WHO IS ACCREDITED?

Private Organization Accreditation

HeartShare assist individuals with developmental disabilities through education, day, residential and recreation programs, case management, and health services, and provides foster care/adoption services, counseling, after school and energy assistance programs, and programs for people with HIV/AIDS.
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VOLUNTEER TESTIMONIAL

Barry Gourley

Volunteer Roles: Endorser; Peer Reviewer

It is an honor to be a COA volunteer. I’ve had a great opportunity to work with fabulous COA volunteers, I’ve grown professionally in the COA accreditation process and I’ve met some wonderful people across this nation who are working hard to help and support children and families.
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Purpose

Comprehensive, systematic, and effective risk prevention and management practices reduce the organization’s risk, loss, and liability exposure.

RPM 11: Technology-Based Service Delivery

When engaging service recipients in technology-based service delivery, services are based on the needs of the service population and are provided by appropriately trained and licensed personnel.

Update:

  • Deleted Evidence - 05/15/17
    Documentation of training for service recipients was removed from the on-site evidence.

Interpretation: “Technology-based service delivery” refers to the delivery of services and interventions using information and communications technology (technologies). Examples of different technologies include, but are not limited to: telephones/mobile phones, computers, tablets, videoconferencing, interactive messaging systems, and other mobile devices and applications. This approach to service delivery allows personnel to see, hear, and/or interact with service recipients from a remote location and provide services at a distance. 

Though the term “technology-based service delivery” is referenced throughout this section, there are a number of terms that refer to the delivery of services via technologies such as telehealth, teleservices, telepractice, telemental health, telepsychiatry, mHealth, online therapy, distance counseling, internet- or web-based interventions, telephonic services, and digital services. The term often reflects the type of service being provided.
 

Interpretation: When engaging service recipients in technology-based service delivery, services can be delivered in real time (synchronous), involving live, two-way interactions between the provider and service recipient. Services can also be asynchronous, where service recipients are able to provide information and communicate with the provider but communication does not occur in real time. Services that are not delivered in real time are often supplementary and provided in conjunction with other services. Examples include digital self-management tools and resources related to recovery, care management and monitoring, medication adherence, and support and education. All of the information provided by the service recipient must be directed back to the service provider and documented in the case record. 

Interpretation: While traditional telehealth modalities include live video, remote patient monitoring, store-and-forward, and mHealth, federal and state entities vary in how they recognize and define telehealth/technology-based service delivery. Organizations should refer to applicable federal and state definitions as they influence laws, regulations, and policies, including those pertaining to reimbursement. 
 

Research Note: Research shows that there are numerous benefits to implementing telehealth initiatives, or providing health-related services via different technologies, including expanded access to services, improved treatment outcomes, increased client engagement and satisfaction, and potential cost-savings. Telehealth has proven to be particularly beneficial for rural service populations as it can reduce geographic barriers to care and address provider shortages.

NA The organization does not engage service recipients in technology-based service delivery. 

Rating Indicators
1
The organization's practices fully meet the standard, as indicated by full implementation of the practices outlined in the RPM 11 Practice standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the RPM 11 Practice standards.
3
Practice requires significant improvement, as noted in the ratings for the RPM 11 Practice standards.
4
 Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the RPM 11 Practice standards. 

Table of Evidence

Self-Study Evidence On-Site Evidence On-Site Activities
    • Processes/procedures for assessing readiness and monitoring and evaluating technologies and services (RPM 11.01)
    • Policies and procedures that guide service delivery (RPM 11.02)
    • Procedures addressing: 
      1. suitability/assessing the appropriateness of services (RPM 11.03) 
      2. consent process (RPM 11.04) 
      3. instruction, training, and/or support for service recipients as appropriate (RPM 11.05)
    • Table of contents of training curricula for personnel (RPM 11.06 & RPM 11.07)
    • Documentation of a readiness assessment, if applicable (RPM 11.01)
    • Training curricula for personnel (RPM 11.06 & RPM 11.07)
    • Documentation of personnel training and credentials  (RPM 11.06 & RPM 11.07)
    • Interview:
      1. Personnel
      2. Supervisors
      3. Program directors
      4. Persons served
    • Review case records 
    • Demonstration of technologies, if appropriate 

  • RPM 11.01

    The organization develops processes for:

    1. assessing readiness when implementing new technology-based service delivery models; and
    2. monitoring and evaluating existing technologies and services on an ongoing basis. 

