The Commission on Accreditation of Rehabilitation Facilities (CARF- International) – A historical analysis

This Major Paper provides a historical analysis of the formation and development of CARF-International, a prominent private accreditation body in the social and human services sector. Accreditation is a system of evaluation, whereby organizations or programs are reviewed based on an established set of standards, in order to become approved, or 'accredited'. Private accreditation, and specifically CARF accreditation, has become mandated and recognized by numerous government agencies across North America, and often acts as a requirement for human/social service agencies to access government funding. However the history and evolution of accreditation, and specifically accrediting institutions in the social/human services sector is not well research, therefore the purpose of this paper is exploratory.

The paper begins with an overview of the literature on accreditation, accrediting institutions, as well as select literature on policy trends in public management, the welfare state, and transnational private regulation. The research is accomplished through a historical case study methodology that draws loosely on research questions utilized in previous research on accrediting institutions. I have identified three broad phases in the evolution of CARF-International: the foundational years (late 1960s to late 80s); building the market (1990s); and growth and expansion (2000s onwards).

Through the analysis I have identified seven key themes that relate the literature review to the evolution of CARF-International: the initial purpose of developing standards and accreditation; accreditation as private regulation; governance structure; CARF as a forum for debate; competition between accrediting institutions; the international 'turn'; and program evaluation. One point of interest is the position of CARF in a governance network (or 'infrastructure'/'assemblage') that crosses traditional boundaries of public-private or local-global. A second point is the changing nature of CARF as an institution—specifically in terms of industry involvement in the governance of CARF—as well as the influence of increasing competition and pressure for growth on the practices of CARF as an institution. A third point for further inquiry questions the impact of accreditation on service providers, and service delivery systems.

Overall this Major Paper offers an in-depth look at CARF as an accrediting institution as a means to expose and explore trends in accreditation and the broader field of social and human services.