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APS Bulletin • Volume 9, Number 4, July/August 1999

Patient Advocacy Groups

Myra Glajchen, DSW, Department Editor

CARF Revises Its Pain Standards

Peggy S. Neale, National Director, CARF

CARF The Rehabilitation Accreditation Commission has revised its pain standards and is offering opportunities for pain programs to be accredited under new standards with a new name—the CARF Interdisciplinary Pain Rehabilitation Program Standards. The revised standards are printed in the 1999 Medical Rehabilitation Standards manual and will be used for surveys after July 1, 1999.

For more than 30 years, CARF, a private not-for-profit organization, has promoted accreditation programs in the medical and vocational rehabilitation fields for people with disabilities and others in need of rehabilitation services.

Each year CARF produces separate standards manuals for its four divisions—Medical Rehabilitation, Behavioral Health, Employment and Community Services, and Adult Day Services. CARF’s standards are developed through a series of leadership panels, national advisory committees (NACs), and field reviews. The standards are published following final acceptance by the CARF Board of Trustees. At present, more than 19,000 programs in the United States, Canada, and Europe have earned CARF accreditation. In addition, many governmental and private entities have mandated, promoted, or endorsed CARF accreditation.

CARF first developed standards for pain programs in 1982. The original standards applied to chronic pain management programs and were first used for surveys in 1983; since then, the standards have been revised several times. The most recent revision occurred in January 1998, when an NAC, which included individuals from the United States, Canada, and Sweden, met in Tucson, AZ. A number of APS members, including Gerald Aronoff, MD, Michael Ashburn, MD, Julia Faucett, PhD, Corey Fox, PhD, Norman Hardin, MD, Bengt Sjolund, MD, Gregory Smith, PhD, Peter Vicente, PhD, Peter Wilson, MBBS PhD, and Larry Young, PhD, participated in this NAC, which developed the new standards.

The CARF Interdisciplinary Pain Rehabilitation Program Standards replace the previous CARF Comprehensive Pain Management Programs Standards. In addition to the name change, the new standards do not differentiate between rehabilitation programs for different types of pain. All pain management programs that seek accreditation will use the same standards, along with some additional specific standards for inpatient programs. The new standards emphasize the need for outcomes measurement and management—including the ability to document evidence of the durability of outcomes after patients are discharged—as well as the importance of sharing information with stakeholders about the outcomes of the program. Education about the appropriate use of healthcare systems and services should be provided to the persons served in each Inter- disciplinary Pain Program. CARF uses the term persons served to define the primary consumer of services, who may be classified as a client, patient, or participant.

The new standards define specific responsibilities for the medical director and the program director. The NAC responsible for developing the new standards considered it crucial that a pain-team physician or a designee be available 24 hours per day, 7 days per week. The revised pain standards also require the formation of an interdisciplinary team of individuals that includes the person served, the pain-team physician, the pain-team psychologist, and, depending on the assessed need of the person served, individuals who will assist in the accomplishment of functional, physical, psychological, social, and vocational goals. These individuals can include, but are not limited to, a biofeedback therapist, case manager, exercise physiologist, nurse practitioner, occupational therapist, pharmacist, physical therapist, physician assistant, psychiatrist, registered nurse, social worker, therapeutic recreational specialist, and vocational specialist.

In addition to meeting all of the standards specific to Interdisciplinary Pain, programs are also required to meet a number of standards related to organizational, leadership, management, and quality. These standards can also be found in the 1999 Medical Rehabilitation Standards Manual.

For additional information about the CARF Interdisciplinary Pain Program Standards or information regarding application for accreditation, contact Peggy Neale, National Director, CARF, Medical Rehabilitation Division, 520/325-1044 ext. 180, pneale@carf.org.

Editor’s note: Members of the CARF board have elected Peter J. Vicente, PhD, chair of the board of trustees. Dr. Vicente, who is the editor of APS Bulletin, a past president of APS, and an APS representative to the CARF Board of Trustees, will serve as chair in 2000.

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