>> Thank you for joining me today. My name is Dawn Hameline.  I am happy to have you here today with me. I have about 25years of clinical practice experience. I currently practice as an Occupational Therapist and Assistive Technology Professional in Rehabilitation Therapies at the University of Vermont Medical Center serving an outpatient population. 
>> Today we will talkabout the process for seeking CARF accreditation. Specifically in the area of assistive technology. I do at the out a little disclaimer got  -- disclaimer,I do not work for CARF and I am not partnering with CARF in any way. I am just sharing information to support the growth and quality of assistive technology service programs. 1st we will talk briefly about accreditation organizations. I will cover survey preparation and standards. Then lastly I will leave you with some suggestions and resources.  they will help you move forward.
>> Accreditation. What is it and who does that? Accreditation is a process of review. It's a way to show that you are meeting predetermined  Standards.Think about accreditation organizations as external peer Auditors.  There are hospitals, there are some that survey for behavioral health, ambulatory surgical centers, it's like an alphabet soup, so it's important that you find an accrediting body that is the right fit for you and the program or services that you provide. 
>> Today we will focus on CARF, Commission of Accreditation of Rehabilitation Facilities .They uniquely offer accreditation in assistive technology. 
>> Why are we doing this? People have a choice as to  Where they go for care. Accreditation is a way to show quality and CARF is considered the gold standard  or rehabilitation facilities.Accreditation is voluntary, but often people view it as essential for many different reasons. In some cases it is necessary for CMS  Reimbursement. It always helps organizations to develop infrastructure for quality and safety and continuous improvement. And accreditation also providesthat benchmark of measuring quality so people in the community know you serve and that you meet hit the high level of standards. 
>> There are 2 options when considering a CARF survey.  You can do a standalone which is very focused, it's one single program. It all comes out of one service manual or you can to a blended. Blended is a much broader survey. You can't include more than one program from more than one standards manual. CARF  does have 7 different standard manuals. There is one for child abuse, vision rehab, opioid treatment, medical rehab, behavioral health, aging services and employment and community services. Assistive technologyfalls under employment and community services manual.  one thing to know about a blended survey, when you get your results, your survey result will be based on the weakest program. Keep that in mind if you pull more than one together.

>>
>> There are a few different survey outcomes. One is a three-year accreditation. This indicates that you are meeting or exceeding CARF standards and do not need to be reviewed for another 3 years. There is a  One-year accreditation, they get this if there are a few deficiencies but there's clear commitment on working to correct those and make progress. Provisional accreditation is usually because they show a few deficiencies and you have a shorter timeframe to get those met or risk receiving non-accreditation. The other is not accreditation, we don't say that one very. -- Very loud.
>> The process. CARF outline standards  and then they send surveyors to check to see if you are in compliance with those standards. The standards that we talk about have been developed with input from providers,consumers, payers and other experts around the world. The survey team is comprised of  industry peers. When they come, they follow more of a consultative approach. That's why CARF surveys  are not surprise visits. You know well in advance when the surveyors are coming. Even a specific date.
>> They do look at everything and a look at it in detail. It's very much like an audit that happens within your clinic, just on a much larger scale.
>> If this is your 1st time seeking CARF accreditation,  you should allow 9 to 12 months to prepare. Part of the reason for this is you need to demonstrate to CARF that you are in compliance with the standards  for a minimum of 6 months before your survey.
>> Communication is key. You want to have good open communication with your leadership your staff needs to be on board and participating in the process and practicing accordingly to your policy and procedures on a day-to-day basis. You may consider creating a CARF committee.  You will want to meet with your CARF liaison.  You may want to find out if there are any pre-existing CARF survey materials  or site reviews. This will save a lot of time and be helpful in the future we talk about standards.
>> You want to submit an intent, that is submitted about 3 months prior to your target survey window. When I talk about the survey window, it's usually about a two-month timeframe that CARF tries to have someone  in there and that span. You what to submit your intent 3 months prior to that. At the 3 months prior to survey, that's also when you want to be considering a mock survey. You may do this internally or you may bring someone from outside into do a survey. By doing it 3 or 4 months in advance, it will give you time to make any necessary changes that you identify.
>> Deadlines. He prepared and keep track of the dates. You want to give yourself money of time to prepare for the survey. There's a lot of information and preparation that goes into this. You want to make sure if you are not good with deadlines then you have someone on the team who is. If you don't and you try to rush things along you definitely risk of Rocky survey experience peers -- experience.

