Psychologists have significantly increased their presence and contributions in a major human-service accrediting organization that's expanding its influence and moving toward a more comprehensive view of services to people. This will ensure the quality of programs for a range of psychosocial and physical problems, from drug and alcohol rehabilitation to work-force development and respite services.

The Commission on the Accreditation of Rehabilitation Facilities (CARF) accredits more than 90 specific types of programs, including assistive technology for employment, child and youth community programs, respite services, addictions case management, prevention and residential programs, and numerous mental health and psychosocial rehabilitation programs.

The psychologists involved with CARF say the profession has gained impressive representation in the commission. Six psychologists serve on the 53-member board of trustees--a significant number given the far-flung nature of the groups represented, which include the American Academy of Neurology, the American Hospital Association, Goodwill Industries, the National Adult Day Services Association and the Assisted Living Federation of America.

Psychologists are even more prominent in CARF's top leadership. In 2000, Peter Vicente, PhD, became the first to serve as the board of trustees' chair. This year, two of the four primary officers are psychologists: Vicente is immediate past chair of the CARF Board of Trustees and Herb Zaretsky, PhD, who is APA's representative to CARF, is secretary-treasurer.

In addition, in February CARF announced that its new executive director is Brian Boon, PhD, a psychologist who was previously vice president of Claimant and Health Care Services for the Workers Compensation Board of Alberta in Edmonton, Canada. Boon has served in a number of CARF positions, including as a board member.

Russ Newman, PhD, JD, APA's executive director for practice, notes that the association has for many years viewed the profession's involvement in CARF as important. APA has had a member on the CARF board for close to two decades.

Growing prominence

CARF has long been the pre-eminent organization for accrediting programs in vocational rehabilitation and medical rehabilitation, notes John Corrigan, PhD, who was APA's liaison to CARF for a number of years. But in the last few years it has moved into accrediting programs as diverse as behavioral rehabilitation, work-force development aimed at breaking the cycles of unemployment, adult day-care services and assisted living.

Indeed, Vicente argues that that diverse focus makes it the primary accrediting player to help with the long-needed harmonization of services. The larger and better-known Joint Commission for the Accreditation of Healthcare Organizations, he notes, is targeted more specifically on hospitals and other medical care facilities.

At the same time CARF now has more than doubled the total number of programs it accredits to more than 25,000 individual programs in 3,000 organizations. It's also quadrupled the number of behavioral health services it accredits to about 31 percent of all such accredited services. CARF has also begun to accredit programs in Europe and Canada.

But beyond its current influence, CARF's expansion poises it to push the complexity of human services toward an integrated "system of service across the life span," says Vicente. That system, he indicates, would make all services more effective by ensuring the individual gets what he or she needs--whether it's at a hospital or workplace situation or wellness program--and ensuring people aren't served in one area only to fall through the cracks in another.

Accrediting organizations are major players in shaping services because they decide which components and levels of quality are acceptable. Often third-party payers--including the federal government, states and insurers--use those organizations' accreditation to decide which facilities they will reimburse for services.

For example, 41 states accept CARF accreditation for reimbursing vocational rehabilitation programs and six now accept it for at least some mental health programs. A number of states also accept the CARF stamp of approval for substance-abuse programs, mental retardation and developmental disabilities, workers' compensation, brain injury and spinal cord injury, comprehensive pain management and other areas.

Most managed-care and managed behavioral health organizations endorse the value of the organization's accreditation, as well, say CARF officials.

In addition, in recent years, CARF has contracted with the U.S. Department of Veterans Affairs (VA) to accredit services for all the rehabilitation programs at VA facilities and with the U.S. Department of Health and Human Services to develop and implement national accreditation for opioid treatment services.

Psychologists finding solutions

There is, indeed, a "rich complexity" in the services CARF has been able to delineate and accredit, says Vicente. But, he argues, the accreditation process allows for the standardization of services, and thus enhances the potential for the many different types of services to be coordinated and to serve people in more cohesive ways.

Zaretsky stresses another key element in CARF's vision for cohesive services: The organization, which has long emphasized that consumers be consulted during any accreditation, recently set goals for further strengthening consumer participation and diversity in all its activities.

Why the relative concentration of psychologists in a body spanning dozens of professions and specialties?

In offering a major reason for the significant participation of psychologists in CARF, Zaretsky notes that psychologists are involved in a wide and diversified range of human services work and that they have the professional and interpersonal skills that help to effectively implement those programs.

Vicente theorizes that the very diversity of services that CARF deals with creates an atmosphere where psychologists thrive. "By professional selection and nature of training," he says, psychologists "seek complexity; they are challenged by complexity, and they have a drive to integrate and provide complex solutions to challenges."

And, says Corrigan, "Having psychologists well-represented on the CARF board, as we do, assures that psychological principles and practice are represented in the standards, especially given the board's involvement in the ongoing revision process for those standards."