    Interpretation: Recognizing and understanding the benefits and risks associated with technology-based service delivery is a recommended risk management practice. This assessment may be included in the organization’s larger technology planning or strategic planning processes.

    Interpretation: There are a number of common readiness factors that an organization can consider as part of the assessment process, including: 

    • the service population and their service needs; 
    • desired client outcomes;
    • relevant laws, regulations, and licensing and liability requirements; 
    • staff capacity (e.g., leadership and administrative support);
    • staff interest, engagement, and buy-in; 
    • funding and reimbursements; and
    • alignment with the organization’s mission and/or strategic planning goals. 

    Research Note: A growing body of literature highlights the importance of assessing organizational readiness prior to implementing a telehealth initiative. By evaluating interests, needs, and resources, the organization is better equipped to develop an effective program.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g.,
    • Processes/procedures address both elements, but could be strengthened.
    3
    Practice requires significant improvement; e.g.,
    • The procedures/processes do not address one of the elements at all.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all. 

  • RPM 11.02

    The organization develops policies and procedures to guide technology-based service delivery that address: 

    1. privacy and security measures specific to the service delivery model; 
    2. the use of acceptable technologies, including staff-owned devices, if applicable; and 
    3. collecting, storing, tracking, and transmitting information gathered electronically.   

    Note: RPM 6.01 and RPM 6.03 address organizational safeguards for protecting confidential and other sensitive information. Organizations should consider the risks associated with technology-based service delivery and implement additional privacy and security measures as needed. 
     

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g.,
    • All elements of the standard are addressed, but some aspects of the policies/procedures need further development; or
    • With few exceptions, policies and procedures are understood by staff and are being implemented appropriately.
    3
    Practice requires significant improvement; e.g.,
    • Two of the elements are not fully addressed; or
    • One of the elements is not addressed all; or
    • Policies and procedures are not well-understood and/or implemented appropriately.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.

  • RPM 11.03

    For each service recipient, the organization:

    1. assesses the appropriateness of technology-based service delivery;
    2. monitors whether or not the service delivery model is effective; and 
    3. arranges for services to be delivered in-person when necessary.  

    Interpretation: Technology-based service delivery may not be a suitable service delivery method for all individuals and families served. Organizations may want to develop inclusion and/or exclusion criteria and incorporate client suitability factors into their screening or assessment processes to decide whether or not this approach is appropriate.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g.,
    • The standard is met in practice, but procedures need minor clarification; or
    • In a few instances documentation in the client’s case record was not found.
    3
    Practice requires significant improvement; e.g.,
    • Procedures need significant strengthening; or
    • Procedures are not well-understood or used appropriately by personnel; or
    • In a significant number of instances documentation in the client’s case record was not found.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.

  • RPM 11.04

    When engaging in technology-based service delivery, service recipients are informed of the following, as appropriate:

    1. the service provider’s physical location, contact information, and credentials;
    2. potential for technical failure and alternate methods of service delivery, including access to other service providers; 
    3. privacy and confidentiality limitations associated with electronic communication; 
    4. risks and benefits associated with the service delivery model; 
    5. emergency response protocols;
    6. how personal information and data will be documented, stored, protected, and used; and 
    7. under what conditions a referral for face-to-face services may be made. 

    Interpretation: The organization needs to consider how their service design/program model informs the consent process and demonstrate that service recipients receive appropriate information to make an informed decision about engaging in technology-based service delivery.

    Interpretation: Regarding element (d), the service recipient should understand the organization’s capacity to respond to emergency and crisis situations and be aware of any limitations. Emergency response protocols depend upon the location where individuals receive services and whether or not they have access to trained professionals. As such, personnel should confirm where the service recipient is located and discuss the importance of consistency in service locations as it informs emergency management.

    Note: The organization must also comply with all relevant standards in CR 1 related to client rights and responsibilities, including consent for services.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g.,
    • The standard is met in practice, but procedures need minor clarification; or
    • In a few instances appropriate information was not provided to service recipients; or
    • In a few instances documentation in the client’s case record was not found.
    3
    Practice requires significant improvement; e.g.,
    • Procedures need significant strengthening; or
    • In a significant number of cases the information was not provided to service recipients; or
    • In a significant number of instances documentation in the client’s case record was not found.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.

