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.


Orange County Government, Youth & Family Services Division

Rodney J. Hrobar Sr., LMHC, CPP, Quality Assurance Manager

As the lead agency in Orange County, providing the safety net for children and families, it is reassuring that our clients can be confident that their needs will be addressed in accordance with the most stringent standards of public, as well as private, accountability as monitored and reviewed by the Council on Accreditation. 
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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.

RTX 7: Coordinated, Individualized Team Approach

Team members are aligned in implementing a structured, individualized therapeutic program in collaboration with residents and families to ensure that residents’ daily living experiences are well integrated and promote the development of positive skills and behaviors.

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 (HR 6.02) and training (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
    • A description of services that includes an overview of how teams align to coordinate and customize treatment and care
    • A description of strategies for promoting family collaboration and engagement
    • Procedures for involving residents in programming and treatment decisions
No On-Site Evidence
    • Interview:
      1. Program director
      2. An interdisciplinary team or observe team meeting
      3. Residents and their families
    • Review case records

  • RTX 7.01

    In collaboration with the resident and their family, an interdisciplinary team coordinates, monitors, and, when necessary, advocates for services tailored to the needs of individual residents and makes decisions regarding service planning and implementation, including:
    1. initial and additional needed assessments;
    2. the appropriate level of care;
    3. delivery of family services or referral to an agency that provides the needed services to resolve concerns that will otherwise extend the resident’s stay;
    4. transition planning and case closing; and
    5. follow-up services.

    Note: Interdisciplinary program elements are discussed in RTX 8.01.

    Research Note: Research has shown that individuals receiving a combination of clinical treatment and recovery supports have had improved outcomes. There has been a trend towards integrating peer support services within traditional delivery systems, including residential treatment programs. Some organizations are including peer support specialists, peer or youth advocates, mentors and/or family advocates in interdisciplinary treatment teams to ensure that residents feel supported and that their voices are heard throughout the treatment process.

  • RTX 7.02

    Interdisciplinary teamwork:
    1. encourages resident participation in treatment team meetings;
    2. specifies the intended result of daily living experiences, activities, and interventions in the service plan;
    3. engages residents in developmentally-appropriate and trauma-informed, culturally sensitive activities and interactions designed to alter or improve behavior, provide support, and promote healthy development and return to their community;
    4. provides opportunities for participation by one or more consistent caring adults, taking into account the resident’s strengths and interests;
    5. coordinates therapeutic and educational and/or vocational activities with individual service and skill development plans; and
    6. maintains predictable routines and activities.

    Research Note: Regarding element (d), a landmark longitudinal study following development of children from infancy to adulthood found that youth who made a successful transition tended in their formative years to seek out and rely on guidance and support of at least one consistent caring adult, usually a family, extended family or community member, or substitute caregiver.

    Research Note: Regarding elements (a),  (c), ( d), and (e), residents in a qualitative study report that a lack of decision-making ability, the lack of a support system, and boredom, particularly during evening hours and on weekends and holidays, contribute to running away from care.

  • FP
    RTX 7.03

    A coordinated team approach promotes establishing and maintaining stable, ongoing, goal-directed caseworker-resident relationships.

    Interpretation: Organizations should establish a coordinated process to minimize the need for multiple case managers from different agencies, when possible. Identifying overlapping responsibilities and tasks; clarifying roles; and establishing guidelines and procedures that ensure collaboration across systems are ways organizations can streamline services and coordinate service goals.

    Research Note: Children that have experienced complex trauma have difficulty developing strong healthy attachments to caregivers. Research shows that for children, treatment progress is influenced by the presence of positive, caring adults. When it comes to establishing a therapeutic bond with a provider, the most important aspect of the relationship is safety, specifically the adult’s ability to help the child feel safe.

  • RTX 7.04

    Residents participate in decision-making processes relating to their treatment and are given an opportunity to formally express feedback including dissatisfaction with aspects of care.

    Interpretation: The establishment of resident councils is one way to involve residents in all aspects of care and ensure that their voice is integrated into programming decisions. Residents should have an opportunity to provide feedback on staff, activities, rules, food, their overall experience, sense of safety and support, and the living environment. This type of activity also provides opportunities for peer advocacy, self-advocacy, and leadership. 

    For programs serving for youth, family advisory councils can be established to involve families in the governance of the program.

    Research Note: Perceptual barriers have a strong effect on youth engagement. When youth perceive that residential providers dismiss their concerns and limit their opportunities to make choices they become frustrated with and disengaged in the treatment process. Providers that create opportunities for youth feedback and value the ideas of youth offer promote engagement and active program participation.

    Innovative programs are allowing youth to assume a leadership role in their own treatment team meetings to encourage taking control over decisions that impact their lives. Encouraging youth empowerment ensures young residents develop a sense of control over their lives and gives them the opportunity to recover from past trauma in order to become healthy adults.

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