CARF Accreditation: Where do I start???

Although it seems like an obvious enough question, I realized recently that I’ve never written a post about it. I’ve addressed how to prepare for a site visit and how to maintain conformance, but haven’t started from the start. Yet it’s absolutely crucial to start things off right to avoid huge pitfalls! So here’s the basics;

Get Connected to CARF and Get the (right) CARF Manual!

The first thing you’ll need to get sorted is which standards manual you will be using (CARF has several) and which standards within that manual you will be applying to your programs (there are literally dozens of possibilities).  It’s always my very first task with a new client seeking accreditation.  You need to know the scope of the work before you can develop a proper workplan.  You can contact CARF directly to get set up and it costs you nothing.  They will assign a Resource Specialist to your organization that will walk you through the process of figuring out which manual you will be using. They will also help you figure out which of their specific program standards will apply, though I strongly suggest getting some third party advice on that topic from colleagues, other similar accredited agencies, or an experienced CARF consultant.  I’ve seen lots of folks end up under the wrong program type, and that has the potential to cause huge problems when the survey team arrives!

Do a Gaps Assessment

Once you know where you fit in the CARF standards manual, you’ll need to figure out what you have and don’t have in relation to the standards.  I suggest being methodical – going standard by standard – to figure out what’s missing.  CARF has developed a resource called the CARF Preparation Workbook that can support this process.   It isn’t required, but some people find it helpful.  I prefer a simple workplan type format that lists the standards being applied, assesses conformance, and allows you to specify who is going to do what to address gaps in conformance.  Remember to review the examples and intent statements that come after each standard in the standards manual to make sure you understand what is required.  It’s also wise to review the appendices in the back of the manual that list what documents are required (Appendix A), what the operational timelines are for time sensitive processes (Appendix B), and what training is required for your staff (Appendix C).

Decide On Your Timeline and Build Your Workplan

With your gaps assessment in hand, you’re ready to plan your work.  I STRONGLY recommend establishing a timeline at the beginning and sticking to it as best as possible.  There is never a good time.  There will always be unforeseen circumstances and challenges. Putting your timeline in writing helps keep everyone focused. The absence of a timeline gives people permission to keep putting it off. You should count on the preparation work taking between six months and one year, depending on number and size of the gaps, the complexity of your organization, and the resources you have available to get the work done.  Work backwards from your deadline to figure out when tasks need to be completed. I tend to leave document development tasks (e.g., certain policies, procedures and plans) until later and focus on process tasks (e.g., performance measurement, staff training) first except where they overlap. I DO NOT recommend working through the standards manual in a linear fashion (from A to Z) because many of the different content areas overlap.  For example, risk management and strategic planning overlap with performance measurement and management. Make sure you develop your plan with that in mind or you can end up creating re-work.

Get Educated & Get Help When You Need It!

CARF offers regular training across the US and Canada.  They also have webinars and resources you can purchase.  It’s absolutely worth it to have one or two staff get trained. It helps you to decipher CARF-ese and make sense of how to implement the standards in your organization.  You can also access your CARF Resource Specialist for free at any time as you prepare for the site visit.  These folks can be an invaluable source of information and assistance in interpreting the standards.  Other organizations that are CARF accredited or that are going through the preparation process at the same time can be a valuable source of support as well.  After all, misery loves company!

Some organizations choose to purchase the services of a consultant to support them through the process. While building up expertise internally is always wise, having outside guidance can help streamline the work and avoid pitfalls.  I’m planning to do a blog post on how to choose a consultant as I think there are more than a few pitfalls to avoid with that as well!

Consider Doing a ‘Mock’ Review

Many of the organizations I’ve worked with hire a local surveyor or consultant to do a ‘mock’ survey.  Having a dry run with someone that is objective helps to ensure that you are ready and haven’t missed anything important in your preparations.  It also helps put staff a bit more at ease as they will get some sense of what the actual survey will be like.

Submit Your Application

Once you’ve worked your plan, it’s time to submit the application to CARF.  Submitting the application is your indication to CARF that you are operating in conformance with the standards. You can expect to have your site visit from CARF inside of six months from the time you submit the application.  The specific timelines are listed in the CARF manual.

Preparing for the Site Visit (aka What to Expect When You’re Expecting… CARF)

The key task in the run up to the site visit is staying on track with all CARF related processes.  You definitely don’t want to let off the gas. If you need assistance with preparing for the actual site visit, you can refer to my blog post “Five Tips for a Successful CARF Accreditation Survey”. And if you need more info or clarification on anything in this article, don’t hesitate to reach out.

A Daring Achievement!

