Enhancing people’s lives

CARF® International is an independent, nonprofit accreditor of health and human services. Through accreditation, CARF assists service providers in demonstrating value by the quality of their services and meeting internationally-recognized organizational and program standards.


Service providers


Accredited programs and services



13+ million

Persons served annually

Our reach

Countries, states, territories, and provinces on five continents recognize one or more of our areas of accreditation, and many mandate CARF accreditation exclusively.

Getting acquainted

Background information about the basis of our success.

CARF International is an independent, nonprofit accreditor of health and human services.

Founded in 1966 as the Commission on Accreditation of Rehabilitation Facilities. We use the acronym CARF when referring to our organization.


The mission of CARF is to promote the quality, value, and optimal outcomes of services through a consultative accreditation process and continuous improvement services that center on enhancing the lives of persons served.


Through responsiveness to a dynamic and diverse environment, CARF serves as a catalyst for providing access to services and improving the quality of life for persons served.

Core values

CARF believes all people have the right to be treated equitably with dignity, respect and inclusion; should have access to needed services that achieve optimum outcomes; and should be empowered to exercise informed choice.

CARF’s accreditation, research, continuous improvement services, and educational activities are conducted in accordance with these core values and with the utmost integrity.

In addition, CARF is committed to:

  • The continuous improvement of both organizational management and service delivery.
  • Diversity and cultural competence in all CARF activities and associations.
  • Enhancing the involvement of persons served in all of CARF’s activities.
  • Persons served being active participants in the development and application of standards of accreditation.
  • Enhancing the meaning, value, and relevance of accreditation to persons served.


In support of CARF’s mission, vision, and core values, CARF’s purposes are:

  • To develop and maintain current, field-driven standards that improve the value and responsiveness of the programs and services delivered to people in need of life enhancement services.
  • To recognize organizations that achieve accreditation through a consultative peer-review process and demonstrate their commitment to the continuous improvement of their programs and services with a focus on the needs and outcomes of the persons served.
  • To conduct accreditation research emphasizing outcomes measurement and management, and to provide information on common program strengths as well as areas needing improvement.
  • To provide consultation, education, training, and publications that support organizations in achieving and maintaining accreditation of their programs and services.
  • To provide information and education to persons served and other stakeholders on the value of accreditation.
  • To seek input and to be responsive to persons served and other stakeholders.
  • To provide continuous improvement services to improve the outcomes for organizations and the persons served and their community of influence.

Established by two national organizations – the Association of Rehabilitation Centers (ARC) and the National Association of Sheltered Workshops and Homebound Programs (NASWHP) – that had been developing standards for their respective memberships for about a decade formed the basis for the earliest CARF standards. The two organizations agreed to pool their interests and formed the Commission on Accreditation of Rehabilitation Facilities, now known as CARF International.

Mary E. Switzer, former Commissioner of the U.S. Department of Health, Education and Welfare (later renamed Health and Human Services), was instrumental in establishing a grant from the department’s Vocational Rehabilitation Administration to establish standards for the rehabilitation field.

In the years since its formation, CARF International has steadily grown in its breadth and reach. The following are some of the significant highlights in our history:

September 1966 

The ARC and the NASWHP (which later merged into the National Association of Rehabilitation Facilities) incorporated the Commission on Accreditation of Rehabilitation Facilities in the state of Illinois as a nonprofit organization with nine directors.


The first four organizations receiving accreditation were: Texas Institute for Rehabilitation and Research, Houston, Texas; EPI-HAB, Los Angeles, California; Vocational Guidance and Rehabilitation Service, Cleveland, Ohio; and Fountain House, New York, New York.


CARF accredited its first program in Canada.

January 1970 

CARF adopted two new categories of rehabilitation program emphases: Speech Pathology and Audiology.


CARF conducted 100th site survey at The Rancho Los Amigos Hospital in Downey, California.

April 1970 

The Council of State Administrators of Vocational Rehabilitation passed a resolution requiring CARF accreditation of all rehabilitation providers. This was one of the key developments in the history of the Commission.

