structure for employer of record tion illustrates how it will be responsive to the
for support services is established and
expectations of the person served and how the
provided to the persons served.
15.V. SDCSS
services provided have the potential to impact his
Intent Statements or her life. Brochures and websites can also give a
Persons have information regarding what ser- short history of the organization’s experience as
vices will cost before charges are encumbered. an employer of record and provide testimonials
from persons served, case managers, and funding
Examples
sources.
A community-based employer of record for
support services usually uses a simple service fee

Intent Statements
3.V. 17. Information regarding payroll policies
The organization ensures that the rights and
and purchasing procedures is provided
responsibilities of persons served and their
and explained to the persons served.
17.V. SDCSS
employees are mutually understood. Job descrip-
Intent Statements tions are created to guide the supports and
The organization demonstrates its commitment services that will assist in achieving the goals and
to following all legal and regulatory requirements outcomes of the person served and conform to
for employment by making persons served aware the funding guidelines for self-directed services.
of their responsibilities. Examples
Examples For each person served in self-directed services,
“New hire” booklets and other personnel policy the organization works with the person to iden-
manuals are often used to clarify the roles and tify the skills and characteristics needed by
responsibilities of the persons served and the employees to assist the person served in the
employees they hire and the legal payroll respon- accomplishment of his or her desired outcomes
sibilities of the employer of record for support and to support the organization in the accom-
services. plishment of its mission and goals.
Booklets may include information on creating 18.d. The organization may present this informa-
job descriptions, recruiting support staff, setting tion through audio recordings, videos, pictures,
up schedules, filling out labor forms correctly, or other media.
and purchasing procedures, as well as outlining
in detail all the responsibilities of the person 3.V. 19. The employer of record for support
served. A separate booklet for service and services maintains:
support staff may include information on data
19.V. SDCSS
a. Information about the individual

privacy, maintaining a working relationship with budget of the person served.
the person served, a mission statement, harass- 19.a.V. SDCSS
b. Information related to support staff

ment policy, and necessary forms to complete. employed by the person served,
In addition, information on vulnerable adults, including:
the Emergency Planning and Community Right 19.b.V. SDCSS
(1) The employment agreement.

to Know Act (EPCRA), and the transmission 19.b.(1)V. SDCSS
of infectious diseases may also be included. (2) Vaccination decline or consent

forms.
19.b.(2)V. SDCSS
(3) Documentation of orientation

3.V. 18. A detailed job description for employees
of employees to the require-
hired by the person served:
18.V. SDCSS ments of the job.
a. Is developed by the person served 19.b.(3)V. SDCSS
(4) The disclosure and authority-

with assistance as needed.
18.a.V. SDCSS to-release-information form
b. Is reviewed annually with (criminal background check).
the employee and updated 19.b.(4)V. SDCSS
(5) Direct deposit authorization,

if appropriate.
18.b.V. SDCSS if applicable.
c. Identifies the functions and qualifi- 19.b.(5)V. SDCSS
c. Government documents as required

cations necessary to assist the person
by law.
served in achieving the goals and 19.c.V. SDCSS
outcomes identified in his or her Intent Statements

individual plan. Procedures are updated on a regular basis to
18.c.V. SDCSS
d. Is explained in an understandable ensure that laws that guide employment prac-

manner to the person served and tices are followed. The organization documents
the employees he or she chooses. its practices to ensure that those providing
18.d.V. SDCSS
services are qualified and safe.

Examples
3.V. 20. As required, employees hired by
An employee handbook may address the require-
the persons served participate
ments of this standard by providing the employer
in mandatory training.
20.V. SDCSS of record and the persons served with consis-
Intent Statements tency in orientation, training, meeting the
Procedures ensure that specific training require- requirements of the position, and the records
ments mandated by funding and state/provincial and forms used for compensation and benefits.
regulations are met.
Examples 3.V. 22. The employer of record for support
The organization’s training program addresses services maintains an information
knowledge and competency needs of the support management system that:
22.V. SDCSS
staff hired by the persons served. Training of a. Provides payroll and nonpayroll
support staff should support the achievement supports.
22.a.V. SDCSS
of the outcome expectations of persons served b. Accounts for multiple funding

and other stakeholders. Often, attention is given streams.
22.b.V. SDCSS
to not only enhancing existing skills and compe- c. Tracks individual budgets in a
tency needs of the service and support staff, but declining balance format.
also to emerging skills, addressing changes in the 22.c.V. SDCSS
d. Addresses all related tax obligations.

support needs of the person served, and com- 22.d.V. SDCSS
e. Provides information to help meet

petencies that may contribute to improved changing circumstances in the plan
outcomes for the persons served. Training and of the person served.
education may be offered by the organization 22.e.V. SDCSS
f. Has a disaster recovery plan that:

or by qualified community resources. Other 22.f.V. SDCSS
resources to consider for training and education (1) Incorporates restoration of:
22.f.(1)V. SDCSS
include journals and the internet. Training (a) Software.

22.f.(1)(a)V. SDCSS
attended or completed is documented as required (b) Master files.

by any mandate.
22.f.(1)(b)V. SDCSS
(2) Includes backup strategies in the

event that the information man-
3.V. 21. The employer of record for support 22.f.(2)V. SDCSS
agement system is unavailable.
services provides persons served with (3) Ensures continuation of payroll
new-employee packets to orient staff and invoice payment systems.
they hire, including: 22.f.(3)V. SDCSS
21.V. SDCSS Intent Statements

a. A participant agreement.
21.a.V. SDCSS The organization has an information technology
b. Labor posters as required. system that is an integral part of its business
21.b.V. SDCSS
c. Privacy notices. strategies and practices for self-directed services,

21.c.V. SDCSS
d. The job description. and it has the hardware and software necessary
21.d.V. SDCSS
e. Job performance review guidelines to to provide reliable payroll and invoice record-
be used by the family/person served. keeping services.
21.e.V. SDCSS
f. Policies and procedures for mileage Examples

and other expense reimbursements. The information technology system may vary
21.f.V. SDCSS
g. Policies and procedures for employee based on the number of persons served in self-
payroll and expenses. directed services. Please see Standard 1.J.1. for
21.g.V. SDCSS
additional guidance on technology and system

Intent Statements
planning.
The organization assists the person served
in meeting all applicable guidelines and
legal requirements.

3.V. 23. The employer of record for support
services has a customer service The following are examples of the types of infor-
mechanism: mation you should have available to demonstrate
23.V. SDCSS
a. To respond to contact from persons
served or their workers regarding
issues such as withholdings, net
payments, lost or late checks, reports, ■ Records of persons served
and other documentation. ■ Individual service plans

23.a.V. SDCSS
b. That includes guidelines for the ■ Progress notes

organization’s personnel regarding ■ Procedures manual
customer service, customer respon-
■ Program mission statement
siveness, and quality assurance.
23.b.V. SDCSS
■ Individual budgets
Intent Statements
For Employer of Record for Support Services:
The organization demonstrates its commitment
to the persons served and the need to maintain ■ Individual budgets
qualified and stable staff to meet the outcome ■ Payroll service information
expectations of persons and families. ■ Fee structure
Examples ■ Brochures
Required and needed levels of qualified staff ■ Job descriptions

are maintained, and personnel turnover at the ■ New-employee packets
organization does not have a negative impact
■ Documented training
on the delivery of quality services and respon-
siveness to inquiries. The persons served and ■ Disaster recovery plans
their support workers are treated as highly

regarded customers in true business fashion.
3.V. 24. The employer of record for support

services regularly conducts an internal
accounting audit to ensure accuracy
and compliance with generally accepted
accounting practices.
24.V. SDCSS
Intent Statements
The organization establishes and maintains
fiscal policies and procedures, including
internal control practices.
Examples
This review by the organization focuses on the
accuracy of billing and coding practices. Reviews
are conducted by individuals trained to compare
the date and service codes on the organization’s
billing system to the date, units, and types of
services provided to the persons served. This
may be required by some funding or regulatory
sources, but it is also a good practice to incorpo-
rate into a fiscal management program to ensure
that services are being billed properly.

Section 3.W. Supported Education Services (SE)
W. Supported Education supports are continuous, and the preferences

of the individual guide services.
Services (SE) Some examples of quality results desired by the
different stakeholders of these services include:
Description ■ Students served attain General Education
Supported education reflects the assumption that Development certificate (GED).

education is a community resource to which all ■ Students served attain their high school
should have access. Society today has a greater diploma.
emphasis on lifelong learning and development ■ Students served are able to access adult
for persons to maintain employment and career learning options in their community.
development. Often there are cycles of education
■ Students served gain access to meaningful
and career transition and development that
employment, community integration, and
persons pass through during their lifetime.
the fulfillment of life goals.
Sometimes persons have dropped out of high
school before graduating and later seek to attain ■ Students served attain job skills needed
their GED or high school diploma. The sup- for employment.

ported education program provides resources ■ Students served obtain a degree or certificate.
that help persons to achieve their educational ■ Students served experience a decrease in
goals. It creates collaborations with other com- symptoms and a decrease in hospitalizations.
munity partners to meet the needs of the persons
■ Students served achieve economic
served in various educational settings.
self-sufficiency through employment
Supported education expresses the belief that and/or a combination of employment
individuals can attend classes, learn, and improve and benefits.
their options. Practices promote participation in
education programs for all who express interest.
Supported education occurs in the community in Applicable Standards
settings such as an academic campus, vocational/ An organization seeking accreditation in
trade school, college, and other post-secondary supported education services must meet the
educational settings, and may include online standards in this section and the standards
learning venues. It may even provide tutoring in the following sections:
services to at-risk youth who may be likely to fall
behind or drop out of school. The purpose of
optional
supported education is to provide supports to
individuals who are enrolled or want to enroll in
an education program to achieve their learning ■ 2.B. Individual-Centered Service Planning,
goals. Design, and Delivery

Supported education provides individualized ■ 2.C. Medication Monitoring and Manage-
services and supports. Supported education ser- ment (as applicable; see page 148)
vices address transitional or remedial academic ■ 2.F. Community Services Principle
needs, develop strategies for educational success, Standards, Standards 1.–4.
and secure resources and accommodations for ■ 2.J. Autism Spectrum Disorder Specific
students to access activities of post-secondary Population Designation (ASD:A and/or
education as desired. Program staff work with ASD:C, optional)
students to create a foundation of skills and to
secure supports necessary to achieve success.
NOTE: The services are integrated with other services
that the individual may be receiving. Follow-along

Intent Statements
3.W. 1. Supported education services offer a
Information is provided so that persons can
broad range of individualized, flexible
make informed decisions about the suitability
supports and resources to enable
of services for them.
persons to participate in educational
opportunities in their community. Examples
1.W. Supported Ed
Intent Statements
Displays of the supported education service’s
marketing materials are visible in locations where
The program is designed to meet the academic
potential students may gather, such as waiting
and support needs of students and to assist
rooms, case manager offices, lunch rooms, and
them in reaching their educational goals.
group program sites. A variety of formats and
Examples media may be used, including web sites, Face-
Supports may include: book, public service announcements, and paid
■ Educational and vocational exploration.
advertising.
■ Educational assessment.
This may include informing persons about
how they can get assistance to access services,
■ Educational goal planning.
if desired.
■ Identifying barriers and developing
strategies to overcome barriers.
3.W. 3. Program personnel meet with the
■ Campus tours. persons served to:
■ Assisting in securing financial aid.
3.W. Supported Ed
a. Clarify the long-term educational

■ Linking to Office of Student with Disability goal of the person.
3.a.W. Supported Ed
or Support Services. b. Identify short-term action steps

■ Assisting in securing reasonable to reach the goal.
3.b.W. Supported Ed
accommodations. c. Identify supports and activities the

■ Securing resources to succeed in education program can provide that will assist
(e.g., tutors, transportation, the person to achieve the goal,
and peer supports). especially considering the person’s:
3.c.W. Supported Ed
■ Assisting in completing post-secondary or

(1) Unique strengths.
3.c.(1)W. Supported Ed
vocational-trade school applications. (2) Learning styles.

3.c.(2)W. Supported Ed
■ Stress and time management strategies. d. Develop the individual plan based
on this information.
■ Offering support groups (professional 3.d.W. Supported Ed
and/or peer facilitated). Examples

■ Help in working with vocational rehabilita- 3.c. Examples of activities that could be offered
tion services. include:
■ Help in approaching instructors/professors. ■ College preparatory instruction to prepare
■ Collaborating with multiple community individuals for their return to post-secondary

academic resources. education or training.
■ On-campus exposure to post-secondary
■ Benefits planning.
educational buildings/departments and their
purposes.
3.W. 2. The program’s outreach efforts provide
■ Participation in campus events such as sport-
information about availability of its
services and supports. ing events, museums, community lectures,
2.W. Supported Ed
and art or cultural events.
■ Structured and unstructured exposure to
peer role models/mentors.

■ Assistance with the application process for ■ Specific dates and responsibilities for the
post-secondary admission. completion of each action step.
■ Assistance in securing financial aid. ■ Interests, aptitudes, and career aspirations.
■ Assistance in securing textbooks and supplies. ■ Accommodations/assistive technology
■ Determination of course schedules and needed to enhance the person's capacities.
degree/certificate requirements. ■ Education and community support needed.
■ Introductions to campus personnel such as ■ Learning styles, including ability to under-
advisors, support services staff, student health stand, recall, and respond to various
staff and library staff. instructions.
■ Tutoring.
■ Assistance in securing academic 3.W. 4. The program offers a range of supports
accommodations. and activities that are effective in
facilitating:
■ Mobile support services when the student 4.W. Supported Ed
requires immediate support. a. The person’s integration into the edu-

cational environment of their choice.
■ Management of benefits and financial 4.a.W. Supported Ed
resources. b. Achievement of the person’s educa-

tional goal.
Instructional supports may include, as 4.b.W. Supported Ed
appropriate: Examples
■ Stress management techniques.

A goal of supported education is to engage indi-
viduals in the program through support and
■ Time management and organizational skills.
reassurance.
■ Listening skills, learning styles, and
4.a. Supported education uses, to the extent pos-
paraphrasing.
sible, methods and settings that are consistent
■ Career interest/education goal-setting. with normal routines of life on the college
■ Practical strategies for test taking and campus.
studying. All aspects of the program are geared toward
■ Techniques for taking notes from a lecture maximizing opportunities for choice.
and from reading/highlighting. An important element of supported education is
■ Writing papers, computer basics, and the opportunity for students to learn from each
searching the internet. other and to develop an ongoing support group
■ College campus resources and policies. or supportive relationships with peers and others
to assist with the pursuit of career goals. Because
3.c.(2) Learning styles include ability to under- many supports may be necessary for learning and
stand, recall, and respond to various instructions. goal achievement, students are encouraged to
3.d. Referral information may provide valuable maintain relationships not only with supported
insights to the development of the plan. An edu- education personnel but also with student ser-
cational assessment tool is often used to identify vices on campus, family members, and other
student interests; review academic history; docu- service providers.
ment future academic aspirations; and identify As another example, although persons with
skills, strengths, and abilities related to education. autism may be admitted to higher education pro-
The plan is updated regularly for each student grams, often the lack of social or organizational
served. skills impact their being successful. A program
Elements included in the individual plan might offer supports such as peer-supported
may include: campus experiences focused on orientation to
■ Long-term academic goals. campus resources, self-advocacy, and problem-
■ Short-term action steps to reach goals.
solving skills necessary for success in college.

Section 3.X. Centers for Independent Living (CIL)
3.W. 5. Ongoing support services are provided X. Centers for

at times and locations that meet the
needs and desires of the students served.
Independent Living
5.W. Supported Ed
Intent Statements (CIL)

Supported education services are responsive to
the individual needs and desires of the students. Description
Examples
Centers for Independent Living (CILs) are
consumer-controlled, community-based, cross-
Service models can include:
disability organizations designed and operated by
■ On-Site Support model: Students attend individuals with disabilities to provide nonresi-
regular post-secondary classes and receive dential services and advocacy by and for persons
support services from on-site education staff. with all types of disabilities. CILs provide five
Sometimes these services are provided by staff core services:
employed by the college in the Office of
■ Advocacy.
Support Services; other times, community
■ Independent living.
organization staff members are housed at the
college but employed through the agency or ■ Information and referral.
supported through other community funding. ■ Peer counseling.
■ Mobile Support model: Students attend regu- ■ Transition services.

lar classes on campus with supports supplied
CILs serve as a strong advocacy voice on a wide
by the organization’s supported education
range of national, state/provincial, and local
program staff. Students are provided with
issues. They work to ensure physical and pro-
comprehensive, individualized supports
grammatic access to housing, employment,
including linkages to academic services and
transportation, communities, recreational
peer supports.
facilities, and health and social services.
■ Self-Contained Classroom model: In this
Designed to provide a service environment of
model, also referred to as a Closed Classroom,
informed choice, CILs continuously improve the
students attend a separate class with a special-
quality of individual services, expand the capac-
ized curriculum. Often these classes consist
ity of their organizations, and strive for enhanced
of only students with a disability. Classes are
accessibility in their communities.
held on a post-secondary educational campus
and usually have a college preparatory empha- Accreditation of CILs assists them in:
sis. Other self-contained classes may focus ■ Being recognized for comprehensive, coor-
on vocational exploration or teach students dinated, effective, efficient, and accountable
specific skills to succeed in a work setting. individualized services and programs.
■ Increasing community presence.
■ Increasing quality services for persons served.
■ Conducting outreach and building sustain-
able community partnerships.
section. See Appendix A for more information ■ Meeting grant requirements and assurances.
on required documentation. ■ Providing services and operating according
■ Records of persons served

to established national CIL standards.
■ Individual service plans of persons served
■ Informational brochures or program

marketing materials
■ Program scope

■ Assuring authorities and funding sources that g. Board training.

grant provisions and specifications are carried
1.g.X. CIL
h. Leadership development.
out appropriately and effectively. 1.h.X. CIL
Intent Statements
■ Generating leadership and growth in the
The CIL defines its community, and input from
community.
this community drives strategic and business
The desired outcomes of CILs are defined by planning.
the persons served, governance, staff, funding
Examples
sources, and the community. Outcome expecta-
tions include: Obtaining ongoing input and participation of
the persons served in this process is vital. CIL
■ Inclusion for all persons into societies and
service operations are based on the desired out-
communities.
comes of the individual, to the point of allowing
■ The creation and provision of supports. individuals to sign a waiver if they do not want
■ Advocacy for collaboration and creation to establish an individual plan.
of community resources. The diversity of the community of persons with
■ Provision of supports to persons served disabilities must be stressed in terms of planning
to develop skills to enhance their lives. for all types of disabilities, races, cultures, etc.
Organizational change is continuously made Ultimately a network is created that addresses
based on input from the persons served, results resources that are respectful and responsive to
of services, and outcomes achieved. the integrity and competence of local cultures
and that builds on the strengths of the commu-
nity by implementing local systems of care.
Organizations seeking accreditation for a CIL 3.X. 2. Policies and procedures are established
must meet the standards in this section as well for the use of government funds that:
2.X. CIL
as the standards in the following sections: a. Prohibit the misuse of funds to

■ 1.A. and 1.C.–1.N.; 1.B. Governance is influence any agency or person
optional in connection with developing
a government grant.
2.a.X. CIL
Standards 1.–19. b. Clarify roles among advocacy,

education, and lobbying activities.
Please contact CARF with any questions. 2.b.X. CIL
c. Require disclosure of lobbying

activities.
3.X. 1. The CIL uses community input to create 2.c.X. CIL
an annual work plan that addresses: Intent Statements

1.X. CIL
a. Long-range planning based on CILs will use funds as determined by the funding
expectations of: source and will meet federal and state/provincial
1.a.X. CIL
requirements.
(1) Persons served.
1.a.(1)X. CIL
(2) The community. Examples

1.a.(2)X. CIL
b. Alignment of business practices Policies and procedures are important for good
with the desired core service stewardship of all funds and for ensuring that
outcomes of the persons served. requirements of specific funding sources are met.
1.b.X. CIL
c. Financing and increased funding. 2.b. In the United States, there are federal
1.c.X. CIL
d. Advocacy. anti-lobbying regulations that apply in certain

1.d.X. CIL
e. Community resource development. situations. It is important to clarify these roles

1.e.X. CIL
and define what will be considered lobbying
f. Training for staff, volunteers, and
that must be reported on IRS Form 990.
persons served.
1.f.X. CIL

participating on membership and advisory

3.X. 3. The CIL has policies and procedures councils and/or program committees.
for meeting state/provincial and federal
grant requirements and assurances, If a person chooses to waive the use of an individ-
as applicable. ual plan, this waiver is documented and kept in
3.X. CIL
the person’s file.
Intent Statements
Governmental authorities will identify what 3.X. 6. Core services are designed to meet
is required to meet these requirements. the outcomes expectations
Examples of persons served.
6.X. CIL
Policies and procedures provide education and Intent Statements

guidance to staff on what should be done opera- Input is used to design and continuously improve
tionally to meet the government guidelines services.
and reporting requirements.
Examples
3.X. 4. To meet the specific provisions of its Core services include advocacy, independent
referral and funding sources, the CIL: living, information and referral, peer counseling,
4.X. CIL
and transition services.
a. Generates:
4.a.X. CIL
(1) Performance information

analyses. 3.X. 7. Based on the present and anticipated
4.a.(1)X. CIL future needs of persons served, the
(2) Timely records and reports.
4.a.(2)X. CIL
CIL creates community options and
b. Shares these with stakeholders. community capacity through:
4.b.X. CIL
7.X. CIL
Intent Statements a. Individual and systems advocacy.

7.a.X. CIL
Information is used to continuously improve b. Technical assistance.

the performance of the CIL and is shared with
7.b.X. CIL
c. Public information and education.

the persons served. 7.c.X. CIL
d. Outreach to unserved or underserved

Examples populations.
7.d.X. CIL
CILs deal with many reporting requirements, e. Collaboration with:

7.e.X. CIL
and systems are usually set up to collect data (1) Service providers.
for required reporting. These same data can
7.e.(1)X. CIL
(2) Government agencies.

also be analyzed and used to improve business 7.e.(2)X. CIL
(3) Community organizations.

performance and service provision. 7.e.(3)X. CIL
Intent Statements
3.X. 5. Persons served by the CIL: The CIL works to ensure that community services
5.X. CIL
are planned and available for persons served to
a. Direct their services.
5.a.X. CIL meet present and future needs. By identifying the
b. Choose whether to use or waive outcomes expectations of the persons served,
the use of individual plans. the leadership and staff of the CIL can create
5.b.X. CIL
c. Are encouraged to participate strategies and tactics to build community service

in organizational governance. options and capacities.
5.c.X. CIL
Intent Statements
The CIL aligns its business practices based on 3.X. 8. Performance information is used to illus-
the outcomes sought by the persons served. trate the effectiveness of the CIL in:
8.X. CIL
a. Independent living services.

Examples 8.a.X. CIL
b. Advocacy.
Persons served can be an active part of this 8.b.X. CIL
c. Information and referral.

person-directed organization, including belong- 8.c.X. CIL
ing to issues groups, acting as mentors, and

d. Peer counseling. d. Public policy that embraces

accessibility.
8.d.X. CIL
e. Transition services. 10.d.X. CIL
e. Reduction of barriers to employment

8.e.X. CIL
Intent Statements
and/or independent living.
Performance information is used to communicate 10.e.X. CIL
the CIL’s needs and effectiveness to the persons

served, other stakeholders, and the community.
3.X. 11. The CIL provides transition services
Examples
that address:
An organization needs only one performance 11.X. CIL
a. Living in the community.

analysis to illustrate its access, effectiveness, 11.a.X. CIL
efficiency, and satisfaction of stakeholders b. Progress toward independent living.

11.b.X. CIL
with services. See Sections 1.M. and 1.N. for c. Linking persons to affordable
additional guidance. The CARF publication and accessible housing.
11.c.X. CIL
Managing Outcomes, which is available on d. Education of healthcare providers on

request from your resource specialist, also alternative community living options.
11.d.X. CIL
provides additional information and resources. e. Youth transition for young adults
The CIL builds and continuously improves its who are moving from services
services based on the outcomes desired by the provided to them during their educa-
organization’s stakeholders, which include the tional process to adult services.
11.e.X. CIL
persons served, employees, and governance. Examples

8.e. Transition services support opportunities CIL staff serve as advocates and support special-
for return to the community instead of placement ists to persons served, but not as case managers
in hospitals or nursing homes. or service coordinators. Persons served are given
resources and support and are encouraged to
3.X. 9. The CIL provides independent living direct and follow through independently on
services that address: the resources that are provided to them.
9.X. CIL
a. Successful integration into society. 11.e. Young adults may be transitioning to

9.a.X. CIL
b. Participation in communities adult services such as post-secondary education,

as desired. employment, or living in the community inde-
9.b.X. CIL
c. Independence and choices. pendent of their family.

9.c.X. CIL
d. Enhanced knowledge and skills

to support individual choices. 3.X. 12. The CIL provides information and referral
9.d.X. CIL
e. Skills training for independent living. services that address:

12.X. CIL
9.e.X. CIL
a. Provision of timely and accurate

Examples
information.
9.e. Skills training for independent living would 12.a.X. CIL
b. Linkages to other services.

cover many areas of skills training, including 12.b.X. CIL
c. Persons served learning how to

employment.
access services on their own.
12.c.X. CIL
d. Support and follow-up.

3.X. 10. The CIL provides advocacy services 12.d.X. CIL
that address:
10.X. CIL
a. Successful self-advocacy.
10.a.X. CIL
b. Organizational advocacy. 3.X. 13. The CIL provides peer counseling and
10.b.X. CIL role modeling services to enhance the
c. Systems change in the community.
10.c.X. CIL
quality of the lives of persons served.
13.X. CIL

Intent Statements b. Promoting:

14.b.X. CIL
The peer counselor can draw on a wide range (1) Employment and community
of unique experiences that may be helpful to access.
his or her peers. 14.b.(1)X. CIL
(2) Internet access and commu-

Examples nications technology.
14.b.(2)X. CIL
Peer counseling and role modeling services oper- (3) Public policy supporting full
ate on the premise that the peer counselor is a community inclusion for all
role model who can serve as a link between the persons with disabilities.
14.b.(3)X. CIL
person seeking services and the service provider. Intent Statements

Outcomes that peer counseling may help to The CIL creates strategies to position its services
achieve include: to be state of the art.
■ Social skills development.
Examples
■ Expressed acceptance of disability.
The CIL may be working to:
■ Expressed increases in expectations for
■ Enact ADA Restoration Act and Community
quality of life. Choice Act legislation.
■ Confidence in self.
■ Shift federal dollars from institutions to
■ Participation in support groups. community-based services.
■ Changing perceptions of the public, ■ Expand access to equal employment and
family, and peers. transportation options.
■ Understanding of the CIL philosophy. ■ Enact Rehabilitation Act Reauthorization
■ Persons served educating other persons and increase funding for the Independent
served. Living Program.
■ Eliminate the Medicare waiting period.
Peer counseling/mentoring is typically not
strictly monitored. Although peer counselors/ ■ Ensure mental health parity.
mentors are trained to provide support and ■ Increase availability of affordable and
guidance, the goal is to develop natural relation- accessible housing.
ships between the peer counselors/mentors and ■ Better serve veterans and older Americans
the persons served. Also, because so many of the
with disabilities.
CIL’s direct service staff are also persons with
■ Focus on independent living internationally.
disabilities, a lot of the peer support/counseling
is built right into the service delivery model. It
varies from CIL to CIL since some are much
larger than others. The following are examples of the types of infor-
3.X. 14. Based on the desired outcomes and
quality expectations of persons served,
the CIL enhances its services by:
14.X. CIL
■ Annual work plan
a. Providing:
■ Policy manual or individual policies
14.a.X. CIL
(1) Assistive technology as appro-

priate to the person’s needs. ■ Governance records
14.a.(1)X. CIL
(2) Community education for service ■ Performance analysis

professionals.
14.a.(2)X. CIL
(3) Person-directed services.

14.a.(3)X. CIL
(4) Benefits planning.

14.a.(4)X. CIL

Section 3.Y. Home and Community Services (HCS)
Y. Home and Community ■ Services for persons who need or want

help with activities in their homes or other
Services (HCS) community settings.
■ Services for caregivers that may include
Description support, counseling, education, respite,
Home and community services (HCS) are person or hospice.
centered and foster a culture that supports NOTE: A service provider seeking accreditation for
autonomy, diversity, and individual choice. Indi- home and community services is not required to
vidualized services are referred, funded, and/or provide all four of the service delivery areas identi-
directed by a variety of sources. In accordance fied in the service description. However, it must
with the choice of the person served, the services include in the site survey all of the service delivery
provided promote and optimize the activities, areas it provides that meet the service description.
function, performance, productivity, participa-
tion, and/or quality of life of the person served.
The Home and community services may serve
persons of any ages, from birth through end of An organization seeking accreditation for
life. Services may be accessed in a variety of set- home and community services:
tings including, but not limited to, private homes, ■ Providing services for persons who are in
residential settings, schools, workplaces, commu- need of specialized services and assistance
nity settings, and health settings. Services are due to illness, injury, impairment, disability,
provided by a variety of personnel, which may or a specific age or developmental need
include health professionals, direct support staff, must meet Standards 1.–18. in this section,
educators, drivers, coaches, and volunteers and and Standard 19. if providing respite service,
are delivered using a variety of approaches, as well as the standards in the following
supports, and technology. sections:
Services are dynamic and focus, after a planning – 1.A. and 1.C.–1.N.; 1.B. Governance
process, on the expectations and outcomes iden- is optional
tified by both the person served and the service – 2.A. Program/Service Structure
providers. The service providers are knowledge- – 2.B. Individual-Centered Service
able of care options and linkages to assist the Planning, Design, and Delivery,
person served; use resources, including technol- Standards 2.B.1.–10.
ogy, effectively and efficiently; and are aware of
– 2.C. Medication Monitoring and Manage-
regulatory, legislative, and financial implications
that may impact service delivery for the person
served. The service providers are knowledgeable – 2.F. Community Services Principle
of their roles in and contribution to the broader Standards
health, community, and social services systems. ■ Providing services for persons who need
Home and community services must include at assistance to access and connect with fam-
least one of the following service delivery areas: ily, friends, or coworkers within their homes
■ Services for persons who are in need of spe-
and communities; services for persons who
cialized services and assistance due to illness, need or want help with activities in their
injury, impairment, disability, or a specific age homes or other community settings; and/or
or developmental need. services for caregivers that may include
support, counseling, education, respite, or
■ Services for persons who need assistance to
hospice must meet Standards 1.–15. in this
access and connect with family, friends, or co-
section, and Standard 19. if providing
workers within their homes and communities.

respite service, as well as and the standards Examples

in the following sections: Gaps in service delivery for a person served may
– 1.A. and 1.C.–1.N.; 1.B. Governance is be addressed by referring the person to another
optional program/service in the local community or con-
– 2.A. Program/Service Structure tracting with an external provider to engage with
the team of the person served. For example a
– 2.B. Individual-Centered Service
therapist working with a person served observes
Planning, Design, and Delivery,
that the person is no longer able to do household
Standards 2.B.1.–2. chores because of pain and lack of mobility and
– 2.C. Medication Monitoring and Manage- as a result, there are now concerns about the
ment (as applicable; see page 148) safety and cleanliness of the home. The therapist
– 2.F. Community Services Principle could refer the person back to the primary physi-
Standards, Standard 2.F.4. cian for medical evaluation of medical and a
■ Any Home and Community Services potential referral for homemaker services.
may add an optional specific population At the level of the program/service, the HCS may
designation as appropriate to the services explore developing a new service, partnering
provided: with another provider in the community to pro-
vide or develop additional services, or advocating
– 2.G. Children and Adolescents Specific
with a payer to cover services that are not cur-
Population Designation (optional)
rently covered.
– 2.H. Older Adults Specific Population
3.Y. 3. To verify the backgrounds of all person-
– 2.I. Medically Fragile Specific Population nel, written procedures identify actions
Designation (optional) to occur:
– 2.J. Autism Spectrum Disorder Specific 3.Y. HCS
a. Prior to the delivery of services

Population Designation (ASD:A to the persons served or to the
and/or ASD:C, optional) organization.
3.a.Y. HCS
b. At stated intervals throughout

3.Y. 1. To facilitate the appropriate level of employment.
services/supports for the person served, 3.b.Y. HCS
c. In response to the information

the home and community services dem- received.
onstrate knowledge of and the ability 3.c.Y. HCS
to identify appropriate service options/ Intent Statements

settings. This standard relates to standard I.2. in Section 1.
1.Y. HCS
To reduce risk and ensure the safety of the per-

Intent Statements
sons served, the organization defines its process
Services are individualized to the persons served. to verify backgrounds of all personnel and take
The home and community services may provide action when appropriate. The organization
a full spectrum of services or only one type of ser- has procedures in place in the event that back-
vice but demonstrate an awareness and use of grounds or credentials cannot be verified.
community resources that may be used to sup- Continued employment might be contingent
port or enhance services to the person served. upon positive verification for some positions; the
organization determines when this is the case.
3.Y. 2. The home and community services iden- Examples
tify and address gaps in service delivery.
2.Y. HCS Personnel may attend orientation but not provide
Intent Statements direct service to the persons served until back-
The HCS may address gaps in service at both ground verification is complete.
the level of the person served and the level

c. Clarification of the roles and

3.Y. 4. Personnel demonstrate competencies responsibilities of:
in the delivery of home and community 5.c.Y. HCS
services, including, but not limited to: (1) Families/support systems.

5.c.(1)Y. HCS
4.Y. HCS
a. Addressing the unique needs of (2) Service providers.

5.c.(2)Y. HCS
persons served. (3) Others, as appropriate.

5.c.(3)Y. HCS
4.a.Y. HCS
b. Communication with persons served d. Contingency plans if either the

and their families/support systems. family/support system or the service
4.b.Y. HCS
c. Communication with other providers provider is unable to deliver care.

5.d.Y. HCS
serving the persons served. e. Unsuccessful delivery of services.

5.e.Y. HCS
4.c.Y. HCS
d. Facilitating active involvement of f. Referral/transition to other services.

5.f.Y. HCS
the persons served and families/ g. Assignment of personnel in accor-

support systems in the service dance with the needs and choices
delivery process. of the persons served.
5.g.Y. HCS
4.d.Y. HCS
e. Facilitating behavioral supports. h. Safety of personnel, including:

5.h.Y. HCS
4.e.Y. HCS
f. Facilitating cognitive interventions. (1) Personal safety while providing

4.f.Y. HCS
g. Handling developmental/life services.

5.h.(1)Y. HCS
transitions. (2) Communication systems.

5.h.(2)Y. HCS
4.g.Y. HCS
h. Knowledge of community resources. (3) Weather conditions and other

4.h.Y. HCS
i. Recognition and reporting of natural environmental events.

5.h.(3)Y. HCS
suspected abuse and neglect. (4) The physical environment at

4.i.Y. HCS
j. Setting and maintaining professional the service delivery site.

5.h.(4)Y. HCS
boundaries. i. Provisions for communication by

4.j.Y. HCS
personnel while providing services

Intent Statements
regarding decisions to continue
In Section 1.I. Human Resources standards, or discontinue services.
organizations are asked to identify skill sets 5.i.Y. HCS
j. Within the scope of services, the

that would assist with the achievement of
availability of home and community
the outcomes for the person served as well as
services to respond to:
organizational mission and goals. This standard 5.j.Y. HCS
identifies areas that would be included in orienta- (1) Persons served.

5.j.(1)Y. HCS
tion as well as ongoing training as appropriate for (2) Families/support systems.

5.j.(2)Y. HCS
the HCS. These are not the only skill sets that an (3) Service providers.
HCS program may include but these should be 5.j.(3)Y. HCS

evident. 5.j.(4)Y. HCS
Intent Statements
3.Y. 5. Policies and written procedures are Home and community services are offered to
implemented that address, at a mini- persons served in a variety of settings. Policies
mum, the following service delivery and procedures address the uniqueness of the
issues: settings and types of situations staff members
5.Y. HCS may encounter when decisions need to be made,
a. Availability of appropriate equip- potentially on an immediate basis, without the
ment, supplies, etc., at the service “on-site” support of supervisors or others who are
delivery site from initial service typically available in a facility-based program.
delivery through exit/transition.
5.a.Y. HCS
Examples
b. Confidentiality and privacy of infor-
mation concerning the persons 5.e. Unsuccessful delivery of services may be
served in the home and community the result of an issue on the part of the provider
environments. or the person served.
5.b.Y. HCS

5.j.(1) The scope of the services may be

focused only on therapeutic interventions and
3.Y. 7. Service delivery is scheduled at an
agreed-upon time that supports
not include social reintegration activities.
the person-centered plan.
5.j.(2) The scope of the services may include the 7.Y. HCS
availability of respite services for family/support Intent Statements

systems. There is a system in place to determine the most
appropriate schedule for service delivery based
3.Y. 6. A risk assessment of each person served on the lifestyle and preferences of the persons
served and the scope of the home and commu-
addresses the following areas:
6.Y. HCS nity services.
a. Behavioral.
6.a.Y. HCS
b. Cognitive.
6.b.Y. HCS 3.Y. 8. In accordance with the choice of the
c. Communication. person served, the home and community
6.c.Y. HCS
d. Developmental. services assist the person served to

6.d.Y. HCS
e. Emotional. develop a disaster preparedness and

6.e.Y. HCS
f. Environmental. emergency plan that considers the

6.f.Y. HCS
g. Physical. following:
8.Y. HCS
6.g.Y. HCS
h. Capability of the family/ a. Assessment of the current knowledge

support system. of:
8.a.Y. HCS
6.h.Y. HCS
i. Other, as appropriate. (1) The person served.

8.a.(1)Y. HCS
6.i.Y. HCS
(2) The family/support system.

Intent Statements 8.a.(2)Y. HCS
b. Assessment of the physical environ-

To decrease the potential of harm to the person
ment where services are delivered,
served, risk assessments are an integral part of
including accessibility of the
home and community services. The analysis of
environment.
this information may result in changes to the 8.b.Y. HCS
person-centered plans as well as improvement c. Identification of modifications neces-

at the level of the services. sary to ensure safety in the event of
an emergency.
Examples 8.c.Y. HCS
d. Community resources, including:

6.c. Risks in communication may be the inability 8.d.Y. HCS
(1) Identification of resources for:

to communicate emergent needs, inability to 8.d.(1)Y. HCS
(a) Evacuation.
understand verbal or written communication, 8.d.(1)(a)Y. HCS
or different languages being spoken by the (b) Shelter.

8.d.(1)(b)Y. HCS
person and staff. (c) Recovery.

8.d.(1)(c)Y. HCS
6.d. Developmental delays may produce risk in (2) Accessibility of resources for:
8.d.(2)Y. HCS
social or work situations. Age of an individual (a) Evacuation.