Those of you who have followed me for a while know that I’m a fan of Dr. Brené Brown.  A Social Work professor and author of ‘Daring Greatly’ and ‘Rising Strong’, I really resonate with her work.  So much so that I decided to go through her “The Daring Way™” certification program.  The Daring Way™ is a community of practitioners who believe in the power of owning our stories, and who recognize that our willingness to be truly open and honest is our most accurate measure of courage.  I just completed the certification process and have been working to integrate the material into my ongoing work with organizations, particularly around strategic planning.  Helping organizations to fully own their stories and immerse themselves in charting an authentic path for their next chapter has been highly rewarding.  While I’m still experimenting with how to bring the material into that work, I’m confident that the language of story is universal and that it can be powerful in shaping how an organization imagines its future.  Beyond strategic planning, The Daring Way™ has been a powerful learning experience that has given me a new set of tools to use in facilitating a variety of conversations.  I’m very grateful that I had the opportunity and that I can now share that learning through my work.

Mind The (CARF) Gap

There’s an incredible feeling of relief you feel when the taillights of the CARF survey team’s vehicle leave the agency parking lot.  You breathe a sigh of relief and hopefully celebrate your achievement with a cocktail (or two).  But that feeling of relief and achievement is quickly in your rear view mirror as you jump back in to the day to day challenges of running a social service organization.  In that day to day buzz, it’s pretty easy (and understandable) to lose sight of all things accreditation.  The problem is that they’re coming back.  And that gap in between surveys goes by with lightning speed.  As I joke when teaching CARF workshops, “This survey never ends!!!”  So, in the spirit of keeping excellence in the forefront, here are some practical tips, advice and wisdom on how best to mind the CARF “gap” so that you’re ready for their return.

Think (and build) Systems that Support Conformance – Although getting prepared for and going through a survey for the first time is quite stressful, I actually think the second survey is harder.  You can treat a first survey like an event (i.e., CARF’s coming – look busy!).  You only need to show six months of conformance, and building a set of plans on a one-off basis is relatively easy.  It’s when you have to show that you’ve lived and breathed those standards for three years that the cracks show up.  The solution is to use systems thinking to make sure that all of the various tasks are part of how business happens at your shop.  Consider using things like perpetual planning calendars or bring forward mechanisms to make sure things don’t get missed.  Some agencies establish standing agendas to ensure that key topics are always in the conversation.

Embed Conformance Deeply in the Organization’s DNA – In the end, you don’t want your conformance with CARF standards to be a thin overlay or veneer.  You want it be deeply embedded so that it’s just how you do business.  That requires making sure that all the pieces of work related to accreditation are integrated.  For example, all plans (risk management, accessibility, technology, etc.) should be integrated into your annual operational cycle, not an overlay that someone has to pay lip service to but that has no meaning outside of CARF accreditation.  In other words, there should be no such things as a ‘plan for CARF’.  They are your plans.  All document processes related to case management with clients should have conformance built in from the start, not added as an afterthought.  Operational activities such as management and team meetings, performance evaluations, supervision, and training offer a myriad of opportunities to embed conformance with numerous standards without adding extra work.

Share Responsibility for Conformance Widely – One of the riskiest strategies for managing accreditation requirements is to invest too much of the responsibility for conformance in one position.  While it will often be the case that one or more people will have primary responsibility, it’s wise to ensure there is some organizational redundancy in terms of knowledge of the standards and how the organization meets them.  The more that staff at all levels of the organization know the standards that are relevant to their positions and understand how their work helps to meet those standards, the easier it will be to consistently meet the standards and maintain a culture of conformance that has everyone contributing to the outcomes and excellence you have committed to through the process.

Stay Current with the Standards – In case you haven’t been told, the CARF standards manual changes every year!  Although missing one years’ worth of changes would likely not have a huge impact, missing three years’ worth could have major consequences.  So make sure you get informed of the changes and address any new requirements.  I would strongly suggest adding the updating process to your perpetual calendar or bring forward file.
Create or Connect to a Supportive Network – I have learned that in order to have at least one good idea, you need to generate several.  Connecting with other organizations who are also accredited can prove to be a helpful way to generate new strategies or solutions to elements of maintaining conformance.  These collaborative connections can offer opportunities to test next ideas.

Audit Yourself Against the Standards Regularly – my final tip is to audit your conformance.  I have clients that do this prior to their next survey and others that do it every year.  It depends on the complexity of the organization and your level of concern that things aren’t being maintained.  If you choose to do it prior to the survey, I suggest having it done at least four months in advance so you have time to address issues.  You may still get recommendations that are in line with the audit findings (depending on how long the you have been out of conformance with a standard), but fixing it will give the survey team confidence in your systems.  You can do the audit yourself, or consider bringing in someone from outside who knows the standards (e.g., a local surveyor or someone from another agency who knows the process and standards well).  It’s a service we offer to our clients that we get huge positive feedback on in terms of making sure the organization is ready.

New Resources Section on Governance!