September 1971 

Fifth anniversary of CARF; transitioned from staffed to contracted surveyors into a peer-review, consultative accreditation system. The number of accredited programs reached 1,000.


After serving two years as Program Director, Alan Toppel became the Executive Director. Under Alan’s leadership, CARF extended beyond its original medical and vocational rehabilitation market to include programs serving persons with developmental disabilities, treating substance abuse, and providing mental health services; and strove to unite professionals, consumers, funding sources, and governmental leaders in focusing on quality services for persons with disabilities.

November 1973 

CARF published a new section of the standards manual for Rehabilitation Facilities, specifically identifying program evaluation standards. These standards became a springboard for extensive future activities by CARF in program evaluation and outcomes.


After attending a meeting with CARF administrators, Caspar W. Weinberger, Secretary of Health, Education and Welfare said, “I am strongly encouraging the Department’s service programs to develop evaluation and information systems which enable them to conduct their own program evaluation. Accountability of our health, education, welfare and social programs is a major priority within the Department. I congratulate you for developing a comprehensive and feasible system for incorporating evaluation standards into your accreditation process.”

November 1974 

Goodwill Industries of America recognized CARF as the accrediting organization for all Goodwill organizations and ended managing this process from within.

January 1975 

CARF introduced a new category of rehabilitation program emphasis: Work Activity Programs.

September 1976 

CARF celebrated its first 10 years of service and received a special congratulatory letter from U.S. President Gerald Ford commending the organization on this “important milestone for all Americans, and most particularly our disabled citizens. I welcome this opportunity to commend your leadership in this vital field.”

December 1976 

CARF reaches 850 accreditations of organizations with programs/services at nearly 1,900 locations.

January 1977 

In an unparalleled action for an accrediting organization, CARF adopted a program evaluation system for ongoing quality assessment.

May 1978 

The Council of Rehabilitation Education began requiring CARF accreditation for facilities that offer clinical experience to graduate students in Rehabilitation Counseling.

August 1978 

CARF relocated its office from Chicago, Illinois to Tucson, Arizona, USA.

September 1978 

The International Association of Industrial Accident Boards and Commissions adopted a resolution that recognized the need of CARF accreditation for rehabilitation facilities serving employees with occupational disabilities.

May 1979 

U.S. President James Carter recognized CARF for its significant efforts to upgrade the delivery of rehabilitation services to the nation’s citizens with disabilities.

November 1980 

The Association of Trial Lawyers of America adopted a resolution urging state workers’ compensation agencies to require CARF accreditation for rehabilitation organizations serving workers with occupational disabilities.

April 1981 

U.S. President Ronald Reagan congratulated CARF on its 15 years of service and leadership in improving services for citizens with disabilities and recognized CARF as a national example of the private sector meeting public needs.

January 1982 

CARF introduced standards for Infant and Early Childhood Development Programs, Occupational Skill Training, Activity Services, Residential Services, Independent Living Programs, and Psychosocial Programs.

January 1983 

Standards for Spinal Cord Injury Programs and Chronic Pain Management Programs were introduced.

January 1985 

Standards for Brain Injury Programs and Programs in Industry were introduced.

January 1986 

Standards for two new program areas were published in the 1986 Standards Manual for Organizations Serving People With Disabilities. They were Respite Programs, and Alcoholism and Drug Abuse Treatment Programs.

September 1986 

U.S. President Ronald Reagan wrote for the 20th anniversary, “The Commission has established a tradition of excellence in monitoring agencies and organizations nationwide which serve people with physical and developmental disabilities.”

January 1988 

The 1988 Standards Manual for Organizations Serving People With Disabilities included new standards in the areas of Post-Acute Brain Injury Programs and Community Mental Health Programs. In addition, the Commission renewed its emphasis on standards for program evaluation systems that emphasize quality.

January 1989 

Standards for Work Hardening Programs were introduced.

January 1990 

Standards for Supported Employment Programs were introduced.