8.d.(2)(a)Y. HCS
may not match their developmental level and (b) Shelter.

increase their risk in daily activities. 8.d.(2)(b)Y. HCS
(c) Recovery.
6.g. Physical risks may include the potential for
8.d.(2)(c)Y. HCS
e. Basic needs in the event of

falls or impulsivity on the part of the person an emergency.
served when moving around his or her home. 8.e.Y. HCS
f. Identification of circumstances
6.h. Risk assessment related to the family/ in which service delivery can
support system might include the availability be postponed or omitted.
of the family/support system, its understanding 8.f.Y. HCS
of the health status of and safety precautions

required for the persons served, and family/
support system dynamics.

g. Provisions for communication by Examples

personnel while providing services A driver who transports persons served to
regarding decisions to continue or appointments in the community is unlikely to
discontinue services. come into contact with environmental controls
8.g.Y. HCS
h. Contingency plans for: and adaptive equipment used by the person

8.h.Y. HCS
(1) The person served. served in his or her home. However, because the
8.h.(1)Y. HCS
(2) The family/support system. person served may use a power mobility device
8.h.(2)Y. HCS
(PMD), the driver would inquire about and
(3) Personnel.
8.h.(3)Y. HCS observe whether the person is able to use the
Intent Statements PMD safely and effectively. If the driver were
Persons served by HCS are at risk in emergent to discover that the person served is not able to
situations because of a variety of issues including use the PMD as intended or was having some
age, developmental, cognitive, and physical lev- mechanical difficulty with it, it would be his
els of functioning. To address these risks persons responsibility to notify the appropriate person
served can seek, if they desire, to receive more who could assist the person served.
information from the HCS on how to address “Smart homes” utilize information and commu-
emergent situations. nication technology that assist with daily living
8.d.(1)(c) and 8.d.(2)(c) Recovery after a disaster activities, safety, falls, health monitoring, and
means the return of the person served to his or environmental control. Smart homes allow and
her home or community setting. provide a way to record the activities or inactivity
of an individual in a home and report the event to
3.Y. 9. If the person served uses assistive tech- a caregiver or family member in accordance with
nology, electronic aids to daily living, the preference of the person served. Examples of
environmental controls, equipment, smart home systems include emergency call sys-
environmental modifications, and/or tems, control of heating and air systems, health
personal emergency response systems, monitoring, safety devices, medication monitor-
the home and community services, ing, video cameras, and keyless entry. A person
on an ongoing basis: served might communicate to the home health
aide that a video camera is not working. The aide
9.Y. HCS
a. Determine that the technology

and/or equipment: notifies the appropriate personnel in the HCS,
9.a.Y. HCS
(1) Functions properly. who then follow up with the appropriate family
9.a.(1)Y. HCS
member or vendor.
(2) Achieves the intended purpose.
9.a.(2)Y. HCS
b. Notify the appropriate designee,

as needed. 3.Y. 10. In accordance with the choice of the per-
9.b.Y. HCS
son served, the home and community
c. In accordance with the person-
services partner with the family/support
centered plan, incorporate the
system throughout the service delivery
technology and/or equipment
process, including ongoing consider-
into service delivery.
9.c.Y. HCS
ation of:
10.Y. HCS
Intent Statements a. The family/support system’s:

10.a.Y. HCS
Technology has an ever-increasing presence in (1) Ability and willingness to sup-

home and community services. It is important port and participate in the plan.
that service providers are attuned to the role and 10.a.(1)Y. HCS
(2) Composition.
impact of technology on the lives of the persons 10.a.(2)Y. HCS
served. The extent to which the service provider (3) Interpersonal dynamics.
10.a.(3)Y. HCS
interacts in the environment in which technology (4) Different methods of:

10.a.(4)Y. HCS
is used by the person served guides the involve- (a) Engagement.

ment of the service provider in the activities of
10.a.(4)(a)Y. HCS
(b) Communication.
this standard. 10.a.(4)(b)Y. HCS

(c) Coping. 10.b. Financial, social, or cultural factors may

influence service delivery in areas such as setting
10.a.(4)(c)Y. HCS
(d) Problem solving.

10.a.(4)(d)Y. HCS
(5) Strengths and limitations. goals for the person served, the provision of
10.a.(5)Y. HCS
information and services, and exit/transition
(6) Knowledge base.
10.a.(6)Y. HCS options.
(7) Expectations of the home
and community services.
10.a.(7)Y. HCS
3.Y. 11. In accordance with the choice of the
(8) Educational needs.
10.a.(8)Y. HCS person served, policies and written
(9) Responsibilities, including procedures facilitate collaboration with
legal responsibilities. the family/support system in decision
10.a.(9)Y. HCS
(10) Geographic proximity to making through the following:

the person served. 11.Y. HCS
a. Accessible information.
10.a.(10)Y. HCS
b. Unique financial, social, or cultural 11.a.Y. HCS
b. Time lines for exchange of

factors that might influence the information.
home and community services. 11.b.Y. HCS
10.b.Y. HCS c. Understanding of the information

c. Health status of the primary provided.
caregiver. 11.c.Y. HCS
10.c.Y. HCS
Intent Statements
Intent Statements
To facilitate the decision-making roles of the per-
When the person served agrees to having mem- son served and family/support system, they are
bers of the family/support system involved in given information in a way that is understandable
the delivery of services, the home and commu- and in sufficient time to make informed decisions.
nity services assess the family/support system to
include it effectively and optimally in the service
delivery process. This assessment process can 3.Y. 12. The home and community services
provide information that impact the opportunity provide education:
12.Y. HCS
for the person to remain in his or her home or a. To:

12.a.Y. HCS
community setting. (1) Persons served.

12.a.(1)Y. HCS
Examples (2) Families/support systems.

12.a.(2)Y. HCS
Factors that might impact participation in service (3) Other relevant stakeholders.
12.a.(3)Y. HCS
delivery or support include that members of the b. In accordance with identified needs,
family/support system live at a distance, work that addresses, but is not limited to:
12.b.Y. HCS
during typical service delivery times, have lim- (1) Accessing emergency care
ited resources to assist, etc. if necessary.
12.b.(1)Y. HCS
10.a.(3) Interpersonal dynamics refers to the (2) Communication with other

interactions between the person served and his service providers.
or her spouse/significant other, friends, peers,
12.b.(2)Y. HCS
(3) Developing a system to record

coworkers, employer, and community. personal health information.
12.b.(3)Y. HCS
10.a.(4) Engagement may include the ability (4) Disease management.

of the family/support system to participate in 12.b.(4)Y. HCS
(5) Information about community

training sessions, learn new skills, call or email resources and how to access
questions or concerns to personnel when they them.
live at a distance, and willingness to participate 12.b.(5)Y. HCS
(6) Preventive care.

in the person-centered plan as appropriate. 12.b.(6)Y. HCS
(7) Procedures unique to the provi-

10.a.(9) Responsibilities may include work and sion of home and community
family-related responsibilities such as being the services.
caregiver for young children or elderly parents. 12.b.(7)Y. HCS

(8) Safety issues related to the delivery site poses any safety risks to the provid-
service delivery site. ers of services.
12.b.(8)Y. HCS
(9) Specific healthcare procedures

12.b.(9)Y. HCS
and techniques, as appropriate. 3.Y. 13. The home and community services have
Intent Statements a mechanism to ensure that both the
person served and the service provider
12.b.(3) Having a system or tool to record
can understand and communicate with
personal health information helps the persons
each other.
served and their families/support systems ensure 13.Y. HCS
that they receive ongoing quality healthcare. Examples

Such information empowers persons served to Accents and other language issues may pose
be responsible for an important step in their care, barriers to communication between the person
lessens the fragmentation of care among health- served and the service provider. Mechanisms for
care settings, and will likely decrease the risk of nonverbal communication such as the use of a
medical errors. communication board or device may be
Examples necessary.
12.b.(2) Examples of other providers with whom
the persons served, families/support systems, 3.Y. 14. Based on the scope of services, to
or other stakeholders may have to communicate enhance the involvement of the persons
might include the person’s primary care served in the community, the home and
physician, pharmacist, or other rehabilitation community services:
14.Y. HCS
providers in the community such as a transpor- a. Are knowledgeable about the

tation provider. options available for:
14.a.Y. HCS
12.b.(3) The system used provides a record (1) Housing.

14.a.(1)Y. HCS
of relevant personal health information and is (2) Transportation.

portable for persons served so that they 14.a.(2)Y. HCS
(3) Technology.
have the appropriate information at each health 14.a.(3)Y. HCS
b. In accordance with the choice of the

encounter and healthcare providers can be person served, advocate for the
efficiently informed by more complete and development of options for:
accurate information than might otherwise 14.b.Y. HCS
(1) Housing.
be available. 14.b.(1)Y. HCS
(2) Transportation.
It is suggested that the format of the system or 14.b.(2)Y. HCS
tool facilitate ease of access and ready availability (3) Technology.

14.b.(3)Y. HCS
in case of an emergency. Formats might include: Intent Statements

■ Index cards with clear writing. Whether the home and community services
■ An eight-by-eleven inch piece of paper. address housing, transportation, and technology
would be guided by the scope of services
■ Folders.
provided. Many times persons served may lack
■ Notebooks. knowledge of options in their area. There may be
■ Flash drive. the need for the home and community services
■ CD.
provider to assist the person served to become
aware of options and resources that they will
■ Bracelet with information.
need to tap into to develop their plan for housing,
■ Web-based applications accessible from transportation and /or technology. This may be
mobile devices. needed to allow the person served to remain in
his or her home and/or community, to get to
12.b.(8) Examples of safety issues may include
and from work, and/or to participate in social
how to evacuate the service delivery site, environ-
activities.
ment modifications, and whether the service

Examples responsible for his or her own finances if

14.a.(1) Housing options may include supported appropriate.
housing, public housing, or general community Training in financial literacy may be provided
housing that is accessible for persons who use a directly by the home and community services
wheelchair. or referred to an appropriate resource in the
14.a.(2) Public transportation options may community.
address transportation that is convenient for
a person served who has limited endurance,
mobility, or cognition and para-transit systems Applicable Standards
for persons served who use assistive mobility Home and community services that provide
equipment. specialized services and assistance due to ill-
14.a.(3) Technology options may include off- ness, injury, impairment, disability, or a specific
the-shelf technology as well as resources for age or developmental need must also meet
customized technology to be used by the person Standards 16.–18.
served in the home and other community
settings. 3.Y. 16. The home and community services
address the impact of the following areas
3.Y. 15. In accordance with the choice of the per- on the service delivery process for each
son served, the home and community person served:
16.Y. HCS
services provide or arrange for financial a. Allergies.

16.a.Y. HCS
assistance and planning that addresses: b. Current medications, including:

15.Y. HCS 16.b.Y. HCS
a. Benefits planning. (1) Medication sensitivities and

15.a.Y. HCS
b. Sustainability of services. adverse reactions.

16.b.(1)Y. HCS
15.b.Y. HCS
c. Contingency planning. (2) Why each medication is

15.c.Y. HCS
d. Education related to financial literacy. prescribed.

16.b.(2)Y. HCS
15.d.Y. HCS
e. Short- and long-term planning for (3) Side effects.

16.b.(3)Y. HCS
future services, including: (4) Drug interactions.

16.b.(4)Y. HCS
15.e.Y. HCS
(1) Funding and supports available. (5) Implications of abrupt discon-

15.e.(1)Y. HCS
(2) Eligibility criteria. tinuation of medications.

16.b.(5)Y. HCS
15.e.(2)Y. HCS
(3) Range of services available. (6) Compliance.

16.b.(6)Y. HCS
15.e.(3)Y. HCS
(4) Amount of services available. (7) Schedule for taking medications.

16.b.(7)Y. HCS
15.e.(4)Y. HCS
(5) Impact on continuing benefits. c. The etiology and anticipated course

15.e.(5)Y. HCS
of the illness, injury, impairment,
Intent Statements disability, or a specific age or
An in-depth financial analysis of the short and developmental need.
long-term costs of living independently will take
16.c.Y. HCS
d. The results of relevant diagnostic

into consideration both the present ability and interventions.
future service needs of the person served. 16.d.Y. HCS
e. The results of relevant therapeutic

In assisting an individual to live independently interventions.
in the community, it is important to evaluate 16.e.Y. HCS
f. Communication ability.
present and future costs associated with the 16.f.Y. HCS
living situation. g. Fatigue.

16.g.Y. HCS
h. Nutrition.
Examples 16.h.Y. HCS
i. Pain.
Factors to be considered include how benefits 16.i.Y. HCS
j. Risk factors.
of the person served might be impacted and the 16.j.Y. HCS
potential of funding for services changing. It is

important that the person served consider being

k. Signs and symptoms of emergent 16.h. Nutrition includes a person’s diet as well as
medical or psychological conditions. the consistency of his or her diet.
16.k.Y. HCS
l. Sleep. 16.j. Risk factors may include that the person

16.l.Y. HCS
Intent Statements
smokes, is overweight, is unsteady and therefore
at risk of falling, can’t afford the medications that
To ensure the safety of the persons served and
are prescribed, or has hypertension.
determine the most appropriate and beneficial
interventions, knowledge of each person’s
health and medical status and history are impor- 3.Y. 17. Depending on individual needs, the
tant. This knowledge will allow the home and home and community services provide
community services to minimize unnecessary ongoing education and training to each
interventions, establish an accurate baseline person served that addresses:
17.Y. HCS
of health and functional status, set realistic a. Disease management.

goals, and optimize results. Whether services 17.a.Y. HCS
b. Health advocacy, including prompt

are provided by credentialed personnel or communication about health issues.
non-credentialed personnel, the impact of 17.b.Y. HCS
these areas on the service delivery for each c. Prevention related to:
17.c.Y. HCS
person served is observed, considered, reported (1) Recurrence of the illness, injury,
as applicable, and, as needed, addressed in the impairment, disability, or a spe-
person-centered plan, including the involve- cific age or developmental need.
17.c.(1)Y. HCS
ment of additional team members as necessary. (2) Potential risks and complications
16.b. The home and community services are due to the illness, injury, impair-
aware of the effects of medications currently ment, disability, or a specific age
taken by the person served on his or her ability or developmental need.
17.c.(2)Y. HCS
to participate in the services and tolerate d. Primary health care.

therapeutic activity. 17.d.Y. HCS
e. Utilization of health care resources.

17.e.Y. HCS
Examples f. Wellness.
17.f.Y. HCS
16.a. Allergies include medication allergies, food Intent Statements

allergies, latex allergies, and any other allergies
The ability for an individual to become engaged
the services need to be aware of to ensure the
with wellness and management of their health
safety of the person served. issues is key to maintaining the ability to remain
16.b. In tailoring an exercise program for a in home and community settings. Appropriate
person with diabetes, the physical therapist education and training is provided to persons
understands the impact of insulin action on the based on their needs.
timing, frequency, and duration of exercise. The
Examples
therapist educates the person served about the
importance of self-monitoring of blood glucose Persons served may take advantage of technology
(SMBG) and recognizing symptoms such as (computer, DVD, CDs) to become better edu-
shakiness or sweating to avoid risks associated cated or engaged with exercise programs, etc.
with hypoglycemia while exercising. They may need education about areas such as
how to be an advocate for their needs, physician
16.g. An example of this would be that the home
appointments, screenings and their importance,
health aide notices and reports that the person
how to become active in health issues, appropri-
served is more fatigued and requires more
ate use of emergency/urgent care, etc.
assistance with bathing when the services are
scheduled in the late afternoon. The nurse 17.b. It is important for persons served to be
responsible for reviewing the service plan able to identify signs and symptoms and when it
adjusts the plan to have home health visits would be appropriate to contact their physician,
occur in the morning. home and community services provider, EMTs,
etc. Signs and symptoms might include frequent

falls, loss of consciousness, shortness of breath manage medications is critical to the person’s
with chest pains, or increased inflammation of safety, health, and well being.
joints with inability to perform daily tasks. The Examples
sudden onset, abruptness, or increased intensity
Education is provided as appropriate to the needs
or frequency of these symptoms signal the person
served to advocate for care, medications, addi- of the persons served and families/support sys-
tems, the scope of the home and community
tional services, etc.
services, and in accordance with any relevant
17.e. Education on utilization of health care practice acts or standards of practice.
resources might include decision making related
18.b.(3) If persons served have difficulty opening
to which health care provider is the most appro-
medication bottles, the home and community
priate to seek advice for specific health issues or
how to use insurance funding most effectively services educate them about requesting blister
packs or easy-to-open bottles. If there are vision
to meet individual needs.
limitations, the home and community services
educate them to request labels with large print
3.Y. 18. The home and community services or to investigate talking labels.
provide education on medication,
18.b.(8) If the home and community services
as appropriate:
18.Y. HCS identify that the person served is taking several
a. To: medications that are prescribed by multiple
18.a.Y. HCS
(1) Persons served. physicians, services educate the person regarding

18.a.(1)Y. HCS
(2) Families/support systems. the importance of notifying each prescribing

18.a.(2)Y. HCS
b. That addresses: physician about all the medications currently

18.b.Y. HCS
(1) Actions to take in an emergency. being taken, not just those related to the condi-
18.b.(1)Y. HCS
(2) Administration. tion being managed by each physician.

18.b.(2)Y. HCS
(3) Dispensing.
18.b.(3)Y. HCS
(4) Disposal. Applicable Standards

18.b.(4)Y. HCS
(5) Errors. Home and community services that provide

18.b.(5)Y. HCS
(6) Expiration dates. respite services must also meet Standard 19.
18.b.(6)Y. HCS
(7) Identification, including purpose

18.b.(7)Y. HCS
of each medication prescribed. 3.Y. 19. When respite services are provided
(8) Implications for management somewhere other than the person’s
of multiple medications. own home, the person served brings
18.b.(8)Y. HCS
(9) Implications of abrupt the following with him or her, if

discontinuation. applicable:
19.Y. HCS
18.b.(9)Y. HCS
(10) Indications and a. Adaptive equipment.

19.a.Y. HCS
contraindications. b. Assistive technology.

18.b.(10)Y. HCS 19.b.Y. HCS
(11) Obtaining medication. c. Emergency contact information.

18.b.(11)Y. HCS 19.c.Y. HCS
(12) Sharing medication. d. Information on everyday routines.

18.b.(12)Y. HCS 19.d.Y. HCS
(13) Side effects. e. Information/instructions regarding

18.b.(13)Y. HCS
(14) Storage. any special needs.

19.e.Y. HCS
18.b.(14)Y. HCS
f. Instructions for specific healthcare

Intent Statements
procedures.
Medication management in home and commu- 19.f.Y. HCS
g. Medications.
nity settings differs from facility-based settings in 19.g.Y. HCS
which medications are controlled by pharmacists, h. Pertinent health/medical history.

19.h.Y. HCS
nurses, and physicians. The ability to assess the

understanding and competency of a person
served and his or her family/support system to

Section 3.Z. Rapid Rehousing and Homelessness Prevention Program (RRHP)
Intent Statements
Z. Rapid Rehousing
The ability for the respite services to create
an environment that will meet the needs of and Homelessness
the person while in that setting is critical.
19.d. In order to maintain a person-centered
Prevention Program
approach, respite services are knowledgeable (RRHP)
about the normal routine of the person served.
Examples Description
19.a.–b. Depending upon the types of persons Rapid rehousing and homelessness prevention
served, respite providers may need to be able to programs are short-term crisis response pro-
use a variety of equipment and assistive technol- grams for persons and households that are
ogy and may need additional training to develop experiencing homelessness or are at imminent
those competencies. Training might be provided risk of homelessness. These programs engage in
by the family, vendors, or other resources. ongoing outreach activities to maximize oppor-
19.c.–h. A portable profile or personal health tunities for contact with persons who, without
information record may be used to provide assistance, are likely to remain or become literally
information. homeless. Interventions are designed to reduce
19.e. Special needs may include nutritional/ barriers to housing and help persons served and
dietary needs. their families rapidly exit homelessness and
return to stable housing or maintain stable hous-
Additional Resources ing. The programs are knowledgeable about and
link with community resources as desired by the
Associations are frequently used resources for
persons served.
information on regulations, accessibility, quality,
development, evidence-based practices, accepted Incorporating a housing first approach, indivi-
practices in the field, and regulatory. Additional dualized, person-centered housing plans guide
resources for information include: service delivery. Each person served participates
in the development of a housing plan that consid-
■ World Homecare and Hospice Association
ers his or her desired housing outcome, barriers
http://www.whho.org
to housing, the need for financial assistance, and
■ National Association of Home Care and
the financial resources available. As needed, the
Hospice program offers education for the persons served
http://www.nahc.org on landlord-tenant relationships, self-advocacy,
 ■ Canadian Home Care Association
http://www.cdnhomecare.ca
and rights and responsibilities as a tenant to
support achievement of housing-specific goals.
Personnel are trained in areas necessary to
Documentation Examples achieve the desired outcomes of persons served
The following are examples of the types of infor- using a person-centered approach.
mation you should have available to demonstrate Key to the programs’ ability to secure housing for
your conformance to the standards in this sub- persons with high housing barriers are recruit-
section. See Appendix A for more information ment and retention of landlords who are willing
on required documentation. to offer flexibility in applying tenant screening
■ Records of the persons served criteria and rent to persons exiting or at immi-
nent risk of homelessness. The programs work to
maximize suitable housing options and to access
■ Progress notes
and manage the available financial resources to
■ Policies and procedures manual facilitate rapid rehousing and/or reduce the risk
■ Individual disaster preparedness plans of homelessness.
■ Documented staff training

NOTE: If an organization provides only a Rapid ■ Through an organized community event such
Rehousing Program or only a Homelessness Preven- as a stand down that brings together people
tion Program, it may still seek accreditation as a who are homeless or at risk in order to con-
Rapid Rehousing and Homelessness Prevention nect them with service.
Program.
■ Through connecting with the Continuum
of Care coordinated assessment system in its
Applicable Standards community. This system, involving 211 net-
works and community social service agencies,
An organization seeking accreditation for a
often identifies for those who require rapid
Rapid Rehousing and Homelessness Prevention
rehousing what are suggested forms of inter-
program must meet the standards in this
vention and prioritizes those most in need.
section and the standards in the following
sections:
3.Z. 2. The program:
■ 1.A. and 1.C.–1.N.; 1.B. Governance is 2.Z. RRHP
optional a. Is knowledgeable about community

resources that are relevant to the
lives of persons served, including:
2.a.Z. RRHP
(1) Housing-related resources.

Design, and Delivery 2.a.(1)Z. RRHP
(2) Nonhousing-related resources.

■ 2.C. Medication Monitoring and Manage- 2.a.(2)Z. RRHP
b. Links to community resources as

ment (as applicable; see page 148) desired by the persons served.
■ 2.F. Community Services Principle Standards
2.b.Z. RRHP
Intent Statements
The program meets the needs and desires of
3.Z. 1. Consistent with its scope of services, the
the persons served by engaging with community
program conducts or participates in sys-
agencies for wraparound service.
tematic, ongoing outreach activities that
maximize opportunities for contact with Examples
persons and households that are at high 2.a.(1) Examples of housing-related resources
risk of: include HUD Continuum of Care programs,
1.Z. RRHP
a. Remaining literally homeless. housing choice vouchers, public housing, HUD-

1.a.Z. RRHP
b. Becoming literally homeless. VASH, private housing, and agencies that will
1.b.Z. RRHP
assist with the cost of utilities and repairs to
Intent Statements the home.
Outreach efforts include reaching persons who 2.a.(2) Nonhousing-related resources that may
may not be aware that services are available. Dif-
impact the ability to maintain or secure housing
ferent strategies may be used to reach different
include transportation, employment, income
groups.
supports, childcare, nutrition assistance, food
Examples banks, clothing banks, healthcare services, legal
Outreach may occur: resources, and peer support.
■ At locations such as a grocery store or
check cashing store which people frequent 3.Z. 3. To maximize housing options for the
for reasons unrelated to housing. persons served, the program implements
■ In collaboration with other homeless program
a plan for landlord:
3.Z. RRHP
providers such as shelters and community a. Recruitment.

3.a.Z. RRHP
programs such as food banks and legal aid b. Retention.

3.b.Z. RRHP
with which potential persons served may

Intent Statements
have contact.
The program demonstrates efforts to maximize
housing options for the persons served through

developing positive business relationships with

landlords, which would include the supports 3.Z. 4. The housing options identified by the
available to landlords who engage with the program are screened for habitability,
program, while still maintaining balance with including:
4.Z. RRHP
advocacy on behalf of the persons served/ a. Safety.

4.a.Z. RRHP
tenants. b. Sanitation.
4.b.Z. RRHP
The plan for landlord recruitment and retention c. Security.

may be part of another plan, such as a strategic 4.c.Z. RRHP
Intent Statements
plan or accessibility plan, or it may be a separate
plan. Housing options are screened to determine that
they are decent and suitable for occupancy in
Examples general.
A program may have a position dedicated to 4.c. Security refers to security of one’s belongings
landlord recruitment and retention, may incor- and a person’s personal security around others.
porate these activities into the responsibilities of
another position, or may partner or contract with Examples
another organization to fulfill this function. Habitability includes the premises being closed
Landlords may be recruited through referrals in against inclement weather; access to decent
from other landlords with whom the program toilets, bathing facilities, running water, heating,
works or identification by the persons served. and electricity; and freedom from noxious smells,
Recruitment may include due diligence on the noise, and garbage.
part of the program to verify the authority of The program might use a habitability inspection
the landlord or its representative to enter into checklist for consistency in items that should be
an agreement. considered.
Landlords are retained by providing supports to It is also advisable to use a move-in checklist to
them, such as checking in with them about how ensure that everything is in working order before
things are going; educating them about the bene- someone actually moves in.
fits of doing business with the program, e.g., they Resources
will get paid on time, there is someone to call if
www.onecpd.info/resources/documents/
there are issues, reduction of their risks, and get-
HabitStandardsChecklist.doc
ting vacancies quickly filled; and assuring them
that prospective tenants will be oriented to tenant
responsibilities such as the correct way to take 3.Z. 5. The screening process for accepting
any issue to the landlord. An aspect of the rela- persons to receive services:
5.Z. RRHP
tionship with landlords includes educating them a. Promotes acceptance of potential

about boundaries related to information that will persons served regardless of housing
be shared about the persons served. and income barriers.
5.a.Z. RRHP
Consider related standards in Section 1.M. and b. For homelessness prevention

identifying landlords as key stakeholders from programs considers:
5.b.Z. RRHP
whom to gather satisfaction data and feedback. (1) Imminent loss of housing.
5.b.(1)Z. RRHP
There are also related standards in Section 1.A. (2) Other suitable housing options.
5.b.(2)Z. RRHP
on codes of ethics. (3) Other resources, including:

5.b.(3)Z. RRHP
(a) Financial resources.

5.b.(3)(a)Z. RRHP
(b) Nonfinancial resources.

5.b.(3)(b)Z. RRHP
(4) Available national or local data

regarding risk factors for literal
homelessness.
5.b.(4)Z. RRHP

c. Results in recommendation(s) for an Intent Statements

alternative program if the identified As needs and/or preferences change, the inten-
needs and desires of the person sity of service provision also changes.
served cannot be met by the scope
Examples
of the program.
5.c.Z. RRHP
Some persons may need more assistance, and the
Intent Statements intensity of assistance is based on the person’s
The program prioritizes its resources to assist desires and level of need. There may be critical
those persons with the highest barriers to times when the intensity must be increased, and
housing and most at risk for becoming literally personnel are attentive to indicators of increased
homeless or who are literally homeless. need. See related Standard 8.c. in this section.
Examples
5.a. Barriers such as previous history of home- 3.Z. 7. The housing plan for each person served:
7.Z. RRHP
lessness, alcohol or other substance abuse, a. Is individualized to the person's

criminal record, mental illness, poor credit his- desired housing outcome.
7.a.Z. RRHP
tory, extremely low income, etc., are not used to b. Utilizes a strengths-based approach.
screen people out of homelessness prevention or 7.b.Z. RRHP
c. Addresses housing barriers.

rapid rehousing programs. Persons with signifi- 7.c.Z. RRHP
d. Identifies the housing-specific goal.

cant barriers can be just as successful as those 7.d.Z. RRHP
e. Considers the needs of the family/

with minimal barriers.
support system related to the
5.b.(3) Resources would include household housing-specific goal.
income and benefits such as SNAP/nutrition 7.e.Z. RRHP
f. Identifies the financial assistance

assistance, Housing Choice Voucher, and Section
required.
8 housing. 7.f.Z. RRHP
g. Identifies the financial resources

5.b.(4) In the field, these are often called “but for” available from:
criteria and reflect the material circumstances 7.g.Z. RRHP
(1) The program.

that differentiate between a household that may 7.g.(1)Z. RRHP
be at risk of eviction, yet has other options/ (2) The person served.
7.g.(2)Z. RRHP
resources and is not imminently literally home- (3) Other sources.

7.g.(3)Z. RRHP
less, and one that does not have such options/ h. Is tracked in a systematic manner
resources and will be literally homeless “but for” until the housing-specific goal is
program assistance. achieved.
7.h.Z. RRHP
5.c. Recommendations for an alternative pro- i. Is revised, as necessary.

7.i.Z. RRHP
gram may be made when there is a program Intent Statements

better suited to meet the housing needs of the
The housing plan for the person served may be
person served or when the person served identi-
part of the individualized service plan addressed
fies a priority to be addressed other than housing.
in Standard 2.B.5., or it may be a separate plan.
Resources Services are focused on housing and not on per-
USICH Housing First Checklist: http:// sonal change or longer-term nonhousing-related
usich.gov/usich_resources/fact_sheets/ goals.
the_housing_first_checklist_a_practical_tool_ For rapid rehousing programs, the plan is geared
for_assessing_housing_first_in/ toward helping households exit homelessness
and move into permanent housing as quickly as
possible.
3.Z. 6. The intensity of service provision is
based on the identified housing barriers Examples
and desires of the person served. 7.c. Accessibility could be a barrier for a person
6.Z. RRHP
with mobility limitations who needs a first floor

apartment or availability of an elevator, or for a

person who does not own a car and needs

housing near public transportation.
3.Z. 9. When the person served is participating
in multiple programs, there is coordina-
7.e. Needs of the family/support system related tion and collaboration to:
to the housing goal may include childcare, 9.Z. RRHP
a. Facilitate continuity of services.

transportation, clothing, and food. 9.a.Z. RRHP
b. Reduce duplication of services.

7.f. Financial assistance required may include 9.b.Z. RRHP
funds for security deposits, utility payments, Intent Statements

move-in costs, rental subsidy, or payment of Persons obtain services promptly and service
rental and utility arrears. The level of financial delivery is effective and efficient.
assistance is individualized to the person.
3.Z. 10. Based on the identified housing needs
3.Z. 8. Based on the identified housing needs and desires of the person served, the
and desires of the persons served, program provides education on:
services coordination includes:
10.Z. RRHP
8.Z. RRHP
a. Tenant rights.
a. Collaboration with the persons
10.a.Z. RRHP
b. Tenant responsibilities.
served and/or their families, as 10.b.Z. RRHP
c. Landlord rights.
appropriate. 10.c.Z. RRHP
8.a.Z. RRHP
d. Landlord responsibilities.
b. Outreach/engagement to encourage 10.d.Z. RRHP
e. Fair housing laws.

participation of the persons served. 10.e.Z. RRHP
8.b.Z. RRHP f. The person’s rental/lease agreement.

c. Coordination of or assistance with 10.f.Z. RRHP
crisis intervention and stabilization g. Self-advocacy.

10.g.Z. RRHP
services, as appropriate. h. Financial management.

10.h.Z. RRHP
8.c.Z. RRHP
d. Optimizing resources and opportuni- Intent Statements

ties through: The need for education may be identified by
8.d.Z. RRHP
(1) Community linkages. the person served, program personnel, and/or

8.d.(1)Z. RRHP
(2) Enhancing social support net- a landlord.

works identified by the person Examples
served.
8.d.(2)Z. RRHP Education can be provided in a variety of ways,
e. Assistance securing safe housing that including one-to-one discussions, brochures,
is consistent with the individual hous- and welcome home packets.
ing plans of the persons served.
8.e.Z. RRHP 10.a. Tenant rights might address eviction
f. Recommendations for the persons notices, including what they mean, how a tenant
served to facilitate housing retention is expected to respond, and in what time frame.
upon exit from the program. The program helps persons to understand what
8.f.Z. RRHP
Intent Statements is legal and what is not.

Services coordination meets the needs of the 10.f. Education might address requirements
persons served in their communities directly related to rental/lease payments, such as when
or through linkages to qualified providers. they are due, acceptable forms of payment, and
Examples late fees; security deposits; children; pets; noise;
smoking; trash; and maintenance and repair of
8.d. Persons served should be connected to ser-
the housing.
vices that address nonhousing personal goals
when it is their priority. The program provides 10.g. The self-advocacy is related to tenancy
linkage and knowledge, but it is up to the choice issues, which might include helping persons
of the individual to pursue those resources. served understand the proper way to take con-
Engaging community agencies to provide wrap- cerns to their landlord and resolve disputes.
around services is often a successful approach.

10.h. Financial management might include Intent Statements

banking; e.g., how to open an account, balance This measure would meet the requirement
a checkbook, deposit and withdraw money; for one of the service delivery performance
household budgeting; insurance; and credit indicators required by Standard 1.M.6.b.
reports and history.
Examples
The essence of rapid rehousing programs is that
3.Z. 11. The program provides documented they are rapid. Success is more likely if persons
personnel training: served are connected quickly to appropriate
11.Z. RRHP
a. At: resources based on their choices. Goals are often

11.a.Z. RRHP
(1) Orientation. focused on ending the current crisis and short-

11.a.(1)Z. RRHP
(2) Regular intervals. term prevention of recurrence, i.e., two to three

11.a.(2)Z. RRHP
b. That addresses: months.

11.b.Z. RRHP
(1) Tenant rights.

11.b.(1)Z. RRHP Additional Resources
(2) Tenant responsibilities.
11.b.(2)Z. RRHP
■ www.endhomelessness.org/library/entry/
(3) Landlord rights.
11.b.(3)Z. RRHP rapid-re-housing2
(4) Landlord responsibilities.
11.b.(4)Z. RRHP ■ www.endhomelessness.org/library/entry/
(5) Fair housing laws. prevention-targeting-101
11.b.(5)Z. RRHP
(6) Housing first approach.

11.b.(6)Z. RRHP ■ http://portal.hud.gov/hudportal/
(7) Terminology used in rental/ HUD?src=/program_offices/
lease agreements. comm_planning/homeless
11.b.(7)Z. RRHP
(8) Financial management. ■ www.onecpd.info/resources/documents/

11.b.(8)Z. RRHP
c. Other topics as appropriate to the HEARTH_HomelessDefinition_FinalRule.

needs of the persons served. pdf
11.c.Z. RRHP
Intent Statements ■ http://usich.gov/
This training supplements personnel training ■ http://www.nationalhomeless.org/publica-

as called for in Section 1.I. tions/facts/youth.pdf
■ www.endhomelessness.org/library/entry/
Applicable Standards coordinated-assessment-toolkit

■ Overrepresentation of Women Veterans
Standard 12. applies only if Rapid Rehousing
is part of the service provided. Among Homeless Women:
http://www.ncbi.nlm.nih.gov/pmc/articles/
PMC1447922/
3.Z. 12. An analysis of average length of time
■ Women Veterans who are Homeless
from entry to the rapid rehousing
Characteristics, Risk Factors, Needs:
program to housing:
12.Z. RRHP http://bpwfoundation.org/documents/
a. Is conducted at least annually. uploads/DWashington_IV_Special_
12.a.Z. RRHP
b. Documents: pop_2_Women_120710.pdf
12.b.Z. RRHP
(1) Performance in relationship to an ■ Ending Homelessness among Veterans:

established performance target. A Report by the United States Interagency
12.b.(1)Z. RRHP
(2) Trends. Council on Homelessness:

12.b.(2)Z. RRHP
(3) Actions for improvement. http://usich.gov/resources/uploads/

12.b.(3)Z. RRHP
(4) Results of performance asset_library/USICH_Ending_

improvement activities. Homelessness_Among_Veterans_Rpt_
12.b.(4)Z. RRHP
(5) Necessary education and February_2013_FINAL.pdf

training of personnel.
12.b.(5)Z. RRHP

■ Veterans and Homelessness:

http://research.policyarchive.org/19918.pdf
■ A National Summit On Women Veteran
Homelessness:
http://vets.syr.edu/wp-content/uploads/
2013/07/Women-Homelessness-
SummaryFinal.7.3.13.pdf
■ Recognizing Work as a Priority in Preventing
or Ending Homelessness:
http://link.springer.com/article/
10.1007%2Fs10935-007-0097-5
■ The Importance of Employment in Ending
Veteran Homelessness:
http://vets.syr.edu/wp-content/uploads/
2013/10/
HomelessnessBiMonthlyReportFI-
NAL.October2013.pdf
■ Housing plans of persons served
■ Landlord recruitment and retention plan
■ Documentation of personnel training
■ Individual plans of persons served
■ Analysis of average length of time from entry

to a rapid rehousing program to housing

SECTION 4
Psychosocial Rehabilitation Programs
The standards in this section are taken from

the 2016 Behavioral Health Standards Manual.
A. Program/Service
Behavioral health programs are organized and Structure
designed to provide services for persons who
have or who are at risk of having psychiatric Description
disabilities/disorders, harmful involvement
A fundamental responsibility of the organization
with alcohol and/or other drugs, or who have
is to provide a comprehensive program structure.
other behavioral health needs. Through a team
The staffing is designed to maximize oppor-
approach, the goal of each such program is to
tunities for the persons served to obtain and
improve the quality of life and the functional
participate in the services provided.
abilities of the persons served. Each program
selected for accreditation demonstrates cultural
competence and relevance. Family members and 4.A. 1. Each program/service:
1.A. Structure and Staffing
significant others are involved in the programs a. Documents the following parameters
of the persons served, as appropriate and to the regarding its scope of services:
1.a.A. Structure and Staffing
extent possible. (1) Population(s) served.

1.a.(1)A. Structure and Staffing
In addition to all standards in Sections 1.A. (2) Settings.

and 1.C through 1.N, all organizations seeking
(3) Hours of services.

accreditation for a psychosocial rehabilitation 1.a.(3)A. Structure and Staffing
(4) Days of services.

core program must meet the standards in at least 1.a.(4)A. Structure and Staffing
(5) Frequency of services.

one of the following core program areas and the 1.a.(5)A. Structure and Staffing
additional standards as noted in that section: (6) Payer sources.

(7) Fees.
4.E. Case Management/Services Coordination 1.a.(7)A. Structure and Staffing
(8) Referral sources.

4.F. Community Integration 1.a.(8)A. Structure and Staffing
(9) The specific services offered,

4.G. Community Housing including whether the services
4.H. Supported Living are provided directly or by
4.I. Assessment and Referral referral.
4.J. Diversion/Intervention b. Shares information about the scope

4.K. Prevention of services with:
1.b.A. Structure and Staffing
(1) The persons served.

