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.


Domestic Violence Intervention Services, Inc.

Donna Mathews, Associate Director

Becoming accredited and maintaining our accreditation through COA has helped us increase our professionalism and thereby provide better services to domestic violence, sexual assault, stalking, and dating violence survivors.
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The agency’s administrative and service environments contribute to agency effectiveness and are respectful, safe, and accessible.

PA-ASE 8: Special Health Precautions

The agency takes appropriate precautions to limit the spread of contagious and infectious disease.

NA The agency is not governed by any legal or regulatory requirements associated with risk of exposure to contagious and infectious disease nor do they serve a population at high risk of TB infection.

Rating Indicators
Full Implementation, Outstanding Performance
A rating of (1) indicates that the agency's practices fully meet the standard and reflect a high level of capacity.  
  • All elements or requirements outlined in the standard are evident in practice, with rare or no exceptions: exceptions do not impact service quality or agency performance. 
Substantial Implementation, Good Performance
A rating of (2) indicates that an agency's infrastructure and practices are basically sound but there is room for improvement.
  • The majority of the standards requirements have been met and the basic framework required by the standard has been implemented. 
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality or agency performance.
Partial Implementation, Concerning Performance
  • A rating of (3) indicates that the agency's observed infrastructure and/or practices require significant improvement.  
  • The agency has not implemented the basic framework of the standard but instead has in place only part of this framework.  
  • Omissions or exceptions to the practices outlined in the standard occur regularly, or practices are implemented in a cursory or haphazard manner.  
  • Service quality or agency functioning may be compromised.  
  • Capacity is at a basic level.
Unsatisfactory Implementation or Performance
  • A rating of (4) indicates that implementation of the standard is minimal or there is no evidence of implementation at all.  
  • The agency’s observed administration and management infrastructure and practices are weak or non-existent; or show signs of neglect, stagnation, or deterioration.
Please see Rating Guidance for additional rating examples. 

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    County/Municipality Administered Agency, State Administered Agency (Central Office), or other Public Entity 
    • See letter signed by the agency head verifying legal and regulatory compliance in PA-RPM 1 (PA-ASE 8.01)
    • Procedures for tuberculosis testing (PA-ASE 8.02)
    • A list of all positions that require TB testing (PAASE 8.02)
    • Documentation of up to date TB testing for required staff (agency-wide for counties, administrative office-wide for state central office) (PA-ASE 8.02)
    State Administered Agency (Regional Office)
    • Documentation of up to date TB testing for required staff in the region (PA-ASE 8.02)
    All Agencies
    • Relevant legal and regulatory documentation as applicable to the agency (PA-ASE 8.01)
    All Agencies
    • Interview:
      1. Relevant personnel

  • FP
    PA-ASE 8.01

    The agency complies with applicable legal and regulatory requirements regarding risk of exposure to contagious and infectious disease.

    Interpretation: COA recommends that agencies consult with local health authorities or a qualified professional about how to minimize the risk of contagious and infectious diseases to the agency’s personnel and persons served, which may include voluntary adherence to CDC guidelines and training program staff on the use of universal precautions.

    Interpretation: Storage, cleaning, and disposal of medical equipment must be in accordance with manufacturers’ recommendations.

    NA The agency is not governed by any legal or regulatory requirements associated with risk of exposure to contagious and infectious disease.

  • FP
    PA-ASE 8.02

    The agency implements a targeted tuberculosis testing program of direct service personnel as appropriate given the identified service population and as required by law or regulation.

    Interpretation: Agencies should be able to articulate and demonstrate how they determined if they serve a population at high risk of TB infection. Local and state public health authorities can be a useful resource when determining if there is a need to implement a targeted testing program among the agency’s staff. Local public health authorities have access to epidemiological data analysis, guidance from national authorities, and local rates of TB infection, which will help agencies assess the risk for TB. Agencies should consult with their local health department if the service population changes in a way that might affect the risk of TB.

    Research Note: According to the American Thoracic Society and the Centers for Disease Control and Prevention, populations at high risk of TB infection include individuals with HIV, the homeless, drug users, the incarcerated, or individuals who have traveled or emigrated from a country with a high rate of infection. The CDC discourages TB testing among individuals with a low risk for developing tuberculosis because it utilizes resources that should be maintained for populations at greater risk of infection and increases the prevalence of false positives. Mandated skin-testing programs should be avoided unless a large percentage of the identified service population is defined as “high risk” by local authorities.

    NA The agency does not serve high risk groups and is not required by law to conduct TB testing.

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