Why accreditation failed agencies serving the blind and visually impaired

Journal of Rehabilitation,  Jan-March, 1997  by C. Edwin Vaughan

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Currently there are at least four organizations providing nationwide accreditation services, the Accreditation Council on Services for People with Disabilities (ACD), the Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on the Accreditation of Health Care Organizations, and the National Accreditation Council for Agencies Serving the Blind and Visually Handicapped (NAC). These accreditation programs frequently focus on a particular aspect of rehabilitation, such as blindness, developmental disabilities or medical aspects of rehabilitation not necessarily related to vocational rehabilitation.

Rehabilitation usually involves a continuum of services and comprehensive agencies try to provide a continuum of care or services. Accreditation becomes a general concern when the accrediting organizations, themselves, become specialized and may only be able to accredit certain aspects of an agency's complete program (Grove, 1995).

Some states require any agencies receiving state appropriations to be certified. Such certification is sometimes done "in house" using state employees for the certification process. Other states, such as Missouri, require that agencies receiving state funding have some form of national accreditation. This brings a national perspective to the state funded programs and does not require the direct use of state funds, which can then be used for client services (Solum, 1995).

The cost of national accreditation is becoming an issue with some agencies. The cost usually varies with the size and complexity of a rehabilitation program. For example, the Accreditation Council for Services for People with Disabilities may charge as low as $3,000 and as much as $18,000. The larger figure would be for a complex agency with several locations. A typical figure would be $8,O00 for a two year accreditation (Nudler, 1995).

Accrediting agencies are created to assure the public that economic resources are properly utilized, that facilities are both safe and adequate and that they have a properly educated staff. Duplication of programs can be minimized and, as the process of professionalization continues, task differentiation can be certified (Rothman, 1987). As a profession develops, it tends to seek increasing control over the organizational settings where services are provided (Abbott, 1988; Larson, 1977). This frequently produces internal conflicts as agencies resist external domination. Conflicts within a profession and consumer criticism and opposition may become insurmountable barriers for an accrediting organization. This paper analyzes the sources of the decline of the National Accreditation Council for Agencies Serving the Blind and Visually Handicapped (NAC) and suggests alternatives for a more effective accreditation program.

Following World War II there was a rapid growth in the number of agencies serving the blind and visually impaired. With this growth came concerns about the quality of programs and the qualifications of professional workers. This concern led to the development of the National Accreditation Council for Agencies Serving the Blind and Visually Handicapped (NAC) in 1967. NAC began with great expectations among professionals who work with the blind and visually impaired. However, it never met the expectation that it would become financially self-supporting and at its height accredited only a small portion of the agencies and organizations in the field of blindness. It has been in decline for the past decade and has been consistently opposed by the largest consumer organization of blind people, the National Federation of the Blind (NFB). It recently lost the financial support of the American Foundation for the Blind (AFB). The AFB had been crucial in providing the financial and staff resources for the process that led to the creation of NAC and had been its largest single source of financial support for over fifteen years. In 1994, the United States Secretary of Education informed the National Accreditation Council that it had been dropped from the Secretary of Education's list of recognized national accreditating agencies (Pierce, 1995). As this paper will show, the number of agencies accredited by NAC has been dropping steadily for the past nine years, moving from a high of one hundred and four to its present sixty-four. NAC's decline comes at a time of increasing national concern about accountability and an increasing emphasis upon the outcome of education and rehabilitation programs (Szymanski & Linkowski, 1995).

Origins of NAC

Two years of a carefully planned organizational effort leading to the formal establishment of NAC attracted both consumer and professional criticism. Disregarded criticism led to a lukewarm support from agency professionals and intense consumer opposition; more articles have appeared in The Braille Monitor about the failures of accreditation than on any other single topic. For more than fifteen years large numbers of blind people, usually between two hundred to three hundred fifty, have come from all over the United States to publicly demonstrate against the failures of NAC (Rabby, 1984). To understand the roots of this conflict, it is necessary to examine some of the developments in the field of working with the blind over the three decades preceding the establishment of the National Accreditation Council. It is then possible to analyze the process by which the new agency was established, along with its goals and early successes. It is also important to consider the reasons it was continually opposed by consumers and why it has been ignored or boycotted by many agencies and professionals working with people who are blind.