August 1991 

CARF celebrated 25 years of service with a two-day conference in Washington, D.C. U.S. President George Bush sent a letter of congratulations on this special occasion commending staff in helping to open doors of opportunity for Americans with disabilities and focusing greater public attention on issues of special concern to Americans with disabilities. The number of CARF accredited programs/services reached more than 3,000 in the U.S., Puerto Rico, and Canada.


Executive Director Alan Toppel retires after 20 years of service.


Don E. Galvin, Ph.D. became CARF’s second President/CEO. During his tenure, he expanded into areas not traditionally identified with rehabilitation, including Adult Day Services and Assisted Living; placed a strong emphasis on outcomes measurement and management; and contracted with major federal agencies.

January 1994 

CARF reorganized its staffing pattern to emphasize three fields: Vocational and Employment/Developmental Disabilities, Medical Rehabilitation, and Alcohol and Other Drugs/Mental Health. For the first time a National Leadership Panel for each field was convened to assist CARF to proactively plan for and address current issues and trends impacting the provision of services to people with disabilities.

January 1995 

CARF published a separate volume of its 1995 Standards Manual and Interpretive Guidelines for each of its divisions — Behavioral Health, Employment and Community Support, and Medical Rehabilitation.

July 1995 

New standards in the areas of Occupational Rehabilitation Programs and Comprehensive Pain Management Programs went into effect in the Medical Rehabilitation Division.

August 1995 

The CARF Board of Trustees approved CARF’s ongoing collaboration with the Professional Services Board of the American Speech-Language-Hearing Association.

October 1995 

The first office building for CARF International headquarters was purchased—located at 4891 E. Grant Road in Tucson, Arizona, USA.

January 1996 

CARF published the first edition of the Accreditation Sourcebook.

July 1996 

In the Medical Rehabilitation Division, standards for a new program area, Home- and Community-Based Rehabilitation Programs, went into effect, along with revised standards in the areas of Brain Injury Programs, both Comprehensive Inpatient and Community Integrative, and Spinal Cord Rehabilitation System of Care.

August 1996 

In its 30th year of operation, CARF accredited its first program in Europe. 

January 1997 

CARF contracted with the U.S. Department of Veterans Affairs to accredit all of its rehabilitation programs over a five-year period.

July 1997 

New standards in the areas of Health Enhancement Programs and Pediatric Family-Centered Rehabilitation Programs went into effect in the Medical Rehabilitation Division.

September 1997 

CARF was awarded a contract by the Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) for the development and implementation of Opioid Treatment Program accreditation.

July 1998 

All the standards were rewritten to be unidimensional, which represented a step in CARF’s initiative in implementing the Standards Conformance Rating System. An Accreditation Condition was added that required an organization to submit a Quality Improvement Plan (QIP) within 90 days following notice of accreditation.

November 1998 

A collaborative partnership began between CARF and the Workers’ Compensation Board in Alberta addressing the quality and value of rehabilitation services delivered to injured workers.

January 1999 

CARF published standards manuals for Adult Day Services programs and also the Veterans Health Administration Comprehensive Blind Rehabilitation Services.

July 1999 

CARF began accrediting networks in Behavioral Health, and Employment and Community Services fields through its Network Administration standards.

February 2000 

CARF published a standards manual for Assisted Living programs.

Fall 2000 

CARF President/CEO Don H. Galvin, Ph.D. retired. Don was a tireless champion of independent living and employment opportunities for individuals with disabilities, providing congressional testimony and presenting at conferences in the U.S. and around the world.

March 2001 

Brian J. Boon, Ph.D. became President/CEO of CARF International and began expanding accreditation activities into more countries and new human service fields. He also introduced the balance scorecard to monitor CARF’s growth and customer satisfaction.

July 2001 

In the Employment and Community Services Division, standards for a new service area, Workforce Development Services, went into effect. Standards were published for One-Stop Career Centers.

September 2001 

In the 35th anniversary year, CARF staff was recognized at having reached the accreditation milestone of 3,550 organizations with accredited programs/services at nearly 27,000 locations.

