Substance abuse programs that provide medical and psychological treatment are governed by the laws of the state in which they reside. In addition, voluntary accreditation is provided to 1,800 behavioral health centers through the Joint Commission for Accreditation of Hospital Organizations, JCAHO. Some facilities also request accreditation from the Council on Accreditation, CAR, and the Council on Acceditation of Rehabilitation Facilities, CARF. Standards are assessed in the areas of administration, financial responsibility and client care.
Financial and Administrative Affairs
Financial standards are designed to insure that drug rehabilitation or substance abuse facility is using the money it charges to provide the services it advertises and those required to meet patient care standards. For-profit businesses may charge much more than they use on patient care and facilities management and that is not regulated by any accrediting body. Some non-profit organizations barely make enough to cover the bills too, but they too can be accredited as long as they can show they are financially stable.
The administrator of a substance abuse treatment facility may be a psychologist, a physician or business administrator and most facilities will also have a medical director. A board of directors and the administration manage the budget, the staffing and supervision of the care provided and accrediting boards look for evidence that the administration has the education and experience needed to carry out their responsibilities.
Staffing
There are many different levels and types of care providers that provide care for people seeking substance abuse rehabilitation. Psychiatrists and psychologists are doctoral prepared providers who lead the treatment team, psychiatric nurse practitioners, licensed professional counselors and clinical social workers have master's degrees and registered nurses and substance abuse counselors may either have a bachelors or associate degrees. The state's practice acts for the individual professions dictates educational requirements, licensure, continuing education requirements, and scope of the practitioner's practice.
Each accrediting organization requires a specific mix of treatment providers and prescribes ratios of providers to clients for group therapy and other activities. Provisions are made for facilities that care for only a small number of clients and for those in rural areas.
Emerging Models of Care
Health care changes constantly and accreditation boards work hard to stay current. What is unheard of one year may become a standard of practice the next if quantified, peer reviewed research supports it inclusion in substance abuse treatment.
Accrediting boards study programs with high levels of efficacy and disseminate information about what they are accomplishing to other facilities. Their goal is that the public can rely on a program's accreditation for reassurance that the program they are entering provides clients with access the the treatments proven to succeed. In substance abuse that means treatments that help program graduates achieve and maintain sobriety.
For example; at the Second Betty Ford Conference in 2009 treatment providers met to develop strategies that would help in this endeavor. They pointed out that continuity of care and integration of professional life coaches into the treatment team were key to long term sobriety. Certified life coaches are trained through post graduate programs of study to strengthen patterns of wellness rather than treating illness. They work with clients to help them create healthy lives and they help families reestablish ways of living that support life long recovery.
Protection of Civil Rights and HIPAA
A client in substance abuse treatment does not leave his civil rights at the door. Rarely a client is committed by court order to a specific program of care; normally done as a condition of release from a correctional facility or because the person has demonstrated a real and present danger to himself and others; but even then the client has the right to accept or refuse treatment and to be treated with respect and dignity.
The Federal Health Insurance Portability and Accountability Act, or HIPAA, applies to substance abuse treatment just as it does to all health care in the United States. This Act protects the right of a client to access his medical records and to prevent transmission of information without his knowledge and consent except where medically prudent.
References
- Joint Commission on Acreditation for Health Care Organizations: Behavioral Health Care
- Center for the Accreditation of Rehabilitation Facilities: Behavioral Health
- Council on Accreditation: Accreditation Standards
- "Journal of Substance Abuse Treatment"; Second Betty Ford Institute Conference Extending the Benefits of Addiction Treatment; James McKay, M.D. et al; March 2009
