Thinking about CARF Accreditation???

Are you thinking about pursuing CARF Accreditation for your organization? Maybe this blog post can help you make that decision and prepare for your first survey visit.  Before you read further though, I have to put out here in cyber-land that I’m a CARF surveyor and an unashamed proponent of CARF accreditation versus other accrediting bodies.  I help organizations get prepared for their CARF survey and walk them through the accreditation process (blatant self promotion here).  So now that you know my bias, here’s some information that may be helpful to you in making your decision to pursue CARF accreditation or not.

So what is CARF?  

CARF aka The Commission on Accreditation of Rehabilitation Facilities is an international 3rd party accreditation for specific programs in various areas, including: Behavioral Health, Aging Services, Business and Services Management Network, Employment and Community Services, Medical Rehabilitation, Opioid Treatment Program, Vision Rehabilitation Services, Child and Youth Services, DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies), One-Stop Career Center, and Continuing Care Retirement Communities.

What are the benefits of CARF accreditation?

Here’s what CARF says on their website (

  • Fiscal savings: Financial institutions, including rating agencies, investment bankers, and insurance carriers, look for accreditation as a sign of financial stability. They value the rigorous due diligence that results from accreditation and respond by offering savings on future financial transactions.
  • A marketing advantage: Accreditation gives organizations a competitive edge in the eyes of prospective residents, families, caregivers, and others. Providers displaying the CARF seal stand out in today’s crowded field of provider options.
  • Risk management: Accreditation can help to reduce an organization’s exposure to risk in areas such as human resources, healthcare, governance, and finance.
  • Access to an international network: Accreditation gives an organization the opportunity to collaborate, form partnerships, and share ideas with an international network of other providers that have earned accreditation.

Personally, I have been able to get contracts with governing entities and community stakeholders due to having CARF accreditation for the programs at my organization.  I’ve found that having accreditation has made my organization stand out among others in the community.  It shows that we care about best practices, and are willing to invest in quality and accountability within the organization.  Another benefit is that having accreditation has saved valuable time and money in the credentialing process with managed care payers allowing us to bypass the need for a site visit by the managed care company.

What I really like about CARF versus other accrediting bodies…(1) all CARF surveyors also work at organizations with CARF accreditation, so we go through the same process of being surveyed ourselves and we know your anxiety in a real sense; (2) the CARF standards are mostly non-prescriptive meaning that there are many ways to demonstrate conformance to the standards and CARF doesn’t prescribe one way of meeting the standard (notice I said “mostly” here…there are some standards that specify certain things); and (3) the CARF survey is consultative rather than inspective in nature and the surveyors offer lots of consultation during the survey to help you be even better as an organization.

How to prepare for your 1st CARF survey?

It’s a lot of hard work to prepare for the initial CARF survey visit and you need to be working on this at least 1 year before you plan to have the survey team come to your organization. Yes, you heard me correctly….you need to start preparing 1 year in advance at least!  Give yourself even more time if you have it and here’s why…

  1. You need to read and figure out how to implement the CARF manual (and it’s a BIG manual).
  2. You are going to have to write and/or revise LOTS of policies and procedures.
  3. Your employees need to be trained on all these new/revised policies and procedures.
  4. You need to get feedback from all your stakeholders (clients served, community partners, staff, and anyone else your organization interfaces with on a regular basis) on how you’re doing and implement that feedback within all those policies and procedures you just wrote.
  5. You have to be doing all of this for 6 months prior to your initial CARF survey visit.

WHEW! Sounds like a lot doesn’t it?!  Well it is…and it’s a somewhat challenging process as your organization goes through all the needed adjustments to meet all the CARF standards.  Don’t lose hope yet though!  It’s a doable process with a little planning and a committee of people at your organization that can divy up the workload.  Or you can always call reinforcements like me to help you get ready (more blatant self promotion :))

I hope you choose accreditation for your organization, and specifically CARF accreditation, as it will demonstrate that your organization is committed to providing quality services that benefit the people you serve.

By: Adrianne Trogden


EMDR…What is that???

Eye Movement Desensitization & Reprocessing aka EMDR.  Now that you know the full name, what you must be thinking is….what in the world is EMDR???