November 2001 

CARF was recognized by the Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT) as an approved accrediting organization for Opioid Treatment Programs.

September 2002 

CARF Canada was incorporated in Edmonton, Alberta.

February 2003 

CARF acquired the Continuing Care Accreditation Commission (CCAC) which was founded in 1985 by the American Association of Homes and Services for the Aging (AAHSA) in Washington, D.C. This created for CARF an independent resource which helps to identify high quality care providers—from children’s services to those for older adults.

November 2003 

The public information policy was extended to include all units.

January 2004 

CARF introduced a new accreditation model in publishing the ASPIRE to Excellence® Standards Manual.

January 2005 

CARF published the Child and Youth Services Standards Manual from a compilation of existing standards. 

December 2005 

CARF accredited its first program in South America.

January 2006 

CARF published the Aging Services Standards Manual.

March 2006 

CARF established the International Advisory Council (IAC), which comprises organizational and individual members representing the spectrum of health and human services it accredits. The IAC provides guidance on development of the CARF standards and input on issues affecting the fields in which CARF offers accreditation.

August 2006 

Standards for Dementia Care were published.

September 2006 

CARF celebrated its 40th anniversary while reaching a new milestone of nearly 5,000 organizations with accredited programs/services at 38,325 locations in more than 10 countries.

January 2007 

The Comprehensive Blind Rehabilitation Services Standards Manual was updated and republished as the Vision Rehabilitation Services Standards Manual with two programs, Comprehensive Blind Rehabilitation Services and Comprehensive Vision Rehabilitation Services.

February 2007 

CARF began accrediting suppliers of certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) with approval from the Centers for Medicare & Medicaid Services (CMS).

April 2007 

CARF launched uSPEQ®—a data collection and reporting system designed to assist organizations in improving organizational well-being and performance improvement.

June 2007 

CARF introduced its extranet Customer Connect (customerconnect.carf.org).

October 2007 

uSPEQ released the Employee Climate Survey—a data collection and reporting system designed to assist organizations with performance improvement.

Other 2007 milestones 

The following sets of new standards were released:

  • Amputation Specialty Programs
  • Autism Spectrum Disorders
  • Comprehensive Benefits Planning
  • Crisis and Information Call Centers
  • Employment Recovery Centers
  • Integrated Behavioral Health/Primary Care
  • Medication Monitoring and Management
  • Mentor Services
  • Self-Directed Community Supports and Services

January 2008 

CARF published its ASPIRE to Excellence® quality framework in all standards manuals. In this framework, business practice standards were restructured to provide a logical, action-oriented approach to ensure that organizational purpose, planning, and activity result in the desired outcomes.

Many of the program-specific standards for Medical Rehabilitation were significantly revised and new standards were added to expand accreditation opportunities across the continuum of services and specialty programs.

June 2008 

CARF introduced the ability to submit a Survey Application online.

CARF accredited its first program in Oceania.

November 2008 

CARF accredited its first program in the Middle East.   

December 2008   

CARF International accreditation was recognized by the Ontario Ministry of Health and Long-Term Care.

CARF Europe was incorporated in London, England, UK.


CARF accredited its first program in Asia.

September 2009   

CARF International accreditation was recognized by the Alberta Ministry of Health and Wellness. 

February 2010 

CARF accredited its first programs on the African continent. 

July 2010  

New Home and Community Services standards were designed as a unique, broad, flexible framework and were published in multiple standards manuals.

CARF International headquarters office moved to 6951 E. Southpoint Road, Tucson, Arizona, USA.

January 2011 

CARF introduced Medically Complex Population Designation standards for Behavioral Health and Child and Youth Services accreditation areas. Child and Youth Services also introduced Adoption standards.

May 2011 

CARF Canada opened an office space in Toronto, Ontario. 

January 2012 

CARF introduced standards for accreditation of Student Counseling, Independent Evaluation Services, and Supported Education, as well as Case Management.

July 2012 

New standards for Health Home Services went into effect in the Behavioral Health accreditation area. 