Kim and I have had the honour of being engaged in a number of recent projects involving Boards of Directors from non-profit organizations.  From facilitating Strategic and Tactical Planning to policy development work to Board training events, it has broadened our understanding of both the needs and challenges that Boards of Directors face.  With that in mind, we are starting a new section in the Resources page of our website dedicated to Governance materials.  We started with posting a sample policy on conflict of interest.  We plan to populate it with many more resources over time.  We’re interested in your feedback about the kinds of resources or articles that would be helpful.

Using Story in Evaluation

Evaluating programs through the use of stories is a powerful way to personalize the experiences of those you serve for your funders and other stakeholders.  And although it’s often more work, the experience of gathering stories and reflecting on them allows you to truly understand a service up close and personal from your client’s perspective.

My colleague Kim and I were recently involved in an evaluation project that involved gathering ‘Most Significant Change’ (MSC) stories from individuals and service providers that had been impacted by a series of health care initiatives.  The stories were incredibly revealing.  Some were very raw.  They pointed to the harsh realities of dealing with persistent substance misuse and mental health issues, often rooted in past traumas.  They also highlighted the daunting and overwhelming challenges of trying to navigate systems that aren’t designed to be easy or accessible to anyone other those with a lot of social or financial capital.

The experience of gathering and then writing and presenting the stories brought me back to my dissertation work.  I utilized a qualitative research methodology called Grounded Theory to try to understand how leadership in social service programs impacts the outcomes that individuals achieve through those programs.  As I wrote about in another blog post, it ended up being about trust and autonomy.  What I realized in reflecting on those experiences is that I have often gravitated towards numbers rather than stories in my work evaluating programs.  For the sake of convenience and to meet funder requirements, it’s been easy to just gather up survey data or data on service utilization patterns and then tell a narrow story of what happened.  Utilizing qualitative methodologies to gather stories takes more time, but I believe has amazing payoffs in terms of gaining a more in-depth understand of patterns.

In the end, I think the best evaluations actually use both quantitative data and stories. Some practical tips that will make it easier for you add in stories to your evaluation process include;

  • Use an outsider to gather the stories.  Program staff or management will bring their own lens to the process that may not be helpful, and those being interviewed may feel some social pressure to answer in certain ways.  If having an outside evaluator isn’t in your budget, you can use staff from other programs or students from a local social service program.
  • Consider what questions might help round out or more fully tell a story about the different aspects of a program or service.  For example, you can ask questions about what people felt was the most powerful or beneficial aspect of a program and use that to bring life to quantitative outcomes data from surveys.
  • Keep the sample small but diverse.  You likely won’t need a massive number of stories to gain a more in-depth understanding as long as you sample for diversity in terms of people’s characteristics (e.g., age, gender identity, cultural background) or their experiences with services (e.g., those that completed the program vs. those that didn’t).
  • Choose your method for gathering the data carefully.  Interviews typically provide richer data, but can be more work than using a focus group methodology.  If you wish to use focus groups, I would consider adding a few interviews as well.  And while phone interviews will suffice, face-to-face is best if you can manage it.
  • Ask permission to record the interview or focus group.  By recording, you free up your mental energy to really focus on what people are saying and ask good follow-up questions.  Promise people that you are only using it to make sure you get the story right and that you will both maintain it securely and destroy it once you’re done.  The recording will allow you to capture verbatim quotes, which can be unbelievably powerful in storytelling.
  • Open up and lean in to the experience!  I’ve found that listening and really engaging with other people’s stories can be profound and enriching.  It’s a real honour to bear witness to people’s stories.  They often feel incredibly grateful for being listened to – particularly people who have been made voiceless through marginalizing experiences.  And those stories can help propel your program forward in its growth and evolution towards better outcomes for those very individuals.

 

Some Gifts to Mark the Season!

Just wanted to take a minute to wish everyone Happy Holidays!!!  Here is a funny Christmas video to keep you entertained (warning… it’s reflects my warped sense of humour), and a link to a couple of new resources (sample policies) on the Free Resources page.  We’ll have at least one new article sometime in January and many more are in the pipeline!  Take care and stay safe.

The Power of Story

I believe we are storied beings. Our lives have a beginning, middle and end. Within that life, there are numerous chapters, plots and sub plots. There have undoubtedly been some unexpected twists. The characters include heroes and villains; perhaps some characters turn out to be a bit of both! And while this all might seem self-evident, the true impact of our need and reflex to story our lives was a relatively recent revelation for me.