If an organization serves any children/adolescents 1.b.(1)A. Structure and Staffing
(up to age 18) in a core psychosocial rehabilitation (2) Families/support systems, in

program for which it is seeking accreditation accordance with the choices
other than Prevention or Diversion/Intervention, of the persons served.
1.b.(2)A. Structure and Staffing
the standards in Section 4.L. Children and (3) Referral sources.

Adolescents are applicable in addition to seeking (4) Payers and funding sources.
accreditation in at least one of the core program
(5) Other relevant stakeholders.

areas listed above. In these programs, Children 1.b.(5)A. Structure and Staffing
(6) The general public.

and Adolescents is termed a Specific Population 1.b.(6)A. Structure and Staffing
c. Reviews the scope of services at least

Designation, which is added to the core program
annually and updates it as necessary.
being surveyed if any children or adolescents are 1.c.A. Structure and Staffing
served.

Intent Statements
4.A. 4. When a person served is found ineligible
The scope is defined at the level of the program/
for services:
service and provides the persons served, 4.A. Structure and Staffing
families/support systems, referral sources, a. The person served is informed

payers, and other relevant stakeholders with as to the reasons.
information that helps them understand what b. In accordance with the choice
the program/service has to offer and determine of the person served:
whether it will meet the needs of the persons
(1) The family/support system is

served. If the program is part of a continuum of informed as to the reasons.
services, the scope is defined for each program 4.b.(1)A. Structure and Staffing
(2) The referral source is informed

or specialty program within the continuum.
as to the reasons.
c. Recommendations are made for

4.A. 2. The organization provides the resources alternative services.
needed to support the overall scope of 4.c.A. Structure and Staffing
each program/service.
Intent Statements
4.A. 5. Each program/service implements
The ability to provide the program/services procedures that address unanticipated
defined in the scope statement is evidenced by service modification, reduction, or exits/
adequate materials, equipment, supplies, space, transitions precipitated by funding or
finances, training, and human resources. other resource issues.
Intent Statements
4.A. 3. Based on the scope of each program/
service provided, the organization The program/service demonstrates its knowl-
documents its: edge of funding sources and their expectations
and time frames for discontinuing or changing
a. Entry criteria.
the program/service. While funding issues impact
b. Transition criteria, if applicable. entry and exit decisions, the program/service
c. Exit criteria. consistently advocates for needs of the persons

3.c.A. Structure and Staffing
served.
Intent Statements
The organization determines which persons
it is qualified and able to serve and identifies 4.A. 6. Service delivery models and strategies
conditions/time/events for transition and/or are based on accepted practice in the
exit. This includes transitions to other levels field and incorporate current research,
of care/services as well as transitions within a evidence-based practice, peer-reviewed
program/service. Transition criteria may also scientific and health-related publica-
address continuing stay criteria. Transition tions, clinical practice guidelines, and/or
may not always occur based on the nature expert professional consensus.
Intent Statements
The service delivery model and the strategies
used are based on accepted practice, including
consideration of areas such as information on
the efficacy of specific techniques, pertinent
research findings, protocols published by various
professional groups, or approaches receiving
professional recognition for achieving successful
outcomes.

this area, who can assist with facilitating changes,

4.A. 7. To facilitate integrated service delivery, if appropriate, in legal autonomy status.
each program/service implements
communication mechanisms regarding
the person served that: 4.A. 9. When services are provided from or
within a mobile unit, written procedures
a. Address:
are implemented that address, at a
(1) Emergent issues. minimum, the unique aspects of the
(2) Ongoing issues. following areas related to mobile

(3) Continuity of services, including: settings:

7.a.(3)A. Structure and Staffing 9.A. Structure and Staffing
(a) Contingency planning. a. Responsibilities of:

7.a.(3)(a)A. Structure and Staffing 9.a.A. Structure and Staffing
(b) Future planning. (1) Drivers.

7.a.(3)(b)A. Structure and Staffing 9.a.(1)A. Structure and Staffing
(4) Decisions concerning the person (2) Service providers.

served.

b. Confidentiality of:
b. Ensure the exchange of information

regarding the person-centered plan. 9.b.(1)A. Structure and Staffing
(2) Communication.
Intent Statements c. Privacy related to service delivery.

This standard addresses the need for timely d. Accessibility.

communication to ensure services and programs
9.d.A. Structure and Staffing
e. Availability of information on
are consistently provided, whether provided resources to address needs unable
24 hours a day, 7 days a week or on a part-time, to be met at the mobile setting.
scheduled basis. 9.e.A. Structure and Staffing
f. Security of:
9.f.A. Structure and Staffing
(1) Medications provided from or

4.A. 8. The program/service demonstrates: within the mobile unit, when
a. Knowledge of the legal decision-making applicable.

authority of the persons served. 9.f.(1)A. Structure and Staffing
(2) Equipment and supplies used

b. When applicable, the provision of in service provision.

information to the persons served 9.f.(2)A. Structure and Staffing
(3) The mobile unit when not in use.

regarding resources related to legal 9.f.(3)A. Structure and Staffing
g. Safety of:
decision-making authority. 9.g.A. Structure and Staffing

Intent Statements 9.g.(1)A. Structure and Staffing
(2) Personnel.
The person served may not have the capacity or 9.g.(2)A. Structure and Staffing
h. Maintenance of:
be of the age to make decisions in his or her 9.h.A. Structure and Staffing
(1) Equipment.
own best interests. An individual may need to be 9.h.(1)A. Structure and Staffing
assigned to make decisions regarding healthcare (2) Vehicles.

9.h.(2)A. Structure and Staffing
choices, financial decisions, or life care planning. Intent Statements

Legal terminology may vary from state to state
Mobile unit services are services provided
or province to province; i.e., healthcare power of
from a vehicle such as a motor home or van
attorney, power of attorney, and guardianship.
that functions as a site for the program/service
The program/service should be able to discuss
seeking accreditation.
how it addresses the issue of the legal decision-
making authority of the persons served. Examples
8.b. Any limitation on a person’s legal decision- 9.b. Written procedures address confidentiality
making authority should be continued only as related to the use of mobile technology for
long as is appropriate and necessary. The pro- documentation and telephonic communication
gram/service assists the person served and his about the persons served.
or her family members/support system to access
resources, such as attorneys with expertise in

9.d. The mobile unit: for the choice of service modality(ies). Many
■ Provides adequate space for persons served
organizations may incorporate the information
to approach and move around inside of it. required in a program description to meet
Standard 4.A.1.a.
■ Is equipped with a ramp, handrails, and
adaptive equipment for use by personnel Examples
and/or persons served. The written program description can be
■ Operates from a location where there is described in policy and procedure manuals,
ample parking. the performance improvement plan, program
■ Operates from a location that limits exposure
handbooks, brochures, or other documentation.
It may vary in length, depending on the size
to the sun and noise in the environment
of the organization and the services that are
such as traffic noise.
provided.
9.f.(3) Security of the mobile unit when it is not 10.a. The program description includes infor-
in use might address the location where the unit
mation such as the populations and age groups
is parked overnight and/or between stops, lock-
served, relevant characteristics of the popula-
ing the unit, protection of records, and the use tions, hours and days of operation, after-hours
of security personnel or surveillance systems to
contact, and admission criteria.
monitor the unit.
10.b.–c. The philosophy and goals of a program
9.g. Safety considerations might include com-
may be the same as the philosophy and goals
munication systems available, availability of of the organization; however, they are restated
emergency procedures in the mobile unit, what
in the program descriptions for clarity.
to do in the event of an emergency situation,
determination of the location where the mobile 10.d. The program description includes modali-
unit provides services, and minimum personnel ties used for prevention, intervention, and
that must be present during hours of operation. treatment as appropriate. The description can
identify the type(s) of therapy(ies) used for specific
9.h. Maintenance of mobile units might include needs of persons served and include when medi-
keeping logs of mileage, gasoline use, oil changes,
cations are routinely prescribed.
and tire wear.
10.e. Special populations may include children
and adolescents, aging and older adults, pregnant
4.A. 10. Each core program for which the organi- women, persons with intellectual or other devel-
zation is seeking accreditation has a opmental disabilities, persons with HIV/AIDS,
written program description that guides IV drug users, DUI offenders, sexual offenders,
the delivery of services and includes: or substance abuse offenders.
a. A description of the program.

b. The philosophy of the program. 4.A. 11. Services are designed and implemented
c. Program goals. to:

d. Description of the service/treatment

a. Support the recovery, health, or

modalities to be provided to achieve well-being of the persons or families
the program objectives. served.
e. Identification or a description of 11.a.A. Structure and Staffing
b. Enhance the quality of life of the

special populations and mechanisms persons served.
to address their needs. 11.b.A. Structure and Staffing
c. Reduce symptoms or needs and

10.e.A. Structure and Staffing
Intent Statements build resilience.

The intent of this standard is to clearly define, d. Restore and/or improve functioning.
in writing, how service delivery is accomplished. e. Support the integration of the per-
Description would include broad strategies to sons served into the community.
be used to achieve objectives and the rationale 11.e.A. Structure and Staffing

Intent Statements approaches and supports. This standard would

Services provided by the organization are apply to any program that deals with persons
designed and implemented to increase with a history of behavioral problems (e.g., anger,
independence and maximize integration into PTSD) or where the goal is to help the persons
the community. served change their behavior. Thus, you could
11.a. Recovery focuses on the development see these policies and procedures in almost any
of new meaning and purpose as individuals or behavioral health program except perhaps pre-
families grow beyond the problems associated vention/intervention, diversion, or call centers.
with the concerns that led them to seek services,
i.e. mental illness, addiction, or family violence. 4.A. 14. When applicable, the program identifies:
a. Written procedures governing the

4.A. 12. When the program is identified as a use of:
treatment program, it identifies: (1) Special treatment interventions.

12.A. Structure and Staffing 14.a.(1)A. Structure and Staffing
a. Treatment modalities used. (2) Restrictions of rights.

12.a.A. Structure and Staffing 14.a.(2)A. Structure and Staffing
b. The credentials of staff qualified b. Methods to ensure that intrusive

to provide identified treatment procedures are administered in a
modalities. safe manner, with consideration
given to the:
Intent Statements 14.b.A. Structure and Staffing
(1) Physical history of the persons

Core programs that require person-centered
served.
plans are typically considered treatment 14.b.(1)A. Structure and Staffing
programs for the purpose of this standard. (2) Developmental history of the
persons served.
4.A. 13. When applicable, there are policies and (3) Abuse history of the persons
written procedures that address positive served.
approaches to the program’s use of c. A process of regularly evaluating:

behavioral interventions, including: (1) Any restrictions placed on the:

13.A. Structure and Staffing 14.c.(1)A. Structure and Staffing
a. An emphasis on building positive (a) Rights of the persons served.

relationships with persons served.
14.c.(1)(a)A. Structure and Staffing

(b) Privileges of the persons
b. Evaluation of the environment. served.
13.b.A. Structure and Staffing 14.c.(1)(b)A. Structure and Staffing
c. Appropriate interaction with staff to: (2) Methods to reinstate restricted

or lost:
(1) Promote de-escalation. 14.c.(2)A. Structure and Staffing
(a) Rights of the persons served.

13.c.(1)A. Structure and Staffing
(2) Manage behavior. 14.c.(2)(a)A. Structure and Staffing
(b) Privileges of the persons

d. Empowering persons served to

manage their own behavior. served.
14.c.(2)(b)A. Structure and Staffing
(3) The purpose or benefit of any

Intent Statements
type of restriction on rights or
The intent of the standard is that organizations privileges.
have policies and procedures that support the 14.c.(3)A. Structure and Staffing
use of positive alternatives to behavioral inter- Intent Statements

ventions such as redirecting and de-escalation 14.a.(1) When used, special treatment inter-
in its effort to avoid negative behaviors by the ventions are individually applied based on
persons served. The policies and procedures the specific needs of the persons served and
should reflect the use of positive approaches as determined safe and effective.
prior to the implementation of behavioral 14.c. Some organizations, aside from using
interventions. seclusion/restraint, restrict privileges when a
The organization demonstrates commitment person enters treatment. As a general rule,
to a system that nurtures personal growth the rights of persons served are described in
and dignity, and it supports the use of positive writing in the organization’s client rights state-

writing in the organization’s client rights state-

ment or document and are “non-negotiable”; i.e., 4.A. 16. In a medically supervised program, there
they cannot be lost by the person served or taken is a medical director who is a physician.
away by the organization. In contrast, privileges Intent Statements

are often extended to persons served as a result To ensure that proper care is provided in a
of exceptional conformance to program rules or medically supervised program, there should
due to extraordinary progress. Privileges, unlike be a medical director who is a physician.
client rights, can be lost through violations
of program rules or a failure to demonstrate Examples
progress in treatment. This includes medically supervised assertive
Examples community treatment, detoxification, inpatient
treatment, partial hospitalization, or residential
14.a. Special treatment interventions may span
treatment programs serving persons with
the range from electroconvulsive therapy (ECT)
medical needs.
to loss of phone and visitation privileges. This
standard includes all interventions used, as In an addiction treatment program, the program
appropriate to the person served, including is encouraged to use a physician certified in
involuntary emergency medication. addiction treatment by the American Society of
Addiction Medicine (ASAM), American Board
14.b. Examples of intrusive procedures may
of Addiction Medicine (ABAM), the Canadian
include strip searches or pat downs.
Society of Addiction Medicine (CSAM), or other
14.c. For example, an alcohol and drug residen- similar organization.
tial treatment program may not allow visitors
the first week a person is in treatment, or a week-
end pass may be revoked if a person served has
4.A. 17. The program offers one or more of
the following:
violated the conditions of treatment for that 17.A. Structure and Staffing
particular organization. a. Peer support.

b. Local advocacy groups.

4.A. 15. The program receives medical consulta- c. Consumer/survivor/ex-patient

tion regarding medically related policies groups.
or procedures, when appropriate. d. Self-help groups.

e. Other avenues of support.

Intent Statements 17.e.A. Structure and Staffing
Medical consultation is typically provided by a Intent Statements

medical director who is a physician. However, The program will provide, arrange, or refer
there may be circumstances in which the con- when needed to applicable support services.
sultation is provided by a licensed physician’s
Examples
assistant, a nurse practitioner, or a registered
nurse. The person does not have to be a staff 17.a. Peer support services may be provided by
member but can be connected through a con- peer staff or through the use of on-site support
tract or a consulting or voluntary agreement. groups. Peer support may be provided by individ-
uals with direct consumer experience or family
Examples
members of persons served.
Medical consultation may be indicated for poli-
17.b. Such local groups could include:
cies and procedures involving medication use,
seclusion or restraint, human resources, health ■ Alcoholics Anonymous or other 12-step
and safety, admission eligibility, infection control, groups, such as Alanon/Alateen.

medical emergencies, or other medically related ■ The local chapter of the National Alliance
issues. for the Mentally Ill.
■ The local chapter of the Association of
Psychosocial Rehabilitation Services.

■ Medical condition support groups. program encourages strengthening or develop-

■ Parents Anonymous. ing community supports to improve and
maintain outcomes upon completion of care.
■ Veterans service organizations.
■ The local chapter of People First.
4.A. 20. Written procedures specify that the
■ The local area Center for Independent Living. program provides or arranges for
Efforts should also be made to recognize cultur- crisis intervention services.
ally specific support groups. Intent Statements

The organization must have procedures for
4.A. 18. The program ensures that information crisis intervention.
and education that is relevant to the
Examples
needs of the persons served is provided.
The organization may have its own on-call or
Examples direct crisis response service or may contract
Information may be provided that focuses on or collaborate with area providers that offer
medical, housing, mental health, alcohol, and crisis intervention services.
other drug issues; relationships; life skills, etc.
Education may be provided through: 4.A. 21. To meet the needs of the persons served,
■ Individual and group sessions. the program demonstrates how it uses
■ Group education. technology to:
■ Audio/video or written materials. a. Increase access to services.

■ The internet. b. Increase supports.

■ Resource listings.
c. Enhance services.
Education may also be provided through other Intent Statements

resources, including community colleges and Program management and leadership seek to
area special education providers, and community find and implement technologies that assist
providers and may include assisting the persons the persons served in meeting their goals. The
served to access information on their own. program can describe what technologies it has
implemented and what it is considering for
the future.
4.A. 19. Families are:
a. Encouraged to participate in Examples

educational programs offered 21.a. The program may improve access to ser-
by the organization. vices through the use of websites, patient portals,
telehealth services, social media, text messaging,
b. Invited to participate in clinical

programs or services with the and other methods to remind the persons served
persons served, with consent of appointments.
or legal right. 21.b. Increased supports could include use of
Intent Statements
technological supports between services, such
as recovery-based applications or encouraging
The program seeks to engage the family of the
persons served to use online support commu-
person served into care. The family can include
nities and electronic communications with
traditional family members such as the person’s
personnel, as appropriate.
spouse, parents, siblings, or other involved rela-
tives. When related persons are not involved or 21.c. The program may enhance services through
their involvement is impractical or inappropriate, technology such as patient portals for making
the program seeks to involve other individuals appointments, requesting refills of medications,
in the person’s life to provide support. Support and accessing medical records; and/or through
systems are vital to successful recovery, and the the use of online tools such as outcome measures,

cognitive behavioral therapy (CBT) tools, When needed, competency-based training is

online assessments, and other services. provided through inservice or access to external
resources.
4.A. 22. For personnel providing direct services,
the organization includes the following 4.A. 23. Team members, in response to the needs
in its assessment of competency and of the persons served:
competency-based training:

a. Help empower each person served
a. Areas that reflect the specific needs to actively participate with the team
of the persons served. to promote recovery, progress, or
well-being.
b. Clinical skills that are appropriate 23.a.A. Structure and Staffing
to the position. b. Provide services that are consistent

with the needs of each person served
c. Person-centered plan development.

d. Interviewing skills. through direct interaction with that

person and/or with individuals
e. Program-related research-based
identified by that person.
treatment approaches. 23.b.A. Structure and Staffing

c. Are culturally and linguistically
Intent Statements competent.
The intent of this standard is to ensure the 23.c.A. Structure and Staffing
d. Meet as often as necessary to carry

necessary competencies are established out decision-making responsibilities.
and demonstrated. 23.d.A. Structure and Staffing
e. Document:
Examples (1) The attendance of participants

In most organizations, the evaluation of staff at team meetings.
23.e.(1)A. Structure and Staffing
competencies begins with ensuring that all clini- (2) The results of team meetings.
cal staff members are licensed/certified by a 23.e.(2)A. Structure and Staffing
Intent Statements
credentialing body that uses a competency-based
process for issuing licenses and certification. The size and composition of the team will vary
Beyond that, evaluation of professional com- according to the services provided to each person
petencies is part of an ongoing process of served. Certain programs, services, or needs of
supervision that provides direct and periodic the persons served may require that the team
include personnel from a variety of disciplines.
observation and documentation of screenings,
intakes, group and individual counseling/therapy Examples
sessions, and other events involving service 23.a. This may be demonstrated through the
delivery. active involvement of the person served in
Competency-based training may include training the development of the person-centered plan,
that is provided or recognized by a professional participation in team meetings, or periodic
association, part of a formal training curriculum, review of identified goals.
or approved for continuing education units
(CEUs) by a credentialing or licensing body. 4.A. 24. A designated individual(s) assists in
Competency in the areas in which training has coordinating services for each person
occurred can be assessed by observing work served by:
and documenting that the skills or knowledge 24.A. Structure and Staffing
a. Assuming responsibility for ensuring

presented are being used on the job, through the implementation of the person-
supervision and clinical review when assessments
centered plan, if applicable.
can be made regarding the retention and use of 24.a.A. Structure and Staffing
b. Ensuring that the person served is

the training information, or through post-tests
oriented to his or her services.
that are administered. 24.b.A. Structure and Staffing

c. Promoting the participation of the

person served on an ongoing basis
4.A. 25. The organization has a policy and written
procedures for the supervision of all
in discussions of his or her plans,
individuals providing direct services.
goals, and status. 25.A. Structure and Staffing
d. Identifying and addressing gaps Intent Statements

in service provision. The intent of this standard is to ensure that all
e. Sharing information on how to individuals providing direct services (including

access community resources relevant staff members, volunteers, trainees, interns, and
to his or her needs. contracted personnel) are provided with appro-
priate supervision or direction. Because of labor
f. Advocating for the person served,
relations concerns, procedures may differ when
when applicable.
24.f.A. Structure and Staffing the organization uses contracted personnel.
g. Communicating information regard-
ing progress of the person served Examples
to the appropriate persons. Supervision may occur through the supervisor’s
participation in treatment/service planning
24.g.A. Structure and Staffing
h. Facilitating the transition process,

including arrangements for follow- meetings, organizational staff meetings, side-
up services. by-side sessions with the person served, or
24.h.A. Structure and Staffing
i. Involving the family or legal one-to-one meetings between the supervisor

guardian, when permitted. and individuals providing direct services.
24.i.A. Structure and Staffing
j. Coordinating services provided

outside of the organization. 4.A. 26. Documented ongoing supervision
24.j.A. Structure and Staffing
of clinical or direct service personnel
Intent Statements addresses:
Having a person designated to coordinate ser- 26.A. Structure and Staffing
a. Accuracy of assessment and referral

vices ensure a more seamless process, thereby skills.
increasing the likelihood that all pertinent areas 26.a.A. Structure and Staffing
are effectively addressed. b. The appropriateness of the treatment

or service intervention selected
Examples relative to the specific needs of
The individual(s) who coordinates services each person served.
may be an employee of the organization, a peer c. Treatment/service effectiveness as

advocate, on the organization’s payroll, under a reflected by the person served
contractual arrangement, on an internship, or a meeting his or her individual goals.
volunteer placement. Various designations may 26.c.A. Structure and Staffing
d. The provision of feedback that

be used, such as peer advocate, case manager, enhances the skills of direct service
case coordinator, program coordinator, primary personnel.
clinician/contact, or team leader. 26.d.A. Structure and Staffing
e. Issues of ethics, legal aspects of

24.e.–f. For persons with intellectual or other clinical practice, and professional
developmental disabilities who are in long-term standards, including boundaries.
residential services, this means offering commu- 26.e.A. Structure and Staffing
f. Clinical documentation issues identi-

nity-based options such as independent living fied through ongoing compliance
programs. review.
24.h. Includes the transition of the person served 26.f.A. Structure and Staffing
g. Cultural competency issues.

from one program to another within the same 26.g.A. Structure and Staffing
h. Model fidelity, when implementing

organization. evidence-based practices.
26.h.A. Structure and Staffing
Intent Statements
This standard addresses clinical supervision and
the provision of clinical consultation as opposed

to what may be considered daily supervision. 27.b.(2) Legal drugs may include over-the-
Clinical supervision is provided by persons counter drugs, vitamins, herbs, and alcohol.
qualified to provide this service as determined 27.b.(5) Tobacco products can include chewing
by state/provincial licensure or certification, tobacco, cigarettes, e-cigarettes, etc.
the experience level of the supervisor, or the
organization’s rules governing the qualifications Peer Support Services
of clinical supervisors.
Peer support services (inclusive of youth or fam-
Examples ily supports) can include a wide range of planned
Supervision may occur through the supervisor’s activities to assist persons served in exercising
participation in treatment/service planning control over their own lives and their recovery
meetings, organizational staff meetings, side- or resilience-building process. Peer support may
by-side sessions with the persons served, or include peer mentoring or coaching, resource
one-to-one meetings between the supervisor connecting, facilitating and leading recovery,
and personnel. educational and support groups, advocating
Clinical supervision documentation specifically for the person/family served, and/or building
includes assessment of professional competencies community supports.
and clinical skills and recommendations for Because peer supports are guided by a founda-
improvement, as opposed to daily supervision. tion of lived experience, peer support specialists
When direct service staff are consultants or inde- are persons who share with others based on that
pendent contractors, expectations regarding experience to encourage, motivate and support
26.a.–g. may be identified in written agreement. persons served and/or their families. They may
be referred to as youth or family support special-
26.d. May include information on best practices
ists or mentors, recovery coaches, guides, peer
or identify areas for needed professional growth.
resource specialists, peer service intervention-
ists, or similar titles.
4.A. 27. The organization implements policies
Peer and youth support services are designed
and procedures:
27.A. Structure and Staffing to have persons with lived experience work
a. For: directly with persons served. Family support
(1) Persons served. services are designed to have persons who have
(2) Personnel. lived experience through their family member’s

b. That address the handling of items participation in services directly work with the
brought into the program, including: family of persons served.
(1) Illegal drugs.

(2) Legal drugs. Applicable Standards

(3) Prescription medication. If an organization employs peer support

(4) Weapons. specialists in any of the core programs

(5) Tobacco products. in Section 4 that are seeking accreditation,

Intent Statements the following standards must also be applied.

Policies and procedures for the handling of
items brought into the program would include 4.A. 28. The organization implements policies
all physical locations and vehicles owned or and procedures that are inclusive of a
operated by the organization. peer workforce.

27.b.(1) Illegal drugs include street drugs and The organization’s policies and procedures are
alcohol (if under the legal drinking age). written with consideration of the various person-
nel it utilizes, such as professional staff, peer

support staff, direct care staff, nondirect care staff, (d) Community supports/
volunteer staff, contract staff, and interns. connections.
31.c.(1)(d)A. Structure and Staffing
(e) The effective use of sharing

4.A. 29. Peer support specialists assist in peer life experiences.
31.c.(1)(e)A. Structure and Staffing
support services: (f) Parenting skills, as

a. Design. applicable.
29.a.A. Structure and Staffing 31.c.(1)(f)A. Structure and Staffing
b. Development. (2) Ongoing training on current

practices in peer support
c. Implementation.
services.
Intent Statements 31.c.(2)A. Structure and Staffing
d. Is provided in a manner that is:

The organization involves members of the peer 31.d.A. Structure and Staffing
(1) Understandable.
support workforce in the process of designing and 31.d.(1)A. Structure and Staffing
implementing these services to ensure that the (2) Appropriate to the develop-
peer support expertise is included. The organi- mental age of the peer support
zation should be able to demonstrate how it specialist being trained.
31.d.(2)A. Structure and Staffing
collected the input of the peer support workforce Intent Statements

in design, development, and implementation.
The organization ensures that the peer support
workforce is adequately trained to perform the
4.A. 30. The organization demonstrates a cli- work assigned. When the organization provides
mate of recovery and/or resilience its own training, it should seek curriculum from
building by: nationally recognized sources such as SAMSHA,
a. Respecting the unique role of peer the Psychosocial Rehabilitation Association, the
support specialists. Certification Commission for Family Support, or
b. Training personnel on the role of other competent source. When the organization
peer support specialists. hires Certified Peer Specialists (or other peer
30.b.A. Structure and Staffing support specialists with an equivalent credential),
Intent Statements it is accepted that the peer support specialist
30.b. All personnel will have a clear understand- has received appropriate initial training.
ing of the unique role of peer support specialists
and how their role differs from the roles of other 4.A. 32. The organization’s written ethical codes
clinical and direct service team members. of conduct specifically address boundar-
ies related to peer support services.
4.A. 31. Peer support specialists receive docu- 32.A. Structure and Staffing
Examples
mented competency-based training that:
This may include how peer support specialists’
a. Is based on a recognized peer-
boundaries with persons served differ from those
support curriculum or a curriculum
of personnel in areas such as sharing meals,
designed and developed with the
attending social events, sharing lived experience,
input of peer support specialists.
31.a.A. Structure and Staffing social media connections, and communication
b. Is provided with the involvement (electronic and other).
of peer support specialists, as
applicable.
4.A. 33. Based on the needs and preferences of
c. Includes:
31.c.A. Structure and Staffing the persons served, peer support:
(1) Initial training on the following 33.A. Structure and Staffing
a. Is provided consistent with or com-

topics:
31.c.(1)A. Structure and Staffing plementary to the person’s identified
(a) Personal advocacy. plan, when applicable.
31.c.(1)(a)A. Structure and Staffing
(b) Engagement. 33.a.A. Structure and Staffing
31.c.(1)(b)A. Structure and Staffing
(c) Recovery and resiliency

principles.
31.c.(1)(c)A. Structure and Staffing

b. Includes the following direct service make appeals and respond to denials if needed.
activities performed by peer support Bridging refers to efforts made to make coopera-
specialists, as applicable: tive connections between the person served and
others and create ties to those who may be help-
(1) Engaging the person served.

(2) Supporting personal recovery ful to them in a variety of ways. It can also involve
goals or building on resiliency. helping to resolve differences and reduce
barriers.
(3) Community networking.
(4) Advocating with and for the 33.c.(3) Life skills are basic skills used to handle
person served. problems and questions commonly encountered
in daily life. This could include problem solving,
(5) Parenting skills.
33.b.(5)A. Structure and Staffing accepting responsibility, money management,
(6) Mentoring. and honoring commitments. Self-care skills such
(7) Bridging or navigating. as cooking, cleaning, laundry, and shopping are

c. Includes the following educational also essential life skills.

activities for the persons served,
as applicable: 4.A. 34. Peer support services are provided
(1) Self advocacy. in locations that meet the needs

(2) Wellness. of persons served.

33.c.(2)A. Structure and Staffing 34.A. Structure and Staffing
(3) Life skills. Examples

(4) Goal setting. Peer support services may be provided in the

(5) Decision-making skills. community, outpatient or inpatient settings,

Intent Statements recovery community organizations or centers,

the home of the person or family served,
Direct service activities may be provided individ-
churches, child welfare organizations, recovery
ually or in a group setting and may be provided
face to face, telephonically, or electronically. homes, drug courts, pre-release jail and prison
programs, parole and probation programs,
Examples behavioral health agencies, HIV/AIDS support
33.b.(2) Peer support specialists can share their centers, medical centers, and/or other social
personal success stories, serve as role models, service centers.
or help the persons served to articulate their
personal goals and identify means to reach
those goals. Peer support specialists can help
the person served make new friends and begin
to build alternative social networks.
33.b.(3) Community networking may include
social, recreational, spiritual, educational, or
vocational linkages. Peer support specialists
encourage and support participation in self-help
groups and provide specific information about
various groups that may be helpful to the person
served.
33.b.(6) Mentoring involves supporting an indi-
vidual’s efforts to achieve his/her goals through
coaching, encouraging, providing positive guid-
ance, sharing life experiences, and offering
feedback to assist with personal development.
33.b.(7) Navigating includes assisting the person
served to find and access services/benefits and to

Section 4.B. Medication Use
Documentation Examples B. Medication Use

section. See Appendix A for more information Medication use is the practice of handling,
on required documentation. prescribing, dispensing, and/or administering
medications to persons served in response to
■ A written plan for each core program
specific symptoms, behaviors, and conditions
surveyed for which the use of medications is indicated
■ Documentation of the attendance of and deemed efficacious. Medication use may
participants at team meetings include self administration, or be provided by
■ Written procedures for crisis intervention personnel of the organization or under contract
services with a licensed individual. Medication use is
■ Documentation of team meetings
directed toward maximizing the functioning of
the persons served while reducing their specific
■ Record of competency-based training
symptoms and minimizing the impact of side
■ Policies inclusive of a peer workforce, effects.
if applicable.
Medication use includes prescribed or sample
■ Documentation of competency-based medications, and may, when required as part of
training for peer support specialists, the treatment regimen, include over-the-counter
if applicable. or alternative medications provided to the person
■ Written ethical codes of conduct that served. Alternative medications can include
specifically address boundaries related herbal or mineral supplements, vitamins, homeo-
to peer support services, if applicable. pathic remedies, hormone therapy, or culturally
specific treatments.
Medication control is identified as the process
of physically controlling, transporting, storing,
and disposing of medications, including those
self administered by the person served.
Self administration for adults is the application
of a medication (whether by injection, inhala-
tion, oral ingestion, or any other means) by the
person served, to his/her body; and may include
the organization storing the medication for the
person served, or may include staff handing
the bottle or blister-pak to the person served,
instructing or verbally prompting the person
served to take the medication, coaching the
person served through the steps to ensure proper
adherence, and closely observing the person
served self-administering the medication.
Self administration by children or adolescents in
a residential setting must be directly supervised
by personnel, and standards related to medica-
tion use applied.
Dispensing is considered the practice of phar-
macy; the process of preparing and delivering a
prescribed medication (including samples) that
has been packaged or re-packaged and labeled

by a physician or pharmacist or other qualified b. The process for persons served

professional licensed to dispense (for later oral to obtain medications needed to
ingestion, injection, inhalation, or other means promote recovery and/or desired
of administration). treatment/service outcomes,
Prescribing is evaluating, determining what agent including whether or not it directly
is to be used by and giving direction to a person provides:
1.b.Medication Use
served (or family/legal guardian), in the prepara- (1) Medication control.

1.b.(1)Medication Use
tion and administration of a remedy to be used in (2) Prescribing.

the treatment of disease. It includes a verbal or 1.b.(2)Medication Use
(3) Dispensing.
written order, by a qualified professional licensed 1.b.(3)Medication Use
(4) Administering.
to prescribe, that details what medication should 1.b.(4)Medication Use
be given to whom, in what formulation and dose,

by what route, when, how frequently, and for
Training and Education
what length of time.
4.B. 2. In response to the needs of the persons

Applicable Standards served and the type of service
■ All organizations must apply Standard 4.B.1. provided, documented ongoing training
A policy for Standard 4.B.1. is developed by and education regarding medications:
2.Medication Use
the organization or each program regard- a. Is received by:

2.a.Medication Use
less of its involvement in medication use, (1) The persons served.

that details the position of the organization 2.a.(1)Medication Use
(2) When applicable, individuals and

on these procedures. family members with legal right
■ All organizations must apply Standard 4.B.2. or identified by the persons
based on the population served and the served.
programs or services provided. 2.a.(2)Medication Use
(3) Personnel providing direct

■ If an organization controls medications, service to the person served.
2.a.(3)Medication Use
Standard 4.B.3. will also apply. b. Includes:

2.b.Medication Use
■ If an organization provides any additional (1) How the medication works.

aspects of medication use, all standards in 2.b.(1)Medication Use
(2) The risks associated with each

this subsection are applicable to the degree medicine.
that they define the organization’s practice. 2.b.(2)Medication Use
(3) The intended benefits, as related

All policies and procedures related to medica- to the behavior or symptom
tion use and medication monitoring are targeted by this medication.
implemented consistent with federal, state, or (4) Side effects.

provincial laws and licensure requirements. 2.b.(4)Medication Use
(5) Contraindications.
To clarify whether your programs provide any 2.b.(5)Medication Use
(6) Potential implications between

level of medication use, as defined by CARF, medications and diet/exercise.
contact the CARF office. 2.b.(6)Medication Use
(7) Risks associated with pregnancy.

(8) The importance of taking medi-

4.B. 1. The organization has a policy that cations as prescribed, including,
identifies: when applicable, the identifica-
1.Medication Use
a. Whether or not medications are tion of potential obstacles to

used in its programs. adherence.
1.a.Medication Use
(9) The need for laboratory

monitoring.

(10) The rationale for each ■ Herbal supplements, homeopathic remedies,

medication. vitamins and mineral supplements, and
hormone therapy.
(11) Early signs of relapse related to

medication efficacy. ■ Culturally specific treatments prescribed by
(12) Signs of nonadherence to traditional healers (e.g., Native American

medication prescriptions. medicine men or women, curanderas, and
(13) Potential drug reactions when shamans).

combining prescription and
nonprescription medications, Medication Control
including alcohol, tobacco,
caffeine, illegal drugs, and 4.B. 3. When the organization physically con-
alternative medications. trols medications (including medications
(14) Instructions on self-administration, self-administered by the person served

when applicable. or the use of samples), written proce-
(15) Wellness management and dures are implemented and include:

3.Medication Use
recovery planning. a. Compliance with all applicable local,

(16) The availability of financial state or provincial, and federal laws

supports and resources to and regulations pertaining to medi-
assist the persons served with cations and controlled substances,
handling the costs associated including on-site pharmacy services
with medications. and dispensing.
3.a.Medication Use
b. Purchase, when applicable.
Intent Statements 3.b.Medication Use
c. Transportation and delivery,

The intent of this standard is to ensure that when applicable.
appropriate education and ongoing training is 3.c.Medication Use
d. Safe storage.
provided to the persons served, family members, 3.d.Medication Use
individuals identified by the persons served, the e. Safe handling.

3.e.Medication Use
team, and service providers and that training is f. Packaging and labeling, when
provided that covers all of the pertinent areas applicable.
of medication management.
3.f.Medication Use
g. Management of biohazards associ-

If a program seeking accreditation does not pro- ated with the use of medications.
vide medication control, prescribing, dispensing,
3.g.Medication Use
h. Safe disposal.
or administering, it would not be required to pro- 3.h.Medication Use
i. Inventory.
vide ongoing training and education regarding 3.i.Medication Use
medications to the persons served or any family j. Self-administration.

3.j.Medication Use
members. Training and education regarding k. Off-site use.

3.k.Medication Use
medications should be provided to personnel Examples

providing direct service to the persons served
3.k. Including home visits, when applicable.
in all programs seeking accreditation.
Resources
Examples
■ 3.h. The FDA publication How to Dispose
2.a.(2) Based on the age or competency of the
of Unused Medicines is a resource for guidelines
person served, training and education may
on safe disposal of medications. (www.fda.gov/
need to be provided to others involved in the
downloads/Drugs/ResourcesForYou/Con-
administration or monitoring of medications.
sumers/BuyingUsingMedicineSafely/
2.b.(13) Alternative medications can include: UnderstandingOver-the-CounterMedicines/
■ Experimental medications not readily ucm107163.pdf
available by prescription.

Medication Prescribing, Dispensing,

4.B. 4. When medications are prescribed for and Administering
or provided to a person served, or in
programs where the persons served
(including those self-administering 4.B. 5. An organization that provides prescrib-
medications) are spending one or ing, dispensing, or administering of
more nights: medications implements written
4.Medication Use
procedures that include:
a. An up-to-date individual record 5.Medication Use
of all medications, including a. Compliance with all applicable local,

nonprescription and nonpsycho- state or provincial, and federal laws
active medications, includes: and regulations pertaining to medi-
4.a.Medication Use
cations and controlled substances,
(1) The name of the medication.
4.a.(1)Medication Use including on-site pharmacy services
(2) The dosage. and dispensing.
(3) The frequency. 5.a.Medication Use
b. Active involvement of the persons

(4) Instructions for use, including the served, when able, or their parents
method/route of administration. or guardians, when appropriate, in
(5) The prescribing professional. making decisions related to the use

b. The program provides ready access of medications.

5.b.Medication Use
to the telephone number of a poison c. Availability of a physician, pharma-

control center to: cist, or qualified professional licensed
4.b.Medication Use
(1) The program personnel. to prescribe for consultation 24 hours

(2) The persons served. a day, 7 days a week.