>>
>> There are 3 different ways to demonstrate performance and conformance. Observation, interviews and documentation for each standard you want to ask yourself, how do we show  That we do this? And how can we show it when surveyor is present? You want to make sure you do what you say, and say what you do. If you have policies in place, is it also in practice and not just on paper? Documentation by far is the keyto success with the survey process. You need to really come to enjoy documentation or have someone on your team who  does. There is a huge focus and documentation.

>>
>> What is in your head needs to be on paper. When we talk about paper is not literally,  It can be in your computer, web-based, a flyer or postcard. But what ever it is, it needs to be somewhere accessible to the surveyors.There are a few different ways to organize your material. The system you choose may be dependent upon the person who is taken the primary lead in your accreditation process.  It's usually what they are most comfortable with. Some find a shared drive difficult to navigate and not quite as intuitive. And they prefer a binder or a paper document method.There is no right or wrong answer. It just needs to be readily available to the surveyors. 
>> CARF identifies some standards that explicitly require written documentation,  It also identifies other documents that are specific to operational timelines. When you look at this slide, here it identifies some of the written documents, patient records, personnel records, department or seizure manual, all of those are written, policies and procedures, job descriptions. When we talk about operational timelines, we are talking about things that need to be completed at set time intervals. For example, if you require your staff have CPR certification annually, you need to have some type of documentation that shows all of your staff did complete it, the dates completed, and make sure it follows your timeline requirement of it being annually. The same thing with equipment maintenance records, different pieces of equipment need to be checked at different intervals. Having a log that the equipment was checked at the 3 month, 6 months nine-month -- whatever the time period is that you have specified.
>> Do not reinvent the wheel. This is probably the biggest timesaving area I can share with you you want to use what is available. Many facilities policies can be used as is or just slightly modified to meet the program specific. Better yet, if your facility has previously completed a CARF survey, a portion of the required section have already  Been tough for you leaving you more time to focus on the assistive technology program requirements. Go visityour quality management office, make friends with the people in human resources and in engineering and safety departments and be clear about what you need and they should be able to help you and save you a lot of time.  and don't forget there are other hospitals that have AT clinics,  use them. People like to share information and like to share what they have done. Use them as a guide to get you through this process.
>> There are 3 general sections to the standards manual relevant for assistive technology supports and services. There is section number 1, number 2 a and number 4. Section 1 and 2 letter a may already be in place if your facility has gone through a survey before. Standards are reviewed and updated regularly so keep in mind this process is continuous improvement, that being said, what you see here may not be accurate -- I guess -- in a month or 2 down the road if changes are made here. The majority may stay but some standards may change so numbers and page numbers may fluctuate and be different.
>> The 1st section 4 assistive technology support and service is ASPIRE to excellence  this refers to business practices of the organization and you are responsible for knowing this. It is a framework off of CARF standards  to make it logical and action oriented we will look through here quickly.
>> A Stance for accessing the environment. Being aware of the environment and helping to guide each program in achieving their message and understanding what the needs are out there. And focusing on the people in the community who need to be served. S stands Force that strategy and this understands where organization is and where it needs to go and the plans being developed. Know how your CARF  -- AT clinic  may fit into the larger local structure. This requires setting up strategies.
>> P stands for Person served. They could be funding sources, person served or stakeholders. We don't really exist as an organization without having them and having them heart of our process.
>> I Stands for implement the plan. In doing so, you need to do it in a financial and regulatory sustainable manner. 
>> R is about reviewing results. Look at how you performed look at how you're doing, looking at outcomes and performance measures.
>> E is about effecting change. Take measures after reviewing your plan and see the changes that need to be made in implementing those changes. This is about having a total cycle of quality improvement.
>> You are expected to know the ASPIRE  standards. You need to own this if you do a standalone  Survey. Is important not to disregard the 1st 2 sections because you are responsible for them.