Two books that I read recently – Brené Brown’s “Rising Strong” and Bessel van der Kolk’s “The Body Keeps the Score” – have really driven home the impact of how we story our lives. Brené’s work is all about story and about owning our stories. It provides a roadmap for how to live through – and rise from – those ‘face down’ moments in our lives. Van der Kolk’s book isn’t specifically about story. It describes how traumatic events in our lives – both the sudden and extreme ones as well as the repeated ones that traumatize us over time – are stored in our brains. Both authors point towards the need to understand how we’ve created (and in some cases, made up by filling in the blanks) the story of those events. In the case of truly traumatic events, it involves opening pathways for the cognitive processing part of the brain (the neo-cortex) to have access to (and help to sort out) the painful memories stored like flashcards in the more ancient limbic part of our brain. The message for me from both books; having an honest and authentic account of our stories and being able to fully own (or integrate) them is critical to our happiness and success in life.

That revelation got me to thinking about the stories we have and hold about the organizations we work in. I believe that the act of owning and integrating our organization’s story can be just as powerful for an organization’s success. After all, once you strip away the buildings and equipment and policies and titles, organizations are nothing more than networks of relationships. So I decided to find ways to integrate the concept of ‘story’ more fully in my work. Along with my colleague Kim Lyster, I used the story metaphor as part of a recent strategic planning event. We helped the organization tell ‘the story up until now’, which included some of the traditional elements of a SWOT analysis. That process confirmed that the stories people made up about the organization were often only partially accurate or complete. We teased out, listened to, and valued all of the stories that people carried about the organization and we rumbled with the differences in those stories. Stories are very real in their consequences; they inform actions and behaviors. So the act of ensuring that the stories are consistent, accurate and fully owned by everyone is critical to building a foundation for the future. The work also included a heavy emphasis on values identification, because I firmly believe that knowing our values is core to us understanding and owning our stories, both as individuals and in our organizations. Having established a firm base of a shared story and common values, the second half of the planning event involved helping the organization to “write the next chapter”. We supported them to clearly define an authentic future state and the steps needed to walk a path towards that desired end based on what they learned through rumbling with their stories. Although we need to continue to refine this approach, I’m very encouraged by our initial experiences and plan to continue to evolve it in some upcoming strategic planning events.

Beyond strategic planning, I’m convinced that the work to give people tools to reality check their stories and rumble with differences will transform organizations. So as you walk your walk everyday in your organization or company, I encourage you to think about the ways in which the people you are interacting with are constructing their stories and how that impacts the work. By remaining curious and honouring those stories, we can open a space to have courageous and sometimes difficult conversations about where we want to go and how to get there. And those conversations can be powerful drivers of positive change.

PS – I plan to discuss how story can be a bigger part of evaluation work in an upcoming post, so stay tuned!

Time to Step Up

In my last‎ blog, I said something about chilling for the rest of the summer before creating new posts. That sounded perfect at the time. Well my friends, I felt inspired. I recently spent a week with an amazing group of people at The Daring Way™ Facilitator Training. It’s based on Brené Brown’s work, who I finally got to meet and spend a day with.  For those of you who don’t know who Brené Brown is, you can check out her Ted Talks from 2010 and 2012 which have received tens of millions of views.  She is an impressive speaker and was every bit as gracious as I expected her to be.

The training was transformative. At the core of Brené’s work is the assumption that we are hardwired to connec‎t, something I believe in my bones. I spoke about it in a blog last year after I ran across a cool article on treating addictions. The Daring Way™ Facilitator training put some ‘meat on the bones’ of that core assumption by way of a comprehensive model and lots of exercises designed to support a ‘deep dive’ into concepts like vulnerability, courage, love, belonging and shame (yes, the ‘S’ word). While our subjects differed, her work aligns very closely with what I found in my dissertation research. All of this got me thinking about the need to step up and figure out where to go next.

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Forgive me… and accept my offering

My apologies… it’s been a while since a posted anything (I’m having flashbacks to being in a confessional!).  Things have been very busy, so I took a bit of a hiatus.  There’s a new resource waiting for you in the Free Resources section.  In lieu of an article, I’ll give a bit of an update.

Some recent developments at WRH Consulting include;

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Use Your Strategic Plan Like It’s Your Budget!

Strategic plans have a lot in common with budgets. They are both plans for the future that outline some expectations. But few organizations hold themselves accountable to the goals in their strategic plans the same way they do with budgets. I think they are equally as important to your future success.

I’ve seen a lot of strategic plans over the years. I’ve been involved in facilitating the development of more than a dozen of them just in the last few years. Although I’ve gotten better at helping to create them, it requires a lot of time and effort to build a process and format that will meet the specific needs of each individual client. I’ve also learned that although the strategic directions or goals chosen by organizations often fall along similar lines, no two plans are alike and the path to achieving a particular direction or goal can be dramatically different. Most importantly, I’ve learned that a failure to develop a detailed plan that outlines how your organization will achieve its goals or directions and a willingness to regularly monitor progress too often ends in lack-luster results. Or even no results. [Read more…]

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