5.c.Medication Use
c. Written procedures address: d. Documentation and reporting of:

5.d.Medication Use
4.c.Medication Use
(1) How medications will be inte- (1) Observed and/or reported

grated into the overall plan of medication reactions.
5.d.(1)Medication Use
the person served. (2) Medication errors.

5.d.(2)Medication Use
4.c.(1)Medication Use
(2) The process for identifying, e. Review of past medication use,

responding to, documenting, and including:
5.e.Medication Use
reporting medication reactions. (1) Effectiveness.

5.e.(1)Medication Use
(3) Actions to be followed in case (2) Side effects.

of emergencies related to the 5.e.(2)Medication Use
(3) Allergies or adverse reactions.

use of medications. 5.e.(3)Medication Use
f. Identification of alcohol, tobacco,

Examples and other drug use.

5.f.Medication Use
4.a. May be in separate medical record, as long g. Use of over-the-counter medications.

5.g.Medication Use
as it is accessible. h. Use of medications by women of

childbearing age.
5.h.Medication Use
i. Use of medications during

pregnancy.
5.i.Medication Use
j. Special dietary needs and restrictions

associated with medication use.
5.j.Medication Use
k. Necessary laboratory studies, tests,

or other procedures.
5.k.Medication Use

l. When applicable, documented

assessment of abnormal involuntary
4.B. 6. An organization that provides prescrib-
ing of medications implements written
movements at the initiation of treat-
procedures that include:
ment and every six months thereafter 6.Medication Use
for persons served receiving typical a. Screening for common medical

antipsychotic medications. co-morbidities using evidence-
5.l.Medication Use
or consensus-based protocols.
m. When possible, coordination with 6.a.Medication Use
the physician(s) providing primary b. Evaluation of co-existing medical

care needs. conditions for potential medication
5.m.Medication Use
impact.
n. Review of medication use activities, 6.b.Medication Use
including medication errors and drug c. Identifying potential drug inter-

reactions, as part of the quality moni- actions, including the use of
toring and improvement system. over-the-counter supplements.
6.c.Medication Use
5.n.Medication Use
d. Documentation or confirmation of
Intent Statements
informed consent for each medica-
This standard does not apply in programs when tion prescribed, when possible.
medication use is limited to self administration. 6.d.Medication Use
e. Continuing a prescribed medication if

Examples a generic medication is not available.
6.e.Medication Use
5.c. Consistent with state and provincial licen- f. Continuity of medication use when
sure, physician assistants, nurse practitioners, identified as a need in a transition
prescribing professionals, or qualified profes- plan for a person served.
6.f.Medication Use
sionals licensed to prescribe may substitute Examples

for physician availability. Consultation can be
obtained through direct employment, contract 6.a. The ADA/APA have published consensus
or consultant agreement, or medical facility guidelines for identification and management
agreements. Organizations may use tele- of diabetes in patients prescribed psychotropic
psychiatry or telemedicine as a method of medications.
obtaining consultation. 6.d. May include info on alternative meds
5.d. May be reported by the person served or alternatives to the use of meds, as well as
or in response to staff observation. intended benefits, possible side effects or contra-
indications. Evidence of consent for prescribing
5.k. Procedures for laboratory and other tests of medications may include formal signed
should be in accordance with established consent forms; a notation by the prescribing
practices in medicine. As a resource, the individual in the record of the person served
American Psychiatric Association that the medication has been discussed and
(www.psych.org) and the American Diabetes agreed upon; or medication to be prescribed
Association (www.diabetes.org) have published listed on a person-centered plan actively
joint consensus papers identifying the frequency developed with the person served.
and types of laboratory tests and metabolic
screenings appropriate for persons prescribed
antipsychotic medications.
5.l. Documentation occurs when medications,
which may result in the identified side effects,
are prescribed. Documentation may include
formal assessment or the result of observation
by appropriate medical personnel.

4.B. 7. An organization that provides prescrib- 4.B. 8. In an organization that provides pre-
ing of medications demonstrates: scribing of medications, a documented
peer review is conducted:
7.Medication Use
a. To the extent possible, the use 8.Medication Use
of treatment guidelines and a. At least annually.

protocols to:
8.a.Medication Use
7.a.Medication Use
b. By a qualified professional with
(1) Promote state-of-the-art legal prescribing authority, or a
prescribing. pharmacist.
7.a.(1)Medication Use 8.b.Medication Use
(2) Ensure the safety of the person c. On a representative sample of

served. records of persons for whom pre-
scriptions were provided.
b. A program of medication utilization 8.c.Medication Use
evaluation, which includes measures d. To assess the appropriateness of each

of: medication, as determined by:
7.b.Medication Use 8.d.Medication Use
(1) Effectiveness. (1) The needs and preferences of

each person served.
(2) Satisfaction of the person served. 8.d.(1)Medication Use
(2) The efficacy of the medication.

Intent Statements 8.d.(2)Medication Use
e. To determine if:
There is emerging consensus in psychiatry and 8.e.Medication Use
other medical disciplines on best practices in (1) The presence of side effects,
medication prescribing, including the use of unusual effects, and contra-
guidelines, algorithms, and protocols as well as indications were identified
the evaluation of the efficacy and safety of new and addressed.
8.e.(1)Medication Use
medications. Each organization regularly moni- (2) Necessary tests were conducted.
tors and evaluates these practice trends in the 8.e.(2)Medication Use
f. To identify:
field and considers the use of formularies to 8.f.Medication Use
(1) Simultaneous use of multiple

measure cost effectiveness to the person served.
medications in the same
Reasons for not adopting such practices should
drug class.
be explained. 8.f.(1)Medication Use
(2) Medication interactions.

7.b. The medication utilization evaluation is con- 8.f.(2)Medication Use
ducted by a qualified physician, pharmacist, or Intent Statements

other professional with legal prescribing author- The peer review is conducted by a qualified pro-
ity who is not immediately responsible for the fessional with legal prescribing authority, or a
prescribing process but able to provide feedback pharmacist, who is not immediately responsible
to the prescribing practitioner. When available, for the prescribing process but able to provide
a system of internal peer review may be used. feedback to the prescribing practitioner. When
Examples available, a system of internal peer review may
be used. The peer review can be conducted by
7.b. The mechanism for periodic review of actual
mid-level practitioners within the scope of their
prescribing practices may include the following: prescribing privileges.
■ Adherence to guidelines and algorithms.
Examples
■ Documentation of appropriate clinical
exceptions. The frequency of the reviews depends on:
■ The degree of severity of the person’s
■ Off-formulary prescribing.
disability/disorder.
■ Polypharmacy and inappropriate or
■ Whether multiple medications are provided
excessive prescribing.
and other contraindications exist.
■ Monitoring for side effects.
■ The intensity of the program.
■ Therapeutic benefit.
■ The average length of stay.
■ Practitioner trends.

8.d.(2) See the Glossary for the definition of Documentation Examples

efficacy. The following are examples of the types of infor-
4.B. 9. In an organization that provides pre- your conformance to the standards in this sub-
scribing of medications, information section. See Appendix A for more information
collected from the peer review process is: on required documentation.
9.Medication Use
a. Reported to applicable staff. ■ Policies related to medication use

9.a.Medication Use
b. Used to improve the quality of ■ Written procedures regarding medication use

services provided. ■ Documentation of ongoing training and edu-
9.b.Medication Use
c. Incorporated into the organization’s cation regarding medications for the persons
performance improvement system. served, individuals, and family members,
9.c.Medication Use
when applicable, and personnel providing

direct services
4.B. 10. An organization that provides dispens- ■ Policies and written procedures regarding
ing or administering of medications the practices of prescribing, dispensing, or
implements written procedures that administering medications, when applicable
address: ■ Up-to-date individual records of all
10.Medication Use
a. Documentation of medication medications

administration, errors, and reactions. ■ Documentation of the administration of
10.a.Medication Use
b. Documentation of the use and medications and related safety practices

benefits of as-needed (prn) doses. ■ Documentation of all prescribed medications
10.b.Medication Use
c. Coordination when a medication is ■ Documentation of a peer review of the

prescribed by a source other than prescribing of medications
the organization.
10.c.Medication Use
■ Individual records, medication logs,
and physician notes

Section 4.C. Nonviolent Practices
C. Nonviolent Practices services, as the use of seclusion or restraint cre-

ates potential physical and psychological dangers
to the persons subject to the interventions, to the
Description staff members who administer them, or those
Programs strive to be learning environments and who witness the practice. Each organization still
to support persons served in the development of utilizing seclusion or restraint should have the
recovery, resiliency, and wellness. Relationships elimination thereof as an eventual goal.
are central to supporting individuals in recovery Restraint is the use of physical force or mechani-
and wellness. Programs are challenged to estab- cal means to temporarily limit a person's freedom
lish quality relationships as a foundation to of movement; chemical restraint is the involun-
supporting recovery and wellness. Providers tary emergency administration of medication,
need to be mindful of developing cultures that in immediate response to a dangerous behavior.
create healing, healthy and safe environments, Restraints used as an assistive device for persons
and include the following: with physical or medical needs are not consid-
■ Engagement ered restraints for purposes of this section.
■ Partnership—power with, not over Briefly holding a person served, without undue
■ Holistic approaches
force, for the purpose of comforting him or her
or to prevent self-injurious behavior or injury
■ Respect
to others, or holding a person’s hand or arm to
■ Hope safely guide him or her from one area to another,
■ Self direction is not a restraint. Separating individuals threaten-
Programs need to recognize that individuals may ing to harm one another, without implementing
require supports to fully benefit from their ser- restraints, is not considered restraint.
vices. Staff are expected to access or provide Seclusion refers to restriction of the person
those supports wanted and needed by the indi- served to a segregated room with the person’s
vidual. Supports may include environmental freedom to leave physically restricted. Voluntary
supports, verbal prompts, written expectations, time out is not considered seclusion, even though
clarity of rules and expectations, or praise and the voluntary time out may occur in response to
encouragement. verbal direction; the person served is considered
Even with supports, there are times when indi- in seclusion if freedom to leave the segregated
viduals may show signs of fear, anger, or pain, room is denied.
which may lead to aggression or agitation. Staff Seclusion or restraint by trained and competent
members are trained to recognize and respond personnel is used only when other less restrictive
to these signs through de-escalation, changes to measures have been found to be ineffective to
the physical environmental, implementation of protect the person served or others from injury
meaningful and engaging activities, redirection, or serious harm. Peer restraint is not considered
active listening, etc. On the rare occasions when an acceptable alternative to restraint by person-
these interventions are not successful and there is nel. Seclusion or restraint is not used as a means
imminent danger of serious harm, seclusion or of coercion, discipline, convenience, or
restraint may be used to ensure safety. Seclusion retaliation.
and restraint are never considered treatment In a correctional setting, the use of seclusion
interventions; they are always considered actions or restraint for purposes of security is not con-
of last resort. The use of seclusion and restraint sidered seclusion or restraint under these
must always be followed by a full review, as part standards. Security doors designed to prevent
of the process to eliminate the use of these in the elopement or wandering are not considered
future. seclusion or restraint. Security measures for
The goal is to eliminate the use of seclusion forensic purposes, such as the use of handcuffs
and restraint in employment and community instituted by law enforcement personnel, are not
subject to these standards. When permissible,

consideration is made to removal of physical understood under what circumstances, if any,

restraints while the person is receiving services seclusion or restraint would be used.
in the behavioral health care setting.
4.C. 2. As applicable to the population served,
all direct service or front-line personnel
employed by the organization receive
All organizations must apply Standard 4.C.1. documented initial and ongoing
Statements and procedures clearly outline the competency-based training in:
expectations regarding response by personnel 2.Nonviolent Practices
a. The contributing factors or causes of

to emergencies involving assault or aggression. threatening behavior, including train-
All policies and procedures related to seclusion ing on recovery and trauma-informed
and restraint are implemented consistent with services and the use of personal
federal, state, or provincial laws and licensure safety plans.
requirements. 2.a.Nonviolent Practices
b. The ability to recognize precursors

All organizations must apply Standard 4.C.2. that may lead to aggressive behavior.
based on the population served and the 2.b.Nonviolent Practices
c. How interpersonal interactions,

programs or services provided.
including how personnel interact
If an organization uses seclusion or restraint, with each other and with the persons
all standards in Section 4.C. apply. served, may impact the behaviors
To determine if an organization’s intervention of the persons served.
2.c.Nonviolent Practices
methods are defined by CARF as seclusion or d. Medical conditions that may con-
restraint, contact the CARF office. tribute to aggressive behavior.
2.d.Nonviolent Practices
e. The use of a continuum of alternative

4.C. 1. The organization has a policy that interventions.
identifies:
2.e.Nonviolent Practices
1.Nonviolent Practices
f. The prevention of threatening
a. How all personnel employed by the behaviors.
organization will be trained on the
2.f.Nonviolent Practices
g. Recovery/wellness oriented
prevention of workplace violence. relationships and practices.
1.a.Nonviolent Practices
b. How it will respond to aggressive

2.g.Nonviolent Practices
h. How to handle a crisis without

or assaultive behaviors. restraints, in a supportive and
1.b.Nonviolent Practices
c. Whether, and under what respectful manner.

circumstances:
2.h.Nonviolent Practices
1.c.Nonviolent Practices Examples

(1) Seclusion is used within the
2.e. Examples may include engagement,
programs it provides.
1.c.(1)Nonviolent Practices one-to-one attention, meditation, mediation,
(2) Restraints are used within the de-escalation, self-protection, time out, re-
programs it provides. direction, sensory or comfort rooms, prompting,
1.c.(2)Nonviolent Practices
Intent Statements or active listening.

Personnel understand the organization’s expec- Organizations may consider training in eCPR,
tations for responding to threatening or violent a holistic empowering approach to assisting
behavior. A policy is required that details whether persons served to cope with emotional crisis.
or not the organization uses seclusion or restraint. Information on this approach can be found at
Therefore, every organization seeking accredita- www.emotional-cpr.org.
tion must have a policy statement that outlines 2.g. In a program serving persons with
its position on the use of seclusion or restraint.
mental illness, recovery is well defined at
Personnel and the persons served understand
www.samhsa.gov and identifies ten
the organization’s policy and position on the
fundamental components of recovery.
use of seclusion and restraint, and it is clearly

f. A review of the role of the debriefing

4.C. 3. All personnel involved in the direct process in supporting the reduction
administration of seclusion or restraint
of the use of seclusion or restraint.
receive documented initial and ongoing 4.f.Nonviolent Practices
competency-based training, provided by Examples

persons or entities qualified to conduct 4.b. Examples may include data from organiza-
such training, on: tion debriefings, best practices from literature,
a. When and how to restrain or seclude and assessing biomechanical safety of techniques
while minimizing risk. used.
b. Recognizing signs of physical distress 4.d. Examples may include: full assessment of
in the person who is being restrained persons served that identify assessment for risk
or secluded. of violence, medical risk factors, trauma history,
positive behavior support, trauma informed ser-
c. The risks of seclusion or restraint to

the persons served or personnel, vices (educates staff about how trauma affects
including: persons’ behaviors), building healthy relation-
(1) Medical risks. ships with boundaries, safety plans including

advance directives, or assessing physical and
(2) Psychological risks.
3.c.(2)Nonviolent Practices environmental factors.
d. First aid and CPR.
e. How to monitor and continually

4.C. 5. A written status report on the plan for
assess for the earliest release.
3.e.Nonviolent Practices minimization or elimination of the use
f. The practice of intervention done of seclusion and/or restraint:
by an individual. 5.Nonviolent Practices
3.f.Nonviolent Practices a. Is prepared annually.

g. The practice of intervention done 5.a.Nonviolent Practices
b. Includes:
by a team. 5.b.Nonviolent Practices
(1) Goals and time lines.
5.b.(1)Nonviolent Practices
(2) Progress made in reduction

of use.
4.C. 4. If the organization uses seclusion 5.b.(2)Nonviolent Practices
(3) Areas still needing improvement.

and/or restraint, a plan is implemented 5.b.(3)Nonviolent Practices
to minimize or eliminate the use of (4) Factors impeding elimination of

restraints and/or seclusion that includes: the use of seclusion and restraint.
a. Identification of the role of c. Is shared with:

leadership. (1) Personnel.

b. Use of data to inform practice. (2) Persons served.

c. Development of workforce attitudes, (3) Other stakeholders.

skills, and practices that

support recovery.
d. Identification of: 4.C. 6. If the organization uses seclusion or
(1) Specific strategies to prevent restraint, written procedures for the
crisis. use of specific interventions are imple-
mented and include protocols for:
4.d.(1)Nonviolent Practices
(2) Time lines to reduce the use 6.Nonviolent Practices
of seclusion and restraint. a. Adults.

4.d.(2)Nonviolent Practices 6.a.Nonviolent Practices
e. Identification of roles for persons b. Children and adolescents.

served and advocates in determining c. Persons with special needs.

if crisis procedures and practices are 6.c.Nonviolent Practices
d. Team interventions, including:

implemented in a positive and pro- 6.d.Nonviolent Practices
(1) Defining team leadership.

active fashion. 6.d.(1)Nonviolent Practices
4.e.Nonviolent Practices (2) Assigning team duties.

6.d.(2)Nonviolent Practices

4.C. 7. If a personal safety plan exists for the 4.C. 9. An organization that uses seclusion or
person served, it is readily available restraint implements written procedures
for immediate reference. that specify that:
7.Nonviolent Practices 9.Nonviolent Practices
a. The intake evaluation of the person

served:
4.C. 8. An organization that uses seclusion or (1) Includes:

9.a.(1)Nonviolent Practices
restraint has policies that specify that: (a) A review of the medical his-
tory to determine whether
a. All attempts will be made to de-

escalate crises and use seclusion or seclusion or restraint can be
restraint only as a safety intervention administered without risk to
of last resort. health and safety.
9.a.(1)(a)Nonviolent Practices
(b) An assessment of physical,

b. Seclusion or restraint (whether

physical, mechanical, or chemical) sexual, and emotional abuse;
is administered by behavioral health neglect; trauma; and expo-
personnel who are trained and com- sure to violence.
9.a.(1)(b)Nonviolent Practices
petent in the proper techniques (2) Identifies contraindications to

of administering or applying and be considered prior to the use
monitoring the form of seclusion of seclusion or restraint.
or restraint ordered. b. Appropriate interaction with staff

c. Seclusion or restraint is used only for occurs as an effort to de-escalate

intervention in an individual’s emer- threatening situations.
gency situation and to prevent harm c. Standing orders are not issued to
to him/herself or others. authorize the use of seclusion or
d. Seclusion or restraint is not used as restraint.

coercion, discipline, convenience, or d. Immediate assessment of contribut-

retaliation by personnel in lieu of ing environmental factors that may
adequate programming or staffing. promote maladaptive behaviors are
Intent Statements identified and actions taken to mini-

mize those factors.
Each program strives for a restraint-free environ- 9.d.Nonviolent Practices
ment and uses techniques, such as mediation and e. The simultaneous use of seclusion
conflict resolution, as preventive measures. and restraint is prohibited unless a
staff member has been assigned for
Examples continual face-to-face monitoring.
8.b. Personnel administering seclusion or 9.e.Nonviolent Practices
f. The physical plant can safely and

restraint receive annual training and demonstrate humanely accommodate the practice
competencies on the particular intervention of seclusion or restraint.
ordered and used. Seclusion or restraint is used 9.f.Nonviolent Practices
g. When seclusion or restraint is used:

only by personnel of the organization. 9.g.Nonviolent Practices
(1) Documentation confirms that

8.d. Seclusion or restraint is not considered an identified contraindications were
appropriate substitution for inadequate staffing. taken into consideration prior to
Inadequate staffing is defined as either maintain- the use of seclusion or restraint.
ing a staffing pattern that is too low for the 9.g.(1)Nonviolent Practices
(2) It is ordered by a physician or

numbers of persons served and/or maintaining
designated qualified behavioral
staff members who do not have the training,
health practitioner who has
education, and experience to intervene safely
training and competence in the
without using seclusion or restraint.
prevention and management of

behaviors that are a danger to 9.g.(4) Consideration is given to the unique

self or others. needs of children, older adults, persons with HIV,
and to persons with varying developmental func-
9.g.(2)Nonviolent Practices
(3) It is administered in a safe man-

ner, with consideration given to tioning levels as well as to a person’s history of
the physical, developmental, and sexual or physical abuse or neglect.
abuse/neglect history of the per-
son served. 4.C. 10. Organizations using seclusion or
(4) Personnel are trained to monitor restraint implement written procedures
for the unique needs of a person to require that:
in seclusion or restraint. a. Documentation demonstrates that

(5) As soon as the threat of harm is less restrictive intervention tech-

no longer imminent, the person niques were used prior to the use
is removed from seclusion or of seclusion or restraint.
restraint. b. A designated, qualified, and compe-

(6) Staff communicate to the person tent physician or qualified behavioral

being secluded or restrained health practitioner provides face-to-
their intention to keep them and face evaluation of the person served
others safe, and how the specific within one hour of the order for
procedure being used will keep seclusion or restraint being given.
them and others safe. c. An order for seclusion or restraint is

(7) When seclusion or restraint is time limited and does not exceed
used, a trained staff member four hours for an adult. For a child
must be assigned for continual or adolescent, the order does not
monitoring. exceed one hour.
9.g.(7)Nonviolent Practices 10.c.Nonviolent Practices
(8) Immediate medical attention d. Orders for seclusion or restraint may

is made available for any injury be renewed for a total of up to
resulting from seclusion or 24 hours. Orders for renewal may
restraint. only occur following a face-to-face
assessment by a designated, trained,

Intent Statements
and competent qualified behavioral
The intent of these standards is not to condone health practitioner.
or promote the use of seclusion or restraint. The 10.d.Nonviolent Practices
e. After 24 hours, a new order is

purpose is to set guidelines for the handling
of emergency or highly disruptive situations required following a face-to-face
requiring this level of intervention. evaluation by a designated, qualified,
and competent physician or qualified
Examples behavioral health practitioner.
9.b. Appropriate interaction may be continuous
f. Appropriately trained personnel

in some cases or may be significantly less continually assess, monitor, and
intrusive when the interaction appears to be re-evaluate the person served to
exacerbating the potentially harmful behavior. determine whether seclusion or
9.c. This standard refers to orders for restraint is still needed.
an individual person served. g. All orders are entered into the record
9.d. Attention is given to the internal environ- of the person served as soon as possi-
ment of the treatment setting and how it impacts ble but not more than two hours after
the behavior, interactions, and communication implementation.
between personnel and the persons served. h. The designated and qualified person-
9.g.(2) See the Glossary for the definition of nel sign the order within the time
qualified behavioral health practitioner. period mandated by law.
10.h.Nonviolent Practices

i. Face-to-face attention, including 10.i. This can be conducted by a qualified behav-

attention to vital signs and the need ioral health practitioner or other designated
for meals, liquids, bathing, and use of personnel appropriately trained to check vital
the restroom, is given to a person in signs and monitor needs of the person served.
seclusion or restraint at least every
15 minutes by authorized personnel. 4.C. 11. A room designated for the use of
10.i.Nonviolent Practices
j. Documentation of re-evaluations and seclusion or restraint has:

face-to-face attention is entered into 11.Nonviolent Practices
a. A focus on the comfort of the

the record. person served, including:
10.j.Nonviolent Practices
k. As applicable and permitted, there 11.a.Nonviolent Practices
(1) Adequate air flow.

is documentation that the family or 11.a.(1)Nonviolent Practices
(2) Comfortable temperature.

significant other(s), legal guardian, 11.a.(2)Nonviolent Practices
(3) A safe, comfortable seating

advocate, and/or treating practitio-
and/or lying arrangement.
ner of the person served is notified 11.a.(3)Nonviolent Practices
as soon as possible but at least within b. An identified plan for emergency exit.
ten hours of the initial use of seclu- c. Access to bathroom facilities, directly
sion or restraint. or through escort.
10.k.Nonviolent Practices
d. Sufficient lighting.
Intent Statements 11.d.Nonviolent Practices
e. Observation availability.
The intent of this standard is to minimize 11.e.Nonviolent Practices
the potential negative impact from the use f. Call capability when ongoing direct
of seclusion or restraint. observation is not utilized.
10.a. When an organization uses seclusion or g. A location that promotes the privacy
restraint, the documentation related to the rea- and dignity of the person served.
sons for its use discusses how less-restrictive

methods were tried and failed or the reasons
less-restrictive methods were considered
4.C. 12. Following the use of seclusion or
inappropriate and, therefore, were not used.
restraint, a debriefing is conducted
10.b. The face-to-face evaluation needs to as soon as possible (preferably within
assess the physical, emotional, and psychological 24 hours) after the incident. The
well-being of the person served. debriefing includes:
10.f. Every effort should be made to discontinue 12.Nonviolent Practices
a. The person served, for the purpose

the use of seclusion or restraint in as short a time of:
as is safely possible. 12.a.Nonviolent Practices
(1) Hearing from the person served

10.i. Attention is given every 15 minutes for the what he/she experienced and/or
duration of the use of seclusion or restraint and his/her perspective.
involves direct observation. Documentation of 12.a.(1)Nonviolent Practices
this observation is a critical component of this (2) Informing the person as to why
standard. The observation includes a review of the restraint/seclusion was used.
the criteria for release of the order. (3) Returning control to the person
served.
Examples 12.a.(3)Nonviolent Practices
b. Involved staff members.

10.b. See the Glossary for the definition 12.b.Nonviolent Practices
c. Others observing the incident,

of qualified behavioral health practitioner.
when permitted.
10.c. The order may be written or verbal, 12.c.Nonviolent Practices
d. Others (family/guardian/significant
depending on the applicable federal, state, or others) requested by the person
provincial laws. Once the order is obtained, both served, unless clinically
the order and the actual intervention will not contraindicated.
exceed the time limits of four or one hour(s). 12.d.Nonviolent Practices

e. A documented discussion that

addresses:
4.C. 15. The use of seclusion or restraint is:
a. Recorded in the information system.
(1) The incident. 15.a.Nonviolent Practices
12.e.(1)Nonviolent Practices
b. Reviewed:
(2) Its antecedents. 15.b.Nonviolent Practices
(3) An assessment of contributing 15.b.(1)Nonviolent Practices
factors on an individual, pro- (2) For:

grammatic, and organizational (a) Analysis of patterns of use.

15.b.(2)(a)Nonviolent Practices
basis. (b) History of use by personnel.

12.e.(3)Nonviolent Practices 15.b.(2)(b)Nonviolent Practices
(4) The reasons for the use of (c) Environmental contributing

seclusion or restraint. factors.
12.e.(4)Nonviolent Practices 15.b.(2)(c)Nonviolent Practices
(5) The specific intervention used. (d) Assessment of program

(6) The person’s reaction to the design contributing factors.

15.b.(2)(d)Nonviolent Practices
intervention. c. Used for performance improvement.

12.e.(6)Nonviolent Practices 15.c.Nonviolent Practices
(7) Actions that could make future Intent Statements

use of seclusion or restraint
The organization determines its frequency
unnecessary.
12.e.(7)Nonviolent Practices of analysis of patterns of use of seclusion or
(8) When applicable, modifications restraint; however, it should be done at least
made to the treatment plan to annually in order to be used for performance
address issues or behaviors that improvement.
impact the need to use seclusion
or restraint.
4.C. 13. The use of seclusion or restraint always

is documented as a critical incident.
4.C. 14. The chief executive or designated man-

agement or supervisory staff member
reviews and signs off on all uses of
seclusion or restraint:
a. After every occurrence.

b. Within a designated time frame.

c. To determine conformance with

applicable policies/procedures.
Examples
14.c. When the management review determines
the use of seclusion or restraint was not
performed within the applicable policies/
procedures, corrective actions are taken to
prevent a recurrence.

Section 4.D. Records of the Persons Served
Documentation Examples D. Records of the Persons

mation you should have available to demonstrate Served
on required documentation. A complete and accurate record is developed
■ Policies and written procedures that govern to ensure that all appropriate individuals have
the use of seclusion or restraint access to relevant clinical and other information
■ A policy regarding the organization’s response regarding each person served.
to aggressive or assaultive behaviors, training
on the prevention of workplace violence, and 4.D. 1. The organization implements policies
its position on the use of seclusion or restraint and procedures regarding information
■ Documentation of initial and ongoing to be transmitted to other individuals
competency-based training on seclusion or agencies that include:
1.Records of Persons Served
and/or restraint a. The identification of information

■ A plan to minimize or eliminate the use that can legally be shared without
of restraints and/or seclusion an authorization for release of
information.
■ An annual written status report on the plan 1.a.Records of Persons Served
to minimize or eliminate the use of restraints b. Forms to authorize release of

and/or seclusion information that:
1.b.Records of Persons Served
■ Written procedures for team interventions

(1) Comply with applicable laws.
1.b.(1)Records of Persons Served
(2) Identify, at a minimum:

■ Documented evidence that all other inter- 1.b.(2)Records of Persons Served
vention techniques were used first (a) The name of the person
about whom information
■ Individual records with complete documen-
is to be released.
tation of orders, face-to-face evaluations and 1.b.(2)(a)Records of Persons Served
assessments, and ongoing monitoring checks (b) The content to be released.

1.b.(2)(b)Records of Persons Served
(c) To whom the information

■ Documentation of debriefings and
is to be released.
discussions held following the use of 1.b.(2)(c)Records of Persons Served
seclusion or restraint (d) The purpose for which the

information is to be released.
■ Documentation of the notification of 1.b.(2)(d)Records of Persons Served
the family or significant other(s) of the (e) The date on which the
use of seclusion or restraint release is signed.
1.b.(2)(e)Records of Persons Served
(f) The date, event, or condition

■ Documentation of any use of seclusion or
upon which the authoriza-
restraint as a critical incident
tion expires.
■ Recording of the use of seclusion or restraint 1.b.(2)(f)Records of Persons Served
(g) Information as to how and

in the organization’s information system
when the authorization can
■ Documentation of personal safety plans, be revoked.
as applicable 1.b.(2)(g)Records of Persons Served
(h) The signature of the person

who is legally authorized to
sign the release.
1.b.(2)(h)Records of Persons Served
Intent Statements
Organizations in the United States submitting
or maintaining information in electronic formats
regarding the persons served need to pay
particular attention to requirements of the

HIPAA (PIPEDA/FOIPA in Canada). Authorization Examples

to share information is documented and specifi- 2.c. Complete refers to a central record contain-
cally refers to the information being transmitted. ing information regarding all the services the
Signed authorization forms that are not specific person receives. This is considered the main
or that are “boilerplates” will not meet this record.
standard.
The standards do not address the specific
4.D. 3. All documents generated by the organi-
instances in which it is necessary to have a signed
zation that require signatures include
release-of-information form. The intent of this
original or electronic signatures.
standard is that, if the organization is providing 3.Records of Persons Served
any information that identifies a person served, Intent Statements

it has an authorized release-of-information form Written signatures are defined as full signatures,
completed, unless exempted by law. However, not initials. Electronic systems that restrict or
this does not mean that there should be a automatically identify the person entering the
separate release form for every instance (every data and the date the information is entered
phone call or conversation with the same agency) will conform to the intent of this standard.
in which information is released; one release
per agency or person, with a time limitation,
is sufficient. There are occasions when signed
4.D. 4. The individual record includes:
release-of-information forms are required by law. a. The date of admission.

4.a.Records of Persons Served
b. Information about the individual’s

Examples
personal representative, conservator,
1.b.(2)(f) Release forms stipulate the expiration guardian, or representative payee, if
date by either providing an actual date or by indi- any of these have been appointed,
cating that the release is valid for only a specific including the name, address, and
amount of time from the date it was signed. telephone number.
Typically, the authorization will not exceed one 4.b.Records of Persons Served
c. Information about the person to

year. However, some laws may require that the contact in the event of an emergency,
authorization for release of information be for including the name, address, and
the tenure of a specific relationship; i.e., during telephone number.
the length of a person’s time on probation or 4.c.Records of Persons Served
d. The name of the person currently

parole. coordinating the services of the
person served.
4.D. 2. The individual record communicates 4.d.Records of Persons Served
e. The location of any other records.

information in a manner that is: 4.e.Records of Persons Served
f. Information about the individual’s

a. Organized. primary care physician, including

b. Clear. the name, address, and telephone

c. Complete. number, when available.

2.c.Records of Persons Served 4.f.Records of Persons Served
d. Current. g. Financial agreement with the

2.d.Records of Persons Served
e. Legible. person served.

4.g.Records of Persons Served
2.e.Records of Persons Served
h. Healthcare reimbursement
Intent Statements
information, if applicable.
The intent of this standard is that the records 4.h.Records of Persons Served
i. The person’s:
be organized in a systematic way to ensure that 4.i.Records of Persons Served
information is readily accessible. CARF does (1) Health history.

4.i.(1)Records of Persons Served
not prescribe any particular type of organizing (2) Current medications.

or filing system. (3) Preadmission screening,

when conducted.
(4) Documentation of orientation.


(5) Assessments. Intent Statements

(6) Person-centered plan, including Although duplicate records may be maintained

reviews. at multiple sites, a central record is kept current
(7) Transition plan, when applicable. and complete.

j. Progress notes. Examples

4.j.Records of Persons Served
k. A discharge summary. In some settings, separate treatment and medical

4.k.Records of Persons Served
l. Correspondence pertinent to records are required to be maintained. Together,

the person served. these constitute a single, main record.
4.l.Records of Persons Served
m. Authorization for release of

information. Documentation Examples
4.m.Records of Persons Served
n. Documentation of internal The following are examples of the types of infor-

or external referrals. mation you should have available to demonstrate
4.n.Records of Persons Served
Intent Statements section. See Appendix A for more information
In order to be comprehensive, the records on required documentation.
of the persons served should contain the ■ Individual records
information above.
■ A policy for making entries to records
Examples
■ Release forms
4.i.(7) A transition plan would not be relevant if
■ Duplicate reports or files
the person served left services without notice.
4.k. There should be a discharge summary for all
persons who have left an organization’s services.
4.D. 5. Entries to the records of the persons

served follow the organization’s policy
that specifies time frames for entries.
Intent Statements
Clearly defined time lines for admission notes,
assessments, treatment plans, and progress notes
are important for comprehensive and efficient
service provision.
Examples
Time frames are needed for treatment planning
and can be based on federal, state, provincial,
or funding source requirements.
4.D. 6. If duplicate information or reports from

the main record of a person served exist,
or if working files are maintained, such
materials:
a. Are not substituted for the main

record.
b. Are considered secondary docu-

ments, with the main record of the
person served receiving first priority.

Section 4.E. Case Management/Services Coordination (CM)
E. Case Management/ ■ 4.C. Nonviolent Practices (apply according

to guidelines in 4.C.)
Services Coordination ■ 4.D. Records of the Persons Served
(CM) ■ 4.L. Children and Adolescents (if any
children or adolescents are served)
Description
4.E. 1. The persons served are linked to services
Case management/services coordination pro-
and resources to achieve objectives as
grams provide goal-oriented and individualized
identified in their person-centered plan.
supports focusing on improved self-sufficiency 1.Case Mgmt
for the persons served through assessment,

planning, linkage, advocacy, coordination, and
monitoring activities. Successful service coordi- 4.E. 2. Personnel providing services have a
nation results in community opportunities and working knowledge of the:
increased independence for the persons served.
2.Case Mgmt
a. Services that are appropriate for the

Programs may provide occasional supportive needs of the persons served.
counseling and crisis intervention services, when 2.a.Case Mgmt
b. Support systems that are relevant

allowed by regulatory or funding authorities. to the lives of the persons served.
Case management/services coordination may be 2.b.Case Mgmt
Intent Statements
provided by an organization as part of its person-
centered planning and delivery, by a department In order to provide the linkages, coordination,
or division within the organization that works and support needed by the persons served, the
with individuals who are internal and/or external case managers are able to demonstrate knowl-
edge of health care, social services, employment,
to the organization, or by an organization with
housing, recreational opportunities, and other
the sole purpose of providing case management/
services and systems available in the community.
services coordination. Such programs are typi-
cally provided by qualified case managers/
coordinators or by case management teams. 4.E. 3. Based on the needs of the persons
served, case management/services
Organizations performing case management/
coordination includes:
services coordination as a routine function of 3.Case Mgmt
other services or programs are not required a. Activities carried out in collaboration
to apply these standards unless they are specifi- with the persons served.
3.a.Case Mgmt
cally seeking accreditation for this program. b. Outreach to encourage the participa-
tion of the persons served.
3.b.Case Mgmt
c. Coordination of, or assistance with,

Applicable Standards crisis intervention and stabilization
An organization seeking accreditation for a services, as appropriate.
psychosocial rehabilitation case management/
3.c.Case Mgmt
d. Assistance with achieving goals as

services coordination program must meet the defined by the persons served.
standards in this section and the standards in 3.d.Case Mgmt
e. Optimizing resources and opportuni-

the following sections: ties through:
3.e.Case Mgmt
(1) Community linkages.

optional 3.e.(1)Case Mgmt
(2) Enhanced social support

■ 2.B. Individual-Centered Service Planning, networks.
Design, and Delivery 3.e.(2)Case Mgmt
■ 4.B. Medication Use (apply according to

guidelines in 4.B.)

Section 4.E. Case Management/Services Coordination (CM)
f. Assistance with:
3.f.Case Mgmt 4.E. 4. The organization provides case manage-
(1) Accessing transportation. ment activities in locations that meet the
3.f.(1)Case Mgmt
(2) Securing safe housing that is needs of the persons served.

reflective of the: 4.Case Mgmt
3.f.(2)Case Mgmt
Intent Statements
(a) Needs of the persons served.
3.f.(2)(a)Case Mgmt
Services, such as assessment, planning, coordi-
(b) Abilities of the persons
nation, and monitoring, can be provided in any
served.
3.f.(2)(b)Case Mgmt setting that provides the best access to the per-
(c) Preferences of the persons sons served and is preferred by the persons
served. served.
3.f.(2)(c)Case Mgmt
(3) Exploring employment or other

Examples
meaningful activities.
3.f.(3)Case Mgmt
g. Provision of, or linkage to, skill devel- Such locations may include residences, correc-
opment services needed to enable tional settings, shelters, community resource
the person served to perform daily sites, hospitals, schools, medical, or other
living activities, including, but not service sites.
limited to:
3.g.Case Mgmt
(1) Budgeting. 4.E. 5. The intensity of case management is

3.g.(1)Case Mgmt
based on the needs of the person as
(2) Meal planning.
3.g.(2)Case Mgmt identified in his or her person-centered
(3) Personal care. plan.
3.g.(3)Case Mgmt
(4) Housekeeping and home 5.Case Mgmt
maintenance. Intent Statements

3.g.(4)Case Mgmt
(5) Other identified needs. The intensity of case management and the fre-
3.g.(5)Case Mgmt
quency of contact are individualized and clearly
h. Evidence of linkage with necessary
defined.
and appropriate:
3.h.Case Mgmt
(1) Financial services. Examples

There is wide variability among types of case
3.h.(1)Case Mgmt
(2) Medical or other health care.

