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Addressing social determinants with higher standards

The CARF standards confront barriers of access, capacity, and social determinants that weaken outcomes for providers and the persons they serve.

Social determinants of health (SDH) are the conditions in which people live, work, and age and include factors like housing stability, employment status, geographic location, education, and other socioeconomic circumstances. SDH, often determined by distribution of wealth and resources, has proven responsible for inequities in healthcare and has become its biggest cost-driver. And this inequity is proving very costly; some $111 billion in health-related costs in the next decade will be the direct result of unstable home conditions, according to a study published by Children’s HealthWatch at Boston Medical Center.

This relationship between SDH and health is continually monitored by the World Health Organization (WHO). WHO’s position is that unjust and avoidable inequalities in environmental risks, between and within countries, call for relevant policies and interventions to mitigate and reduce risk in the affected population groups. Echoing WHO initiatives, Healthy People 2020 has established and reports on its ten-year national objectives for SDH, with the goal of creating better health across the U.S.

These global and national initiatives aim high, but the disparity in healthcare is most prevalent at the community level, and it’s the providers of health and human services who are directly absorbing the high cost and are expected to address SDH on the frontline. “Social determinants of health are no longer a novelty; they are part of a comprehensive strategy to deliver quality, affordable healthcare,” writes Margaret A. Murray, CEO of the Association for Community Affiliated Plans, in Modern Healthcare. “Collaboration between health plans, providers, state agencies, and the federal government should be the norm, not the exception.”

Providers can turn to the CARF standards for guidance in confronting barriers of access, capacity, and social determinants that can weaken service outcomes. Outcomes- and evidence-informed service delivery involves addressing the unique, changing needs of individuals across ages and life situations. As persons served transition through life milestones related to behavioral health, disability, and medical rehabilitation, their services must adapt. Any transition can pose barriers that affect service delivery and, ultimately, a person’s quality of life and outcomes. CARF’s accreditation model is ideally constructed to address these barriers and to help maintain service continuity.

CARF accredits programs that serve individuals across the lifespan. The field review and standards development process ensures that evidence-based practices related to service integration, transitions, and population specialization are written into all areas of the standards.

“We have been developing quality standards for services that address social needs since our inception,” says Debbi Witham, CARF’s managing director of public policy. “Our standards are designed to encourage organizations to include this in their planning. For instance, the standards related to accessibility planning include financial, attitudinal, transportation, and other barriers related to social needs that may impact an individual’s ability to access services that may improve their health and community functioning.”

CARF standards require accredited programs to examine the needs of the community when developing services. These needs should inform strategic planning efforts and how outcomes and improvement data are collected. CARF’s General Program/Care Process standards support and guide organizations to better understand and stratify the needs of the population served and create collaborative relationships with community resources.

The accreditation process also connects providers with expert peers across the global health and human services community. CARF surveyors bring expertise from their own programs and offer insight and consultation stemming from hands-on experience in similar communities.

CARF works with more than 2,700 providers accredited for programs that target SDH, many in conjunction with social services that encourage a holistic health perspective. Although the concept and practice of assessing and addressing SDH appears in the ASPIRE Performance Measurement, Management, and Improvement standards, CARF does accredit specific programs that deal more directly with SDH, including:

  • Case Management/Services Coordination
  • Community Housing
  • Community Integration
  • Crisis Intervention
  • Crisis Stabilization
  • Employee Assistance
  • Health Home
  • Home and Community Services
  • Supported Living
  • Rapid Rehousing and Homelessness Prevention Program
  • Foster Family and Kinship Care

Witham says CARF will continue to concentrate on improving healthcare quality for persons served with a strong focus on social needs. “These services have not historically been purchased through traditional healthcare payment systems. However, that’s changing, and many payers are struggling with how to identify quality in those services and realize an effective return on investment. CARF’s standards and accreditation process can help payers identify quality services delivered by organizations with efficient business practices and performance management systems that focus on ensuring a strong ROI.” Deploying data-driven systems and tools, providers can effect real change—locally and globally—in reducing SDH-related barriers and improving outcomes for persons served.

For a full list of CARF program descriptions, visit www.carf.org/accreditation/programs.