ASAM Level of Care Certification by CARF: From concepts to practice

“It was not the most opportune time to begin [due to the global pandemic], but people in the industry knew it was coming, and many organizations were interested in starting the certification survey process,” said Michael Johnson, Senior Managing Director of Behavioral Health for CARF International. “Now, with it being a 3-year certification, we have many organizations in the midst of recertifying which is a testament to some of its value.”

Independent assessment by CARF (carf.org/loccertification/) ensures providers demonstrate capacity to deliver one or more residential Levels of Care that is in alignment with the nationally-recognized standards found in The ASAM Criteria—thereby distinguishing themselves to payers, regulators, referral sources, and persons served.

“I believe that going through the certification process takes the criteria from abstraction to operationalization. Organizations have familiarity with the criteria, but translating it into specific actions they should take is a way to create accountability. When you become certified, then you are demonstrating your fidelity to The ASAM Criteria, to the individuals you are serving, to payers in the marketplace, and regulators,” said Johnson.

“For the certification survey, organization staff members have to prepare, think through and articulate the criteria, as well as adapt processes even though they might have felt they were aligned with the criteria before that. Actually implementing the elements in their organization has strengthened the overall quality and commitment to the criteria.”

Certification is available for adult Levels of Care 3.1, 3.5, and 3.7 (www.asam.org/asam-criteria/about-the-asam-criteria). ASAM and CARF International have continued the collaborative partnership by working together on revising the fourth edition of the ASAM Level of Care Certification Manual.

To date 326 organizations have received ASAM LOC certification by CARF and 125 of those have completed the recertification process.

“It is gratifying to work with organizations committed to enhancing quality and fidelity to The ASAM Criteria,” said Dr. Susan Johnson, one of the ASAM LOC surveyors for CARF and Principal, SMJ Associates, LLC. “Providers consistently report a positive experience with the process. It is exciting to witness providers’ dedication to persons served and continuous quality improvement.”

We asked ASAM LOC certified organizations to answer a few questions about the CARF certification process and their experience. Below are their answers:

Q: Briefly can you describe your experience with the process for ASAM LOC certification by CARF?

My organization received its ASAM certification for our Orlando, Florida program (detox/residential program), in fall 2021. The program received a three-year certification. Then in the next 12 months, my organization got the remaining 11 detox and residential programs ASAM certified, all receiving 3-year certifications. Next in 2024, the program in Orlando was recertified for another three years. Each of the certification surveys lasted one day, and it was very easy to navigate through the survey. The entire process has been very collaborative, educational, and insightful for all our staff members who have been involved with ASAM and CARF. The surveyor that we have had for our surveys in 2022 and then again in 2024, Dr. Susan Johnson, has been delightful; she is extremely knowledgeable and supportive throughout the surveys.

–Joe Baldassarre, Director of Licensing and Compliance, Praesum Healthcare
Corporate Office located in Lake Worth Beach, Florida with Sunrise Detox and Evolve Recovery
locations in Georgia, Florida, Massachusetts, New Jersey, and New York.

Unlike other surveys that feel punitive, our experience with CARF was entirely different. The certification process was simple and straightforward, from submitting the application through completion of the survey. The ASAM manual and workbook provided all the necessary elements for a successful outcome. The surveyor’s professionalism, positivity, and expertise in substance abuse treatment combined with her background in quality assurance and compliance made the survey process both enjoyable and educational. It was a true collaborative, peer-to-peer approach, and the surveyor played a key role in helping us improve the quality of care and treatment services by recommending revisions to our organization’s policies, procedures, and practices. The consistent presence of the same surveyor across all our facilities allowed for a comprehensive understanding of our entire organization. It also made it easier to anticipate her expectations and prepare to meet the rating element requirements.

–Alisha Spring, Director of Quality Assurance, Haven Health Management
Corporate Office located in West Palm Beach, Florida with facilities in Arizona, Arkansas, Florida,
Indiana, Massachusetts, New Jersey, and New York.