3.h.(2)Case Mgmt
(3) Other community services. management. Many programs provide intensive

3.h.(3)Case Mgmt
case management to a small, select group
Intent Statements of individuals, and other programs provide
These case management activities are carried services only periodically. However, there
out in partnership and collaboration with the per- is a clear relationship between how often
sons served. Elements provided are dependent individuals are served and their specific needs.
on the needs of persons served and/or funder/
Some programs, such as Healthy Families
regulatory requirements.
America, have clearly defined criteria for
3.c. In some programs, such as Healthy Families increasing/decreasing the intensity of services.
America, guidelines specify a variety of positive
outreach methods and are used to build trust,
engage the person served in services, and 4.E. 6. When multiple case management
maintain ongoing involvement. providers exist:
6.Case Mgmt
3.h.(2) Medical or other health care includes a. A primary case manager is identified.
6.a.Case Mgmt
the coordination of the health care of the b. There is coordination to:

6.b.Case Mgmt
persons served. Often individuals are seeing a (1) Facilitate continuity of care.
variety of health care professionals and using a
6.b.(1)Case Mgmt
(2) Reduce duplication of services.

variety of medications that need to be monitored 6.b.(2)Case Mgmt
and coordinated. When working with infants or

children, health care includes immunizations.

Section 4.F. Community Integration (COI)
4.E. 7. With the permission of the persons F. Community Integration

served, personnel provide advocacy
by sharing feedback regarding the
(COI)
services received with the agencies
and organizations providing the Description
services. Community integration is designed to help
persons to optimize their personal, social, and
7.Case Mgmt
vocational competency in order to live success-

Documentation Examples fully in the community. Activities are determined
The following are examples of the types of infor- by the needs of the persons served. The persons
served are active partners in all aspects of these
your conformance to the standards in this sub- programs. Therefore, the settings can be informal
section. See Appendix A for more information in order to reduce barriers between staff mem-
bers and program participants. In addition to
services provided in the home or community, this
■ Person-centered plans for the persons served
program may include a psychosocial clubhouse,
■ Assessment and documentation of progress a drop-in center, an activity center, or a day
toward individual goals program.
Community integration provides opportunities
for the community participation of the persons
served. The organization defines the scope of
these services based on the identified needs and
desires of the persons served. A person may
participate in a variety of community life experi-
ences that may include, but are not limited to:
■ Leisure or recreational activities.
■ Communication activities.
■ Spiritual activities.
■ Cultural activities.
■ Vocational pursuits.
■ Development of work attitudes.
■ Employment activities.
■ Volunteerism.
■ Educational and training activities.
■ Development of living skills.
■ Health and wellness promotion.
■ Orientation, mobility, and destination

training.
■ Access and utilization of public
transportation.
NOTE: The use of the term persons served in
Community Integration may include members,
attendees, or participants.

(2) Interpersonal relations.

Applicable Standards 2.e.(2)COI
(3) Recreation or use of leisure

An organization seeking accreditation for a time opportunities.
psychosocial community integration program 2.e.(3)COI
(4) Vocational development or

must meet the standards in this section and employment.
the standards in the following sections: 2.e.(4)COI
(5) Educational development.

2.e.(5)COI
(6) Self-advocacy.
optional 2.e.(6)COI
(7) Access to nondisability related

■ 2.B. Individual-Centered Service Planning, social resources.
Design, and Delivery 2.e.(7)COI
Intent Statements
The organization demonstrates that a range of
basic services is provided. These services could
guidelines in 4.B.) be arranged within a psychosocial clubhouse,
■ 4.C. Nonviolent Practices (apply according an activity center, or a day program, but the
to guidelines in 4.C.) common services consist of providing assistance
■ 4.D. Records of the Persons Served with independent living skills and the other
activities described in this standard.
■ 4.L. Children and Adolescents (apply if any
children or adolescents are served) 2.e.(1) The program assists the person served
to develop the skills needed to live as indepen-
dently as possible in the community.
4.F. 1. The persons participating in services/
activities move toward: Examples
2.e.(1) Assistance may be provided to develop or
1.COI
a. Optimal use of:

1.a.COI
(1) Natural supports. enhance skills related to performing household

1.a.(1)COI
activities, cooking, grocery shopping, laundry,
(2) Self-help.
1.a.(2)COI or money management.
b. Greater self-sufficiency.
1.b.COI 2.e.(3) This may include volunteer activities.
c. Greater choice.
1.c.COI
d. Greater control of their lives.

1.d.COI 4.F. 3. If work is performed by program
e. Increased participation in the participants, legal wage guidelines
community. are observed.
1.e.COI
3.COI
4.F. 2. Services/activities are organized around: 4.F. 4. Services are provided at times and
2.COI
a. The stated goals of the persons locations that meet the needs of
served. the persons served.
2.a.COI
b. The identified preferences of the 4.COI
Intent Statements
persons served.
2.b.COI
The program’s services and hours of operation,
c. The identified needs of the persons
served.
2.c.COI evaluated periodically to ensure that the services
d. Improving the ability of the persons are available and accessible to meet the needs
served to understand their needs. and interests of the persons served.
2.d.COI
e. Assisting the persons served to

achieve their goals of choice in the 4.F. 5. Personnel are available to meet with
following areas: persons served to discuss matters of
2.e.COI
(1) Community living skill mutual interest or concern.

development. 5.COI
2.e.(1)COI

Examples to reduce all barriers to access. The intent of this

These meetings could be community meetings or standard is to ensure that the program adopt
house meetings for the purpose of collaboratively procedures that describe how the program will
discussing issues such as: coordinate services and referrals to reduce dis-
ruption of the persons served.
■ Hours of operation. Documentation Examples

■ Problems. The following are examples of the types of infor-
■ Plans. mation you should have available to demonstrate
4.F. 6. The organization provides information
or referral to assist the persons served
in securing assistance to meet their ■ Meeting schedules and notes
basic needs.
6.COI
Examples
This may include any of the following based on
the needs of the person served:
■ Income maintenance.
■ Benefits.
■ Food, clothing, and household goods.
■ Short-term or emergency shelter.

housing.
■ Medical and health care.

■ Transportation.
Other relevant behavioral health services may

include therapy, testing, medication manage-
ment, crisis intervention, and psychiatric
assessment.
4.F. 7. The program’s outreach to and follow-up

procedures for the persons served are
directed to:
7.COI
a. Those who drop out of services.

7.a.COI
b. Those who have been admitted to

a treatment, institutional, or other
setting.
7.b.COI
Intent Statements
Each program is encouraged to work coopera-
tively with other agencies in the community to
develop a seamless continuum of services and

Section 4.G. Community Housing (CH)
G. Community Housing Community housing may include either or both

of the following:
(CH) ■ Transitional living that provides interim sup-
ports and services for persons who are at risk
Description of institutional placement, persons transition-
Community housing addresses the desires, goals, ing from institutional settings, or persons
strengths, abilities, needs, health, safety, and life who are homeless. Transitional living can
span issues of the persons served, regardless of be offered in apartments or homes, or in
the home in which they live and/or the scope, congregate settings that may be larger than
duration, and intensity of the services they residences typically found in the community.
receive. The residences in which services are ■ Long-term housing that provides stable,
provided may be owned, rented, leased or oper- supported community living or assists the
ated directly by the organization, or a third party, persons served to obtain and maintain safe,
such as a governmental entity. Providers exercise affordable, accessible, and stable housing.
control over these sites. The residences at which community housing
Community housing is provided in partnership services are provided must be identified in the
with individuals. These services are designed to survey application. These sites will be visited
assist the persons served to achieve success in during the survey process and identified in the
and satisfaction with community living. They survey report and accreditation outcome as a site
may be temporary or long term in nature. The at which the organization provides a Community
services are focused on home and community Housing program.
integration and engagement in productive
activities. Community housing enhances the
independence, dignity, personal choice, and Applicable Standards
privacy of the persons served. For persons in An organization seeking accreditation for a
alcohol and other drug programs, these services psychosocial rehabilitation community hous-
are focused on providing sober living environ- ing program must meet the standards in this
ments to increase the likelihood of sobriety section and the standards in the following
and abstinence and to decrease the potential sections:
for relapse. ■ 1.A. and 1.C.–1.N.; 1.B. Governance is
Community housing programs may be referred optional
to as recovery homes, transitional housing, sober ■ 2.B. Individual-Centered Service Planning,
housing, domestic violence or homeless shelters, Design, and Delivery
safe houses, group homes, or supervised inde-
pendent living. These programs may be located
in rural or urban settings and in houses, apart- ■ 4.B. Medication Use (apply according to
ments, townhouses, or other residential settings guidelines in 4.B.)

owned, rented, leased, or operated by the organi- ■ 4.C. Nonviolent Practices (apply according
zation. They may include congregate living to guidelines in 4.C.)
facilities and clustered homes/apartments in ■ 4.D. Records of the Persons Served
multiple-unit settings. These residences are often
■ 4.L. Children and Adolescents (if any
physically integrated into the community, and
children or adolescents are served)
every effort is made to ensure that they approxi-
mate other homes in their neighborhoods in
terms of size and number of residents.

(6) Employment/income generation

4.G. 1. Each person served is in a residential activities.
setting with his or her own personal 2.g.(6)CH
space that: (7) Necessary transportation.

2.g.(7)CH
1.CH
a. Respects privacy. (8) Self-help groups.

2.g.(8)CH
1.a.CH
b. Promotes personal security. (9) Other activities as identified

1.b.CH in the person’s plan.
c. Promotes safety. 2.g.(9)CH
1.c.CH h. Policies related to:

Intent Statements 2.h.CH
(1) Visitors or guests.

Persons served have a right to personal, 2.h.(1)CH
(2) Pets.
private space. 2.h.(2)CH
Intent Statements
Examples
Persons served have choice in services/supports.
1.a. This standard does not require a separate
room for each resident, but it does suggest the Examples
provision of a safe, secure, private location that 2.a. These meetings could be community
can be thought of by the person served as his meetings or meetings for the purpose of
or her own. collaboratively discussing issues such as:
1.c. Safety needs are determined on the basis ■ Program operations.
of the individuals’ strengths and needs. See also ■ Problems.

standards in Section 1.H. Health and Safety ■ Plans.
for all sites owned, leased, or operated by the
organization.
2.b. The program encourages all persons served
4.G. 2. The organization provides the following to take increasing responsibility for cooperative
community living components: operation of the household. Activities may
2.CH
a. Regular meetings between the include the preparation of food and the per-
persons served and staff. formance of daily household duties.
2.a.CH
b. Opportunities to participate in 2.f. Depending on the program structure and

typical home activities. the needs of the persons served, there may be
2.b.CH
procedures for maintaining separate sleeping
c. Appropriate linkage when health-
areas in accordance with the genders, ages,
care needs of the persons served
and developmental level of the persons served.
are identified.
2.c.CH Whenever possible, each person served has the
d. A personalized setting. choice of a private room or the opportunity to
2.d.CH
e. Daily access to nutritious meals participate in the selection of roommates.

and snacks.
2.e.CH
2.g.(8) Activities could include meetings of
f. The opportunity for expression 12-step and other self-help groups.
of choice by the persons served in
regard to rooms and housemates.
2.f.CH 4.G. 3. In-home safety needs of persons served
g. Based on the choice of the persons are addressed with respect to:
served, opportunities to access: 3.CH
2.g.CH a. Environmental risks.

(1) Community activities. 3.a.CH
2.g.(1)CH b. Abuse and/or neglect inflicted

(2) Cultural activities. by self or others.
2.g.(2)CH
(3) Social activities. 3.b.CH
c. Self-protection skills.
2.g.(3)CH
(4) Recreational activities. 3.c.CH
d. Medication management.
2.g.(4)CH
(5) Spiritual activities. 3.d.CH
2.g.(5)CH


Safety needs are determined on the basis of The safety and security of the living arrange-
the individuals’ strengths and needs. ments of the persons served are assessed, risk
factors and accessibility issues are identified,
Examples
and modifications are made to make the housing
See also standards in Section 1.H. Health and choices acceptable.
Safety for all sites owned, leased, or operated
by the organization. Examples
Successful transition of a person served to safe
4.G. 4. When possible, persons served have and affordable housing requires the organization
options to make changes in their to establish organizational procedures based on
living arrangements: input from a variety of customers and stakehold-
4.CH
ers. Planning considerations should include the
a. At their request.
4.a.CH strengths and needs of the persons served, as
b. At the request of their families, well as areas of organizational consideration and
when applicable. resources that will need to be addressed. Those
4.b.CH
c. In transitional living, on a periodic areas include accessibility plans and resources

basis when initiated by the budgeted to remove barriers, appropriate review
organization. of health and safety factors as defined by local
4.c.CH
d. Based on informed choice. authorities, and the various aspects of risk

management, and are all part of the individual
4.d.CH
Intent Statements
services and organizational planning necessary
Residential services and supports are flexible to secure transitional housing.
and fluid, as the needs and desires of the
persons served change.
4.G. 6. Each person served receives:
Examples 6.CH
a. Skill development necessary to live

The preference for a different living situation as independently as possible.
is typically addressed at the person’s planning 6.a.CH
b. Ongoing support/services as he or
meeting. she explores changes in his or her
Knowledge of existing and planned services is living arrangements.
important for the persons served so that they can 6.b.CH
Intent Statements
make informed choices about alternative living
arrangements. Alternative living arrangements The person served has continuous access to
may be provided by the organization or other services and support. The person’s plan is con-
providers. The term living arrangements refers tinuously monitored, and modifications are
to the service model and not the residence or made in the plan as the needs and circumstance
home itself. of the person served change.
6.b. The person served may need confidence and
courage to try alternative living arrangements. It
4.G. 5. Based on the needs of persons transi- is the responsibility of the provider organization
tioning to other housing, there are
to attempt to minimize risks of trying alternative
procedures in place to assist them in living arrangements.
securing housing that is:
5.CH
a. Safe. Examples
5.a.CH
b. Affordable. A number of resources can be helpful in planning

5.b.CH
c. Accessible. delivery of services/supports. These include the

5.c.CH CARF publication Using Individual-Centered
d. Acceptable.
5.d.CH
able on request from your resource specialist, as
well as related standards regarding accessibility,

health and safety, and fiscal management found Intent Statements

in Section 1 of this manual. Often, the develop- When transportation cannot be accessed
ment of a professional team and a circle of independently by the persons served, the
support and friends can be helpful in encourag- organization coordinates transportation to
ing persons served to try alternative living other relevant services and activities.
arrangements.
4.G. 11. The organization demonstrates efforts
4.G. 7. Personnel are on site based on the to maintain a person’s residence as long
needs of the persons served, as iden- as possible during temporary medical,
tified in their person-centered plans. legal, or personal absences.
7.CH 11.CH
Intent Statements
Personnel have the experience/training needed
to effectively deal with the needs of the persons 4.G. 12. The organization provides information
served. to residents that includes:
12.CH
Examples
a. How to access community resources
if needed.
If the program serves persons with autism, per- 12.a.CH
b. Safety issues related to the service

sonnel have experience and training in this area.
delivery site.
12.b.CH
c. Access to emergency care when

4.G. 8. There is a system for the on-call it is needed.
availability of designated personnel 12.c.CH
24 hours a day, 7 days a week. d. Specific healthcare procedures

8.CH
and techniques.
12.d.CH
e. Contingency plans in case either

the support system or the service
4.G. 9. In congregate housing, provisions provider is unable to deliver care.
are made to address the need for: 12.e.CH
9.CH
f. A review of how to deal with emer-
a. Smoking or nonsmoking areas. gencies and evacuation from the
9.a.CH
b. Quiet areas. residence.

9.b.CH
12.f.CH
c. Areas for visits. NOTE: This standard applies only to programs pro-
9.c.CH
d. Separate sleeping areas based on: vided in apartment-type situations where agency
9.d.CH
(1) Age. staff do not reside at the site.

9.d.(1)CH
(2) Gender.
9.d.(2)CH Documentation Examples
(3) Developmental need.
9.d.(3)CH
e. Other issues, as identified
by the residents.
9.e.CH your conformance to the standards in this sub-
Intent Statements section. See Appendix A for more information
When housing is shared by two or more individu- on required documentation.
als, the program actively addresses the need to ■ Policies related to visitors, guests, and pets
designate space for privacy and individual ■ A descriptive outline or curriculum for
interests.
training
4.G. 10. The organization assists the person

served to identify and utilize available
modes of transportation.
10.CH

Section 4.H. Supported Living (SL)
H. Supported Living (SL) ■ 4.B. Medication Use (apply according to

guidelines in 4.B.)
Description ■ 4.C. Nonviolent Practices (apply according
Supported living addresses the desires, goals,
strengths, abilities, needs, health, safety, and life ■ 4.D. Records of the Persons Served
span issues of persons living in their own homes ■ 4.L. Children and Adolescents (if any
(apartments, townhouses, or other residential children or adolescents are served)
settings). Supported living services are generally
long term in nature, but may change in scope, 4.H. 1. Based on the needs of the persons
duration, intensity, or location as the needs and served, assistance is offered in securing
preferences of individuals change over time. or maintaining housing that is:
1.SL
Supported living refers to the support services a. Safe.

provided to the person served, not the residence
1.a.SL
b. Affordable.
in which these services are provided. A sampling 1.b.SL
c. Accessible.
of these sites will be visited as part of the inter- 1.c.SL
d. Chosen by the individual.

view process of the person served. Although 1.d.SL
the residence will generally be owned, rented, Intent Statements

or leased by the person who lives there, the Although these services are provided to persons
organization may occasionally rent or lease an in their own homes, it may or may not be neces-
apartment when the person served is unable to sary for the provider to offer assistance in locating
do so. Typically, in this situation the organization an appropriate location.
would cosign or in other ways guarantee the lease
or rental agreement; however, the person served 4.H. 2. In-home safety needs of persons served
would be identified as the tenant. The home or are addressed with respect to:
individual apartment of the person served, even 2.SL
when the organization holds the lease or rental 2.a.SL
b. Abuse and/or neglect inflicted

agreement on behalf of the person served, is not
by self or others.
included in the survey application or identified as 2.b.SL
a site on the accreditation outcome. c. Self-protection skills.

2.c.SL
NOTE: The term home is used in the following stan- d. Medication management.
2.d.SL
dards to refer to the dwelling of the person served; Intent Statements

however, CARF accreditation is awarded based on Health and safety risks may be greater in this
the services provided. This is not intended to be cer- type of residential support service. This standard
tification, licensing, or inspection of a site. amplifies those in Section 1.H. and should be
considered in their context.
An organization seeking accreditation for a 4.H. 3. Persons served have input into:
3.SL
psychosocial rehabilitation supported living a. Where they live.

3.a.SL
program must meet the standards in this b. With whom they live.
3.b.SL
section and the standards in the following Intent Statements

sections:
These elements of interdependence and self-
determination are fundamental to the concepts
optional of supported living and will enhance satisfaction
■ 2.B. Individual-Centered Service Planning, results for the persons served.

Section 4.H. Supported Living (SL)
i. Financial stability.
4.H. 4. Persons served determine the décor 8.i.SL
in their homes. j. Other identified needs.

8.j.SL
4.SL
Intent Statements
Supported living services may be more inclusive
4.H. 5. Support personnel are available based of life needs than traditional residential support
on the needs of the person served, as for basic food and shelter requirements.
identified in the person-centered plan. Examples
5.SL
Intent Statements 8.b. This may include assistance with daily needs,
Supported living services may be up to 24/7/365 personal hygiene, shopping, meal preparation,
support, depending on local regulatory require- selection of wardrobe, and/or personal
ments and definitions. This is individualized to belongings.
each person’s specific needs.
4.H. 9. Persons served are provided opportuni-
4.H. 6. Support personnel collaborate with the ties to choose and access:
9.SL
person’s support network, as directed a. Community activities.

9.a.SL
by the person served. b. Cultural activities.

6.SL
9.b.SL
Intent Statements c. Social activities.

9.c.SL
This standard defines the amount of control d. Recreational activities.

9.d.SL
the person served has over the living supports. e. Spiritual activities.
9.e.SL
f. Employment/income generation
4.H. 7. A system is in place to provide access to activities.
9.f.SL
needed services 24 hours a day, 7 days g. Transportation, when necessary.

a week.
9.g.SL
7.SL
h. Other.
9.h.SL
Intent Statements
Refer to Standard 5. above. The extent of service
support is determined by the needs of the indi- 4.H. 10. The organization provides information
vidual and based on the program plans, local to residents that includes:
definitions, and regulations. 10.SL
a. How to access community resources

if needed.
4.H. 8. Based on the needs and desires of the 10.a.SL
b. Safety issues related to the service

person served, support is offered in delivery site.
the following areas: 10.b.SL
c. Access to emergency care when

8.SL
a. Healthy lifestyles. it is needed.

8.a.SL
b. Personal care. 10.c.SL
d. Specific healthcare procedures

8.b.SL
c. Home maintenance. and techniques.

8.c.SL 10.d.SL
d. His or her role as a tenant, when e. Contingency plans in case either

applicable. the support system or the service
8.d.SL
e. Effective self-advocacy and provider is unable to deliver care.

10.e.SL
decision making. f. A review of how to deal with emer-

8.e.SL
f. Family contact, if desired. gencies and evacuation from the

8.f.SL
g. Social life and friendships/ residence.

10.f.SL
relationships. NOTE: Standard 10. applies only to programs

8.g.SL
h. Community membership and provided in apartment-type situations where

social networks. agency staff do not reside at the site.
8.h.SL

Section 4.I. Assessment and Referral (AR)
Documentation Examples I. Assessment and

mation you should have available to demonstrate Referral (AR)
on required documentation. Assessment and referral programs provide
■ Records of the persons served a variety of activities, including prescreening,
■ Person-centered plans screening, psychosocial assessment, determina-
■ Progress notes
tion of need, and referral to appropriate level of
care. The provision of information on available
■ Health and safety information
resources is not considered a full assessment and
■ Procedures manual referral program. An adequate assessment must
be conducted to provide more informed referrals.
Such programs may be separate, freestanding
programs, an independent program within a
larger organization, or a specifically identified
activity within a system of care. Organizations
performing assessment and referral as a routine
function of entrance into other core programs,
such as their outpatient treatment, case manage-
ment, or residential programs, are not required to
apply these standards unless they are specifically
seeking accreditation for assessment and referral.
An organization seeking accreditation for a
psychosocial rehabilitation assessment and
referral program must meet the standards in
this section and the standards in the following
sections:
optional
■ 4.A. Program/Service Structure, Standards
1.–10., 18., 20., 21., 24., and 25.
guidelines in 4.B.)
■ 4.C. Nonviolent Practices (apply according
■ 4.D. Records of the Persons Served
■ 4.L. Children and Adolescents (apply if

any children or adolescents are served)

Section 4.I. Assessment and Referral (AR)
4.I. 1. The program implements policies and 4.I. 3. When requested, the program provides
procedures for assessment and referral a written summary of the assessment
that include: and referral(s) to the person served or
his or her legal representative.
1.A/R
a. Identification of the use of valid, reli- 3.A/R
able, or standardized assessment

tools, tests, or instruments.
1.a.A/R
b. A demonstrated method of identify-

ing appropriate levels of care for the The following are examples of the types of infor-
person served. mation you should have available to demonstrate
1.b.A/R
c. Linkage to: your conformance to the standards in this sub-

1.c.A/R
(1) Emergency services. section. See Appendix A for more information

1.c.(1)A/R
(2) Crisis intervention services, on required documentation.

as needed. ■ Policies for assessment and referral
1.c.(2)A/R
■ Assessment tools
Intent Statements
■ A community resources file
1.a. Valid and reliable assessment tools consist of
public- or private-domain tests and instruments
that have been validated for use as methods of
screening and assessing the severity of symptoms
and level of functioning.
1.b. The organization should use valid assess-
ment tools that determine the level of care or
have criteria in place for level-of-care placement.
4.I. 2. The program provides the following

services in collaboration with the
person served:
2.A/R
a. Assessment of the needs of the

person served.
2.a.A/R
b. Identification of the choices available

for community resources.
2.b.A/R
c. Provision of informational materials

pertaining to community resources,
when possible.
2.c.A/R
d. Identification of services that are:

2.d.A/R
(1) Culturally appropriate.

2.d.(1)A/R
(2) Age appropriate.

2.d.(2)A/R
e. Implementation of methods to:

2.e.A/R
(1) Determine if services were

accessed by the persons served.
2.e.(1)A/R
(2) Provide follow-up, when

indicated.
2.e.(2)A/R
Examples
2.b. The program may provide information
through the use of a community resource site,
brochures, or service listing(s).

Section 4.J. Diversion/Intervention (DVN)
J. Diversion/Intervention children or adolescents, the standards in

Section 4.L. do not apply.
(DVN)
4.J. 1. Services are designed by personnel with
Description demonstrated skill and knowledge in
Diversion/Intervention programs may include current evidence-informed/evidence-
programs traditionally thought of as intervention based intervention/diversion theory and
that focus on changing outcomes for persons practice or diversionary alternatives.
1.Diversion/Intervention
served and targeting antecedents of the problem. Examples

Diversion/Intervention programs utilize strate- The program can demonstrate conformance to
gies designed to intervene with at-risk or this standard through staff member interviews
identified individuals to reduce or eliminate and documentation of skills and training in per-
identified concerns. Within the child welfare sonnel files.
field, examples include alternative response,
differential response, or multiple response sys-
tems. Diversion/Intervention programs may 4.J. 2. The program collaborates with other
serve persons on a voluntary and/or involuntary programs and stakeholders within the
basis. Programs that serve persons on an invol- community to:
untary basis are designed to implement special a. Ensure that agencies are knowledge-
strategies for engaging this population. able of each others’ services.
2.a.Diversion/Intervention
Diversion programs may include programs such b. Assist with the process of referrals.
2.b.Diversion/Intervention
as juvenile justice/court diversion, substance c. Coordinate community planning

abuse diversion, truancy diversion, DUI/OWI and development services.
2.c.Diversion/Intervention
classes, report centers, home monitoring, after- Intent Statements

school tracking, anger management, and building
The program works collaboratively with other
healthy relationships.
prevention, diversion, intervention, treatment,
Intervention programs target persons who are and community services to coordinate with and
exhibiting early signs of identified problems and avoid overlapping use of community resources.
are at risk for continued or increased problems.
Examples
Collaboration can be demonstrated by:
Applicable Standards ■ The use of the program’s services by other
An organization seeking accreditation for organizations.
a psychosocial rehabilitation diversion/ ■ Memberships on planning councils.
intervention program must meet the
■ Participation in multiagency United Way
standards in this section and the standards
and other community organizations
in the following sections:
or public health activities such as health fairs.
■ 1.A. and 1.C.–1.N.; 1.B. Governance
■ Participation in communitywide health
is optional
education activities.
Standards 1.–11., 13., and 19.–21.
4.J. 3. The program provides applicable infor-
■ 4.B. Medication Use (apply according
mation in one or more of the following
to guidelines in 4.B.) areas:
■ 4.C. Nonviolent Practices (apply
a. Mental health.
according to guidelines in 4.C.) 3.a.Diversion/Intervention
b. Alcohol, tobacco, and other drug use.

■ If an organization is seeking accreditation
c. Child abuse and neglect.

for a diversion/intervention program for 3.c.Diversion/Intervention
d. Suicide prevention.
3.d.Diversion/Intervention

e. Violence prevention.
3.e.Diversion/Intervention 4.J. 5. The program includes two or more of
f. Health and wellness. the following strategies:
3.f.Diversion/Intervention
g. Social and community issues. 5.Diversion/Intervention
a. Increasing knowledge and raising

3.g.Diversion/Intervention
h. Internet safety. awareness.

3.h.Diversion/Intervention
i. Acceptance of cultural diversity. 5.a.Diversion/Intervention
b. Building skills and competencies.

3.i.Diversion/Intervention
j. Effective parenting. 5.b.Diversion/Intervention
c. Increasing involvement in healthful

3.j.Diversion/Intervention
Examples alternatives.
Information may be provided through: d. Increasing access to services.

■ Sponsorship or participation in community

e. Improving early identification of:
5.e.Diversion/Intervention
events and activities. (1) Needs.

5.e.(1)Diversion/Intervention
■ Participation in health fairs. (2) Referrals.

5.e.(2)Diversion/Intervention
■ Public service announcements.

f. Influencing behavioral change.
5.f.Diversion/Intervention
■ Community seminars and workshops.

g. Reducing incidence of problem
behaviors.
Specific topic areas could include: 5.g.Diversion/Intervention
h. Changing institutional policies.

■ 3.a. Stress management education; teen help
5.h.Diversion/Intervention
i. Influencing how laws are:

lines. 5.i.Diversion/Intervention
(1) Developed.
■ 3.b. Education regarding tobacco use, sub- 5.i.(1)Diversion/Intervention
(2) Interpreted.
stance reduction, MADD/SADD groups, 5.i.(2)Diversion/Intervention
(3) Enforced.
prescription drug abuse, and drug-free 5.i.(3)Diversion/Intervention
workplace programs. j. Building the capacity of collaborative

partnerships.
■ 3.e. Domestic violence, including inter- 5.j.Diversion/Intervention
personal, family, and intimate partner k. Building the capacity of the commu-
relationships; bullying, gangs, and nity to address its needs.
5.k.Diversion/Intervention
school-based violence. l. Mentoring.

5.l.Diversion/Intervention
■ 3.f. Safe sex, sexually transmitted diseases,

HIV/AIDS, communicable diseases, teen
pregnancy. 4.J. 6. The program has a plan or written
■ 3.g. Spirituality-based programs; dating logic model that details:
issues. a. The specific theoretical approaches

to be used.
4.J. 4. Program activities are: b. The methodological approaches

a. Culturally relevant. to be used.

b. Age appropriate. c. How the approaches will be applied

within the community.
c. Gender appropriate. 6.c.Diversion/Intervention
d. Targeted toward multiple settings Intent Statements

within the community. The program is able to document that the
approach it uses has a sound theoretical
Examples
foundation.
4.d. The activities can be directed to:
Examples
■ Individuals.
Specific theoretical or methodological prevention
■ Families.
approaches could include the use of:
■ Organizations.
■ Health and wellness models.
■ Systems of care.
■ Developmental models.
■ The community and the region.

■ Risk and resiliency models. Documentation Examples

■ Public health models. The following are examples of the types of infor-
■ Social competency models. mation you should have available to demonstrate
7.Diversion/Intervention on required documentation.
a. Has procedures for referring
■ Written plan or logic model that details
persons served to other:
7.a.Diversion/Intervention specific approaches to be used
(1) Health services, as needed.
7.a.(1)Diversion/Intervention
■ Plan for individual outcomes
(2) Social services, as needed.
7.a.(2)Diversion/Intervention
■ Documentation of evaluation of programs/
b. Demonstrates that personnel
are knowledgeable of current services and training activities
c. Conducts evaluation of its:

(1) Programs/services.
7.c.(1)Diversion/Intervention
(2) Training activities.

7.c.(2)Diversion/Intervention
Intent Statements
7.a. If, as a result of diversion/intervention ser-
vices or activities, individuals identify themselves
or are identified by family members, significant
others, or personnel as needing treatment, pro-
gram staff members know how to refer these
individuals for appropriate services.

a. Utilizes a screening or assessment

process to identify individuals for
participation or enrollment in the
program.
b. Includes a documented plan for

individual outcomes.
Intent Statements
While it is important to accurately determine a
participant’s appropriateness for the diversion/
intervention program, the screening or assess-
ment may be completed by an external entity.

Section 4.K. Prevention (P)
K. Prevention (P) ■ Training programs provide curriculum-based

instruction to active or future personnel in
human services programs.
Description
Examples of training programs include case-
Prevention programs are proactive and evidence- worker training, child welfare supervisory
based/evidence-informed, striving to reduce training, foster parent training, leadership
individual, family, and environmental risk fac- training, guardian/guardian ad-litem training,
tors, increase resiliency, enhance protective and childcare assistant training.
factors, and achieve individual and compre-
hensive community wellness through a team
or collaborative approach. Prevention programs Applicable Standards
utilize strategies designed to keep individuals, An organization seeking accreditation for
families, groups, and communities healthy and a psychosocial rehabilitation prevention
free from the problems related to alcohol or other program must meet the standards in
drug use, mental health disorders, physical ill- this section and the standards in the
ness, parent/child conflict, abuse or neglect, following sections:
exposure to or experience of violence in the
■ 1.A. and 1.C.–1.N.; 1.B. Governance
home and community; to inform the general
public of problems associated with those issues, is optional
thereby raising awareness; or to intervene with ■ 4.A. Program/Service Structure,
at-risk individuals to reduce or eliminate identi- Standards 1.–10. and 20.

fied concerns. Programs may be provided in the ■ 4.B. Medication Use (apply according
community, school, home, workplace, or other to guidelines in 4.B.)
settings. ■ 4.C. Nonviolent Practices (apply
Organizations may provide one or more of the according to guidelines in 4.C.)
following types of prevention programs, catego- ■ If an organization is seeking accreditation
rized according to the population for which for a prevention program for children or
they are designed: adolescents, the standards in Section 4.L.
■ Universal programs target the general popula- do not apply.
tion and seek to increase overall well-being NOTE: If the program is strictly a training program
and reduce the overall prevalence of problem and no direct services to persons served are pro-
behaviors, and include comprehensive, well- vided, Standard 6. in this section is not applicable.
coordinated components for individuals,
families, schools, communities, and organi-
4.K. 1. Services are designed by personnel with
zations. Universal prevention programs
demonstrated skill and knowledge in
promote positive behavior and include social
current evidence-informed/evidence-
marketing and other public information
based prevention theory and practice.
efforts. 1.Prevention
■ Selected programs target groups that are

Examples
exposed to factors that place them at a greater The program can demonstrate conformance to
than average risk for the problem. These pro- this standard through staff member interviews
grams are tailored to reduce identified risk and documentation of skills and training in
factors and strengthen protective factors. personnel files.
Examples of prevention programs include
pregnancy prevention, drop-out prevention,
Strengthening Families, substance abuse pre-
vention, violence prevention, HIV prevention,
tobacco use prevention, child abuse preven-
tion, and suicide prevention.

4.K. 2. The program includes efforts to increase 4.K. 3. Program activities are:
public awareness in one or more of the
3.Prevention
a. Culturally relevant.
following areas: 3.a.Prevention
b. Age appropriate.
2.Prevention
a. Mental health. 3.b.Prevention
c. Gender appropriate.
2.a.Prevention
b. Alcohol, tobacco, and other drug use. 3.c.Prevention
d. Targeted toward multiple settings

2.b.Prevention
c. Child abuse and neglect. within the community.

2.c.Prevention
d. Suicide prevention.
3.d.Prevention
2.d.Prevention Examples
e. Violence prevention.
2.e.Prevention 3.d. The activities can be directed to:
f. Health and wellness.
2.f.Prevention ■ Individuals.
g. Social/community issues.
2.g.Prevention
■ Families.
h. Internet safety.
2.h.Prevention
■ Organizations.
i. Acceptance of cultural diversity.
■ Systems of care.
2.i.Prevention
j. Effective parenting.
■ The community and the region.
2.j.Prevention
Intent Statements
For training programs, efforts are targeted to
prepare personnel to provide services in one
4.K. 4. Universal and selected programs include
or more of the areas identified. two or more, and training programs
include a.–g., of the following strategies:
Examples 4.Prevention
a. Increasing knowledge and raising

Public awareness efforts may include: awareness.
4.a.Prevention
■ Sponsorship of or participation in b. Building skills and competencies.

community events.
4.b.Prevention
c. Increasing awareness of healthy

■ Participation in health fairs. alternatives.
4.c.Prevention
■ Public service announcements. d. Increasing awareness of available

■ Community seminars and workshops.
services.
4.d.Prevention
e. Improving early identification of:

Specific topic areas could include: 4.e.Prevention
(1) Needs.
■ 2.a. Stress management education; teen help 4.e.(1)Prevention
(2) Referrals.
lines. 4.e.(2)Prevention
f. Influencing behavioral change.

■ 2.b. Education regarding tobacco use, sub- 4.f.Prevention
g. Reducing incidence of problem

stance reduction, MADD/SADD groups,
behaviors.
prescription drug abuse, and drug-free 4.g.Prevention
workplace programs. h. Changing institutional policies.

4.h.Prevention
■ 2.e. Domestic violence, including inter-

i. Influencing how laws are:
4.i.Prevention
personal, family, and intimate partner (1) Developed.

4.i.(1)Prevention
relationships; bullying, gangs, and (2) Interpreted.

4.i.(2)Prevention
school-based violence. (3) Enforced.

4.i.(3)Prevention
■ 2.f. Safe sex, sexually transmitted diseases, j. Building the capacity of collaborative
HIV/AIDS, communicable diseases, teen partnerships.
pregnancy.
4.j.Prevention
k. Building the capacity of the commu-

■ 2.g. Spirituality-based programs; dating nity to address its needs.
4.k.Prevention
issues. Intent Statements

Prevention, consultation, education, and training
services typically employ a variety of strategies.

Examples
4.K. 7. Training programs document a written
4.i. Programs may work to influence develop-
comprehensive curriculum for each
ment or enforcement of laws such as curfews or
course offered that guides the training
laws related to use of seat belts or bicycle helmets.
and includes:
7.Prevention
a. The course philosophy.

4.K. 5. The program has a plan or written 7.a.Prevention
b. The course outline.

logic model that details: 7.b.Prevention
5.Prevention
c. Competency-based objectives.
a. The specific theoretical approaches 7.c.Prevention
to be used. d. Instructional methods and materials.

7.d.Prevention
5.a.Prevention
b. The methodological approaches e. The sequence and hours of

to be used. instruction.
7.e.Prevention
5.b.Prevention
c. How the approaches will be applied f. Clinical/practicum expectations,

within the community. if applicable.
7.f.Prevention
5.c.Prevention
g. A revision schedule and
Intent Statements methodology.
The program is able to document that the 7.g.Prevention
approach it uses has a sound theoretical Examples

foundation. 7.g. The course is reviewed and revised on an
annual basis through the use of course evaluation
Examples
feedback, trainees’ successful completion rate,
Specific theoretical or methodological prevention and subject matter content changes.
approaches could include the use of:
■ Health and wellness models.
4.K. 8. Training programs:
■ Developmental models.
8.Prevention
a. Utilize an expert advisory committee.

■ Risk and resiliency models.
8.a.Prevention
b. Satisfy regulatory requirements lead-

■ Public health models. ing to certification, as applicable.
8.b.Prevention
■ Social competency models. c. Focus on the care of the persons

served.
8.c.Prevention
4.K. 6. The program: d. Identify educational and other

6.Prevention
a. Has procedures for referring persons prerequisite requirements.

