Private Organization Accreditation

Sweetser, a Maine non-profit agency operating since 1828, provides comprehensive mental and behavioral health and substance abuse treatment services. Statewide, it serves around 15,000 consumers a year, including children, adults, and families in outpatient, office-based, and residential settings.


Advantage Credit Counseling Service

Mary Loftus, VP, Agency Service

Our agency is preparing for reaccreditation under the Eighth Edition Standards. The COA site is well organized and very easy to use. Our team of employees working on the reaccreditation process has found the tools index to be very helpful, particularly some of the templates.
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Residential Treatment Services provide individualized therapeutic interventions and a range of services, including education for residents to increase productive and pro-social behavior, improve functioning and well-being, and return to a stable living arrangement in the community.

CA-RTX 16: Residential Facilities

Residential facilities contribute to a physically and psychologically safe, healthy, homelike, non-institutional, therapeutic environment.

Interpretation: “Homelike” settings are assessed within the context of the organization’s location and environment. 

Research Note: Physical environments convey symbolic and concrete messages. The way in which organizations maintain, design, and decorate their residential facilities can greatly impact residents’ perception of safety and security. For example, facilitates that are warm and inviting, and incorporate age, developmentally, and culturally appropriate decor into the aesthetic impart a sense of belonging to residents.  

Rating Indicators
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice standards.
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted, however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations (CA-HR 6.02) and training (CA-TS 2.03); or
  • Active client participation occurs to a considerable extent.
Practice requires significant improvement, as noted in the ratings for the Practice standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • A number of client records are missing important information  or
  • Client participation is inconsistent; or
  • One of the Fundamental Practice Standards received a rating of 3 or 4.
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or
  • Documentation is routinely incomplete and/or missing; or  
  • Two or more Fundamental Practice Standards received a rating of 3 or 4.

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • Procedures for establishing a homelike, therapeutic environment 
    • Procedures for maintain a clean and safe environment 
No On-Site Evidence
    • Interview:
      1. Program director
      2. Relevant personnel
      3. Residents
    • Observe facility and outdoor area/grounds

  • CA-RTX 16.01

    Living quarters are age, developmentally, gender, and culturally appropriate, and consist of separate cottages or units in a residential building that include:

    1. a common room, dining and/or kitchen area, and space for indoor recreation;
    2. private areas where residents can meet with family and friends;
    3. private facilities for bathing, toileting, and personal hygiene; and
    4. ready access to a telephone and other technology, as permitted, for use by residents and personnel.

    Interpretation: Programs must have gender-specific sleeping areas and private facilities for bathing, toileting, and personal hygiene to ensure a residents’ privacy from residents of the opposite gender.

    Programs serving children should have facilities that are developmentally appropriate and culturally responsive, including separate bathrooms and shower areas, and outdoor and indoor play spaces with adequate toys, books, and other recreational supplies.

    Note: The organization is responsible for developing policies or procedures addressing the use of cellphones and other types of technology. See evidence at CA-RTX 17.

    Research Note: Literature emphasizes the importance of creating a sensitive and nonjudgmental service environment for LGBTQ individuals. Organizations can create and maintain a safe environment by posting a nondiscrimination policy that explicitly includes sexual orientation and gender identity, and by allowing transgender residents to use bathrooms and showers based on their gender self-identity and gender role.

  • CA-RTX 16.02

    Personal accommodations for residents are age, developmentally, gender, and culturally appropriate and include:

    1. single rooms, rooms for groups of two to four residents, and/or accommodations for larger groups, if appropriate for therapeutic reasons;
    2. adequately and attractively furnished rooms with a separate bed for each resident, including a clean, comfortable, covered mattress, pillow, sufficient linens, and blankets; 
    3. a non-stacking crib for each infant and toddler that is 24 months or younger that meets federal safety regulations; and
    4. a safe place such as a locker to keep personal belongings and valuables.

    Interpretation: Bedroom space should, at a minimum, meet legislative, regulatory and/or contractual requirements and accommodate the basic furnishings the standard mentions. Some provincial regulations require 7.4 metres of floor space for single rooms and at least 5.6 square metres for each person in rooms housing more than one individual. 

    Interpretation: Group assignments and room accommodations may be adjusted as appropriate to the service provided, therapeutic considerations, level of risk, or developmental appropriateness. 

    Note: Element (c) will not apply to organizations that do not allow residents to bring their children to the treatment program.

  • CA-RTX 16.03

    Organizations that serve families house families as a unit and keep sibling or family groups together, whenever possible. 

    NA The program does not serve families, or housing families as a unit is not possible or prohibited by law.

  • CA-RTX 16.04

    Residents participate actively in:

    1. decorating and personalizing their sleeping area; 
    2. choosing clothing based on their personal preferences; 
    3. food preparation and meal planning; and
    4. contributing to decisions about how to make living areas inviting, comfortable, and reflective of the residents’ interests and diversity.

    Note: Some standards elements may not be applicable for crisis stabilization and short-term diagnostic programs due to length of stay and program design. 

  • CA-RTX 16.05

    Facilities support quality therapeutic programs and settings and do not create obstacles to providing:

    1. choice among individual, small, and large group activities;
    2. activities that invite use of community resources;
    3. a variety of after school, evening, weekend, holiday, and school break programs for use by residents, guests, family, and community members;
    4. a variety of activities that are focused around the resident’s home community and extended family and friends
    5. space for quiet reading, study hours, and help with school assignments;
    6. space for individual hobbies and group projects that may be large and constructed over time; and
    7. alternatives to watching television, such as art, photography, or other creative activities.

    Note: Some standards elements may not be applicable for crisis stabilization and short-term diagnostic programs due to length of stay and program design. 

  • CA-RTX 16.06

    Residential facilities provide:

    1. sufficient and culturally appropriate supplies and equipment to meet residents’ needs;
    2. access to a computer and the internet;
    3. adequate space for storage and maintenance needs;
    4. rooms for providing occasional on-site services, as needed
    5. accommodations for informal gathering of residents including during inclement weather;
    6. at least one room suitably furnished for the use of on-duty personnel; and
    7. private sleeping accommodations for personnel who sleep at the facility, if applicable.

  • CA-RTX 16.07

    The organization has adequate facilities for administrative support functions, food preparation, housekeeping, laundry, maintenance, and storage.

  • CA-RTX 16.08

    The residential facility and outdoor space should be clean and maintained in good condition to promote the health and safety of personnel and residents. 

    Interpretation: The facility’s outdoor area should be inviting and contain sufficient space for recreational activities. Outdoor equipment must meet all playground equipment safety standards and be appropriate for the number, age, and developmental level of residents. 

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