In preparing for our certification survey, I worked for several months on researching best evidence-based practices for each of our levels of care. This was a great opportunity to familiarize myself with current advancements in addiction treatment. This process allowed us to identify practices that were aligned with our mission and vision. During the actual survey, our surveyor was very helpful and encouraging. She was incredibly complimentary of our policies and procedures which reinforced our commitment to providing appropriate person-centered services.

–Kristi Bierbaum, LPC-S, Chief Operating Officer, Uprising Addiction Center, Shreveport, Louisiana

I believe I can speak for all Chrysalis House staff who were involved in the CARF ASAM LOC certification process that the overall experience was very positive. The surveyors have been thoughtful and eager to engage in meaningful conversations with staff regarding ASAM elements of care. As a provider of LOC 3.5 and 3.1 there was a sense of ease knowing that patient care was at the center of the certification process.

–Kama L. Orr, Executive Director, Chrysalis House, Lexington, Kentucky

We had a fantastic experience at the time of our initial certification and with our triennial recertification. The surveyors at both visits, while focused on the document review for alignment of our procedures and practices to prescribed requirements, were willing to take time to provide consult about best practices happening across the country. Both showed a genuine interest in our staff, clients, and programs. They recognized our programs’ challenges and strengths, conveying feedback and recommendations in a strength-based way that left us feeling inspired and encouraged.

–Jennie Hulette, LCSW, Vice President of Quality, Seven Counties Services, Inc., Louisville, Kentucky

Q: What was your organization’s motivation for getting certification?

My organization has always placed a heavy emphasis on this process, in what we seek for our day-to-day operations, our written policies and procedures, and overall business practices to align with the latest standards as set forth by the entities that license, certify and accredit our programs. We strive to ensure that our patients receive the best quality care possible and that our staff are always providing those services to patients when they need them the most. ASAM certification has further solidified our operations in that it provides a well-defined outline for detox and residential practices that can be practiced throughout all our locations. –Joe

The ASAM Level of Care Certification provides documented evidence of our organization’s adherence to the criteria. Through an on-site peer-review process, we’ve demonstrated our commitment to delivering evidence-based addiction treatment. As more payers adopt The ASAM Criteria, certification has become invaluable in ensuring clients receive the treatment they need and families can have confidence that their loved one is receiving safe, quality care.–Alisha

We wanted to make sure that our program was aligned with ASAM expectations and that services were being provided using evidence-based practices. Becoming certified demonstrates our commitment to the delivery of services consistent with The ASAM Criteria. –Kristi

Chrysalis House is a national model for integrated care in a residential setting for pregnant and postpartum women. As Chrysalis House evolves, it is important that nationally recognized standards are met to the highest level of compliance. Achieving and maintaining ASAMLOC certification ensures that Chrysalis House administers a high degree of care aimed to improve the overall quality of treatment. By adhering to The ASAM Criteria, Chrysalis House can implement evidence-based practices and treatment protocols that are proven to be effective. This can lead to better treatment outcomes for patients, including higher rates of sobriety and improved mental health. By pursuing ASAM certification, Chrysalis House can better serve its patients, enhance its treatment programs, and ensure sustainable operations in the competitive field of addiction treatment. –Kama

Q: What kind of value does certification bring to your organization?

The value in which this certification brings to our organization has been paramount. Not only have there been several occasions in which insurance carriers have deemed it necessary for my organization to maintain this certification, but the feedback that my colleagues and I have received with each inspection has been tremendously valuable with our written policies and procedures, electronic medical record system documentation, and staff development and education. We look forward to every opportunity that we have with each survey to further push us to be an even better treatment provider. –Joe