8.d.Prevention
served to other: e. Utilize consistent evaluation.

8.e.Prevention
6.a.Prevention
(1) Health services, as needed. f. Provide a coordinated, logical

6.a.(1)Prevention
learning experience.
(2) Social services, as needed. 8.f.Prevention
6.a.(2)Prevention
b. Demonstrates that personnel Intent Statements

are knowledgeable of current 8.c. The focus and emphasis of the training is
community resources. to provide instruction and tools to the trainees
so they will provide quality care to the persons
6.b.Prevention
c. Conducts evaluation of its:

6.c.Prevention
(1) Programs/services. served.

6.c.(1)Prevention
(2) Training activities. Examples

6.c.(2)Prevention
Intent Statements 8.a. A recognized expert/teacher in the field

who is external to the program, an external
6.a. If, as a result of education and awareness
administrator, and an external service provider
activities, individuals identify themselves or
meet biannually to review the curriculum and
are identified by family members or significant
others as needing treatment, program staff the program’s policies and procedures in order
members know how to refer these individuals to support utilization of the latest research and
for appropriate services. accepted practices.

Section 4.L. Children and Adolescents (CA)
8.f. The program provides the theoretical basis of

the curriculum prior to teaching the application
L. Children and
of that knowledge in a practical, hands-on man- Adolescents (CA)
ner. The trainee learns the stages of grieving and
methods of counseling before applying these Description
skills to a person served.
Programs for children and adolescents consist
Documentation Examples of an array of behavioral health services designed
specifically to address the treatment needs of
The following are examples of the types of infor- children and adolescents. Such programs tailor
mation you should have available to demonstrate their services to the particular needs and pre-
your conformance to the standards in this sub- ferences of children and adolescents and are
section. See Appendix A for more information provided in a setting that is both relevant to
on required documentation. and comfortable for this population.
■ Written plan or logic model that details
specific approaches to be used
■ Documentation of evaluation of programs/
services and training activities If children or adolescents (up to age 18 unless
legally emancipated) are served in any core
program in Section 4 that is seeking accredita-
tion other than Diversion/Intervention or
Prevention, the standards in this section must
be applied in addition to standards for the pro-
gram(s) for which the organization is seeking
accreditation. An organization cannot be
accredited for children and adolescents alone,
but rather must select at least one core pro-
gram to which it wants this designation
applied.
NOTE: Legal emancipation generally occurs
through marriage, a court order, or specific
rules of the Indian Child Welfare Act.
4.L. 1. Assessments of each child or adolescent

served include information on his or her:
1.CA

developmental age factors, motor
development, and functioning.
1.a.CA
b. Medical or physical health history.

1.b.CA
c. Culture/ethnicity.
1.c.CA
d. Treatment history.
1.d.CA
e. School history.
1.e.CA
f. Language functioning, including:

1.f.CA
(1) Speech functioning.

1.f.(1)CA
(2) Hearing functioning.

1.f.(2)CA
g. Visual functioning.
1.g.CA
h. Immunization record.
1.h.CA
i. Learning ability.
1.i.CA

j.Intellectual functioning. c. Culture.

1.j.CA 2.c.CA
k. Family relationships. d. Education.

1.k.CA 2.d.CA
l.Interactions with peers.

1.l.CA
m. Environmental surroundings.
1.m.CA
n. Prenatal exposure to alcohol, 4.L. 3. When the services disrupt the child’s
tobacco, or other substances. or adolescent’s day-to-day educational
1.n.CA
o. History of use of alcohol, tobacco, environment, the program provides or

or other substances. make arrangements for the continuity
1.o.CA
p. Parental/guardian custodial status. of his or her education.

3.CA
1.p.CA
q. When applicable, parents’/ Examples

guardians’: Arrangements could include:
1.q.CA
(1) Ability/willingness to participate ■ Use of a facility-based school.

in services.
1.q.(1)CA ■ Use of a private school at the organization.
(2) Strengths.
1.q.(2)CA
■ Use of on-site educators from a local school
(3) Preferences.
1.q.(3)CA
system.
Intent Statements ■ Coordination with home school services.
In short-term programs (such as Assessment and ■ Coordination and monitoring of assignments.
Referral), the amount of information collected
■ Coordination with the community school to
may be limited by time or the condition of the
person served. The intent of the standard is to facilitate reintegration.
collect an adequate amount of information to
provide appropriate and safe services. 4.L. 4. Based on the needs of each child or
1.f.–g. Speech, hearing, and visual functioning adolescent, or as required by law, an
are often included in yearly physical exams and/ educational specialist is a member
or in schools. Source documents are not required; of the team.
4.CA
however, any identified needs of the child/youth Intent Statements

should consider whether language and/or visual
functioning is a contributing factor. When applicable, the educational specialist
assists in the planning, implementing, and
1.h. The assessment includes a determination evaluating of the child’s or adolescent’s
of the status of the child’s immunization. A copy educational activities.
of the immunization record is not required.
Organizations can note when children and ado- The educational specialist can be available when
lescents are enrolled in school settings where needed and is not required to attend all team
verification of immunization is legally required. meetings. Please refer to Standard 4.A.23. for
the functions of the team.
1.k. Information about family relationships
includes siblings as well as extended family. Fam-
ily relationship information would also document 4.L. 5. If educational services are provided,
changes in the family constellation and persons they:
5.CA
moving into or out of the home. a. Are appropriate to the person served.
5.a.CA
1.m. Environmental surroundings include family b. Meet applicable federal, provincial,

moves and changes in placements for children and state requirements.
5.b.CA
placed out of the home. c. Include provisions for:

5.c.CA
(1) Evaluation.
4.L. 2. The assessments are appropriate with 5.c.(1)CA
(2) Group instruction.

respect to the child’s or adolescent’s: 5.c.(2)CA
(3) Individual instruction.

2.CA
a. Age. 5.c.(3)CA
2.a.CA
b. Development.
2.b.CA

Intent Statements
Educational services should be appropriate to  In Canada, depending on provincial/territorial/
tribal requirements, a criminal record check and
the developmental and clinical needs of each a child welfare information system check would
child and adolescent served. be required to meet this standard.
Examples
4.L. 6. Based on the needs of the children
Background checks may be conducted prior to
or adolescents served, the program
employment for new personnel, at the time of
includes the development of:
6.CA job change when beginning to work with chil-
a. Community living skills. dren or adolescents, or prior to an accreditation
6.a.CA
b. Social skills. survey for existing personnel.

6.b.CA
c. Social supports.
6.c.CA
d. Vocational skills. 4.L. 9. For residential services provided in con-

6.d.CA
gregate facilities or sites that are owned,

rented, or leased by the organization,
4.L. 7. The environment is configured appropri- staff support is available on site 24 hours
ately to meet the needs of children and a day, 7 days per week.
9.CA
adolescents, including: Intent Statements

7.CA
a. The physical plant. Residential services may include group homes,

7.a.CA
b. The furniture. residential treatment, child caring institutions,

7.b.CA
c. The equipment. inpatient facilities, or residential detoxification

7.c.CA
programs. Treatment or therapeutic foster care
Intent Statements that is provided in facilities that are owned,
The location in which services are provided rented, or leased by the organization is also
reflects the ages, cognitive levels, interests, included. Staff members are in the residential
concerns, and cultural and developmental facility around the clock and able to respond to
needs of the children or adolescents served. emergencies quickly. If there are times when no
persons are served in the facility (such as during
Examples
off-site school attendance), staff may be off site,
Considerations include the provision of: but need to be available.
■ Appropriately sized furniture.
■ Recreational equipment. 4.L. 10. If residential services are provided, the

■ Age-appropriate reading materials and program provides opportunities for vis-
video equipment. its, when appropriate and in compliance
with applicable laws and court orders,
with:
4.L. 8. The organization implements a policy 10.CA
and procedures for obtaining criminal a. Family members and significant

background checks on all persons others.
10.a.CA
providing direct services to children b. Peers.

10.b.CA
or adolescents.
8.CA
Intent Statements
Background checks may include fingerprinting 4.L. 11. The program does not exclude children
and FBI criminal history checks. Persons providing or adolescents from services solely on
direct services include personnel, students, the basis of their juvenile justice status.
11.CA
interns, volunteers, or contracted providers of Intent Statements

direct services. The provision of direct services
Although specific behaviors may be identified
includes transportation.
by a program as exclusionary admission criteria,
children and adolescents cannot be excluded

from services solely because they are involved

in the juvenile justice system.
■ Assessments of the children or adolescents
served
■ Filed, current information on law pertaining
to educational specialists and educational
services
■ Staffing pattern chart for residential,
or 24/7 programs
■ Policy related to background checks on
all personnel

APPENDIX A
Required Written Documentation
The following tables list standards that explicitly require some form of written
evidence in order to achieve full conformance.
When interpreting CARF standards, the following terms always indicate the need
for written evidence: policy, plan, documented, documentation, and written.
Other terms may also indicate the need for specific written information.
This list of standards is not inclusive of all the documentation that will be
reviewed during the survey of your organization.
Section 1. ASPIRE to Excellence®

Standard(s) Requirements
1.A. Leadership
1.A.5.a. Cultural competency and diversity plan
1.A.6.a., b. Ethical codes of conduct and written procedures to deal with

allegations of violations of ethical codes
1.A.7.a. For U.S. organizations receiving federal funds, policy on corporate

compliance
1.A.7.b.(1) Written designation of a staff member to serve as the organization’s

compliance officer
1.B. Governance (Optional)
1.B.1. Governance policies that facilitate ethical practices, assure

accountability, and meet legal requirements
1.B.2. Governance policies regarding organization and development

of the board, and signed conflict of interest and ethical declarations
1.B.5. Policies addressing executive leadership development and evaluation,

including a written performance review and succession plan
1.B.6. Policies, written statements, and documented processes addressing

executive compensation

Appendix A. Required Written Documentation
Set Strategy
1.C. Strategic Planning
1.C.2.a.–c. Strategic plan
Implement the Plan

1.E. Legal Requirements
1.E.2. Written procedures to guide personnel in responding to subpoenas,

search warrants, investigations, and other legal actions
1.E.3. Policies and written procedures on records
1.F. Financial Planning and Management
1.F.2. Written budgets
1.F.4.e. If appropriate, financial solvency remediation plans
1.F.6.a. Fiscal policies and procedures including internal controls
1.F.7.b.(1) If the organization bills for services, a quarterly review of a

representative sampling of records for persons served documents
the comparison of services billed/actually received
1.F.9. Written procedures for managing funds of persons served

(if applicable)
1.F.10. Annual review or audit by an independent, authorized accountant
1.F.11. If a review or audit generates a management letter, both the letter

and management’s response
1.G. Risk Management
1.G.1.a. Risk management plan
1.G.3. Written procedures regarding communications, including

media relations and social media
1.H. Health and Safety
1.H.2. Written procedures that promote the safety of persons served

and personnel
1.H.4. Documentation of competency-based training in health and safety

for personnel both upon hire and annually
1.H.5. Written emergency procedures

Implement the Plan (Continued)

1.H.7.d. Written evidence of unannounced tests of all emergency procedures
1.H.9. Written procedures regarding critical incidents
1.H.10. Written analysis of critical incidents
1.H.12.h. Written emergency procedures related to transportation services
1.H.13.b. External inspections reports
1.H.14.b. Self-inspection reports
1.H.15. Written procedures concerning hazardous materials
1.I. Human Resources
1.I.2. Written procedures related to verification of personnel backgrounds

and credentials
1.I.5. Documentation of personnel training provided at orientation and

regular intervals
1.I.6.a., b.(2) Job descriptions and performance evaluations
1.I.7.a., f., g. Signed agreements, dismissal policies and written procedures, and
confidentiality policies regarding the use of students or volunteers
1.I.8.b. Personnel policies that address: employee relations, including

grievance and appeal procedures, disciplinary action, and
termination; employee selection, including promotions and
job postings; and nondiscrimination
1.J. Technology
1.J.1. Technology and system plan
1.J.2. Written procedures for services delivered via information

and communication technologies, if applicable
1.K. Rights of Persons Served
1.K.2. Policies on the rights of persons served
1.K.3.a. Policy(ies) and written procedure by which persons served

may make a formal complaint
1.K.3.c. Documentation of formal complaints
1.K.4. Annual written analysis of all formal complaints
1.L. Accessibility
1.L.2. Accessibility plan


1.L.3.d. Documentation of requests for reasonable accommodations
Review Results
1.M. Performance Measurement and Management
1.M.1. Description of performance measurement and management system
1.M.3.d. Business and services delivery objectives, performance indicators,

and performance targets
Effect Change
1.N.1. Performance analysis
1.N.1.c.(2) Performance improvement action plan
2.A. Program/Service Structure
2.A.1.a. Scope of services
2.A.3. Entry, transition, and exit criteria
2.A.9. Written procedures for mobile unit services
2.A.10. Policies and procedures for acceptance into services
2.A.12. Complete record maintained for each person served
2.A.15. Policy and written procedures that address the program’s use
of positive interventions
2.A.17.b. Policy on rights restrictions (if applicable)
2.A.18.a. Written agreement for contracted services

2.A.19.b. Record of the person’s criminal history, when services are provided
to persons placed in services through an arrangement with a court
or criminal justice system
2.A.20. Policy that identifies whether the organization has any role
related to medications used by persons served
2.B. Individual-Centered Service Planning, Design, and Delivery
2.B.3. Individualized service plan for persons served
2.B.5. Coordinated individualized service plan for persons served
2.B.6. Assistive technology and reasonable accommodations, addressed

in individual plans
2.B.7.b. Risk assessment results, documented in individual service plan
2.B.10. Exit summary report
2.C. Medication Monitoring and Management
2.C.1. Record of all medications used by the person served
2.C.2. Written procedures for medication handling
2.C.4. Documentation that the use of all medications by the person served
is reviewed on at least an annual basis
2.C.5. Written procedures for medication management
2.C.6. Written procedures for medication management
2.D. Employment Services Principle Standards
2.D.7. For U.S. organizations, documentation regarding individuals

receiving less than the minimum wage
2.E. Standards for Workforce Development Services
2.E.1. Formal agreement with the One-Stop Career Center
2.E.2. Policies and procedures that document the relationship between

the organization and the One-Stop Career Center
2.E.9. Policies on confidentiality of information, employment-related

laws and regulations, and resources for staff development
2.F. Community Services Principle Standards
2.F.2. Individualized service plans of persons served

2.G. Children and Adolescents Specific Population Designation
2.G.18. Criminal background checks for all personnel providing

direct services to children or youths
2.H. Older Adults and Older Adults/Dementia Care Specific Population

Designations
2.H.3. Periodic screenings, observation, or review of persons served

to identify functional changes and changes in behavior
2.H.12. Assessments of persons served
2.H.13. Service plans for persons served
2.I. Medically Fragile Specific Population Designation
2.I.1. Program plan for service delivery
2.I.3. Assessments of persons served
2.I.5. Written procedures for updating assessments annually and as needed
2.I.16. Written schedule for equipment maintenance
2.J. Autism Spectrum Disorder Specific Population Designation (ASD)
2.J.9. Information about persons served is obtained, maintained, and

shared with other providers or educators, when related to services
the person is receiving or transition to other services
Section 3. Employment and Community Services
3.A. Employment Planning Services (EPS)
3.A.4. Written employment planning report
3.A.5.
3.B. Evaluation Services
Comprehensive Vocational Evaluation Services (CVE)
3.B.1. Individual evaluation plans for persons served
3.B.3. Individual evaluation plans for persons served
3.B.6.b. Written instructions for evaluators using work samples

to provide assessments

3.B.9. Evaluation report from functional capacities assessment
Targeted Employment Screening Services (TES)
3.B.13.d. Documentation of modifications/adaptations and their effectiveness
3.B.15.b. Written instructions for personnel administering work samples
Job Development (CES:JD)
3.C.2. Individual service plans
Employment Supports (CES:ES)
3.C.7.b. Backup contingency plans for support staff ’s absence or tardiness
3.D. Self-Employment Services (SES)
3.D.3. Self-employment plan of implementation for person served
3.E. Employee Development Services (EDS)
3.E.3.a. Course description for employee development training course
3.F. Employment Skills Training Services (EST)
3.F.2. Course description/curriculum
3.F.4. Course description/curriculum
3.F.5.c. Clear description of role and function of program staff members

assigned to the apprenticeship site
3.F.5.e.(2) Contingency plans for supervision when the supervisor is late

or absent
3.F.5.f. Written procedures and techniques specific to the services provided

and the location, shared with all appropriate parties
3.H. Affirmative Business Enterprise (ABE)
3.H.1. Business plan
3.H.2. Marketing plan
3.H.3.c. Written job descriptions for each position
3.H.3.f. Annual performance evaluations for all personnel
3.I. Child and Youth Services (CYS)
3.I.18. Criminal background checks for all personnel providing

direct services to children or youths

3.J. Family-Based/Shared Living Supports
Family Services (FS)
3.J.5. Plan for family relief, including 24-hour emergency response system
and respite services and supports if needed
Foster Family Services (FFS)
3.J.14. Plan for foster family relief, including 24-hour emergency response
system and respite services and supports if needed
3.J.15.a. Signed foster family provider agreement
Host Family/Shared Living Services (HF/SLS)
3.J.23.a. Written agreements with each host family/shared living provider
3.J.24.d. Documentation of results of monitoring visits
3.J.25. Evidence of provider plans for respite/relief and emergency response
3.O. Transition Services (TS)
3.O.3. Plan for transition from school to community services
3.Q. Assistive Technology Supports and Services (AT)
3.Q.6. Individual service plan that identifies each person’s desired outcomes
from using assistive technology
3.Q.7. Individual service plan, additional requirements
3.Q.12. Exit summary report for persons served
3.R. Behavioral Consultation Services (BCS)
3.R.7. Behavioral assessments
3.R.8. Functional assessment
3.R.11. Written behavioral strategies for persons served
3.R.13. Written procedures addressing the use of behavioral strategies
3.R.14.a. Curriculum for Early Intensive Behavior Intervention (EIBI),

if provided
3.R.18. Written procedures specifying that the consultation service provides

or arranges for crisis intervention services
3.R.19. Plan for the supervision of direct service personnel

3.U. Personal Supports Services (PSS)
3.U.3. Plan and written procedures for the supervision of personnel,

including provision of timely feedback to enhance skills, and for
addressing unplanned absences to ensure continuity of supports
3.U.6. If training/education is provided, a written description for each

offering that includes all items listed
3.V. Self-Directed Community Supports and Services (SDCSS)
3.V.7.b. Individual budgets, developed based on input from persons served
3.V.14. Written guidelines to avoid conflicts of interest
3.V.16. Brochures and other informational materials provided to

persons served
3.V.18.a.–c. Detailed job description for employees hired by the person served
3.V.19. Information and documents maintained by the employer of record

for support services
3.V.21. New-employee packets provided to persons served to orient

staff they hire
3.V.22.f. Disaster recovery plan
3.V.24. Regularly conducted internal accounting audit to ensure accuracy

and compliance with generally accepted accounting practices
3.X. Centers for Independent Living (CIL)
3.X.1. Annual work plan, based on community input
3.X.2. Policies and procedures for the use of government funds
3.X.3. Policies and procedures for meeting state/provincial and federal

grant requirements and assurances, as applicable
3.X.4.a. Timely performance information analyses, records, and reports

to meet the specific provision of referral and funding sources
3.Y. Home and Community Services (HCS)
3.Y.3. Written procedures to verify backgrounds of personnel
3.Y.5. Policies and written procedures addressing all listed service

delivery issues
3.Y.8. Emergency plans that include assessment of current knowledge,

physical environment, modifications necessary, community
resources, utility needs, program continuation, provisions
for communication, contingency plans, emergency preparedness

3.Y.11. Policies and written procedures to facilitate collaboration with

family/support system
3.Z. Rapid Rehousing and Homelessness Prevention Program (RRHP)
3.Z.3. Landlord recruitment and retention plan
3.Z.7. Housing plan for each person served
3.Z.11. Documented personnel training
3.Z.12. Documented analysis of average length of time from entry to a

rapid rehousing program and housing
Section 4. Psychosocial Rehabilitation Programs
4.A.1.a. Scope of services
4.A.3. Entry, transition, and exit criteria
4.A.9. Written procedures related to mobile unit services
4.A.10. Written program description that guides service delivery
4.A.13. Policies and written procedures addressing positive approaches

to behavioral interventions, when applicable
4.A.14.a. Written procedures governing the use of special treatment

interventions and restrictions of rights
4.A.20. Written procedures that specify the program provides or

arranges for crisis intervention services
4.A.23.e. Documented attendance of participants at team meetings

and results of team meetings
4.A.25. Policy and written procedures for supervision of direct service

personnel
4.A.26. Documented ongoing supervision of clinical or direct service

personnel, as applicable
4.A.27. Policies that address handling of items brought into the program
by persons served and personnel in all locations and in all vehicles
owned or operated by the organization
4.A.28. Policies and procedures that are inclusive of a peer workforce
4.A.31. Documented competency-based training for peer support specialists

4.A.32. Ethical codes of conduct specifically address boundaries related

to peer support services
4.B. Medication Use
4.B.1. Policy that identifies whether medications are used in the program
and the process for persons served to obtain medications needed
4.B.2. Documented ongoing training and education regarding medications

for persons served and, when applicable, individuals and family
members with legal right or identified by the persons served and
personnel
4.B.3. Written procedures for medications physically controlled

by the program
4.B.4. Documentation of all medications provided or prescribed,

poison control information, and other pertinent information
4.B.5. Written procedures for prescribing, dispensing, or administering

of medications
4.B.6. Written procedures for prescribing of medications
4.B.7. Treatment guidelines and protocols related to prescribing

of medications and medication utilization evaluation
4.B.8. Documented annual peer review related to prescribing of

medications
4.B.10. Written procedures for dispensing or administering of medications
4.C.1. Policy that identifies how the organization will respond to aggressive
or assaultive behaviors and whether and under what circumstances
seclusion and restraints will be used
4.C.2. Documented initial and ongoing competency-based training for all

direct service or front-line personnel employed by the organization
4.C.3. Documented initial and ongoing competency-based training for per-

sonnel involved in the direct administration of seclusion or restraint
4.C.4. Plan to minimize or eliminate the use of restraints and/or seclusion,

if these are used
4.C.5. Annual written status report on the plan for minimization

or elimination of the use of seclusion and/or restraint
4.C.6. If the organization uses seclusion or restraint, written procedures for

the use of specific interventions including the identified protocols
4.C.8. Policies on the use of seclusion or restraint

4.C.9. Written procedures for use of seclusion or restraint
4.C.10. Written procedures for use of seclusion or restraint
4.C.12.e. Documented discussion following any use of seclusion or restraint
4.C.13. Use of seclusion or restraint is always documented as a critical

incident
4.C.14. All uses of seclusion or restraint reviewed and signed off on by chief
executive or designated management or supervisory staff member
4.C.15.a. Use of seclusion or restraint recorded in the information system
4.D. Records of the Persons Served
4.D.1. Policies regarding information to be transmitted to other individuals

or agencies and forms to authorize release of information
4.D.2. Individual record of each person served
4.D.3. All documents that require signatures have original or electronic

signatures
4.D.4. Individual record for each person served contains the identified
elements
4.D.5. Entries to the records of the persons served follow the organization’s
policy on time frames for entries
4.G. Community Housing (CH)
4.G.2.h. Policies related to visitors, guests, and pets
4.I. Assessment and Referral (AR)
4.I.1. Policies for assessment and referral that include the identified
elements
4.I.3. Written summary of assessment and referral(s), provided to

person served or legal representative when requested
4.J. Diversion/Intervention (DVN)
4.J.6. Plan or written logic model that details the specific theoretical
and methodological approaches to be used and how the approaches
will be applied within the community
4.J.7.c. Documentation of evaluations of programs/services and training

activities
4.J.8.b. Documented plan for individual outcomes

4.L. Children and Adolescents (CA)
4.L.1. Assessments of each child/adolescent served that include

the identified elements
4.L.8. Policy for obtaining criminal background checks for all

persons providing direct services to children or adolescents

APPENDIX B
Operational Time Lines
The following tables list CARF standards that require activities be conducted at
specific time intervals. The documents assembled as part of survey preparation
should provide evidence that these activities occur.
Standards that specify an activity be conducted at least or no less than a specific time
period are listed in the table for the maximum time frame within which they may
occur. During an original survey the organization is expected to demonstrate, for
standards that specify an activity be conducted on or within a specific time period
(e.g., quarterly, at least annually), that the activity has occurred at least once within
such period prior to the survey.
Standards that require a policy that includes a time frame, such as for the reporting
of complaints or recording information into the records of the persons served, are
not included in this appendix. Standards that require activities be conducted on
an ongoing or as needed basis are also not included here.
The time lines for the standards listed in the last table, Activities to be Conducted at a
Frequency Determined by the Organization, may be influenced by various factors, such
as local regulations or the needs of the organization and the persons served—e.g., the
verification of personnel licenses and certifications, and certain types of personnel
training. For these standards, you should identify the frequency with which these
activities are scheduled. The surveyors will want to see evidence that you are following
your identified time lines.
Activities to be Conducted Every Two Years
Related Standard Activity
2.J.21. Life planning for persons served is updated and adjusted
Activities to be Conducted Annually
1.A.3.k. Review of policies guided by leadership
1.A.5.c. Cultural competency and diversity plan reviewed for relevancy
1.B.2.g.(3), Board conducts self-assessment of the entire board, and signs

(5)–(6) written conflict of interest declaration and ethical code of conduct
declaration
1.B.5.a.–b. Review of executive leadership performance and executive

leadership succession plan

Appendix B. Operational Time Lines
Activities to be Conducted Annually (Continued)
1.B.6.e.(6) Review of executive compensation records
1.B.7. Review of governance policies
1.C.2.e. Strategic plan reviewed for relevance
1.F.2. Budgets are prepared and approved
1.F.10. Review or audit of the financial statements of the organization by

an independent accountant authorized by the appropriate authority
1.G.1.b.(1) Risk management plan reviewed for relevance
1.G.2.a. Review of organization’s insurance package
1.H.4. Personnel receive training in health and safety practices,

identification of unsafe environmental factors, emergency and
evacuation procedures, identification and reporting of critical
incidents, reducing physical risks, and medication management,
if appropriate
1.H.7. Unannounced tests of all emergency procedures, including

complete actual or simulated physical evacuation drills, tested
on each shift at all locations
1.H.10. Critical incidents are reviewed, resulting in a written analysis

provided to or conducted by leadership
1.H.12.l. If transportation services are contracted, the contract is reviewed

against Standards 1.H.12.a.–k.
1.H.13. Comprehensive external health and safety inspection conducted

at all facilities where the organization delivers services or provides
administration on a regular and consistent basis, resulting in a
written report
1.I.4.b. Assessment of current competencies of personnel
1.I.6.a.(1) Review of job descriptions
1.I.6.b. Performance evaluations of directly employed personnel
1.I.6.c. Review of all contract personnel
1.J.1.c. Review of technology and system plan
1.K.1.a.(3) Rights of persons served shared with persons served who have
been in the program longer than one year
1.K.4. Written analysis of all formal complaints that determines trends,

areas needing performance improvement, and actions to be taken
1.L.2.b. Accessibility plan annual review
1.N.1. Performance analysis
2.A.1.c. Review of scope of services

Activities to be Conducted Annually (Continued)
2.A.16.b. Personnel training in the use of positive interventions
2.A.18.c. Contracted services are evaluated
2.C.4. Review of use of medications by persons served, when applicable
2.D.7.d. Annual prevailing wage studies
2.D.10.b. Analysis of prices for products and services
2.H.16. Education for service personnel on dementia-related topics
2.I.5.a. Assessments are updated
3.E.3.b.(1) Course content is reviewed at least annually
3.G.4. Persons are provided informed choices for exploration of other

work opportunities, as desired
3.H.3.c. Written job description for each position is reviewed annually
3.H.3.f. Annual performance evaluations for all personnel employed

by the affirmative business enterprise
3.H.7. Prices of products are analyzed at least annually
3.V.18.b. Job descriptions for employees hired by the person served are
reviewed annually
3.X.1. Annual work plan is created with community input
3.Z.12. Annual analysis of average length of time from entry to a rapid

rehousing program and housing
4.A.1.c. Review of scope of services
4.B.8.a. Annual peer review of medications prescribed to persons served
4.C.5. Written status report on the plan for minimization/elimination

of the use of seclusion and restraint
4.C.15.b.(1) Review of use of seclusion and restraint

Activities to be Conducted Semiannually
1.H.14.* Health and safety self-inspections conducted on each shift at all

facilities where the organization delivers services or provides
administration on a regular and consistent basis
2.D.8.a. When persons make less than the minimum wage, they are informed
at least semiannually about how their productivity affects their wage
3.C.12. For persons receiving long-term services, review at least

semiannually of the level of ongoing supports needed
4.B.5.l. Documented assessments of abnormal involuntary movements are

performed every six months for persons served receiving typical
antipsychotic medications
* Applicable only to locations owned, rented, or leased by the organization and

pertaining to the services seeking accreditation, including administrative offices.
Activities to be Conducted Quarterly
1.F.7. Review of representative sampling of records of persons served

and billing for services
Activities to be Conducted Monthly
1.F.3.c. Review of actual financial results
1.F.9.f. If responsible for funds of the persons served, monthly account

reconciliation
3.R.4. Monthly team meetings with all involved in the person’s

individual plan
Activities to be Conducted Daily
3.K.2.e. Daily meals and snacks provided
4.G.2.e. Daily access to nutritious meals and snacks in Community

Housing programs

Activities to be Conducted at a Frequency

Determined by the Organization
1.B.2.g.(4) Periodic self-assessment of individual members of board
1.H.12.b. Regular review of driving records of all drivers
1.H.12.k. Maintenance of vehicles owned or operated by the organization
1.I.2.b.(2) Verification of backgrounds and credentials of personnel

throughout employment
1.I.5.a.(2) Personnel training at regular intervals
1.M.5.b., d. For service delivery improvement, data collected on the persons

served at appropriate intervals and at points in time following
services
2.I.16. Written schedule for equipment maintenance and calibration
3.J.24.a. Monitoring of provider performance
3.K.2.a. Regular meetings between the persons served and staff
3.S.1.b. Regular analysis of environmental trends
3.U.6.f. Regular review of written descriptions for training/educational

activities offered
3.V.7.h. Individual budgets for home- and community-based supports

are reviewed and monitored according to a determined method
and frequency
3.V.12. Regular reporting to appropriate oversight agency or organization
3.V.24. Regular internal accounting audits to ensure accuracy and

compliance with generally accepted accounting practices
3.Y.3.b. Backgrounds of all personnel verified at stated intervals

throughout employment
3.Z.11.a.(2) Personnel training at regular intervals
4.G.2.a. Regular meetings between persons served and staff members

in psychosocial rehabilitation community housing programs

APPENDIX C
Required Training
The following tables list the standards that require an organization to provide some form of education
or training to personnel, persons served, and/or other stakeholders.
NOTE: Some standards require specifically qualified or trained personnel to provide certain services or require
an organization to verify or ensure that personnel have appropriate qualifications, education, and/or training
but do not require the organization to directly provide the requisite education or training. Such standards are
not included in this appendix. Please contact your resource specialist with any questions.
Section 1. ASPIRE to Excellence®

Competency-
Standard(s) Training Requirements Provided To Based Frequency
A. Leadership
1.A.6.c. Education on ethical codes of conduct Stakeholders No None specified
1.A.7.c. Training on corporate compliance Personnel No None specified
1.A.8. Education to stay current in the field Personnel No None specified
B. Governance
1.B.2.d. Board education Board members No None specified
Implement the Plan

Competency-
F. Financial Planning and Management
1.F.6.b. Training related to fiscal policies Appropriate Initial and

No
and procedures personnel ongoing
H. Health and Safety
1.H.3. Education designed to reduce

Persons served No None specified
identified physical risks
1.H.4.b.(1) Training in health and safety practices Personnel Yes Upon hire and
annually
1.H.4.b.(2) Training in identification of unsafe Personnel Yes Upon hire and

environmental factors annually

Appendix C. Required Training

Competency-
1.H.4.b.(3) Training in emergency procedures Personnel Yes Upon hire and

annually
1.H.4.b.(4) Training in evacuation procedures, Personnel Yes Upon hire and

if appropriate annually
1.H.4.b.(5) Training in identification of critical Personnel Yes Upon hire and

incidents annually
1.H.4.b.(6) Training in reporting of critical Personnel Yes Upon hire and

incidents annually
1.H.4.b.(7) Training in medication management, Personnel Yes Upon hire and

if appropriate annually
1.H.4.b.(8) Training in reducing physical risks Personnel Yes Upon hire and
annually
1.H.7.c.(4) Necessary education and training Personnel No As needed

of personnel regarding emergency
procedures
1.H.10.b.(5) Necessary education and training Personnel No As needed

of personnel regarding critical
incidents
1.H.11.b.(1) Training regarding infections Personnel, per- No None specified

and communicable diseases sons served, and
other stakeholders
1.H.12.g. Training of drivers regarding Personnel No None specified

the organization’s transportation with driving
procedures and unique needs responsibilities
of persons served
I. Human Resources
1.I.5.b.(1) Training that addresses the identified Personnel No At orientation

competencies needed by personnel and regular
intervals
1.I.5.b.(2) Training that addresses confidential- Personnel No At orientation

ity requirements and regular
intervals
1.I.5.b.(3) Training that addresses customer Personnel No At orientation

service and regular
intervals


Competency-
1.I.5.b.(4) Training that addresses diversity Personnel No At orientation

and regular
intervals
1.I.5.b.(5) Training that addresses ethical codes Personnel No At orientation

of conduct and regular
intervals
1.I.5.b.(6) Training that addresses promoting Personnel No At orientation

wellness of the persons served and regular
intervals
1.I.5.b.(7) Training that addresses person- Personnel No At orientation

centered practice and regular
intervals
1.I.5.b.(8) Training that addresses reporting Personnel No At orientation

of suspected abuse and neglect and regular
intervals
1.I.5.b.(9) Training that addresses rights Personnel No At orientation

of the persons served and regular
intervals
1.I.5.b.(10) Training that addresses rights Personnel No At orientation

of personnel and regular
intervals
1.I.5.b.(11) Training that addresses the unique Personnel No At orientation

needs of the persons served and regular
intervals
1.I.7.d. Training of students or volunteers Students/ No None specified

volunteers
J. Technology
1.J.3. Training in equipment features, Personnel who Yes None specified

set up, use, maintenance, safety deliver services via
considerations, infection control, information and
and troubleshooting communication
technologies
1.J.4. Instruction and training in Persons served, No None specified

equipment features, set up, families/support
use, maintenance, safety systems, and
considerations, infection control, others, as
and troubleshooting appropriate

Competency-
2.A.16. Training in use of positive Service personnel No Initially and

interventions annually
2.A.17.c.(2) Training in the use of restrictive Service personnel No Prior to

procedures (if restrictions are placed implementation
on the rights of a person served)
2.C. Medication Monitoring and Management
2.C.3.a. Advocacy training to assist persons Persons served No As requested

served in being actively involved in
making decisions related to use of
medications
2.C.3.b. Training and education regarding Persons served No As requested

medications
2.G. Children and Adolescents Specific Population Designation
2.G.8. Educational opportunities for families Family No None specified
2.G.9. Training that covers all areas listed Service personnel No None specified
in the standard, as appropriate to the
services provided
2.H. Older Adults and Older Adults/Dementia Care Specific Population Designation
2.H.1.g. Education on end-of-life services Persons served No None specified

and/or families
2.H.5. Training in aging processes and Service personnel No None specified

their implications for older adults
with disabilities, changes that may
indicate Alzheimer’s disease or other
forms of dementia, signs of sensory
impairment, and monitoring of
function
2.H.16. Education for service personnel on Personnel No Initial and

dementia-related topics annual
2.J. Autism Spectrum Disorder Specific Population Designation
2.J.3. Training on ASD that covers all areas Personnel No Initial and
listed in the standard ongoing

Section 3. Employment and Community Services
Competency-
3.C.3.f. Education in self-directed job search Persons served No Based on

and ADA rights and EEOC, as needed individual need
per individual plans of persons served
3.C.3.g. Disability awareness education, Employers No Based on

when indicated individual need
3.G. Organizational Employment Services
3.G.2. Training activities that address all Persons served No Based on

areas listed in the standard, as needed individual need
by the person served
3.I. Child and Youth Services
3.I.9. Educational opportunities for families Family No None specified
3.I.10. Training that covers all areas listed Service personnel No None specified
in the standard, as appropriate to the
services provided
3.J. Family-Based/Shared Living Services
3.J.7. Training to meet identified needs Foster family No None specified

of the persons served that covers providers
all areas listed in the standard
3.J.22. Training that addresses all areas listed Host family/shared Yes None specified
in the standard living providers
3.K. Community Housing
3.K.6. Skill development necessary to live Persons served No None specified

as independently as possible
3.N. Services Coordination
3.N.3.g. Skill development services needed Persons served No None specified

to enable persons served to perform
daily living activities, including all
areas listed in the standard
3.R. Behavioral Consultation Services
3.R.1.b.(2) Training provided by the behavioral Individuals No None specified

consultation service’s personnel involved with the
person served

Competency-
3.R.2. Training on specific behavioral change Direct service staff No None specified
strategies/techniques
3.R.10. Behavioral strategies and training, Persons served, No Prior to

as needed and appropriate, in all family, and support implementation
areas listed in the standard persons, as needed of behavioral
and appropriate for strategies
each person served
3.R.14.b. Curriculum training (if consultation Families, interven- No None specified

in Early Intensive Behavior Interven- tion workers, and
tion is provided) other applicable
individuals
3.R.14.g. Training in behavioral learning theory Interveners No None specified

and practical skills (if consultation in
Early Intensive Behavior Intervention
is provided)
3.R.21.a. Training in the use of adaptive devices Personnel No None specified

and equipment, when applicable
3.R.21.b.–d. Training in the use of adaptive devices Person served, No None specified
and equipment, when applicable family, and
caregivers
3.S. Comprehensive Benefits Planning
3.S.3. Training on competency in all areas All new benefits Yes None specified
listed in the standard planning specialists
3.S.7. Education for persons served on Persons served No None specified

all areas listed in the standard
3.T.2. Design and continuous improvement Mentors Yes None specified

of competency-based training process
for mentors
3.U. Personal Support Services
3.U.2. Training that includes all areas listed Personnel No None specified
in the standard
3.U.4.a. Training in the use of adaptive devices Personnel No None specified

and equipment, when applicable
3.U.4.b.–d. Training in the use of adaptive devices Person served, No None specified
and equipment, when applicable family, and
caregivers

