Private Organization Accreditation

Southeastern Regional Mental Health, Developmental Disabilities and Substance Abuse Services is a Local Management Entity, covering the geographic areas of Bladen, Columbus, Robeson, and Scotland counties. SER ensures continuity of care to consumers through access to a quality of care system available 24/7/365 days a year through management of our network provider services.


Ulysses Arteaga, L.C.S.W.

Volunteer Roles: Commissioner; EPPA; Marine Reviewer; Military Reviewer; Peer Reviewer; Team Leader

The Consuelo Foundation 2012 Peer Reviewer of the Year, Mr. Arteaga conducts two to three site visits a year, often volunteering for visits that require a Spanish speaking peer.
read more>>


Youth participating in Psychosocial Services (CA-YPS) receive community based services that facilitate childhood development and resiliency using a holistic approach that improves family functioning and increases child well-being and safety.

CA-YPS 5: Rehabilitation Team

The rehabilitation team consists of personnel that represent each sector providing services to the youth as well as the youth themselves, the primary caregiver, and any appropriate family members or natural supports.

Interpretation: Wraparound services are a holistic form of service planning that includes all individuals relevant to the well-being of the youth (family members, primary caregivers, other natural supports, service providers, etc.) working collaboratively. Wraparound programs may not always provide direct services, but act as a coordinator between all of the various other providers. 

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 designated roles and responsibilities are noted, however, these do not significantly impact service quality; or
  • Job description need strengthening; or
  • With few exceptions roles and responsibilities are understood by staff; 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
  • In a few instances client or staff signatures are missing and/or not dated; 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
  • Role designation not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • In a number of instances client or staff signatures are missing and/or not dated (RPM 7.04); or
  • Quarterly reviews are not being done consistently; or
  • Appropriate family involvement is not documented; or 
  • Documentation is routinely incomplete and/or missing; or
  • Assessments are done by referral source and no documentation and/or summary of required information present in case record; 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
    • A description of service
    • Documentation of provider network 
    • Job description and resume of qualified care providers 
    • List of members of the rehabilitation team and their roles (including child and family team members if providing Wraparound services)
    • Interview:
      1. Clinical or program director
      2. Relevant personnel
      3. Individuals or families served
    • Review Case Records

  • CA-YPS 5.01

    The rehabilitation team, with input from the youth and primary caregiver, coordinates services with specialty mental health, substance use treatment, education, child welfare, primary health care, and juvenile justice, as appropriate.

    Note: If the organization does not provide any of the services listed above, such as may be the case for Wraparound programs, then it is formally documented how those youth’s needs are being met. If the services are not necessary for the youth (e.g., they are not involved with juvenile justice at all), there is documentation that the youth was assessed for those needs and it was determined unnecessary.

    Research Note: The research shows that the creation of one plan among multiple service providers with related goals leads to a higher likelihood of more successful outcomes (e.g., decreased placement in more restrictive environments).

  • CA-YPS 5.02

    A lead worker will serve as the primary point of contact for the youth and family in the service planning process, ensuring to include:

    1. performing a strengths-based assessment;
    2. conducting plan-of-care meeting;
    3. helping to determine needs and resources;
    4. arranging for provision of specific services; and
    5. monitoring implementation of the Service Plan.

    Interpretation: A point of contact may have a different title from organization to organization; Wraparound programs would refer to this individual as the care coordinator.

  • CA-YPS 5.03

    The wraparound care coordination team includes a care coordinator, personnel providing services from each sector, the youth, the child and family team, a mobile crisis team, and a provider network.

    Note: If the organization does not provide the service, it should be noted which organization does provide it and the name of the primary contact from that organization. If the youth does not need support in that service sector, it should be noted that the youth was evaluated and the service was deemed unnecessary.

    NA The organization does not provide wraparound services.

  • CA-YPS 5.04

    The child and family team consists of the youth and, in addition to the primary caregiver, all adults and family members that play a positive role in the youth’s life as well as provide natural community support.

    Interpretation: Child and family teams often include a family support partner (also referred to as a family support specialist) who is a parent who has had similar experiences with their own family and as a result has an understanding of the various systems and is able to provide support to the other adults to help them find their voice.

    NA The organization does not provide wraparound services.

  • CA-YPS 5.05

    A mobile crisis team that includes psychologists and social workers trained in crisis intervention is available to meet the needs of youth and families in the absence of the lead worker.


    Interpretation: If a mobile crisis team is not readily available from the organization’s resources, a third party (such as a crisis hotline) – as permitted by state regulation -- can be contracted to provide assistance during a crisis. Youth and their primary caregivers are made aware of how to utilize the resource prior to a crisis situation.

    Note: An example of when a mobile crisis team may be of use is when reviewing a potential inpatient psychiatric hospitalization of a youth and the care coordinator is not available.

    NA The organization does not provide wraparound services.

  • CA-YPS 5.06

    The organization creates a provider network by cultivating a relationship with an array of service providers to help support the youth and family’s needs.

    Research Note: The research on Wraparound programs shows positive outcomes with a diverse array of service providers within the organization’s network. It increases the choices families have when selecting providers and the services they wish to receive.

Copyright © 2019 Council on Accreditation. All Rights Reserved.  Privacy Policy and Terms of Use