January 2013 

CARF introduced standards for Eating Disorder Treatment programs in the Behavioral Health accreditation area. 

January 2014 

CARF introduced standards for Cancer Rehabilitation Specialty Program in the Medical Rehabilitation accreditation area. New standards for Peer Support Services were also published in several standards manuals.

December 2014 

CARF Europe opened an office space in London, England, UK.

January 2016

CARF published the CARF Standards Manual Supplement for Networks and the CARF Standards Manual Supplement for Employment Services Centres in Canada.

The CARF–CCAC Standards Manual was renamed the Continuing Care Retirement Community Standards Manual.

September 2016

CARF celebrated 50 years of enhancing lives and with nearly 7,000 organizations with accredited programs/services at more than 52,300 locations worldwide.

December 2016

U.S. President Barack Obama sent a letter congratulating CARF International on its 50th anniversary.

May 2017

CCAC entity and accreditation process fully integrated into CARF. CCAC name as an entity is no longer in use.

July 2017

New CARF standards address suicide prevention as a public health crisis and convened suicide-prevention experts for an International Standards Advisory Committee. The program standards support the National Strategy for Suicide Prevention’s goal to reduce the annual suicide rate by 20% over the next eight years.

January 2019

CARF added suicide risk screening to the accreditation standards of Behavioral Health and Opioid Treatment Program.

In all 2019 standards manuals, CARF published significantly expanded technology guidelines, from portals and apps to firewall and malware protection, technology is increasingly vital to modern health and human services, and increased consumers’ access to it.

CARF developed standards for Office Based Opioid Treatment (OBOT) programs. The standards were published in the Behavioral Health Standards Manual.

June 2020

CARF partnered with the American Society of Addiction Medicine (ASAM) and began offering ASAM Levels of Care certification of residential substance use disorder treatment services.

April 2023

Michael J. Connolly, D.O., joins CARF as its first Chief Medical Officer to provide medical leadership across all accreditation areas.

November 2023

CARF launched a newly redesigned user-centric website at carf.org.

December 2023

CARF designed standards for Certified Community Behavioral Health Clinics (CCBHCs) based on the SAMHSA criteria and began offering accreditation for CCBHCs.

January 2024

CARF published standards for Concussion Rehabilitation Programs—the first interdisciplinary, field-driven standards for concussion management.

Board of Directors

Twelve elected members of the CARF Board of Directors approve policies regarding standards development and the accreditation process and fiscal matters governing the operation of CARF. The board’s composition reflects individuals whose expertise, experience, and perspectives are invaluable to CARF’s business interests and success:

  • Board Chair: Donald J. Dew, MSW, ACSW, Chicago, Illinois
  • Susanne M. Bruyère, PhD, CRC, Ithaca, New York
  • Thomas J. Buckley, EdD, La Puente, California
  • Aashif Esmail, MD, Edmonton, Alberta
  • Richard Forkosh, Kirkwood, Missouri
  • G. Thomas Heath, Salt Lake City, Utah
  • Kayda Johnson, Naples, Florida
  • Marvin Mashner, CPA, Maple Glen, Pennsylvania
  • Paul Prem Nathenson, DNP, APRN, NP-C, ND, Oregon City, Oregon
  • D. Sharon Osborne, Seattle, Washington
  • Robert H. Short, Salt Lake City, Utah
  • Herb Zaretsky, PhD, New York, New York
CARF Canada and CARF Europe are governed by their respective boards

Board Chair: Brian J. Boon, PhD, Tucson, Arizona

CARF Leadership

Brian J. Boon, PhD, president/CEO, joined CARF in 2001 after serving as an at-large trustee on the CARF Board of Trustees between 1998 and 2000. Prior to joining CARF, he was a CARF surveyor for six years and participated in many CARF advisory committees and leadership panels dating back to 1990. Brian holds a doctorate in counseling psychology from the University of Alberta and was formerly a practicing/registered psychologist. He also held many progressive leadership positions with the Alberta Workers’ Compensation Board, culminating as the vice president of claims and healthcare services. Brian’s broad professional experiences as a payer, provider, and regulator have contributed to his “systems solution” leadership approach—an orientation well suited in his role at CARF in working with the many key stakeholders to advance quality for persons served in the global health and human service industry.

