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The newest quality frontier: child and youth services

By Leslie Ellis-Lang, managing director of child and youth services, CARF International

Note: As part of CARF’s 50th year anniversary celebration in 2016, we are sharing snapshots of the industries in which we offer accreditation. This is part 5 of a series: Child and Youth Services.

Leslie ellis-LangThe youngest (no pun intended) of CARF’s major accreditation areas is child and youth services. In 2005, the Child and Youth Services standards manual was first released in response to growing requests from advocacy organizations and programs that served children and adolescents, especially child welfare programs. Those first standards were originally developed using established standards from CARF’s various other accreditation areas serving persons under age 18. In many ways, CARF’s development and advancement of distinct child and youth standards parallel how society itself has viewed children and young persons over time.

It’s hard to believe that child abuse awareness (child welfare) is such a relatively new concept. Widespread consciousness of the issue only really began to take off in the United States, both publicly and within health and human service industries, in the 1960s and ‘70s, the same decades that CARF was beginning to establish itself as an accreditor. This was due to a few convergent factors, such as important Supreme Court decisions, creation of youth associations, new child abuse reporting statutes, and passage of the Child Abuse Prevention & Treatment Act, which helped influence legal and public perceptions. Another important event was instrumental in defining child abuse as a clinical condition that could be treated: a pediatrician named C. Henry Kempe began to notice the medical manifestations of abuse in his patients. Kempe and his colleagues published an article in the Journal of the American Medical Association titled The Battered-Child Syndrome that played a significant role in growing the issue into the social arena.

Extending the spotlight beyond child abuse awareness, this 15- to 20-year period also saw the emergence of cultural diversity and ethics in the child and youth services field that mirror CARF’s core values. First, there was an increasing focus on maintaining the child’s cultural heritage. The 1978 Indian Child Welfare Act was passed, for instance, which granted tribal governments authority over Indian children and allowed them to preserve cultural identity. Second, behavioral health services began to recognize distinctly different needs for the child and youth population compared with adults. And third, there was an increasing focus on serving children in their communities, in their own families, or in as close proximity to their families as possible. Diversity, individuality, respect – the application of these concepts in the field evolved during this period, which truly defined the philosophical groundwork that allows for the person-focused services for children and youth that we see today.

Of course, this timeframe was only the tipping point and the child and youth services field is still very much in growth mode. New approaches and tools are constantly emerging. We have seen the major CDC-Kaiser ACE Study that illuminated the effects of childhood abuse on lifelong health and well-being, the increasing use of electronic health records that make it easier to share information among various healthcare providers and throughout the duration of services, and a growing number of youth-run self-advocacy organizations giving a voice to youth. The result of these and other developments has been an increase in different types of services that address children and youth from different vantage points. But this can pose challenges for the industry. In a previous blog article, Three recent additions to CARF’s International Advisory Council part of larger expansion of child and youth focus over past decade, I discussed the ongoing trend toward integrating behavioral health, child welfare, and other areas to better serve the whole child. CARF’s standards for this population include the major field categories of child welfare, protection, well-being, and healthy development in addition to special populations for juvenile justice and medical complexities. It’s important that these separate (yet connected) areas continue to unify and strive for quality.

This growth and fine-tuning is vital for us to get services to the level where they need to be. In the U.S., child welfare has received an increasing amount of negative scrutiny. Since 2000, the federal government has been reviewing the quality of child welfare system within states, and public reports since that time have repeatedly concluded that the current system is broken. A report in 2012 by the Center for the Study of Social Policy (CSSP) stated that child advocates often resorted to class action litigation to resolve difficult and longstanding problems with child welfare systems to address poor outcomes for children and families. At that time, 70 lawsuits were active or pending decisions in 30 states. Several states, including California in a recent major foster-care reform initiative, are exploring legislation or other means to improve the industry. Providers are eager for a solid, quality foundation upon which to build.

This is the type of input CARF was receiving from providers that prompted the creation of standards tailored to child and youth services. Between 2003 and 2004, both the Ministry of Children and Youth Services in Alberta, Canada, and the Child Welfare League of America (CWLA), recognized and partnered with CARF for the creation of the standards. CWLA’s consultation in particular was integral. Since then, the accreditation area has grown quickly. I came on board in 2009, and CARF now has six* child and youth services representative organizations on the International Advisory Council (IAC) giving input on new and updated standards. But that is not nearly the end of the story.

Moving forward, I’m interested to see how accreditation and other quality mechanisms continue to grow in importance. The previously mentioned CSSP report cited national accreditation as a potential solution to alleviate conflicts. In addition, there is currently a national bipartisan bill called Family First Prevention Services Act, which has passed the house and sits in the senate. This bill has several key components aimed at improving the child welfare system, including a mandate for national accreditation for foster care as well as “group” or “congregate” care types of programs. I’m also eager to see the continued shift in focus toward outcomes and evidence-informed service delivery. This involves further clarifying the differing needs of children—factoring in age (infants, toddlers, preschoolers, young adults, etc.)—and new collaborative relationships between the professional field and community resources. As CARF celebrates its 50th anniversary, the child and youth services field looks forward to a flurry of activity and growth. I look forward most of all to offering the field a solid foundation of quality that CARF has built over the past 50 years.

*CARF’s child and youth services IAC representatives include:

(50th Anniversary,Child and Youth Services)

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