  • RPM 11.05

    Service recipients receive instruction, training, and support as appropriate on how to access services and use required technologies.

    Interpretation: Support may include technical assistance and/or information on alternative methods for connecting with the service provider or other more immediate resources.

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • The curriculum is not fully developed or lacks depth; or
    • A few clients have not received appropriate instruction, training, and/or support.
    3
    Practice requires significant improvement; e.g.,
    • The curriculum is insufficient to ensure competence; or
    • A significant number of clients have not received appropriate instruction, training, and/or support.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.

  • RPM 11.06

    Personnel are competent in and receive training on: 

    1. equipment and software; 
    2. privacy and confidentiality issues specific to the service delivery model; 
    3. recognizing and responding to emergency or crisis situations from a remote location; and
    4. engaging and building rapport with service recipients when communicating electronically.  

    Interpretation: Regarding element (a), personnel should be trained on how to properly use all required technologies as appropriate to their position and the services being provided, which may include: 

    • set up;   
    • features; 
    • maintenance;
    • safety and security measures; and/or 
    • troubleshooting. 
    Training may also include responding to technical matters (e.g., maintenance issues and troubleshooting) directly or instructing personnel on the appropriate parties to contact for assistance.  

    Interpretation: Regarding element (c), organizations must consider the safety needs of the population they are serving and be aware of the risks associated with providing services to individuals located in settings without immediate access to trained professionals. For example, in the event of a medical emergency personnel should know how and when to contact local emergency responders (e.g., 911) and/or service recipients’ emergency contacts. 

    Interpretation: Regarding element (d), when communicating electronically there is greater risk for miscommunication or misunderstandings between the provider and the service recipient. Personnel should be aware of the differences between in-person and electronic communication and understand how those differences may effect service delivery. Furthermore, it is equally important for personnel to educate service recipients on the service delivery approach and the impact it may have on their professional interactions.
     

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • The curriculum related to one of the elements is not fully developed or lacks depth; or
    • A few personnel have not been trained, but are scheduled to be trained.
    3
    Practice requires significant improvement; e.g.,
    • The curriculum related to two of the elements is not fully developed or lacks depth; or
    • Training does not address one of the elements at all; or
    • A significant number of staff have not been trained.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all.

  • RPM 11.07

    Personnel comply with all applicable legal and ethical requirements related to technology-based service delivery and only provide services to service recipients located in states where they are appropriately licensed, if required. 

    Note: Organizations should consult state licensing requirements, as well any state policies, laws, or regulations regarding technology-based service delivery to ensure compliance.
     

    Research Note: Cross-state licensure issues continue to be a challenge, as states have unique telehealth-related policies, laws, regulations, and licensing requirements. States are proactively working to overcome barriers by establishing agreements to enable out-of-state providers to deliver services in different localities in order to expand the accessibility of services and address provider shortages. For example, in 2005 following Hurricane Katrina these types of agreements were put in place to allow providers from other states who lacked licensing and liability coverage to offer services to individuals and families throughout the affected region. Lessons learned have informed the role of telehealth in meeting unmet service needs nationwide. 
     

    Rating Indicators
    1
    The organization's practices reflect full implementation of the standard.
    2
    Practices are basically sound but there is room for improvement; e.g., 
    • While staff are appropriately licensed, legal or ethical requirements have not been recently reviewed; or
    • Some staff have not received training on legal and ethical requirements.
    3
    Practice requires significant improvement; e.g.,
    • Personnel have not received training on legal and ethical requirements; or
    • The organization is aware of compliance problems and is working to remediate deficiencies; or
    • The organization has been notified of compliance problems and is working with the relevant authority to remediate deficiencies.
    4
    Implementation of the standard is minimal or there is no evidence of implementation at all; e.g., 
    • The organization is aware of compliance problems and is not working to remediate deficiencies; or
    • The organization has been notified of compliance problems but there is no evidence that efforts are being made to remediate deficiencies; or
    • Staff report providing services to service recipients in states where they are not appropriately licensed.
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