Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

• Author: Madeline Y. Lee
• Date: 01 March 2014
• Published date: 01 March 2014
• DOI: http://doi.org/10.1002/nml.21098

FROM THE FIELD

Motivations to Pursue

Accreditation in Children’s

Mental Health Care

A Multiple Case Study

Madeline Y. Lee

Tulane University

Accreditation is a growing, worldwide phenomenon that has

spread to a range of industries and fields, including nonprofit

social services and mental health care. Thousands of organiza-

tions are accredited, but it is not known what is driving the

growth of this phenomenon. Using a multiple case study design,

this exploratory study aimed to understand children’s mental

health agencies’ motivations to pursue accreditation. In-depth

interviews, focus groups, document reviews, and limited observa-

tions were conducted at five children’s mental health agencies that

had recently undergone or were undergoing the Council on Accred-

itation process. Agencies were influenced by external factors, such

as policies that require accreditation, wanting to assert their posi-

tions in the field, and the need to increase funding opportunities.

Other factors were internal, related to agency leadership using

accreditation as a platform for change and agencies’ genuine

intent to improve services. Implications for agencies, accreditors,

and future research are offered.

Correspondence to: Madeline Y. Lee, School of Social Work, Tulane University, 6823

St. Charles Ave., Bldg. 9, New Orleans, LA 70118. E-mail: mlee17@tulane.edu.

NONPROFIT MANAGEMENT & LEADERSHIP, vol. 24, no. 3, Spring 2014 © 2014 Wiley Periodicals, Inc 399

Published online in Wiley Online Library (wileyonlinelibrary.com) DOI: 10.1002/nml.21098

This work was supported by grants from the National Institute of Mental Health

(F31 MH086218–01) and the Fahs-Beck Fund for Research and Experimentation.

Special thanks to Curtis McMillen for his valuable input and insight throughout

the development of this work, and also to Enola Proctor, Ramesh Raghavan,

Melissa Jonson-Reid, Bradley Stoner, Barton Hamilton, Charles Figley, Fred Buttell,

and Henrika McCoy.

400 LEE

Nonprofit Management & Leadership DOI: 10.1002/nml

Keywords: children’s mental health, nonprofit social services,

accreditation, Council on Accreditation, multiple case study

ACCREDITATION IS A GROWING, worldwide phenomenon

(Braithwaite et al. 2006). Everything from hospitals to tree

care companies can be accredited, and millions of people

rely on accredited institutions everywhere from Australia to Zambia.

As a potential signal of quality, credibility, and trustworthiness, ac-

creditation has spread to a range of industries and fields, including

nonprofit social services and mental health care. Although not

without critics, accreditation is seen as a way to improve account-

ability and oversight of organizations (Gibelman and Gelman

2002; Shaw and Allen 2009), but it is not known what is driving

the growth of the accreditation phenomenon.

The aim of this exploratory study is to understand children’s

mental health agencies’ motivations to pursue accreditation, specifi-

cally with the Council on Accreditation (COA). COA was founded

in 1977 when the Family Service of America (now the Alliance for

Children and Families) and the Child Welfare League of America

jointly proposed to develop a national accreditor specifically for

children and family services (Carman 1996). COA was established

to identify agencies eligible for funding, for third-party insurance

reimbursement, and determine the quality of services delivered

(Carman 1996).

In 2010, COA accredited or was in the process of accrediting more

than 1,800 organizations that serve more than seven million individu-

als and families in the United States, Canada, Bermuda, Puerto Rico,

England, and the Philippines (COA n.d.). Today, the COA office

remains located in New York City and is staffed with approximately

fifty employees and nearly one thousand volunteer peer reviewers.

Motivations and Trends behind the

Accreditation Phenomenon

Overall, a small but growing literature on accreditation has pro-

vided moderate evidence for accreditation’s merit (Cerqueira 2006;

Mays 2004), but little research has been published on its determinants,

the motivations, and trends behind accreditation (Shaw, Kutryba,

Braithwaite, Bedlicki, and Warunek 2010). Although accreditation

has long existed for schools and hospitals, it has been growing in

other fields (Bothwell 2000).

One recent, illustrative example of the accreditation movement

is in public health. In 2011, the Centers for Disease Control and

Prevention (CDC), together with the Robert Wood Johnson Foun-

dation, launched the Public Health Accreditation Board (PHAB), a

national, voluntary accreditation program for local, state, territorial,