Terrence Carolan, MSPT, MBA, managing director of the Medical Rehabilitation and Aging Services accreditation areas, has more than 20 years of experience as a provider, administrator, and educator in the human services field. Prior to joining CARF in 2021, he worked in clinical and administrative leadership positions within Select Medical and Kessler Institute for Rehabilitation. Terrence was a CARF surveyor for 10 years. He holds a master’s degree in business administration at the University of Wisconsin-Eau Claire, a master-of-science degree in physical therapy from Simmons University in Boston, and did his undergraduate work in biology at The College of New Jersey.

Chasity Chamberlin, managing director of the Employment and Community Services accreditation area, brings 20 years of experience to her role having worked as a provider, administrator, and executive director for residential, employment, and community integration organizations. She served on a county board and oversaw funding for individuals receiving services. She was also a CARF surveyor for seven years.

Michael J. Connolly, DO, chief medical officer, provides medical leadership across CARF’s accreditation areas, including behavioral health and substance use treatment, medical rehabilitation, and aging services. An awarded clinician with more than 30 years’ experience in health and human services, Michael has a long history of developing and improving patient care models, and optimizing clinical and financial outcomes in value-based care models. Michael received his doctorate in Osteopathic Medicine from the New York College of Osteopathic Medicine in Old Westbury, New York, and completed his residency in Internal Medicine at Yale University and a Geriatric Medicine fellowship at Stony Brook University.

Jodi M. Dedrick, SPHR, SHRM-SCP, GTML, CDP, chief human resources officer, leads the organization’s human resources, learning and development, and accreditation education functions. Prior to joining CARF in 2011, Jodi served in various corporate leadership and field operations roles with the world’s largest private sector employer. Jodi is a certified human resources professional with specialty credentials in global talent management, diversity and inclusion, and risk management and holds a master’s degree in human resources management. She currently serves on the board of directors for a state-level association of equal employment opportunity, affirmative action, and diversity practitioners.

Leslie Ellis-Lang, MSEd, LMFT, managing director of the Child and Youth Services accreditation area, joined CARF in 2009. Leslie’s career spans more than 35 years in the behavioral health field with an emphasis on services for children, youth, young adults, and families. Prior to joining CARF, she served as the clinical director for behavioral health and child welfare services and the quality improvement leader for a state-wide organization in Florida. Leslie is a licensed marriage and family therapist and holds a master of science degree in counselor education from Northern Illinois University.

Penny Gagnon, MA, chief advisor, accreditation standards, CARF Canada, has more than 20 years of executive leadership experience specializing in nonprofit, and health and human services organizations, and expertise in the development of person- and family-centered practices and quality frameworks for organizations across Canada. Penny’s depth of experience in operationalizing administrative and care standards within organizations continues with CARF as she is involved in a wide array of international standards-development processes and committees representing Canadian interests, trends, and legislation. She is highly motivated in collaborating with others to create systems that promote a stronger vision for and commitment to the quality of services in enhancing the lives of persons served.

Emily Hosea, MEd, NCC, managing director of the Behavioral Health and Opioid Treatment Programs accreditation areas, joined CARF in 2012. Other positions held at CARF were the administrator for opioid treatment programs, and a senior resource specialist in the behavioral health, child and youth services, and opioid treatment programs customer service units. Prior to CARF, Emily’s career was in direct service and utilization management in a variety of settings that focused on substance use disorders, mental health, crisis intervention, and education. She holds a master’s degree in education from Northern Arizona University and undergraduate degrees in psychology and sociology from the University of Arizona. 

Cindy L. Johnson, CPA, chief resource officer since 2006, provides executive leadership over finance, information technology, research and quality improvement, publications and communications, human resources, and education and training functions. Cindy joined CARF in 1999 as director of finance and administration after several years of financial and leadership experience in the aerospace and mining industries.