EMDR enables people to heal from the symptoms and emotional distress that are the result of disturbing life experiences. Now I don’t know about you, but I think most of us who have lived on this planet for any length of time have some disturbing life experiences! We could benefit from EMDR if those life experiences continue to disturb us in some way or if we have lingering symptoms that started when we experienced something disturbing. EMDR is described as an integrative psychotherapy approach that has been extensively researched and proven effective for the treatment of trauma in particular, but also helps people who have anxiety, depression, phobias, and addictions.  It is a set of standardized protocols that incorporates elements from many different treatment approaches.  There are 8 phases of treatment with EMDR.  Here are the basics of each phase (check out the resources section of this post for where to find more detailed information about each phase):

  1. History and Treatment Planning – gathering relevant history of the problem and specific memories associated with the problem
  2. Preparation – client learns coping strategies for dealing with emotional disturbance outside of counseling sessions
  3. Assessment – identifying a scene or image from the target memory for processing along with a negative belief representing how the client felt at the time, and a positive belief of how the client would like to view self in the scene/image. Assessment also includes the client rating self on how disturbing the memory is to them, how valid the positive cognition is to them, and identifying any tension within their body
  4. Desensitization – the therapist leads the client in sets of eye movement (or other forms of stimulation) until client self ratings on above-mentioned scales reduce disturbance and body tension as well as increase association with positive belief
  5. Installation – goal is to concentrate on and increase the strength of the positive belief that the person has identified to replace his original negative belief
  6. Body Scan – the therapist will ask the person to bring the original target event to mind and notice any residual tension in the body. If so, these physical sensations are then targeted for reprocessing
  7. Closure – Ends every treatment session ensuring that the client leaves at the end of each session feeling better than at the beginning
  8. Reevaluation – Opens every new session checking to make sure that the positive results have been maintained, identifying any new areas that need treatment, and continuing reprocessing the additional targets

Therapists who use EMDR have gone through a series of trainings and supervised practical experiences using EMDR, so they are well-versed in using the protocol.

Think you may need EMDR therapy?  Check out this link to find a therapist near you trained in EMDR.

Are you a therapist and want to get trained in EMDR? Check out this link to find trainings near you.

Resources for more detailed info about EMDR:

  • A full description of the theory, sequence of treatment, and research on protocols can be found in F. Shapiro (2001) Eye movement desensitization and reprocessing:  Basic principles, protocols and procedures (2nd edition) New York: Guilford Press.


By: Adrianne Trogden


What is Counseling???

Taking the step to go to counseling is a courageous one, but what are you really getting yourself into??

I see counseling as a relationship first and foremost between the therapist and the client.  Counseling is a process in which the client and therapist having come to understand and trust one another, work as a team to explore and define present problems, develop future goals for an improved life, and work in a systematic fashion toward realizing those goals.

A typical counseling session lasts 50 minutes and can be done individually, with a couple or family.  You can expect to start with an intake session where the therapist asks you questions about several areas of your life including history and present concerns to get an understanding of what has gone on in your life that has led you to this point in time. From there, you will identify and develop goals with your therapist.  These goals are your goals for your life and the therapist works with you to achieve these goals.  Ultimately, you do the work in counseling to achieve your goals and the therapist walks with you on this path offering guidance, encouragement, support and accountability.  From this point on, you and your therapist work together to realize your goals.  There are many approaches to counseling and your therapist may ask you to try things that may be outside your comfort zone, but these approaches are designed to help you make changes (that may be uncomfortable) in order to reach your goals.

Most therapists have areas of expertise and a code of conduct they must abide by according to their professional licensing board in their state.  Counseling is confidential and is considered privileged communication, meaning that it cannot be disclosed to anyone without the expressed written permission of the client. In Louisiana (where I practice), we have the following caveats to confidentiality:

Material revealed in counseling will remain strictly confidential except for material shared under the following circumstances, in accordance with State law:

  1. The client signs a written release of information indicating informed consent of such release.
  2. The client expresses intent to harm him/herself or someone else.
  3. There is a reasonable suspicion of abuse/neglect against a minor child, elderly person (60 or older) or a dependent adult.
  4. A court order is received directing the disclosure of information.

So what are your responsibilities as a client??

You, the client, are a full partner in counseling. You need to show up and participate in the process. Your honesty and effort are essential to success. As you work together with your therapist and you have suggestions or concerns about your counseling, you need to share these so the necessary adjustments can be made to your counseling. If it is determined by you or your therapist that you would be better served by another mental health provider, then your therapist should help you with the referral process. If you are currently receiving services from another mental health professional, you should inform your therapist and grant them permission to share information with this other professional in order to services for you.  Inform your therapist if you have any physical health issues that arise or medications that you begin taking as they may impact your counseling process.

What are the risks and benefits to counseling??

Risks: Since therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. Talking about experiences in your life may be painful. Making changes  can be scary, and sometimes disruptive to your current relationships. It is important that you consider carefully whether these risks are worth the benefits to you of changing. However, there are no guarantees of what you will experience.

Benefits: You hopefully feel better! Counseling can lead to better relationships, solutions to specific problems, and significant reductions in feelings of distress. It may also result in feeling better about oneself and others, strengthening coping skills, reaching or making progress on one’s counseling goals, improving interpersonal relationships, solving problems, improved academic performance, determining a major/career direction, having a safe place to express emotions, or building on one’s strengths. Again…no guarantees.

Hopefully this has given you a better understanding of the counseling process and what you can expect.  I hope you choose to try counseling and embark on your path to wellness.


By: Adrianne Trogden