The ASAM Level of Care Certification plays a crucial role in ensuring patients receive appropriate treatment and families can trust the quality of care provided. Certification assures that our organization’s policies, procedures, and practices have undergone a rigorous evaluation and adhere to The ASAM Criteria. Through certification we are able to show our commitment to evidence-based practices, safety, and continuous improvement. Our organization has leveraged the ASAM Level of Care Criteria for quality assurance chart audits and we have been able to proactively identify potential placement issues and address them promptly. By using The ASAM Criteria, we are ensuring that charts consistently meet medical necessity for each level of care. –Alisha

Certification has opened credentialing doors with several managed care organizations. We had some difficulty getting credentialed with a particular organization as they wanted assurance that services were ASAM aligned. Once we obtained certification, we were able to become credentialed. –Kristi

Certification has meant enhanced quality of care, increased credibility and trust, regulatory compliance, comprehensive care continuum, supporting staff development, and positively impacting the community. –Kama

Q: Did going through the certification process help you understand the criteria better?

Yes, with every inspection that my colleagues and I have undertaken, it has provided us with more knowledge of criteria as set forth by ASAM. My organization can truly see how we have improved our operations and service deliveries in the time that we have gotten all our programs certified with ASAM. –Joe

The certification process significantly enhanced my understanding of The ASAM Criteria. Our organization relied on the ASAM Level of Care Certification Manual and the preparation workbook during our survey preparations. I was able to move beyond mere recitation of the rating elements and truly grasp their meaning. The workbook facilitated a comprehensive review of our existing processes, covering everything from training requirements to staff supervision and policies. By utilizing the checklists and recommendations within the workbook, we ensured that any necessary policy adjustments aligned with The ASAM Criteria for each level of care. Based on our initial survey experiences, we developed a compliance tool for each level of care that now helps us maintain sustained adherence to the ASAM rating elements.
–Alisha

Absolutely, going through the certification process allowed me to learn more about the criteria and become the ASAM point of contact when managing and developing new programs. –Kristi

Yes, it definitely did, by going through the certification process we were able to apply each aspect of The ASAM Criteria to our program and make modifications as needed. –Kama

The ASAM Level of Care Certification Manual is a highly effective and beneficial programming resource. The manual was our ‘playbook’ to guide the development and operations of running our ASAM 3.7, 3.5, and 3.1 residential programs. Preparation for certification was a diligent process but one that improved our entire program because it created an intentional structure to comprehensively review and align our procedures to the specifications of the standards and rating elements. In doing so, we know that we are best positioned to deliver life-changing addiction treatment services in our community. –Jennie

Q: What improvements or impact has certification had on your care delivery?

We have made significant improvements with our electronic medical record system, as well as our written policies and procedures which has equated to better patient care and a more educated workforce since obtaining ASAM certification. The standards, which are dictated by ASAM and CARF, are well written and easy to understand (as told to me by my colleagues) and have had an incredibly positive impact on our enterprise. –Joe

The certification process drives continuous improvement across all areas of the organization. We have been able to streamline operations and ensure consistency through standardized processes throughout the organization, implementation of industry best practices, and adoption of a common language irrespective of the program location. These improvements have primarily manifested in changes to our policies and procedures, and an enhanced staff training program – directly impacting the quality of care and our ability to provide effective treatment services. Since the rating elements and ASAM manual are consistently updated to comply with industry changes, certification has also helped us to remain current with industry standards and best practices. –Alisha

The biggest impact has been in staffing. Our state regulations regarding staffing are primarily left up to the facility. However, we decided to move into team staffing to reasonably improve the delivery of services. This ensures that each client has an assigned therapist, nurse and behavioral health technician. –Kristi

ASAM certification has impacted our care delivery by being able to provide individualized services for our patients. They are receiving the appropriate levels of support as they progress through different stages of recovery, facilitating smoother transitions and continuous care. The certification process includes regular reviews and updates, ensuring that Chrysalis House continues to improve its services and stays current with best practices. –Kama

Thank you to all who contributed to this article. We are grateful for your commitment to continuous improvement and demonstrating fidelity with The ASAM Criteria®.