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among many state licensure/certification boards is to require accreditation from JCAHO, NCQA, the Rehabilitation Accreditation Commission (CARF), COA, or URAC to become licensed or certified in that state. The domains of the various accreditation agencies are different but sometimes overlap.

Accreditation Organizations

The committee reviewed accreditation materials from five organizations that accredit behavioral health plans, programs, and services: CARF, COA, JCAHO, NCQA, and URAC. Representatives of these organizations were invited to make presentations at the committee's two public workshops. This section briefly describes each of the organizations, which are further compared in Table 6.2.

The Rehabilitation Accreditation Commission (formerly the Commission on Accreditation of Rehabilitation Facilities) (CARF)

CARF accredits programs that serve individuals with disabilities and others who need rehabilitation. The organization was developed in 1966 through efforts of the American Rehabilitation Association and the Association of Sheltered Workshops. In CARF's first 2 years, it received administrative support from JCAHO, and the two organizations are developing a “recognition initiative” that eventually will recognize the other's accreditation standards and thus eliminate the need for dual accreditation.

CARF currently accredits more than 11,000 programs in the United States and Canada, including alcohol and drug programs, mental health programs, and community-based rehabilitation programs that are primarily designed for the chronically and persistently mentally ill. CARF has a consumer-centered philosophy that actively encourages consumer involvement in assessing community needs, planning services, participating in governance activities, and collaborating in the development of individual treatment plans. CARF also requires that programs have a plan to reduce barriers to care, including cultural, architectural, attitudinal, and other barriers (Slaven, 1996).

Council on Accreditation of Services for Families and Children (COA)

COA was founded in 1977 and currently accredits about 1,000 behavioral health programs and 3,000 social service programs in the United States and Canada. COA has developed standards for more than 50 services, including outpatient mental health and substance abuse services, day treatment, foster care and day care for children, services for persons with developmental disabilities, services for victims of domestic violence, adoption services, vocational and employment services, and others.

COA has developed a set of core standards that apply to all organizations

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