Michael W. Johnson, MA, CAP, senior managing director of the Behavioral Health accreditation area, joined CARF in 2013. Michael is a certified addictions professional and has more than 30 years of experience as a clinician, manager, and executive working in mental health, substance abuse, and intellectual disabilities. He was a CARF surveyor for 16 years. Michael holds a bachelor’s degree in interpersonal communications and a master’s degree in communications, both from the University of Central Florida.

Shanna Lawson, MPA, account manager, is directly responsible for account services operations across all customer service units. Before joining CARF in 2008, Shanna’s professional experience spanned quality improvement management in health and human services, accreditation readiness, and direct service provision. She earned a master’s degree in public administration from Upper Iowa University.

Darren M. Lehrfeld, JD, chief accreditation officer and general counsel, provides direct executive leadership over all accreditation operations, legal affairs, public policy and compliance matters. Prior to joining CARF in 2003, Darren was the sole shareholder of a professional corporation that provided business and legal counsel to CARF and other international, national, regional, and local organizations in healthcare and other industries. He earned his juris doctor and business administration degree from the University of Arizona and is an active member of the State Bar of Arizona and Pima County Bar Association.

Julia Meashey, MA, senior business development specialist of the Aging Services accreditation area, joined CARF in 2015. She has experience working in aging services advocacy, program management and grant administration focused on ensuring quality health care for older adults and their families. Prior to CARF, she served as director of operations for the Hartford Change AGEnts Initiative and managed the National Center on Gerontological Social Work Excellence. Julia began her career as a local long-term care ombudsman in North Carolina before moving to Washington, D.C. to work for the National Ombudsman Resource Center. She has a master of arts in gerontology from Appalachian State University, and bachelor of science in psychology from Guilford College.

Di Shen, PhD, chief research and quality improvement officer, spearheads accreditation research and quality improvement efforts, performance indicator and outcomes management, and has oversight responsibility for internal performance improvement systems and research data infrastructure for CARF since 1997. He oversees the uSPEQ stakeholder feedback surveys, including instrument design, development, benchmark analysis, and comparison. Dr. Shen has published and presented at numerous national and international conferences and workshops in his areas of expertise. He has served on several U.S. and Canadian national committees on measurement methodology and performance indicators. His doctoral degree in psychology is from the University of Arizona.

The International Advisory Council (IAC) creates a partnership for CARF and IAC members to promote quality in human services and enhance the lives of persons served. The IAC is a forum for its members to provide guidance and input into standards development and the accreditation process and also provide insight on issues affecting the fields in which CARF provides accreditation services. The IAC represents a broad spectrum of stakeholders, including persons served, providers, and professionals, in the health and human services field. IAC members support CARF’s mission, purposes, values, and vision. The IAC liaison may be contacted at iac@carf.org.

CARF is pleased to include the following organizations as members of IAC:

Choosing a retirement community to live in requires a thorough review of the many options available. Key to this decision is an analysis of its long-term viability. CARF’s Financial Advisory Panel conducts ongoing analyses within the industry and publishes resources that can be used by provider organizations and consumers alike.

The Financial Advisory Panel (FAP) comprises leading finance experts, including CFOs and consumers from accredited organizations, investment banking, accounting, and other related firms.

2024 Financial Advisory Panel Members:

  • A.V. Powell & Associates, LLC – Alwyn V. Powell, Founder & CEO
  • Baker Tilly US, LLP – Patrick Heavens, Partner.
  • Baptist Senior Family – Tim Myers, President & CEO
  • Eventus Strategic Partners – Alan Wells, President
  • Frasier – John Jenkins, Person Served/Resident
  • Herbert J. Sims & Co., Inc. – Jim Bodine, Executive Vice President 
  • Moorings Park – Mary Morton, CFO
  • Presbyterian SeniorCare Network – Todd Boslau, Senior Vice President & CFO
  • RKL, LLP – Jeffrey Boland, Partner, Senior Living Services Consulting Group
  • St. Catherine’s Village – Scott Kersh, CFO
  • Ziegler – Thomas Meyers, Senior Managing Director, Senior Living Finance

The FAP provides input on development of financial standards and strategic educational resources, including:

  • Developing operational indicators.
  • Enhancing financial standards for all areas of Aging Services within CARF’s purview.
  • Reviewing aggregate data to identify financial trends and issues in the field.