>>
>> I think it is helpful to understand how the standards manual is written.  I took the 1st section of section 2a,  if you notice where it is written 2a  number 1. This is the standard and is written to the outcome focus. The section -- the 2nd section is the intent. This identifies why they think the standard is important. And the 3rd is learning and teaching. This is about providing examples or resources that might help support meeting the standard. If you look at this one, the standards, documents the following parameters. That includes the patient's name, age, and environment, some of the different things we might include in an evaluation and shared information about the scope. That is about sharing information almost like in a brochure. How do people know about your program and what information is included? The 3rd part is the scope is reviewed on an annual basis. Beckel 
>> To documenting according to timeline. -- That goes back to documenting according to timeline.
>> The intent is to provide people information for persons to make informed choices. This shows you can meet standards, and the handbook by outlining expectations. The orientation and intake process of evaluating a client, different performance indicators and information, and having the timeline checklist stethoscope is reviewed on an annual basis would also be part of this.
>> Section number 1 was ASPIRE. In section number 2  there are 13 standards we talked briefly about the 1st one. On the next few slides, I went through and wrote the CARF  standard followed by examples of possible ways you could demonstrate conformance to that standard. These should all be pretty evidenced and built in the day-to-day operations of your organization so hopefully many of these are not of surprise. 
>> When I used the term evidenced by, I refer to examples to demonstrate conformance. These are not all inclusive, they are suggestions and recommendations to help in your process if you get hung up with the language of the standard.
>> As we go through the standards you want to ask yourself, how do we demonstrate that? How do we demonstrate we do this? If we look at standard number 2, provides needed resources to support the scope. How do you do that? Do you have qualified staff? If you do have qualified staff, what keeps them qualified? Do you have and offer educational opportunities? Do you do competency or trainings? In terms of equipment, what do you do for budgeting? Strategic planning for changes that might be affected. Different ways to show conformance to that standard. 
>> Number 3 is based on the scope of each program. It once documentation of your policy for entry. The criteria for transition as well as exit criteria. Number 4 and 5, standard number 4 is you're a policy in place if someone is an eligible forcer -- is ineligible for services. How do you notify? How do you get a referral so this isn't a continual problem? They look for documentation on that. 
>> Number 5 procedures to address unanticipated service modification. Exit or transitions, funding resources. You need to have some demonstration and knowledge of the funding sources. What expectations are and time frames you may be working with. -- Working within.
>> Number 6 looks at your process for service delivery. How do you know your current? How do you know your staff is skilled? There are number of different ways but you are probably doing this. You need to make sure the information is available to the surveyor. You need to staff training,. Audits, you may have learning modules or in services, you want to be sure they are all documented and you know where to find them when the surveyor's request them.

>>
>> Number 7 is looking to see that members of the care team are working together and  Sharing information. Some of this could be written or it could be oral communication. Progress notes. Sometimes if you have even in your template for an evaluation a little spot that just says team communication, that will leave a space or trigger someone to document they have collaborated with another discipline or is taken into account special needs of another department that may be addressed whether it be specific mobility or communication challenges happening in other departments.

>>
>> Number 8 is the policy regarding care of an individual who may not have the capacity. This should be a policy already in the facility.  You want to have it and make that specific. Specific to your needs.
>> Number 9 relates to a mobile unit. If you have a mobile unit, you will have policies in place to determine who is an appropriate driver, what service providers and services are provided through the unit, how confidentiality is maintained, all of this you should have in policy. Don't feel you need to reinvent it. If you have a mobile unit go to the leadership and get access to this.
>> Number 10 refers to initiation of services and making sure provide -- services are provided with no discrimination or subjective judgment 1 new thing is there must be a process for handling a wait list. My guess there is one already established in your facility. Have access to that and know what it is, nowhere to pull it up when the surveyors arrive. -- Make sure you know where to pull it up when surveyors arrive. 
>>Number 11 you must have information about the program availability needs to be  Understandable. This is pamphlets flyers, it needs to be understandable. Is it written at a level to meet many different needs? Is it available in different languages? Is it accessible to all? Is it captioned?
>> Number 12 is maintaining a medical record and these should comply with organizational standards.

>>
>> Number 13 is a policy for confidential information, that should already be in place at the organization but you must have specific time limitations and the cannot be open-ended. 
>> The next section is assistive technology specific. The 1st standard is related to universal design and knowing and understanding universal design. Basically you want to design needs to be useful to people of all abilities and easy to understand. You want to include different modes of communication, language, pictures, verbal, different ways of explaining things about your program to get through to people.

>>
>> Standard number 2 states  That every program should have its own statement. You want to make this program specific here this is a great place to start -- I apologize I got behind. This is a great place to start when you're developing your program. Developed the scope of practice statement. From their you can draft policies and procedures according to each area of assistive technology within that program. For example once you have designed the scope of practice, you may have a wheelchair and seating clinic, seating and positioning clinic, driver rehabilitation clinic, you may have it augmentative and alternative communication clinic, they may share the same scope of practice but they will have different policies and procedures according to each.
>> The person served is supposed to be the center of the treatment team. They need to be educated about the process of care. Howdy show that you do that? There are different things you might include. You want to make sure the person is educated about the how -- about how the services will be delivered. Timeline. And end results. Talking about equipment, they need to understand what their responsibilities will be for maintenance cost. It's about allowing people to have the information to make educated decisions.
>> Making informed decisions about what is available and what will work best.. Information is informed decisions and lots of different ways to do it again sure the equipment is the right fit for the person.