Competency-
3.V. Self-Directed Community Supports and Services
3.V.20. Mandatory training, as required Employees hired by No None specified

persons served
3.X. Centers for Independent Living
3.X.9.e. Skills training for independent living Persons served No None specified
3.Y. Home and Community Services
3.Y.12. Education that addresses all areas Persons served, No None specified
listed in the standard, in accordance families/support
with identified needs systems, and
other relevant
stakeholders
3.Y.18. Education on medication that Persons served and No None specified

addresses all areas listed in the families/support
standard, as appropriate systems
3.Z. Rapid Rehousing and Homelessness Prevention Program
3.Z.11. Training that addresses tenant and Personnel No At orientation

landlord rights and responsibilities, and regular
fair housing laws, housing first intervals
approach, terminology used in rental/
lease agreements, financial manage-
ment, and other topics as appropriate
to the needs of the persons served

Section 4. Psychosocial Rehabilitation Programs
Competency-
4.A.18. Information and education relevant Persons served No None specified

4.A.22.a. Training that includes areas that Personnel provid- Yes None specified
reflect the specific needs of the ing direct services
persons served
4.A.22.b. Training that includes clinical skills Personnel provid- Yes None specified
that are appropriate for the position ing direct services
4.A.22.c. Training that includes person-centered Personnel provid- Yes None specified
plan development ing direct services
4.A.22.d. Training that includes interviewing Personnel provid- Yes None specified
skills ing direct services
4.A.22.e. Training that includes program- Personnel provid- Yes None specified
related research-based treatment ing direct services
approaches
4.A.30.b. Training on the role of peer support Personnel No None specified

specialists
4.A.31. Documented competency-based Peer support Yes None specified

training specialists
4.A.18. Information and education relevant Persons served No None specified

4.A.22.a. Training that includes areas that Personnel provid- Yes None specified
reflect the specific needs of the ing direct services
persons served
4.B. Medication Use
4.B.2.b.(1) Training and education regarding Persons served, No Ongoing

how the medication works individuals and
family members
with legal right
or identified by
person served, and
personnel provid-
ing direct services
4.B.2.b.(2) Training and education regarding the Same as above No Ongoing

risks associated with each medicine

Competency-
4.B.2.b.(3) Training and education regarding Same as above No Ongoing

the intended benefits, as related to
the behavior or symptom targeted
by this medication

side effects

contraindications

potential implications between
medications and diet/exercise

risks associated with pregnancy

the importance of taking medications
as prescribed, including, when
applicable, the identification of
potential obstacles to adherence

the need for laboratory monitoring

the rationale for each medication

early signs of relapse related to
medication efficacy

signs of nonadherence to medication
prescriptions

potential drug reactions when
combining prescription and
nonprescription medications,
including alcohol, tobacco,
caffeine, illegal drugs, and
alternative medications

instruction on self-administration,
when applicable

Competency-

wellness management and recovery
planning
4.B.2.b.(16) Training and education regarding the Same as above No Ongoing

availability of financial supports and
resources to assist the persons served
with handling the costs associated
with medications
4.C.2.a. Training in the contributing factors Direct service Yes Initial and
or causes of threatening behavior, or front-line ongoing
including training on recovery and personnel
trauma-informed services and the
use of personal safety plans
4.C.2.b. Training in the ability to recognize Same as above Yes Initial and
precursors that may lead to aggressive ongoing
behaviors
4.C.2.c. Training in how interpersonal Same as above Yes Initial and

interactions may impact the ongoing
behaviors of the persons served
4.C.2.d. Training in medical conditions that Same as above Yes Initial and
may contribute to aggressive behavior ongoing
4.C.2.e. Training in the use of a continuum Same as above Yes Initial and
of alternative interventions ongoing
4.C.2.f. Training in the prevention of Same as above Yes Initial and

threatening behaviors ongoing
4.C.2.g. Training in recovery/wellness oriented Same as above Yes Initial and

relationships and practices ongoing
4.C.2.h. Training in how to handle a crisis Same as above Yes Initial and
without restraints, in a supportive ongoing
and respectful manner
4.C.3.a. Training on when and how to restrain Personnel involved Yes Initial and
or seclude while minimizing risk in the direct ongoing
administration
of seclusion or
restraint
4.C.3.b. Training on recognizing signs of Same as above Yes Initial and

physical distress in the person ongoing
who is being restrained or secluded
Competency-
4.C.3.c. Training on the risks of seclusion Same as above Yes Initial and
or restraint to the persons served ongoing
or personnel including medical
and psychological risks
4.C.3.d. Training on first aid and CPR Same as above Yes Initial and
ongoing
4.C.3.e. Training on how to monitor and Same as above Yes Initial and
continually assess for the earliest ongoing
release
4.C.3.f. Training on the practice of Same as above Yes Initial and

intervention done by an individual ongoing
4.C.3.g. Training on the practice of Same as above Yes Initial and

intervention done by a team ongoing

GLOSSARY
NOTE: This glossary has been prepared for use with ABI does not include brain injuries that are con-
all CARF standards manuals. Terms have been genital, degenerative, or induced by birth trauma.
selected for definition because they are subject to
a wide range of interpretation and therefore require Acquired impairment: An impairment that has
clarification of their usage in CARF’s standards and occurred after the completion of the birthing
materials. The glossary does not define practices or process.
disciplines. Acquisition: The purchase by one legal entity
CARF has not attempted to provide definitions that of some or all of the assets of another legal entity.
will be universally applicable. Rather, the intention In an acquisition, the purchasing entity may or
is to define the meanings of the terms as they are may not assume some or all of the liabilities of
used by CARF. the selling entity. Generally, the selling entity
These definitions apply to all programs and services continues in existence.
seeking accreditation. In some instances, glossary
Activities of daily living (ADL): The instructional
terms are used differently in different standards
area that addresses the daily tasks required to
manuals. In such cases, the applicable manual is
noted in parentheses after the term heading and function in life. ADL encompass a broad range
before the definition. of activities, including maintaining personal
hygiene, preparing meals, and managing house-
Access: Barriers or lack thereof for persons in hold chores.
obtaining services. May apply at the level of the
individual persons served (timeliness or other Activity: The execution of a task or action by an
barriers) or the target population for the individual. (This definition is from the World
organization. Health Organization’s International Classification
of Functioning, Disability, and Health [ICF].)
Acquired brain injury: Acquired brain injury
(ABI) is an insult to the brain that affects its Activity limitations: Difficulties an individual
structure or function, resulting in impairments may have in executing activities. (This definition
of cognition, communication, physical function, is from the World Health Organization’s Interna-
or psychosocial behavior. ABI includes both trau- tional Classification of Functioning Disability, and
matic and nontraumatic brain injury. Traumatic Health [ICF].)
brain injuries may include open head injuries Adaptive equipment: Equipment or devices,
(e.g., gun shot wound, other penetrating injuries) such as wheelchairs, walkers, communication
or closed head injuries (e.g., blunt trauma, devices, adapted utensils, and raised toilet seats,
acceleration/deceleration injury, blast injury). that help persons perform their activities of daily
Nontraumatic brain injuries may include those living.
caused by strokes, nontraumatic hemorrhage
(e.g., ruptured arterio-venous malformation, Adjudicated: (Behavioral Health, Child and
Youth Services) Sentenced by a juvenile court
aneurysm), tumors, infectious diseases (e.g.,
or criminal court.
encephalitis, meningitis), hypoxic injuries
(e.g., asphyxiation, near drowning, anesthetic Administration: The act of managing or support-
incidents, hypovolemia), metabolic disorders ing management of an organization’s business
(e.g., insulin shock, liver or kidney disease), affairs. Business affairs include activities such
and toxin exposure (e.g., inhalation, ingestion). as strategic planning, financial planning, and
human resources management.

Glossary
Administrative location: Sites where the organi- Affiliation: A relationship, usually signified by
zation carries out administrative operations for a written agreement, between two organizations
the programs or services seeking accreditation under the terms of which one organization agrees
and/or personnel who provide the programs to provide specified services and personnel
or services seeking accreditation are located. to meet the needs of the other, usually on a
scheduled basis.
Adolescence: The period of life of an individual
between childhood and adulthood, beginning Affirmative enterprises: Operations designed
at puberty and ending when one is legally and directed to create substantial economic
recognized as an adult in one’s state or province. opportunities for persons with disabilities.
Advance directives: Specific instructions given Assessment: Process used with the person served
by a person served to a care provider regarding to collect information related to his or her history
the level and extent of care he or she wishes to and strengths, needs, abilities, and preferences
receive. The intent is to aid competent adults in order to determine the diagnosis, appropriate
and their families to plan and communicate in services, and/or referral.
advance their decisions about medical treatment
Assistive technology: Any item, piece of
and the use of artificial life support. Included is
equipment, or product system, whether acquired
the right to accept or refuse medical or surgical
commercially off the shelf, modified, or cus-
treatment. Includes psychiatric advance direc-
tomized, that is used to increase or improve
tives where allowed by law.
functional capabilities of individuals.
Adverse events: An untoward, undesirable, and
Aversive conditioning: Procedures that are
usually unanticipated event such as a death of
punishing, physically painful, emotionally
a person served, an employee, a volunteer, or a
frightening, deprivational, or put a person served
visitor in a provider organization. Incidents such
at medical risk when they are used to modify
as a fall or improper administration of medica-
behaviors.
tions are also considered adverse events even
if there is no permanent effect on the individual Behavioral health: A category of medicine and
or person served. rehabilitation that combines the areas of alcohol
and other drug services, mental health, and
Advocacy services: Services that may include
psychosocial rehabilitation.
one or more of the following for persons with
disabilities or other populations historically in Board: See Governing board.
need of advocacy:
Catastrophe: A disaster or accident that immedi-
■ Personal advocacy: one-on-one advocacy ately impacts an organization’s ability to provide
to secure the rights of the person served. its programs or services or significantly impacts
■ Systems advocacy: seeking to change a policy how the programs or services will be provided
or practice that affects the person served. in the future.
■ Legislative advocacy as permitted by law: Child/adolescent: An individual up to the age
seeking legislative enactments that would at which one is legally recognized as an adult
enhance the rights of and/or opportunities according to state or provincial law.
for the person served.
Commensurate wage: A wage that is proportion-
■ Legal advocacy: using the judicial and quasi-
ate to the prevailing wage paid to experienced
judicial systems to protect the rights of the
workers in the vicinity for essentially the same
person served.
type of work. It is based on the quantity and
■ Self-advocacy: enabling the person served
quality of work produced by the worker with
to advocate on his/her own behalf. a disability compared to the work produced
by experienced workers.

Glossary
Communication skills: The instructional area Competency: The criteria established for the
that teaches the use of adaptive skills and assistive adequate skills, knowledge, and capacity required
technology for accomplishing tasks such as to perform a specific set of job functions.
reading, writing, typing, managing finances,
Competency-based training: An approach
and storing and retrieving information.
to education that focuses on the ability to dem-
Community integration: (Aging Services, onstrate adequate skills, knowledge, and capacity
Child and Youth Services) Being part of the to perform a specific set of job functions.
mainstream of family and local community life,
Complaint: (Formal) The submission of an issue
engaging in typical roles and responsibilities,
and being an active and contributing member to an organization for resolution.
of one’s social groups, local town or area, and Computer access training: The instructional area
of society as a whole. that teaches the skills necessary to use specialized
Community relations plan: (Opioid Treatment
display equipment in order to operate computers.
Program) Supports program efforts to help This includes evaluating the person served with
minimize negative impact on the community, large print, synthetic speech, and Braille access
promote peaceful coexistence, and plan for devices in order to perform word processing
change and program growth. functions and other computer-related activities.
Community resources: Services and/or assis- Concurrent physician care: Services delivered
tance programs that are available to the members by more than one physician.
of a community. They commonly offer persons Concurrent services: Services delivered by
help to become more self-reliant, increase their multiple practitioners to the same person served
social connectedness, and maintain their human during the same time period.
rights and well being.
Congenital impairment: An impairment that is
Community settings: Locations in the commu- present at the completion of the birthing process.
nity that are owned or leased and under the
control of another entity, organization, or agency, Consolidation: The combination of two or more
and where organization personnel go for the legal entities into a single legal entity, where the
purpose of providing services to persons in those entities unite to form a new entity and the origi-
locations. Examples include: community job nal entities cease to exist. In a consolidation, the
sites that are owned or leased by the employer(s) consolidated entity has its own name and identity
where the organization may provide employment and acquires the assets and liabilities of the
supports such as job coaching, vocational evalua- disappearing entities.
tion, or work adjustment; school settings where Consumer: The person served. When the
services such as early intervention or prevention person served is legally unable to exercise
services may be provided during the school’s self-representation at any point in the decision-
regular school, pre-school, or after-school pro- making process, person served also refers to those
gram hours; or public or private sites such as persons willing and able to make decisions on
libraries, recreational facilities, shopping malls, behalf of the person served. These individuals
or museums where services such as community may include family members, significant others,
integration, case management, or community legal representatives, guardians, and/or advo-
support may be provided. cates, as appropriate. The organization should
Comparative analysis: The comparison of past have a means by which a legal representative of
and present data to ascertain change, or the com- the person served, if any, is invited to participate
parison of present data to external benchmarks. at appropriate points in the decision-making pro-
Consistent data elements facilitate comparative cess. By the same token, a person who is legally
analysis. able to represent his or her own interests should
be granted the right to choose whether family,
significant others, or advocates may participate

Glossary
in the decision-making process. In standards that Corporate status: The existence of an entity as
deal with infants, children, and/or adolescents, a corporation under applicable law. Maintenance
the family may be referenced directly as the of corporate status typically requires ongoing
family may serve as a person served in such compliance with state requirements.
situations.
Costs: The expenses incurred to acquire, pro-
Continuum of care/Continuum of services: A duce, accomplish, and maintain organizational
system of services addressing the ongoing and/or goals. These include both direct costs, such as
intermittent needs of persons at risk or with those for salaries and benefits, materials, and
functional limitations resulting from disease, equipment, and indirect costs, such as those for
trauma, aging, and/or congenital and/or develop- electricity, water, building maintenance, and
mental conditions. Such a system of services may depreciation of equipment.
be achieved by accessing a single provider, multi-
Cultural competency: An organization’s ability
ple providers, and/or a network of providers.
to recognize, respect, and address the unique
The intensity and diversity of services may vary
needs, worth, thoughts, communications,
depending on the functional and psychosocial
actions, customs, beliefs, and values that reflect
needs of the persons served.
an individual’s racial, ethnic, religious, and/or
Controlled/operated: The right or responsibility social groups or sexual orientation.
to exercise influence over the physical conditions
Culturally normative: Providing the persons
of a facility where service delivery/administrative
served with an opportunity to experience pat-
operations occur. An organization is considered
terns and conditions of everyday life that match
in control of all facilities where it delivers services
as closely as possible those patterns and condi-
to persons who are present at the time of service
tions typical of the mainstream experience in the
delivery for the sole purpose of receiving services
local society and community. This requires the
from the organization (e.g., services provided to
use of service delivery systems and settings that
students at a school outside of the school’s regular
adapt to the changing norms and patterns of
school, pre-school, or after-school program
communities in which the persons served func-
hours). An organization is not considered in
tion so as to incorporate the following features:
control of facilities where it delivers services to
■ Rhythms of the day, week, and year and life
persons who are present at the time of service
delivery for purposes other than receiving ser- cycles that are “normal” or typical of the
vices from the organization (e.g., services community.
provided at a school to students who are present ■ A range of choices, with personal preferences
at the school to participate in the school’s regular and self-determination receiving full respect
school, pre-school, or after-school programs). and consideration.
■ A variety of social interactions and settings,
Core values: The essential and enduring tenets
of an organization. They are a small set of time- including family, work, and leisure settings
less guiding principles that require no external and opportunities for personal intimacy.
justifications. They have intrinsic value and ■ Normal economic standards.
importance to those inside the organization. ■ Life in housing typical of the local
Corporate citizenship: An organization’s efforts,

neighborhoods.
activities, and interest in integrating, contribut- Culture: The integrated pattern of human behav-
ing, and supporting the communities where it ior that includes the thoughts, communication,
delivers services to better address the needs of actions, customs, beliefs, values, and institutions
persons served. of a racial, ethnic, religious, social, or other group.

Glossary
Customers: The persons served, families, Diversity: Differences due to cognitive or

communities, funding agencies, employers, physical ability, culture, ethnicity, language,
etc., who receive or purchase services from religion, economic status, gender, age, or
the organization. sexual orientation.
Data: A set of values of qualitative or quantitative Donated location/space: Physical space not
variables, e.g., facts, objective information, or owned or leased by the organization but made
statistics collected, assembled, or compiled for available to the organization without charge
reference, analysis and use in decision-making. for the purposes of delivering services or for
administrative operations on an ongoing basis
Demonstrate: To show, explain, or prove by
and which the organization controls or operates
evidence presented in program documentation,
during the time of service delivery/administra-
interviews, and behavior how an organization
tive operations. The location and availability of
or a program consistently conforms to a given
the space does not vary at the discretion of the
standard.
donating entity.
Debt covenants: Requirements found in loan
Durability: Maintenance or improvement over
documents that require an organization to meet
time of outcomes achieved by persons served
certain predefined performance targets to be
at the time of discharge.
measured at predefined time periods. The per-
formance targets can be financial (for example, Duty of care: Obligation of governing board
the organization must maintain a certain level members to act with the care that an ordinarily
of days with cash on hand) or nonfinancial (an prudent person in a similar position would use
organization must maintain a certain occupancy under similar circumstances. This duty requires
level). governing board members to perform their
duties in good faith and in a manner they
Detoxification treatment: (Opioid Treatment
Program) Dispensing an opioid agonist treat-
reasonably believe to be in the organization’s
ment medication in decreasing doses to an best interest.
individual to alleviate adverse physical or Duty of loyalty: Obligation of governing board
psychological effects of withdrawal from the members to refrain from engaging in personal
continuous or sustained use of an opioid drug activities that would harm or take advantage of
and as a method of bringing the individual to the organization. This duty prohibits governing
a drug-free state within such period. board members from using their position of trust
Discharge summary: (Aging Services, Behavioral and confidence to further their private interests.
Health, Child and Youth Services, and Opioid It requires an undivided loyalty to the organi-
Treatment Program) A document prepared at zation and demands that there be no conflict
discharge by the staff members designated with between a governing board member’s corporate
the responsibility for service coordination that duty and self-interest.
summarizes the person’s course of treatment, Duty of obedience: Obligation of governing board
level of goal(s) achievement, final assessment members to perform their duties according to
of current condition, and recommendations applicable statutes and the provisions of the
and/or arrangements for further treatment organization’s articles of incorporation and bylaws.
and/or aftercare.
Effectiveness: Results achieved and outcomes
Diversion control plan: (Opioid Treatment observed for persons served. Can apply to differ-
Program) A document that contains specific
ent points in time (during, at the end of, or at
measures to reduce the possibility of diversion
points in time following services). Can apply
of controlled substances from legitimate treat-
to different domains (e.g., change in disability
ment use and must assign specific responsibility
or impairment, function, participation in life’s
to medical and administrative staff for
activities, work, and many other domains
implementation.
relevant to the organization.)

Glossary
Efficacy: The ability to produce an effect, or Fee schedule: A listing of prices for services ren-
effectiveness. dered. These prices may be designed for and used
with third-party payers, outside funding sources,
Efficiency: Relationship between resources used
and/or the persons served, their families, and
and results or outcomes obtained. Resources can
caregivers.
include, for example, time, money, or staff/FTEs.
Can apply at the level of the person served, pro- Functional literacy: The ability to read, com-
gram, or groups of persons served or at the level prehend, and assimilate the oral and written
of the organization as a whole. language and numerical information required
to function in a specific work or community
Employee-owner: An individual who delivers
environment. Accommodation strategies for
administration or services on behalf of an
those with reduced functional literacy may
organization if such individual is also:
include picture instructions and audio or video
■ with respect to a for-profit organization,
recordings.
a person holding an ownership interest
in the organization; or Governance authority: (Medical Rehabilitation,
Opioid Treatment Program) The individual or
■ with respect to a nonprofit organization, a
group that provides direction, guidance, and
person with the right to vote for the election
oversight and approves decisions specific to the
of the organization’s directors, unless that
organization and its services. This is the individ-
right derives solely from the person’s status ual or group to which the chief executive reports.
as a delegate or director.
Governing board: The body vested with legal
Entitlements: Governmental benefits available
authority by applicable law to direct the business
to persons served and/or their families.
and affairs of a corporate entity. Such bodies are
Executive leadership: The organization’s princi- often referred to as boards of directors, trustees,
pal management employee, often referred to as or governors. Advisory and community relations
the chief executive officer, president, or executive boards and management committees do not
director. The executive leadership is hired and constitute governing boards.
evaluated directly by the organization’s governing
Governmental: Regarding any city, county, state,
board and is responsible for leading management federal, tribal, provincial, or similar jurisdiction.
in conducting the organization’s business and
affairs. Grievance: A perceived cause for complaint.
Family/support system: (Aging Services, Home: (Employment and Community Services)

Continuing Care Retirement Communities, The individual’s living environment as impacted
Aging Services Networks, and Medical by the individual’s personal articles, friends,
Rehabilitation) A group of persons of multiple roommates, or significant others. Individuals’
ages bonded by affection, biology, choice, con- homes are considered central to their identity.
venience, necessity, or law for the purpose of
meeting the individual needs of its members. Host organization: Employer of an individual
eligible for employee assistance program services.
Family: (Behavioral Health, Child and Youth
Services, Employment and Community Services, Impairment: Problems in body function or struc-
Vision Rehabilitation Services) A person’s par- ture such as a significant deviation or loss. (This
ents, spouse, children, siblings, extended family, definition is from the World Health Organiza-
guardians, legally authorized representatives, tion’s International Classification of Functioning,
or significant others as identified by the person Disability, and Health [ICF].)
served. Independent (board representation): The
Family of origin: Birth family or first adoptive absence of conflict of interest by a governing
parents. board member with respect to any organizational
transaction. A governing board member is

Glossary
typically independent with respect to a trans- disabilities. In addition, the persons served
action if neither the individual nor any related have equal access to and full participation in
person or entity benefits from the transaction or community resources and activities available
is subject to the direction or control of a person to the general public.
or entity that benefits from the transaction. (See
Integration: (Aging Services, Continuing Care
definition of unrelated.) For purposes of the fore- Retirement Communities, Employment and
going, direction or control is often evidenced by Community Services, Medical Rehabilitation,
the existence of an employment relationship or Vision Rehabilitation Services) The opportu-
other compensation arrangement. nity for involvement in all aspects of community
Indigenous: Indigenous people are the descen- life. Integration into communities, work settings,
dants—according to a common definition—of and schools provides all individuals opportuni-
those who inhabited a country or a geographical ties to be active, fully participating members of
region at the time when people of different cul- those communities or environments. In inte-
tures or ethnic origins arrived. CARF is using the grated settings, diversity is viewed as a goal; it is
term indigenous as a generic term as defined by recognized that diversity enriches all community
the United Nations for many years. Practicing members.
unique traditions, indigenous people retain Interdependence: Movement from dependence
social, cultural, economic and political character- toward interdependence may be demonstrated
istics that are distinct from those of the dominant by an increase in self-sufficiency, self-advocacy,
societies in which they live. In some countries, or self-determination, with offsetting decreases
there may be preference for other terms includ- in artificial or paid services.
ing tribes, first peoples, or Aboriginals; specific
examples include Native Americans, First Interdisciplinary: Characterized by a variety
Nations, Métis, and Inuit. of disciplines that participate in the assessment,
planning, and/or implementation of a person’s
Individual plan: An organized statement of the program. There must be close interaction and
proposed service/treatment process to guide a integration among the disciplines to ensure that
provider and a person served throughout the all members of the team interact to achieve team
duration of service/treatment. It identifies the goals.
input from the person served regarding goals
and objectives and services to be provided, Investigation: A detailed inquiry or systematic
persons responsible for providing services, examination by a third party into the appro-
and input from the person served. priateness of acts by an organization or its
personnel, if such acts: (a) relate directly to
Information: Understanding derived from look- conformance or nonconformance to applicable
ing at facts; conclusions from looking at data. standards; or (b) are of such breadth or scope
Informed choice: A decision made by a person that the organization’s entire operations may
served that is based on sufficient experience and be affected.
knowledge, including exposure, awareness, inter- Joint venture: A business undertaking by two or
actions, or instructional opportunities, to ensure more legal entities in which profits, losses, and
that the choice is made with adequate awareness control are shared, which may or may not involve
of the alternatives to and consequences of the the formation of a new legal entity. If a new entity
options available. is formed, the original entities continue to exist.
Integration: (Behavioral Health, Child and Youth Kinship care: (Child and Youth Services) Kinship
Services) Presence and participation in the care is the full-time care, nurturing and protec-
mainstream of community life. Participation tion of children by relatives, members of their
means that the persons served maintain social tribes or clans, godparents, stepparents, or any
relationships with family members, peers, and adult who has a kinship bond with a child.
others in the community who do not have This definition is designed to be inclusive and

Glossary
respectful of cultural values and ties of affection. Medical director: (Opioid Treatment Program)
It allows a child to grow to adulthood in a family A physician, licensed to practice medicine in the
environment. (This definition is from the Child jurisdiction in which the opioid treatment pro-
Welfare League of America [CWLA].) gram is located, who assumes responsibility for
administering all medical services performed by
Leadership: Leadership creates and sustains a
the program either by performing them directly
focus on the persons served, the organization’s
or delegating specific responsibility to authorized
core values and mission, and the pursuit of program physicians and healthcare professionals
organizational and programmatic performance
functioning under the medical director’s direct
excellence. It is responsible for the integration
supervision.
of the organization’s core values and performance
expectations into its management system. Medically complex: (Behavioral Health, Child
Leadership promotes and advocates for the and Youth Services) Persons who have a serious
organization’s and community’s commitment ongoing illness or a chronic condition that meets
to the persons served. at least one of the following criteria:
■ Has lasted or is anticipated to last at least
Linkages: Established connections and
twelve months.
networks with a variety of agencies, companies,
and persons in the community. ■ Has required at least one month of
hospitalization.
Living arrangements: (Employment and
■ Requires daily ongoing medical treatments
Community Services) The individual model of
services delivered—Supported Living, Indepen- and monitoring by appropriately trained
dent Living, Group Home, Intermediate Care personnel, which may include parents or
Facility (ICF), etc. other family members.
■ Requires the routine use of a medical device
Long-term detoxification treatment: (Opioid or the use of assistive technology to com-
Treatment Program) Detoxification treatment
pensate for the loss of usefulness of a body
for more than 30 days but no more than 180 days.
function needed to participate in activities
Maladaptive behavior: Behavior that is destruc- of daily living.
tive to oneself, others, or the environment, ■ The medically complex condition of the
demonstrating a reduction or lack of the ability person served presents an ongoing threat
necessary to adjust to environmental demands. to his or her health status.
Manual skills: The instructional area that is Medically fragile: (Employment and Community
designed to assess and enhance skills in all Services) An individual who has a serious
aspects of sensory awareness with an emphasis ongoing illness or a chronic physical condition
on adaptive and safety techniques. Skill training that has lasted or is anticipated to last at least
focuses on organization, tactual awareness, spa- 12 months or who has required at least one
tial awareness, visual skills, memory sequencing, month of hospitalization. Additionally, this
problem solving, and confidence building. Activ- individual may require daily ongoing medical
ities range from basic tasks using hand tools to treatments and monitoring by appropriately
advanced tasks using power tools and wood- trained personnel, which may include parents or
working machinery. other family members. Moreover, this individual
Material litigation: A legal proceeding initiated may require the routine use of a medical device
by a third party concerning the appropriateness or the use of assistive technology to compensate
of acts by an organization or its personnel, if such for the loss of usefulness of a body function
acts: (a) relate directly to conformance or non- needed to participate in activities of daily living.
conformance to applicable standards; or (b) are
of such breadth or scope that the organization’s
entire operations may be affected.

Glossary
Medically supervised withdrawal (MSW): take the medication without any assistance
A medically supervised, gradual reduction or from personnel.
tapering of dose over time to achieve the elimina-
Medication unit: (Opioid Treatment Program)
tion of tolerance and physical dependence to
A facility that is part of but geographically
methadone or other opioid agonists or partial
separate from an opioid treatment program
agonists.
from which licensed private practitioners or
Medication-assisted treatment: (Opioid community pharmacists dispense or administer
Treatment Program) Medication-assisted an opioid agonist treatment medication or
treatment (MAT) is the use of medications, in collect samples for drug testing or analysis.
combination with counseling and behavioral
therapies, to provide a whole-patient approach Medication use: (Aging Services, Behavioral
Health, Child and Youth Services, Employment
to the treatment of substance use disorders. and Community Services, Opioid Treatment
Research shows that when treating substance Program) The practice of handling, prescribing,
use disorders, a combination of medication and dispensing and/or administering medication to
behavioral therapies is most successful. MAT is persons served in response to specific symptoms,
clinically driven with a focus on individualized behaviors, and conditions for which the use of
patient care. (Definition from SAMHSA) medications is indicated and deemed efficacious.
Medication control: (Aging Services, Behavioral Mental status: A person’s orientation, mood,
Health, Child and Youth Services, Employment
affect, thought processes, developmental status,
and Community Services, Opioid Treatment
Program) The practice of providing a secure
and organic brain function.
storage area and controlled access for medica- Merger: The combination of two or more legal
tions that are brought into a program and used entities into a single legal entity, where one entity
by the person served. This would include medi- continues in existence and the others cease to
cations self-administered by the persons served exist. In a merger, the surviving entity retains its
or the use of samples. name and identity and acquires the assets and
Medication management: (Aging Services, liabilities of the disappearing entities.
Employment and Community Services, Medical Mission: An organization’s reason for being.
Rehabilitation, Vision Rehabilitation Services) An effective mission statement reflects people’s
The practice of prescribing, administering, and/or idealistic motivations for doing the organization’s
dispensing medication by qualified personnel. work.
It is considered management when personnel
in any way effect dosage, including taking pills Natural proportions: A principle that states
out of a bottle or blister pack; measuring liquids; that the number of persons served in any given
or giving injections, suppository, or PRN setting, such as a work setting, should be in pro-
medications. portion to the number of persons with disabilities
in the general population.
Medication management: (Opioid Treatment
Program) The practice of prescribing, adminis- Natural supports: (Behavioral Health, Child and
Youth Services) Supports provided that assist the
tering, and/or dispensing any medications
approved for the treatment of opioid use disorder persons served to achieve their goals of choice
by qualified medical personnel. and facilitate their integration into the commu-
nity. Natural supports are provided by persons
Medication monitoring: (Employment and who are not paid staff members of a service pro-
Community Services, Vision Rehabilitation vider but may be initiated or planned, facilitated
Services) The practice of providing a secure
in partnership with such a provider.
storage area and controlled access for medica-
tions that are brought into a program and used
by the person served. The person served must

Glossary
Natural supports: (Employment and Community a specific service. Outcomes measures should
Services, Vision Rehabilitation Services) be related to the goals that recent services were
Supports that occur naturally in the community, designed to achieve. Other measures in the out-
at work, or in a social situation that enable the comes management system may include progress
persons served to accomplish their goals in life measures that are appropriate for long-term ser-
without the use of paid supports. vices (longer than six months in duration) that
Offender: An inmate, detainee, or anyone serve persons demonstrating a need for a slower
under the community supervision of a criminal pace in order to achieve gains or changes in
justice agency. functioning.
On-the-job evaluation: An evaluation per- Paid work: Employment of a person served that
formed in a work setting located outside the results in the payment of wages for the produc-
organization in which a person is given the tion of products or provision of services. Paid
opportunity to experience the requirements work meets the state and/or federal definition
necessary to do a specific job. Real work of employment.
pressures are exerted by the employer, and Participation: An individual’s involvement in life
the person’s performance is evaluated by the situations. (This definition is from the World
employer and the evaluator. Health Organization’s International Classification
Opioid agonist treatment medication: (Opioid of Functioning, Disability, and Health [ICF].)
Treatment Program) Any opioid agonist drug Participation restrictions: Problems an individ-
approved by the U.S. Food and Drug Admin- ual may experience in involvement in life
istration under Section 505 of the Federal Food, situations. (This definition is from the World
Drug, and Cosmetic Act for use in the treatment Health Organization’s International Classification
of opioid use disorder. of Functioning, Disability, and Health [ICF].)
Organization: A legal entity that provides an Pathological aging: Changes due to the impact
environment within which services or programs of disease versus the normal aging process.
are offered.
Pediatric medicine: The branch of medicine
Orientation and Mobility (O&M): The instruc- dealing with the growth, development, and care
tional area that addresses the use of the of infants, children, and adolescents and with
remaining senses in combination with skill the treatment of their diseases.
training utilizing protective techniques and
assistive devices in order to travel independently Performance indicator: A quantitative expression
in a safe, efficient, and confident manner in that can be used to evaluate key performance in
both familiar and unfamiliar environments. relation to objectives. It is often expressed as a
percent, rate, or ratio. For example, a perfor-
Outcome: Result or end point of care or status mance indicator on return to work might be:
achieved by a defined point following delivery percentage of clients in competitive employment
of services. 90 days after closure.
Outcomes measurement and outcomes Performance target: Measurable level of achieve-
management: A systematic procedure for deter-
ment identified to show progress toward an
mining the effectiveness and efficiency of results overall objective. This could be set internally
achieved by the persons served during service by the program, organization, or it could be
delivery or following service completion and a target established by an external entity. The
of the individuals’ satisfaction with those results. performance target could be expressed as a cer-
An outcomes management system measures out- tain percentage, ratio, or number to be reached.
comes by obtaining, aggregating, and analyzing
data regarding how well the persons served are
functioning after transition/exit/discharge from

Glossary
Periodically: Occurring at intervals determined according to the current Diagnostic and Statistical
by the organization. The organization uses Manual of Mental Disorders, which may also
information about and input from the persons include a secondary diagnosis.
served and other stakeholders to determine the
Pharmacotherapy: Any treatment of the persons
frequency of the intervals.
served with prescription medications, including
Person served: The primary consumer of ser- methadone or methadone-like drugs.
vices. When this person is unable to exercise
Plan: Written direction that is action oriented
self-representation at any point in the decision-
and related to a specific project or defined goal,
making process, person served also refers to those
either present and/or future oriented. A plan may
willing and able to make decisions on behalf of
include the steps to be taken to achieve stated
the primary consumer. These individuals may
goals, a time line, priorities, the resources needed
include family members, significant others, legal
and/or available for achieving the plan, and the
representatives, guardians, and/or advocates, as
positions or persons responsible for implement-
appropriate. The organization should have a
ing the identified steps.
means by which a legal representative of the
primary consumer, if any, is invited to participate Plan of care: The document that contains the
at appropriate points in the decision-making program that has been designed to meet the
process. By the same token, a person who is needs of the person served. This document is
legally able to represent his/her own interests prepared with input from the team, including the
should be granted the right to choose whether person served. The plan is modified and revised,
other members of the family, significant others, as needed, depending upon the needs of the
or advocates may participate in that decision- person served.
making process.
Policy: Written course of action or guidelines
Personal care: Services and supports, including adopted by leadership and reflected in actual
bathing, hair care, skin care, shaving, nail care, practice.
and oral hygiene; alimentary procedures to assist
Predicted outcomes: The outcomes established
one with eating and with bowel and bladder
by the team at the time of the completion of the
management; positioning; care of adaptive
initial assessment.
personal care devices; and feminine hygiene.
Preferred practice patterns: Statements devel-
Personal representative: An individual who is
oped as a guideline for blind rehabilitation
designated by a person served or, if appropriate,
specialists that specify procedures, clinical indi-
by a parent or guardian to advocate for the needs,
cations for performing the procedures, clinical
wants, and rights of the person served.
processes, setting, equipment specifications,
Personnel: An individual employed full time documentation aspects, and expected outcomes.
or part time or on a contract.
Prevailing wage: A wage paid to experienced
Personnel: (Behavioral Health, Child and workers in the vicinity who do not have disabili-
Youth Services, Opioid Treatment Program) ties that impede them in doing the work to be
All categories of individuals who provide services performed. An experienced worker is one who
in a program on a part- or full-time basis as staff has become proficient in performing a job and
members, independent contractors, volunteers, is not receiving entry-level wages. Prevailing
students, trainees, or interns. wage rates must be based on work done using
Persons with severe and persistent mental similar methods and equipment. The informa-
illness: (Behavioral Health) Adults with a pri- tion to be recorded in documenting prevailing
mary diagnosis of schizophrenia, psychiatric wage rates includes:
disorders, major affective disorders (such as ■ The date of contact with the firm.
treatment resistant major depression and ■ The name, address, and phone number
bipolar disorder), or other major mental illness of the firm.

