(Note: This column was written by Julia Finken, Executive Director of Behavioral Health Care and Psychiatric Hospital Accreditation for The Joint Commission)
I’m sitting in my office and yet another article arrives in my email regarding a substance use provider delivering substandard services. On any given day, in any selected media, there are dozens of stories about unethical practices by substance use disorder (SUD) treatment providers. What we don’t hear about every day is the high quality and effective SUD care provided by many organizations on a daily basis. We don’t regularly hear about those individuals who remain abstinent after completing treatment, or those individuals that return to productive, meaningful lives with the support of medication assisted treatment, or individuals who are reunited with their families and loved ones after years of battling addiction. Every day, thousands of SUD providers strive to provide quality services to those individuals in need so that they can live productive, meaningful lives surrounded by those they love. The Joint Commission is helping these providers achieve these goals by raising the bar for the quality and safety of the care treatment and services these organizations provide to the individuals they serve.
In 2016, approximately 20.1 million people aged 12 or older had an SUD in the past year, including 15.1 million people who had an alcohol use disorder and 7.4 million people who had an illicit drug use disorder. In 2017, approximately 3 million people received SUD treatment. It is estimated that approximately one in six problem drug users globally receives treatment for drug use disorders or dependence each year. The overriding finding regarding the efficacy of SUD treatment is that treatment is associated with a reduction in harmful behaviors that are associated with problem drug use. The majority of treatment seekers received care-coordinated treatment, expressed satisfaction with their care, were retained in treatment beyond three months, and reported significant and substantial reductions in drug use and offending, and improvements in mental well-being and social functioning. Medication assisted treatment (MAT) has been shown to increase participation in behavioral therapy and reduce both drug use and criminal behavior. Yet, because of what consumers, payers and providers read regularly in the media, there is a lack of confidence that there are an ample number of ethical, effective SUD providers in the United States today.
So how can one discern between the providers that adhere to a higher standard of care and those that don’t? Joint Commission accreditation is one way to identify the providers who achieve a higher standard of care. The Joint Commission has accredited Behavioral Health Care (BHC) providers since 1969. Accreditation of Substance Use Disorder providers has been a growing segment of Joint Commission accredited BHC providers, with the fastest expansion beginning in 2013 and continuing through 2017. The Joint Commission currently accredits more than 2,800 BHC providers, more than half of which offer SUD services. Substance use disorder providers who are Joint Commission accredited must adhere to a rigorous set of standards, covering topical areas including:
- Care Treatment and Services
- Human Resource Management, Leadership
- Environment of Care
- Emergency Management
- Infection Prevention and Control
- Information Management
- Life Safety
- Medication Management
- National Patient Safety Goals
- Performance Improvement
- Record of Care Treatment and Services
- Rights and Responsibilities of the Individual
- Waived Testing
What does Joint Commission Accreditation mean for providers and consumers? It means that Joint Commission accredited SUD providers must admit only those individuals in which the provider can deliver the care, treatment, and services that will meet that individual’s needs. The Joint Commission has developed a set of standards in collaboration with BHC industry leaders that are based on trauma informed concepts and the tenents of resilience and recovery. This means that care, treatment, and services must be patient centered and developed through the process of a comprehensive individual assessment, development of a plan of care, treatment, and services based on needs identified for the individual served and the implementation of such plan. This plan for care, treatment, and services includes objectives and goals for each individual served. The individual’s progress towards goal is monitored and outcomes of the plan are measured through the use of a standardized instrument. Only qualified staff who meet the requirements for licensure, certification, education, and training as required by the organization, State, or Federal authority may provide care, treatment, and services. Joint Commission Accredited organizations must provide a safe environment of care including minimizing the risk for infection and having a regularly tested plan to manage emergencies. The buildings in which care, treatment, and services are provided must be determined to be in compliance with Life Safety Code Requirements. Individual care is documented, and that documentation is maintained in a manner compliant with organization, Federal, and State requirements to preserve the integrity and confidentiality of the record. Medications must be procured, stored, prepared, dispensed, and administered in compliance with strict standards of safety. Organizations must regularly evaluate their own performance and gather information from the individuals they serve regarding the perception of the quality and safety of the care provided. The findings from this data must be utilized to improve the quality and safety of the care, treatment and services provided to the individuals served and the population served.
Substance Use Providers who seek to become and maintain Joint Commission Accreditation must undergo an initial on-site survey, conduct a self-assessment of standards compliance at 12 and 24 months following their last survey, and an on-site survey every three years. These surveys are performed by field representatives, including Licensed Clinical Social Workers, Clinical Psychologists, Registered Nurses, Psychiatrists, Advanced Practice Nurses, Physician Assistants, and Engineers. These field representatives have extensive experience in the BHC services and settings that they survey. They hold advanced degrees and must have substantial clinical and administrative level experience in the services and settings in which they survey. During the survey, the Field Representative will identify Requirements for Improvement and offer organizations ideas for correcting such findings. Based on customer feedback, the survey is highly consultative and educational in nature. Within 60 days of completion of the survey, the organization must complete an Evidence of Standards Compliance (ESC) for each survey finding. Once the ESC is accepted, the organization is granted an Accreditation for 36 months.
Many consumers seeking care for a substance use disorder also need assistance with their physical health needs. Some SUD providers take the extra step to become a Behavioral Health Home, meaning that they’ve taken the extra step to earn a Behavioral Health Home Certification on top of their accreditation. This certification validates that the provider demonstrates a high level of integration of treatment of substance use disorder and/or mental health and physical health care services. A BHH-certified provider must demonstrate that there is a consistent high degree of coordination and communication between the mental health, SUD and physical health care staff in order to develop an integrated plan of care and meet the goals of the plan of care. The staff must demonstrate additional competencies and training in MH, SUD and physical health services, integration of care, care coordination, and care management. Organizations are required to perform additional measurement, such as disease management outcomes, the individual’s access to care within timeframes determined by the organization, the individual’s perception of the coordination of care, treatment and services, the individual’s perception of the continuity of care treatment and services and the individual’s experience and satisfaction in regard to access to care, treatment, and services, to name a few.
So if you are looking for a Substance Use Disorder provider that is held to a higher standard of care, look for the Joint Commission “Gold Seal” of Accreditation. You can find a directory of Joint Commission Accredited providers at https://www.qualitycheck.org/. Joint Commission Accredited Behavioral Health Care providers can be found in all 50 states, U.S. principalities, and internationally. As I shut down my computer for the day, I am heartened by the data showing that we continue to accredit additional Substance Use Disorder providers every day.