The FAP produces two publications, the Financial Ratios & Trend Analysis of CARF-accredited Continuing Care Retirement Communities (produced annually and distributed in the fall) and the Consumer Guide to Life Plan Communities: Quality and Financial Viability, which are highly acclaimed resources for service providers and consumers, respectively.

Financial Ratios & Trend Analysis of CARF-accredited Continuing Care Retirement Communities — This publication includes information about the financial position of organizations that have been through CARF’s accreditation process for CCRCs. A valuable benchmarking resource, the information serves as a point of reference for developing internal targets of financial performance. This publication is offered for purchase through CARF’s Online Store.

Consumer Guide to Life Plan Communities: Quality and Financial Viability — Given the long-term commitment involved in choosing an LPC or CCRC, this objective resource booklet reviews important criteria for consideration. It describes and compares various fee structures and contract types for CCRCs. It is a collaborative effort of CARF’s FAP, provider organizations, and involved residents. This guide may be downloaded for free (PDF).

Giving Quality a Voice

uSPEQ® (pronounced “you speak”) stands for Universal Stakeholder Participation and Experience Questionnaire. It supports continuous improvement in health and human services by gathering focused feedback. uSPEQ surveys were developed by experts with input from providers and researchers to collect data in a standardized way regarding consumer experience and employee climate.

An organization needs data to measure its performance and demonstrate the effectiveness of its services. CARF’s ASPIRE to Excellence® standards for performance measurement, management, and improvement require ongoing assessment of stakeholder satisfaction. uSPEQ provides a tool that is statistically proven to be reliable.

uSPEQ data is kept separate from the accreditation activities of CARF and using uSPEQ surveys alone will not satisfy all requirements of the CARF standards. You must demonstrate how you collect data on an ongoing basis as well as how you analyze and use the information to create action plans.

uSPEQ surveys yield clear, reliable, and measurable information that empowers you to:

  • Prioritize areas for improvement to develop targeted action plans.
  • Monitor effectiveness of your action plans and year-over-year progress.
  • Utilize benchmarks to compare yourself to organizations just like yours.

Visit www.uspeq.org for more information.

Since 1966, the CARF seal has been the hallmark of quality in human services. CARF’s reputation for advancing excellence in the industry is founded on its unique consultative peer-review survey model, conformance focus, and evolving field-driven standards.

Areas that we accredit: aging services, behavioral health, child and youth services, continuing care retirement communities, employment and community services, medical rehabilitation, opioid treatment programs, and vision rehabilitation services.

There are CARF-accredited programs/services in countries in North and South America, Europe, Asia, and Oceania.

Persons served, as defined below, shall be the moral owners of CARF.

Persons served are the primary consumers of services. They are the principal decision maker throughout the course of a program/service. Persons served have the right to choose whether members of the family, support system, or advocates may participate in that decision-making process. In circumstances when the person served is unable to exercise self-representation at any point in the decision-making process, person served is interpreted to also encompass those persons legally authorized to make decisions on behalf of the person served.


Nonprofit, independent organization.

Primary business

Accreditation. CARF officially recognizes health and human service providers as having met standards for quality of service.

Secondary business

Education, research, publishing.


More than 1,500 in North and South America, Europe, the Middle East, and Asia.

Revenue sources

Survey fees from applicant service providers, registration fees from seminars and conferences, sales of publications, contributions from International Advisory Council (IAC) members, and grants from public and private agencies.

Welcome to CARF International

Learn more about the purpose, value, and impact of CARF accreditation from CARF President/CEO Brian J. Boon, PhD.