The accreditation process begins with the submission of the Accreditation Services Application, completion and submission of self-study reports, payment of appropriate fees, and agreement to an on-site evaluation (conducted prior to the conferral of Initial and Continuing Accreditation).
The self-study reports (SSRs) have two general objectives: (i) to verify that the program meets prescribed Standards and (ii) to promote programmatic self-evaluation and continuous quality improvement. Through the self-study, the sponsoring institution identifies programmatic strengths, weaknesses, and areas in which improvement is needed or desired. This SSR includes documentation, data, and descriptive text that collectively provides evidence of compliance with the Standards and supports the sponsoring institution’s self-evaluation of the degree to which the program meets, exceeds, or fails to meet (as appropriate) the requirements of each Standard. The self-studies also describe strategies undertaken or planned to ensure that compliance and programmatic strengths are maintained and areas in which improvement is needed or desired are addressed in a timely and efficient manner.
The Executive Office provides an administrative review of each SSR followed by a detailed analysis by the Program Referee. The results of this review and analysis are documented on the Referee Analysis of the SSR, which serves as the basis for final determination by the CoARC Board of Commissioners (the “Board”) of compliance (or otherwise) with the Standards and subsequent conferral or denial of accreditation. The primary objective of the Referee Analysis of the SSR is to facilitate consistency of evaluation within and between Program Referees as well as consistency of the accreditation actions and recommendations of the Board.
To initiate the accreditation process, the sponsoring institution submits a Letter of Intent Application and required supplementary information. As part of the required supplementary documentation, the sponsor must convene a study group composed of individuals from an independent, external, community of interest (employers) for the purpose of evaluating the need for the new program. In addition to performing a needs assessment, the study group must also assess availability of sufficient clinical resources. Once all documentation is received and reviewed by the Executive Director, the Executive Office will assign a Program Referee who is responsible for conducting a second review of the documentation. The role of the Referee (a current Commissioner) is to serve as the liaison between the program and the Board. In addition to Board member responsibilities, the Referee is also responsible for providing consultation during the self-study process; analyzing the accreditation record for compliance with the Standards; assisting the program to identify ways to meet those Standards; and recommending appropriate accreditation action to the Board.
Following review of the Letter of Intent and supplementary documentation, the Referee submits a recommendation for action at the next scheduled Board meeting. The Board will either grant an Approval of Intent or deny the Approval of Intent. The sponsor will be notified of the Board’s decision following the meeting. If the decision is to deny the Approval of Intent, the Board will include in its correspondence to the sponsor, the rationale for its decision, and the documentation/evidence required from the sponsor to receive an Approval of Intent.
Following the Approval of Intent, the program submits a Letter of Review Self-Study Report (LSSR). The Referee reviews the LSSR and communicates with the Program Director, as necessary, until s/he is satisfied that the program appears to meet the Standards. The Referee will then recommend to the Board at its next scheduled meeting to either confer or deny a Letter of Review. A Board decision to deny a Letter of Review is subject to reconsideration and appeal as described in CoARC Policy 1.07. A Letter of Review is a pre-accreditation status signifying that a program seeking Initial Accreditation has demonstrated sufficient compliance with the Standards. The conferral of Letter of Review status denotes a developmental program, in which assurances are expected to be provided that the program may become accredited as programmatic experiences are gained, generally, by the time the first class has graduated. The conferral of a Letter of Review also authorizes the sponsor to admit its first class of students.
Within 6 months after the graduation of the first class, the program submits an Initial Self-Study Report (ISSR). The Executive Office forwards a copy of the ISSR to the Referee, who reviews the information and evaluates the program for compliance with the Standards. When the Referee completes the review of the ISSR and determines that it is acceptable, an on-site visit is scheduled. Following the on-site visit, the Referee reviews the on-site review report and the rest of the program’s accreditation record to confirm compliance with the Standards. The Referee will then recommend the program for Initial Accreditation at the next Board meeting. If the Board approves the Referee’s recommendation, it will confer Initial Accreditation which will replace the Letter of Review. Initial Accreditation is valid for 5 years. If the accreditation record reveals significant Standards violations, the Referee will recommend to the Board to Withhold Initial Accreditation. If the Board approves this recommendation the sponsor will be notified of the adverse action. The conferral of Withhold of Initial Accreditation is subject to reconsideration and appeal as described in Policy 1.07.
The Continuing Accreditation review process repeats each 10-year cycle. A program, once accredited, remains accredited until the program formally terminates its accreditation status or the Board terminates the Program's accreditation through a formal action. Accreditation does not end merely because a certain length of time has elapsed, but continues unless subject to formal mination by either the program or the Board. |