>>
>> Standards number 4, 5, and 6 are all related to treatment plans. You need to include some desired functional outcomes  Achievedthrough the inclusion of assistive technology. This can be included through a comprehensive documentation  template. Look at your evaluation and really see what things are involved and make sure you have met all of the criteria.
>> Standard number 7 is about having the individualized treatment plan. Again, it's looking at each person individually and identifying what their needs are and why. You what to make things like the environment is assessed, what potential barriers they may be, potential health risks, what previous experience with assistive technology the individual has had Rex as well as the participants desired outcome -- as well as knowing what the patient's desired outcome is.
>> Standard number 8 looks at interdisciplinary. You want to look at things like the staff training, it can be provided by someone in your clinic about assistive technology.
>> Standard number 9. CARF once to see  there are -- CARF  once -- wants to see there are relationships within the community and collaboration.This could include relationships with vocational rehab, maybe you have a peer mentoring program for you can  Bring people in. As you are doing this you need to make sure you have documentation to show these things are happening. It could also be including collaborations with an adaptive sports program for equipment selection and fitting. That might sound like a one-time deal, but if you keep documentation of that, it would also show relationships developed within the community. This is often an area or standard where you might need more nontraditional documentation. It could be a flyer or postcard or a notice of offense and that there is a partnership occurring.
>> Standard number 10 identifies the timelines and timelines are important. They are critical and need to be included as performance indicators.
>> Standard 11 looks at things having a team approach and making sure the right confessional is providing the necessary care. And that referrals are generated if the referral has come to the wrong place. It wants to see there is that connection.
>> Standard number 12, CARF  was to see a comprehensive discharge plan to make sure the client is satisfied and that there are outcomes. We do our discharge summaries in the chart, but also think about providing and after visit summary to give the individual the education that you provided verbally in the clinic. There may be so much information and most people only leave with a portion, having something provided is a nice way to support standard number 12 at carry that information forward for the individual as they lead your clinic. -- As they leave the your clinic.
>> Standard number 13 is about people in the community. Employer's often don't have or have limited awareness of assistive technology and workplace accommodation. There is I miss conception -- there is a misconception about cost and having the assistive technology. Service providers who provide assistive technology do have a community responsibility as a resource to employers to help support and encourage this relationship in the community. Sometimes it's done by being on a board or doing lectures organizations as requested.
>> Suggestions and summary for preparing for CARF.  Irecently had a conversation with Melissa Oliver out of Richmond. There they were awarded a three-year accreditation with assistive  technology supports and services. Some of the things they did that worked well for them, they went with the binder method versus the shared drive to organize written documentation. If you look here, there are 12 to 15 different headings. They have a binder for each one. It holds all of the documentation to meet that criteria. Other suggestions she also shared was to learn and understand ASPIRE.  I think that is one people get very focused in their own area of assistive technology and feel because it's a larger bigger plan, feel it doesn't relate to them as much but it does. Each identify section you are held responsible for. Understand efficiency and effectiveness. Allow time for the mock survey to me changes. To the mock survey 3 to 4 months in advance of your survey date -- to -- Do your mock survey 3 to 4 months in advance whether you bring someone in or you some insight and give yourself plenty of time to make changes. Develop relationships with other departments. It will save you lots of time if you reach out to people in other departments who may already have policies, procedures, maintenance records, those types of things, timelines in place that you can use and modify to meet your specific program needs. Another thing is to reach out to other AT clinics.  They are growing around the country. It is definitely worth it. People want to support each other in this growing area. I am sure people are happy to support each other. 
>> A few others, use your local CARF liaison.  You will be assigned a person, you may already have a CARF  liaison in your hospital if you have gone through this before. Use them to help interpret standards that might be more difficult. CARF  offers training throughout the year so take advantage of that. Go and sit in and learn and bring it back to your team to be able to implement. Referred of the CARF standards manual. You'll carry that around with you  and check and make sure that as you plot a standard that you have proof. Complete the survey preparation handbook. That helps give checklist and guidelines to make sure you are complete with all of your work. I would also add practice your teamwork. This is not just a small group working to gain accreditation. This is about you as an entire team working forward so work together. Allow time to prepare and call your CARF specialist. 
>> Remember, do not reinvent the wheel and stick to your timelines. Your program will benefit from the quality of this and the services that you provide will be all the better for it. CARF is not just a certificate you hang on the wall. It's a sign of quality  and people in the community will recognize that as well as other people within your organization. I wish you luck. You can do this. 
>> [ Event Concluded ]