Glossary
■ The individual contacted within the firm. Proprietary organization: An organization that
■ The title of the individual contacted. is operated for profit.
■ The wage range provided. Publicly operated organization: An organization
■ A brief description of the work for which that is operated by a governmental entity.
information is provided. Qualified behavioral health practitioner:
■ The basis for the conclusion that the wage rate (Behavioral Health, Child and Youth Services,
is not based on an entry-level position. Opioid Treatment Program) A person certified,
licensed, registered, or credentialed by a govern-
Primary care: Active, organized, structured mental entity or professional association as
treatment for a presenting illness. meeting the educational, experiential, or com-
Private homes: An apartment, duplex, house, petency requirements necessary to provide
or condominium owned or leased by a person mental health or alcohol and other drug services.
served. Persons other than a physician who are desig-
If a person served and the organization co-sign nated by a program to order seclusion or
restraints must be permitted to do so by federal,
a lease for the person served for an apartment,
state, provincial, or other regulations.
duplex, or townhouse, this living arrangement
will be considered a private home. The organiza- Qualified practitioner: (Child and Youth
tion will not technically be considered a lessor of Services) A person who is certified, licensed,
this private home for the person served, but will registered, or credentialed by a governmental
be considered a financial guarantor for the per- entity or professional association as meeting the
son served who is leasing his or her own private educational, experiential, or competency require-
home. ments necessary to provide human services.
Procedure: A “how to” description of actions Reasonable accommodations: Modifications or
to be taken. Not required to be written unless adjustments, which are not unduly burdensome,
specified. that assist the persons served or staff members
to access benefits and privileges that are equal
Prognosis: The process of projecting:
to those enjoyed by others. Examples taken from
■ The likelihood of a person achieving the Americans with Disabilities Act include
stated goals. making existing facilities readily accessible to and
■ The length of time necessary for the person usable by persons with disabilities; restructuring
to achieve his or her rehabilitation goals. jobs; modifying work schedules; reassigning per-
■ The degree of independence the person sons to vacant positions; acquiring or modifying
is likely to achieve. equipment or assistive devices; adjusting or mod-
ifying examinations, training materials, policies,
■ The likelihood of the person maintaining
and procedures; and providing qualified readers
an outcome achieved.
or interpreters.
Program: A system of activities performed for
Regular: Occurring at fixed, uniform intervals
the benefit of persons served.
of time determined by the organization. The
Program sponsor: (Opioid Treatment Program) organization assesses and uses information
The person named in the application for certifi- about and input from the persons served and
cation as responsible for the opioid treatment other stakeholders to determine the frequency
program and who assumes responsibility for all necessary.
its employees, including any practitioners, agents,
Rehabilitation: The process of providing those
or other persons providing medical, rehabilita-
comprehensive services deemed appropriate
tive, or counseling services at the program or
any medication units. to the needs of persons with disabilities in a
coordinated manner in a program or service
designed to achieve objectives of improved

Glossary
health, welfare, and realization of the person’s Reliability: The process of obtaining data in
maximum physical, social, psychological, and a consistent or reproducible manner.
vocational potential for useful and productive
Representative sampling: A group of randomly
activity. Rehabilitation services are necessary
selected individuals determined through a
when a person with a disability is in need of
procedure such that each person has an equal
assistance and it is beyond the person’s personal
probability of inclusion in the sample. If sampling
capacities and resources to achieve his or her
is used, the sample should reflect the population
maximum potential for personal, social, and
to which the results are generalized. Although no
economic adjustment and beyond the capabilities
specific percentage of persons served is required
of the services available in the person’s usual daily
to be included in the sample, general principles
experience. Such assistance continues as long as
of data analysis state that the larger the sample,
the person makes significant and observable
the less the error that is expected in comparing
improvement.
the sample to the entire population of persons
Rehabilitation nursing services: The formalized served. The number of persons sampled within
organizational structure that delineates the each program area or subgroup should be suffi-
appropriate accountability, staff mix, and com- cient to give confidence that the characteristics
petencies and provides a process for establishing, of the sample reflect the distribution of the entire
implementing, and maintaining patient care population of persons served.
standards and nursing policies that are specific to
Residence: (Employment and Community
rehabilitation nursing. The nursing staff includes Services) The actual building or structure in
members who provide direct care and those who which a person lives.
provide supervision and perform support func-
tions. This staff usually includes clinical nurse Residential settings: (Employment and
specialists, registered nurses, licensed practical Community Services) The individual model
(vocational) nurses, nursing assistants, and unit of services delivered—Supported Living,
clerical support. Nursing services are provided Independent Living, Group Home, Intermediate
under the direct supervision of a registered nurse Care Facility (ICF), etc.
unless supervision is otherwise defined by appli- Restraint: The use of physical, mechanical, or
cable state practice acts or provincial legislation other means to temporarily subdue an individual
for nursing. or otherwise limit a person’s freedom of move-
Rehabilitative treatment environment: A ment. Restraint is used only when other less
rehabilitation setting that provides for: restrictive measures have been found to be
ineffective to protect the person served or
■ The provision of a range of choices, with
others from injury or serious harm.
personal preference and self-determination
receiving full respect and consideration. Risk: Exposure to the chance of injury or loss.
■ A variety of social interactions that promote
The risk can be external, such as a natural
community integration. disaster, injury that occurs on the property of
a program, or fire. The risk can be internal to
■ Treatment of a sufficient volume of persons
the organization and include things such as
served to ensure that there is an environment
back injuries while performing job duties, it
of peer support and mentorship.
can involve liability issues such as the sharing
■ Treatment of a sufficient volume of persons of information about a person served without
served to support professional team involve- consent, or it can jeopardize the health of those
ment and competence. internal or external to the organization due to
■ A physical environment conducive to such things as poor or nonexistent infection
enhancing the functional abilities of control practices.
the persons served.

Glossary
Risk factors: (Behavioral Health) Certain condi- Short-term detoxification treatment: (Opioid
tions and situations that precede and may predict Treatment Program) Detoxification treatment
the later development of behavioral health for no more than 30 days.
problems. Examples of risk factors may include Should: Inasmuch as CARF is a standards-setting
poverty, family instability, or poor academic and consultative resource rather than a regula-
performance. Examples of protective factors tory or enforcement agency, the term should is
may include an internal locus of control, a posi- used synonymously with the term shall. CARF’s
tive adult role model, and a positive outlook. intent is that each applicable standard and each
Risk factors: Aspect of personal behavior or life- policy within this document will be addressed
style, environmental exposure, or variable or and met by organizations seeking to become
condition that increases the likelihood of an accredited or maintain current accreditation.
adverse outcome. Skilled healthcare provider: Licensed, certified,
Screening: A face-to-face, computer-assisted, or registered healthcare provider (e.g., nurse,
or telephone interview with a person served physician, or respiratory therapist).
to determine his or her eligibility for services Skilled healthcare provider: (Behavioral Health,
and/or proper referral for services. Child and Youth Services) Licensed, certified,
Seclusion: The separation of an individual from or registered healthcare provider (e.g., nurse,
normal program participation in an involuntary physician, or respiratory therapist). Can also
manner. The person served is in seclusion if include specifically trained natural or foster
freedom to leave the segregated room or area family member knowledgeable in the care of
is denied. Voluntary time-out is not considered the specific individual.
seclusion. Staff member: A person who is directly
Sentinel events: An unexpected occurrence employed by an organization on either a
within a CARF-accredited program involving full- or part-time basis.
death or serious physical or psychological injury Stakeholders: Individuals or groups who have
or the risk thereof. Serious injury specifically an interest in the activities and outcomes of an
includes loss of limb or function. The phrase organization and its programs and services.
“or risk thereof ” includes any process variation They include, but are not limited to, the persons
for which a recurrence would carry a significant served, families, governance or designated
chance of a serious adverse outcome. Such events authority, purchasers, regulators, referral sources,
are called sentinel because they signal the need personnel, employers, advocacy groups, contrib-
for immediate investigation and response. utors, supporters, landlords, business interests,
Service: Activities performed for the benefit and the community.
of persons served. Strategic planning: An organization’s directional
Service access: The organization’s capacity to framework, developed and integrated from a
provide services to those who desire or are in variety of sources, including but not limited to
need of receiving it. financial planning, environmental scans, and
organizational competencies and opportunities.
Service referral: The practice of arranging for
a person to receive the services provided by a Supervisor: The lead person who is responsible
given professional service unit of the organiza- for an employee’s job performance. A supervisor
tion or through some other appropriate agent. may be a manager or a person with another title.
This arrangement, which is usually made by Supports: Individuals significant to a person
the individual responsible for the program served and/or activities, materials, equipment,
of the person served, should be documented or other services designed and implemented
by notation in the person’s permanent record. to assist the person served. Examples include

Glossary
instruction, training, assistive technology, Unrelated (board representation): The absence

and/or removal of architectural barriers. of an affiliation between a governing board mem-
ber and any person or entity that benefits from
Team: At a minimum, the person served and
any organizational transaction. For purposes
the primary personnel directly involved in the
of the foregoing, affiliation generally means a
participatory process of defining, refining, and
relationship that is:
meeting the person’s goals. The team may also
■ Familial;
include other significant persons such as employ-
ers, family members, and/or peers at the option ■ Characterized by control of at least a
of the person served and the organization. 35 percent voting, profits, or beneficial
interest by the member; or
Team integration: The process of bringing indi-
■ Substantially influenced by the member.
viduals together or incorporating them into a
collaborative team. The entire team becomes the Validity: Refers to the appropriateness, meaning-
dominant culture and decision-making body for fulness, and usefulness of a measure and the
the rehabilitation process. There is recognition of inferences made from it. Commonly regarded
and respect for the value of information provided as the extent to which a test measures what it is
by an individual team member, with a focus on intended to measure.
the interdependence and coordination of all team
members. Through coordinated communica- Value: The relationship between quality and cost.
tion, there is accountability by the team 24 hours Visit: Episode of service delivery to one person
per day, 7 days per week for all decisions made. served on one day by one service or discipline.
Transition (from school): (Employment and Visual skills: The instructional area that
Community Services) The process of moving addresses the needs of persons with partial vision
from education services to adult services, to gain a better understanding of their eye prob-
including living and working in the community. lems through patient education and teaches them
Transition: The process of moving from one level how to utilize their remaining vision effectively
of care or service/support to another, changing through the use of low vision techniques. It also
from child/adolescent service systems to adult includes assessment and training with special
systems, or leaving care or services/supports. optical aids and devices designed to meet the
various needs of the persons served. These needs
Transition plan: (Aging Services, Behavioral may include reading, activities of daily living,
Health, Child and Youth Services, Opioid
orientation, mobility, and home repairs.
Treatment Program) A document developed
with the full participation of the person served Wellness education: Learning activities that are
that (a) focuses on a successful transfer/transition intended to improve the patient’s health status.
between program or service phases/levels/steps These include but are not limited to healthcare
or (b) focuses on a successful transition to a education, self-management of medication(s),
community living situation. The plan could be nutritional instruction, exercise programs, and
part of the individual plan and details how the training in the proper use of exercise equipment.
person served will maintain the gains made
Youth: The time a person is young—generally
during services and support ongoing recovery
referring to the time between childhood and
and/or continued well-being at the next
adulthood.
phase/level/step.
Treatment: A professionally recognized approach
that applies accepted theories, principles, and
techniques designed to achieve recovery and
rehabilitative outcomes for the persons served.

INDEX
A product pricing 242–243

quality control system 242
Acceptance tools, equipment, and machinery 242
policies and procedures 136
Americans with Disabilities Act
Accessibility information resources 108
leadership responsibilities 104
plan, requirements 107 Annual Conformance to Quality Report
requests for reasonable accommodations, (ACQR) 6, 10, 17
requirements 109 Appeal panel 23
Accreditation Applying for a survey 11
allegations 21 ASPIRE to Excellence
certificate 18 assess the environment 31
conditions 5 effect change 121
decisions 6, 10 implement the plan 57
nonaccreditation 7 persons served and other stakeholders—
provisional accreditation 7 obtain input 53
extension of awards 20 process diagram 29
multiple programs and services 12 review results 111
overview 8 set strategy 49
policies and procedures 5 Assessment and referral programs
preliminary 7 description 385
preparing for 8, 11 emergency and crisis intervention
public identification 18 services 386
suspension of 21 policies and procedures 386
Affirmative business enterprise services provided 386
benefits package, provided for all written summary 386
employees 241 Assistive technology supports and services
bids for contract work 242 collaboration with other agencies 286
business plan, requirements 240 description 283
career advancement resources 244 exit summary report, requirements 287
description 240 individual service plan,
educational resources for persons requirements 285–286
served 244 information about the program,
employment resources 244 requirements 284
information informed decisions by persons served 284
gathered about persons served 243 integration with other services 286
provided to persons served 243 planning process 286
job descriptions 241 referrals for additional services 287
legal decision-making authority of resources for employers 287
persons served 245 service development, requirements 285
marketing plan 241 service goals 285
performance evaluations 241

Index
time frame for services 287 Behavioral consultation services

universal design principles, promotion adaptive devices and equipment,
of 283 training 293
Autism spectrum disorder assessments 290
adults with ASD functional, for targeted behaviors 290
benefits planning 202 assistive technology, use of 293
community resources, information behavioral consultation plan 289
about and referrals to 198 contacts with persons served 290
description 197 crisis intervention services
life planning 200 written procedures 292
self-advocacy support services 199 description 289
services provided 198 early intensive behavior intervention (EIBI),
assistive technology 192 consultation in, requirements 291
services 192 education and information, provided to
children with ASD persons served 292
description 194 medical consultation regarding medically
diagnostic services 194 related policies and procedures 292
education for peers 197 medically supervised programs 292
educational system needs of persons served, considered in
advocacy for families 196 service provision 290
sharing information with 196 personnel
family-centered care 196 skills and competencies 289
information for families 195 supervision of 292
mentor services 195 plan, written
support system for families 196 supervision of direct service
community awareness of ASD, personnel 292
promoting 190 policies and procedures
community resources 193 medically related 292
information about persons served, procedures for crisis intervention services,
collecting and sharing 193 written 292
outcomes, monitoring 190 procedures, written
personnel use of behavioral strategies 291
competencies 191 reasonable accommodations in service
training requirements 191 provision 293
population designations 189 strategies 291
reasonable accommodations, use of assistive consistency across environments 290
technology and adaptations 191 formal monitoring of, requirements 291
research, evidence-based and accepted procedures, written 291
practices 190 written, requirements 291
transition planning 193 team meetings 289
training 291
adaptive devices and equipment 293
B direct service staff 289
Barriers, removal Behavioral interventions
resources for additional information 108 policies and written procedures 349
Behavioral change Billing, quarterly reviews 64
positive interventions 138 Blended surveys 3

Index
Board peer counseling and role modeling

governance policies 41 services 325
processes 45 performance information, use of 324
relationship with executive leadership 44 persons served
selection 41 desired outcomes 326
Bomb threats, emergency procedures 72 direction of services 324
outcomes expectations 324
Budget preparation, requirements 61
participation in organizational
governance 324
C policies and procedures
Cancellation/change, fee 13 grant requirements and assurances 324
use of government funds 323
CARF public information and education 324
consultation with 8, 11 records, reports, and performance
education and training events 11 information, provided to referral and
mission 1 funding sources 324
publications, ordering 11 transition services 325
purposes 2 use of government funds, policies and
standards development 2 procedures 323
standards manuals, ordering 4
values 1 Certificate of Accreditation 18
vision 1 Child and youth services
Case management/services coordination continuity of education for child/youth
programs served 249
advocacy 376 description 246
description 374 early intervention services 249
intensity 375 educational opportunities, provided
linkages to services and resources 374 for families 249
locations 375 educational services, requirements 250
multiple providers 375 information
personnel, qualifications 374 gathered from families 246–247
roles and responsibilities 374 methods for gathering 247
provided to support transitions to new
Centers for Independent Living services 251
advocacy 324 shared with families 247
services 325 juvenile justice status and service access 250
annual work plan 323 needs of child/youth served, considerations
assistive technology 326 in identifying 248
benefits planning 326 personnel
community capacity and options 324 criminal background checks 251
community input resources for families 251
on annual work plan 323 personnel, training requirements 249
core services, design 324 planning team members, requirements 250
description 322 service environment configuration 250
enhanced services 326 service provision, basis for 248
grant requirements and assurances, policies services offered 248
and procedures 324 transition planning 251
independent living services 325
information and referral services 325

Index
Children and adolescents Community employment services

applicable standards 393 employment supports
assessments 393–394 career planning and advancement 226
continuity of education 394 crisis intervention services 226
educational services, requirements 394 description 222
educational specialist, included as team individualized support services
member 394 provided 224
eligibility 395 integration into employment setting 225
policies and procedures nonwork needs of persons served 224
criminal background checks of review of ongoing long-term supports,
personnel providing direct semiannual 226
services 395 supervision at employment site,
population designation, description 393 requirements 223
service environment, requirements 395 times and locations of service
skills development 395 provision 225
staff support, availability 395 training strategies 223
visits 395 job development
Children and adolescents specific population activities 219
designation description 216
continuity of education for child/youth individual service plans
served 169 periodic revisions to 218
description 166 requirements 218
early intervention services 169 information
educational opportunities, provided for provided to employees 220
families 168 provided to employers 221
educational services, requirements 169 planning considerations 217
information service description 215
gathered from families 166–167 Community housing programs
methods for gathering 167 activities 264, 380
provided to support transitions to new changes in living arrangements 265, 381
services 170 community living components 264, 380
shared with families 167 description 262, 379
juvenile justice status and service access 170 housemates 380
needs of child/youth served, considerations housemates, selection of 264
in identifying 167 information provided to residents 382
personnel in-home safety 380
criminal background checks 170 in-home safety needs of persons served 264
resources for families 171 maintaining residences during
personnel, training requirements 168 absences 266, 382
planning team members, requirements 169 meals and snacks 264, 380
residential services medication management 264, 380
safety needs addressed 171 ongoing support/services 265, 381
sleeping areas 171 personnel availability
visits, opportunities for 171 on call 266
service environment configuration 170 on site 266
service provision, basis for 168 personnel, availability
transition planning 170 on call 382
on site 382

Index
pets 264 Comprehensive benefits planning

policies description 294
pets 380 follow up with persons served 297
visitors or guests 380 individual planning, quality controls for 296
procedures information, provided to the public about
securing appropriate housing 265 services offered 295
residential setting 380 personnel
residential setting, requirements 263 process to maintain current
securing housing, procedures 381 knowledge 296
skills development 265, 381 training, competencies 296
smoking/nonsmoking areas 266, 382 persons served, education for 296
transportation 382 program design 295
transportation availability 266 service provision, requirements 296
visiting areas 266 Comprehensive vocational evaluation services
visitors and guests 264 career exploration activities 210
visits 382 description 207
Community integration employment exploration sites,
activities and service goals 281 assessment of 210
assistance to meet basic needs 282 evaluator qualifications 209
description 279 functional capacities assessment,
outreach and follow-up procedures 282 evaluation report 211
personnel availability 281 individual evaluation plan
service goals 280 preparation of 208
times and locations of service provision 281 requirements 207
Community integration programs individual written evaluation plan
description 376 process identification 208
legal wage guidelines 377 strategies to use assistive technology 208
objectives 377 information, assessed or obtained 211
outreach and follow-up 378 modification of assessment tasks/
personnel, availability 377 activities 209
persons served, meeting basic needs 378 psychological testing 209
services/activities, organization 377 supervision requirements 209
times and locations 377 work samples, use of 210
written evaluation report, requirements 211
Community services programs
written instructions for evaluators 210
early signs of dementia or age-related
decline, identifying and addressing 164 Consultation with CARF 8, 11
inclusion in community activities 163 Contracted services, requirements 139
individualized service plans for persons Corporate citizenship 35
served 163
Corporate compliance
participation in community activities 163
policy 37
principle standards 163
reporting 37
quality of life, enhancing 163
requirements 37
skills development 164
risk assessments 37
staffing considerations 164
training for personnel 37
Complaints
Critical incidents
annual review and written analysis of 103
procedures 80
from persons served, policy and
written analysis 81
procedures 103

Index
Cultural competency employment planning report

written plan 34 requirements 206
sharing and dissemination of 206
information provided to persons served 205
D service description 204
Data Employment skills training services
collection 113, 116 description 233
performance improvement, ensuring expansion, modification, and
integrity of 112 discontinuation of services 235
Disputed survey outcomes 21 industry-based apprenticeships
Diversion/intervention programs confidentiality requirements 235
activities provided 388 contingency plans for supervision 235
collaboration with other programs and design and implementation 234
stakeholders 387 written procedures and techniques 235
description 387 information provided to persons served 234
evaluation of programs/services and needs addressed 234
training activities 389 training course
information provided 387 description/curriculum 233
personnel, knowledge of community design 233
resources 389 instructors, qualifications 233
plan for individual outcomes 389 Ethics
procedures for referrals to other services 389 codes of conduct 35
program plan, requirements 388 violations, procedures 35
requirements 389 Evacuation
service design, personnel responsible for, procedures, requirements 72
qualifications 387 route identification, requirements 77
strategies used 388
Exit summary report, requirements 147
Diversity
of stakeholders, responding to 34
Documents, falsification of 18 F
Facilities
health and safety requirements 70
E
Families
Emergency procedures participation 351
requirements 72
Family services
testing 77
description 252
Employee development services emergency response system, 24-hour 253
additional services 231 information on community resources,
course content, annual review of 232 provided to persons served 252
description 230 plan for relief 253
services provided 231 planning
training course, written description 232 collaborative 253
Employment planning services planning requirements 252
assessments 205 provision of and referrals for support
employment exploration sites, services 252
requirements 204 Federal funding
corporate compliance 37

Index
Fees policies 41, 45

past due 13 annual review 46
requirements 64 board selection 41
supplemental survey 20 executive compensation 45
survey 9, 13 leadership development and
application 11 evaluation 45
cancellation 13 practices 41
rescheduling 13
Financial H
planning and management 60
policies and procedures 63 Hazardous materials, procedures for
related entities, requirements 62 safe handling 88
results, reporting 61 Health and safety
reviews 61 leadership responsibilities 32
solvency, leadership responsibilities 32 requirements for facilities 70
statements, annual review of, training for personnel 70
requirements 65–66 See also Emergency procedures, Evacuation
Fire, emergency procedures 72 procedures, and Universal precautions
First aid Home and community services
equipment and supplies 79 assistive technology and other equipment,
supplies, in vehicles 83 used by persons served 331
communication between person served
Foster family services
and provider, requirements 333
advocacy 254–255
description 327
description 253
disaster preparedness and emergency plan,
emergency response system, 24-hour 256
for persons served 330
foster family providers
education
recruitment, screening, training, and
on medication 336
monitoring of 256
education, provided to persons served
selection of, involvement of persons
and family/support system 332
served 256
family/support system, involvement
information provided to facilitate
in service delivery 331
transitions 257
gaps in service delivery 328
needs of persons served, addressed 257
personnel
participation in services 254
competencies 329
plan for relief 256
persons served
planning, requirements 255
education and training 335
signed agreements, requirements 256
financial assistance and planning 334
training
involvement in the community, options
for foster family providers 254
for housing, transportation, and
Funds of persons served, procedures 65 technology 333
policies and procedures
G collaboration with family/support
system in decision making 332
Governance requirements 329
board processes 45 procedures
description 40 personnel
executive leadership 44 background verification 328

Index
respite services 336 L

risk assessments 330
service delivery process 334 Leadership
service delivery schedule 330 analysis of critical incidents 81
service options and settings, development 45
identification of 328 ethics 35
evaluation 45
Host family/shared living services person-centered philosophy of 31
description 258 relationship with board 44
emergency response plans 262 requirements
matching process 260 accessibility 104
persons served accountability 31
linkages to community 262 responsibilities 31–32, 39
procedures roles and responsibilities 33
monitoring of providers 261 structure 31
providers use of input from stakeholders 54
background checks 259
plan for respite or relief 262 Leadership responsibilities
training for 260 compliance with legal and regulatory
written agreements with 261 requirements 32
recruitment of providers 259 establishing mission of the organization 32
respite/relief plans 262 financial solvency 32
screening process 259 health and safety 32
Legal requirements
compliance 32
I compliance with obligations 57
Infection control procedures 82
Information M
confidential, release of 137
provided to persons inquiring about Media relations
services 136 procedures 68
provided to persons served 142 Medical consultation
requested by CARF 6 regarding medically related policies
technology plan 96 or procedures 350
Informed consent, policies 101 Medical director 350
Input Medical emergencies
from personnel 53 procedures 72
from persons served 53 Medically fragile
from stakeholders 53 advance directives 183
for budget preparation 61 advocacy 185
used in planning 54 ancillary services 185
Insurance assessments 181–182
as part of risk management plan 68 procedures 182
for vehicles and personnel 83 team responsibilities 183
collaboration with healthcare providers 185
communication, with primary care
J physician 184
Job descriptions, requirements 93

Index
community residential settings education and training 358

living environment 187 information collected 363
meals and snacks 188 medication utilization evaluation 362
on-site support for persons served 188 peer review 362
sleeping areas 188 policies, requirements 358
visits 188 procedures
decision making, role of person served 183 prescribing 361
designated care coordinator, for person prescribing, dispensing,
served 184 administering 360
end-of-life planning 186 requirements 359
information, provided to persons served 185 programs that prescribe or provide
in-home services, safety needs 186 medications, requirements 360
management of services 181 programs where persons served spend
medical equipment and supplies, one or more nights 360
maintenance and calibration of 186 treatment guidelines and protocols 362
persons served written procedures on dispensing or
decision making roles 183 administering 363
designated care coordinator for 184 Mentor services
information provided to 185 access to information, provided by
in-home safety needs 186 mentors 300
memorial services and rituals 187 accommodations, individualized to persons
procedures served 299
assessments 182 activities 299
program plan for delivery of services 181 community networks, identification of 300
service delivery team, competency-based training for mentors 299
requirements 183–184 description 298
specific population designation 180 matching of mentors to persons served 298
staff competencies 185 mentor networking opportunities 300
support networks, for families and orientation to services 299
caregivers 186 persons served, strategies and supports
transition planning 184 for 300
transition/discharge planning 183 recruiting of mentors 298
Medication management security of mentors 300
advocacy for persons served 148 Mission
annual review of medications used by establishment of, leadership
persons served 149 responsibilities 32
education and training for persons
Mission of CARF 1
served 148
information provided to persons served 148
procedures for 150 N
Medication monitoring and management Natural disasters, emergency procedures 72
individual records of persons served, Nonaccreditation 7
requirements 148 review and appeal 22
procedures
documenting medication use 148 Nonviolent practices
storage and handling 148 debriefing 369
designated room 369
Medication use documentation 370
description 357

Index
implementation 366 exploration of other work opportunities,

minimization, elimination 366 offered annually 239
policies information provided to persons served 237
requirements 364–365, 367 resources provided to persons served 238
procedures training activities 237
implementation 367–368 available during periods of reduced
interventions, protocols 366 work 239
review 370 Outstanding debt 13
safety plan 367
training 365–366
usage 370 P
Peer support services
O description 354
design and development 355
Older adults/dementia care ethical codes of conduct 355
advocacy 173 peer support specialists
care options and settings 175 activities performed by 355
community awareness 175 role 355
decision-making, resources and training for 355
information provided 174 personnel training on role of peer
description 172 support specialists 355
end-of-life persons served, educational activities
planning, requirements 175 for 356
support services, education about 173 policies and procedures 354
memorial services and grief expression, service provision locations and times 356
opportunities for participation 176 training
personnel for peer support specialists 355
responsibilities 174 for personnel 355
supervision requirements 175
Performance improvement
training requirements 174
action plan 122
persons served with Alzheimer’s disease and
analysis, annual, requirements 121
other dementias
description and requirements 121
assessments 176
care planning 177 Performance indicators
information provided to families/ analysis 123
caregivers 178 in relation to targets 121
personnel training requirements 178 measuring 117
planning for changing needs 177 Performance information, sharing 123
service plans 177 Performance measurement and
screenings/reviews for persons served 174 management 111
services provided 173 data collection, requirements 113, 116
transition planning 175 indicators
wellness activities 174 measuring 117
One-Year Accreditation service delivery 118
review 21 system, written description 111
Organizational employment services Person(s) served
description 236 complaint policy and procedures 103
disclosure of fees 64

Index
education 351 policies

education, to reduce physical risks 70 planning process 302
emergency contact information 79 procedures
funds handled by organization 65 reasonable accommodations,
information provided to 142, 351 in service provision 303
regarding performance 123 service planning process
input from 53 policies 302
involvement in survey process 14 services provided, identification of 302
legal decision-making authority 135, 347 training
medication use, procedures for for personnel 302
managing 150 Personnel
records 137, 371 background checks 89
access 101 clinical or direct service, supervision of 353
safeguarding 58 competencies 91
referrals to other providers 146 competency assessments and training 352
resources for securing benefits 146 contract, performance management 93
rights 100 emergency contact information 79
evaluation of restrictions 349 grievance and appeal procedures 94
policies 101 input from 53
promoting 349 nondiscrimination policy 94
requirements 100 performance evaluations 93
restrictions 139 performance management 93
services coordination for 352 policies 94
sharing strategic plan with 51 qualifications 91
through arrangement with a court or recruitment and retention 90
criminal justice system, requirements 140 resources and education for 39
transporting, safety requirements 83 service provision process, requirements 95
Personal supports services sharing performance information with 123
adaptive devices and equipment, students or volunteers 94
training 302 sufficient staffing 89
assistive technology 303 training
description 301 fiscal policies and procedures 63
education/training offered, written health and safety 70
description 303 infection control procedures 82
immigration supports information and communication
assistance to meet basic needs 305 technologies 98
description 304 positive interventions 138
personnel availability 305 requirements 92
program design 304 restrictive procedures 139
service goals 304 transportation of persons served 83
times and locations of service training on corporate compliance 37
provision 305 Plans
information and referral services 303 accessibility 107
personnel cultural competency 34
training quality improvement (QIP) 6
use of adaptive devices and risk management 67
equipment 302 technology and information
management 96

Policies Procedures
admission/acceptance criteria 136 abuse, neglect, exploitation, or fraudulent
corporate compliance 37 use of funds 310
financial 63 admission/acceptance criteria 136
governance 45 crisis intervention services 351
annual review of 46 critical incidents 80
executive compensation 45 documentation of medication use 148
handling of medications used by persons emergency
served 140 annual tests 77
health and safety requirements 72
legal and illegal drugs 354 ethics violations, allegations 35
weapons 354 evacuation 72
informed consent 101 financial 63
peer support services 354 formal complaints from persons served 103
personnel 94 funds of persons served 65
students/volunteers, dismissal 94 health and safety
persons served hazardous materials handling 88
admission/acceptance criteria 136 legal and illegal drugs 354
rights weapons 354
promoting 349 individual budgets of persons served 311
restrictions 139, 349 infection control and prevention 82
positive behavioral interventions 349 managing medications 150
positive interventions 138 media relations 68
records, requirements 58 medication storage and handling 148
rights of persons served 101 on dispensing or administering
supervision of all individuals providing medications 363
direct services 353 peer support services 354
use of tobacco products 354 personnel
Preliminary Accreditation 7 background checks 89
grievance and appeal 94
Preparing for a survey 14
responding to legal actions 58
Prevention programs students/volunteers, dismissal 94
activities provided, requirements 391 persons served
description 390 admission/acceptance criteria 136
evaluation of programs/services and rights
training activities 392 restrictions 139
personnel, knowledge of community positive behavioral interventions 349
resources 392 positive interventions 138
program plan, requirements 392 records
public awareness efforts 391 confidentiality 58
strategies used 391 of persons served, requirements 58
training programs safety 70
curriculum, requirements 392 social media 68
requirements 392 supervision of all individuals providing
Prevention/diversion programs direct services 353
procedures for referrals to other services 392 universal precautions 82
service design, personnel responsible for, use of information and communication
qualifications 390 technologies 98
use of tobacco products 354
Index
Program/service structure personnel training 342

entry, transition, and exit criteria, persons participating in multiple programs,
documented 133, 346 coordination and collaboration 341
mobile unit services, requirements 135, 347 services coordination 341
persons found ineligible for Reasonable accommodations
services 134, 346 requests, reviewing and documenting 109
persons served
Records
communication mechanisms,
discharge summary
requirements 135, 347
of person served 373
procedures
duplicate records, handling of 373
unanticipated service
of persons served 137
modification, reduction, or
of persons served, safeguarding 58
exits/transitions 134, 346
organization 372
resources, provided by
requested by CARF 6
organization 133, 346
requirements
scope of services
regarding persons served 371–372
documented parameters 132, 345
signatures
information about,
of persons served 372
requirements 132, 345
time frames for entries 373
service models and strategies 134, 346
Regulatory requirements
Provisional Accreditation 7
compliance 32
review 21
Release of information 373
Public identification of accreditation 18
Reports
Purposes of CARF 2
Annual Conformance to Quality 6, 17
corporate compliance 37
Q exit summary 147
external safety inspection, annual 85
Quality Improvement Plan (QIP) 6, 16
financial results 61
submitting 10
internal safety inspection 87
requested by CARF 6
R Rescheduling a survey 13
Rapid rehousing and homelessness prevention Respite services
program communications to family 272
acceptance into program 339 description 271
annual analysis of time from program family members as respite trainers 271
entry to housing (rapid rehousing medications, equipment, and instructions
programs only) 342 for care of persons served, available at
community resources, linkages respite site 272
and utilization 338 planning requirements 271
description 337 respite site, matched to needs of
education for persons served 341 persons served 272
housing options, screening of 339 service design 271
housing plans, requirements 340 services provided, determined by
intensity of service provision 340 persons served 271
landlord recruitment and retention plan 338 Restrictive procedures
outreach activities 338 training of personnel 139
use of, requirements 138

Index
Rights individual budget management

of persons served 100 services 313
promoting 349 program description 308
restrictions 139 reporting to oversight agency 313
of persons served, requirements 100 support service planner
Risk management roles and responsibilities 312
description 67 individual budgets
insurance 68 adjustments to 311
plan procedures
annual review of 67 evaluating expenditures 311
requirements 67 for moving funds 311
requirements 310
review and monitoring 311
S information
Safety provided to persons served 310
inspection mission and philosophy 308
annual 85 participation agreements 309
external 85 person(s) served
internal 87 choice of support team 308
report 85 individual budgets, establishing 309
self-inspection 87 individual plans 308
procedures 70 information provided to 309–310
vehicles 83 responsibilities of 309
Scheduling of survey 13 procedures
abuse, neglect, exploitation, or
Self-directed community supports and services fraudulent use of funds 310
description 306
employer of record services Self-employment services
accounting audits 318 assistance and referrals provided to
conflicts of interest, guidelines 315 persons served 229
customer service requirements 318 budget, for implementation of self-
fee structure, provided to persons employment plan 229
served 315 business plan development 228
information implementation plan, requirements 229
maintained by organization 316 informed choices of persons served,
provided to persons served 315–316 requirements 228
information management system, service description 227
requirements 317 Self-inspections, health and safety 87
job descriptions, for employees of Service delivery
persons served 316 guided by person-centered philosophy 31
new employee packets, for employees performance goals, setting 118
of persons served 317 performance indicators, requirements 118
service description 314 using information and communication
services provided 314 technologies
training, mandatory, for employees description and applicable standards for
of persons served 317 all organizations 97
flexible supports planning services Service plan
assistance for persons served 311 assistive technology 145
community resources, use of 311 development of 143

Index
requirements 143 Supported education services

risk assessment, documented 145 activities and supports offered 321
Service planning description 319
information gathered prior to 141 information and outreach efforts 320
information to be considered 143 personnel, responsibilities 320
services offered 320
Services
times and locations of service provision 322
coordination, for persons served 352
design 348 Supported living
implementation 348 access
to activities 270
Services coordination
to transportation 270
accessing transportation 274
access to services, 24-hour 269
advocacy 276
décor, determined by persons served 269
crisis intervention and stabilization
description 267
services 274
home maintenance support 269
intensity of services 275
in-home safety 268
linkages to services and resources 273
input from persons served 268
locations and times of service provision 275
personal care support 269
multiple service coordinators 276
personnel
personnel, knowledge and
availability 269
competencies 274
collaboration with person’s
program description 273
support network 269
securing safe housing 274
securing/maintaining housing 268
services provided 274
skill development services 274 Supported living programs
access
Social media
to activities 384
procedures 68
to services 384
Staff to transportation 384
See Personnel availability of support personnel 384
Stakeholders description 383
information provided to 32 determination of décor in the homes
input from 53 of persons served 384
Standards manuals information, provided to residents 384
in alternative formats 4 input, from persons served 383
ordering 4 medication management 383
Steps to accreditation 8 persons served, safety needs 383
securing or maintaining housing 383
Strategic plan supports offered 384
annual review of 50
requirements 50 Survey
review and updating of, based on after the survey 16
performance indicators 123 application 5
sharing of 51 application fee 11
application process 11
Strategic planning blended 3
considerations 49 disputed outcomes 21
description 49 fees 9, 13
technology to support service delivery 49 multiple programs and services 12
Supplemental surveys 19 preparing for 8, 11, 14

Index
process 14 Training of personnel

schedule 15 emergency and evacuation procedures 70
selection of programs and services 12 orientation and ongoing, requirements 92
supplemental 19 positive interventions 138
team safety procedures 70
language interpreters, providing 13 medication management 70
selecting 9, 13 Transition services
time frames 12 description 277
Suspension of accreditation 21 information provided to persons served 277
outreach to persons served 277
transition plan
T coordination of 278
Targeted employment screening services requirements 278
information Transportation of persons served
gained from screening, requirements health and safety 83
214
Treatment programs
gathered about persons served 214
modalities 349
modification of tasks/activities during
staff credentials and qualifications 349
screening 213
personnel Treatment team
written instructions for 214 See Team
personnel administering work samples
qualifications and requirements 214 U
personnel conducting psychometric
assessments Universal precautions, procedures 82
qualifications 213 Utility failures
screening process, requirements 213 emergency procedures 72
service description 213
Team V
meetings, frequency 352
responsibilities 352 Values of CARF 1
Technology Vehicles
considered in strategic planning 49 first aid supplies 83
for enhancement of and access to services insurance requirements 83
and supports 351 owned by organization, safety
information management system plan 96 requirements 83
services provided using information and staff use of personal vehicles 83
communication technologies Vision of CARF 1
description and applicable standards for Volunteer staff, requirements 94
all organizations 97
emergency procedures 99
equipment maintenance 99 W
personnel training requirements 98 Workforce development services
service delivery, requirements 99 coordination of services 161
training for persons served 98 formal agreement, with one-stop career
written procedures 98 center 160
Training and educational events sponsored information
by CARF 11 provided to one-stop career center 160

Index
orientation to services 161

outreach efforts 161
performance indicators, use 160
policies and procedures 162
relationship with one-stop
career center 160
reports and services 161
service description 159
Written program description,
requirements 348

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2016

July 1, 2016–June 30, 2017

Employment and Community Services

We remain committed to helping organizations ASPIRE to Excellence® in

Herb Zaretsky, Ph.D., Board Chair

2016 Employment and Community Services Standards Manual i

Section 2. Quality Individualized Services and Supports .........................125

Section 3. Employment and Community Services....................................203

ii 2016 Employment and Community Services Standards Manual

U. Personal Supports Services (PSS) ..........................................................................301

2016 Employment and Community Services Standards Manual iii

CARF International is a private, nonprofit

2016 Employment and Community Services Standards Manual 1

Purposes Development of the

2 2016 Employment and Community Services Standards Manual

Applying the Standards Blended Surveys

2016 Employment and Community Services Standards Manual 3

Aging Services ■ Aging Services Standards Manual

Behavioral Health ■ Behavioral Health Standards Manual

Employment and ■ Employment and Community Services Standards Manual

Medical Rehabilitation ■ Medical Rehabilitation Standards Manual

4 2016 Employment and Community Services Standards Manual

a. The use and implementation of

2016 Employment and Community Services Standards Manual 5

2. The organization must provide such Intent Statements

standards and comply with CARF’s policies and

6 2016 Employment and Community Services Standards Manual

organization’s capability to correct the deficien- Accreditation, or Nonaccreditation decision

2016 Employment and Community Services Standards Manual 7

Overview of the Steps to Accreditation

Consult with a An organization contacts CARF, and a resource specialist is designated

Conduct a The organization conducts a self-study and evaluation of its conformance

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■ The organization is informed of the survey team’s findings related

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CARF Events manual and its companion publication, the sur-

Step 2. Conduct a self-evaluation

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Survey Time Frame At a Glance Selection of Programs and Services to be

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Second or Last Day After the Survey

Opening of business The survey team reports its findings to CARF.

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QIP is required by Accreditation Condition 3 ■ Relocation of an accredited program

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Falsification of Documents involving accreditation without prior approval

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itself or its programs and services as accredited

When an organization’s leadership or ownership

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of organizations with accredited programs. A completed after the last survey.

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The purpose of this section is to identify notable 1.C. Strategic Planning

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Section 4. Psychosocial Rehabilitation Glossary