Question 1

What is CARF Community Integration accreditation?

Accepted Answer

CARF International publishes Community Integration standards within its Employment and Community Services (ECS) Standards Manual. Community Integration services are defined as those that facilitate the participation of persons with disabilities in the social, recreational, vocational, and civic activities of their communities — enabling community membership, relationship development, and meaningful participation alongside persons without disabilities. CARF Community Integration accreditation validates that an organization's services genuinely facilitate community participation and natural support development — not supervised group programming in segregated settings. CARF distinguishes community presence (being in the community) from community participation (engaging alongside others) from community membership (belonging with relationships and roles). The accreditation standard targets genuine participation and membership.

Question 2

What is the difference between CARF Community Integration and CARF Day Services?

Accepted Answer

Within CARF's ECS Standards Manual, Community Integration services specifically focus on facilitating genuine community participation, relationship building, and community membership — the accreditation is specifically for programs whose primary purpose is community integration rather than skill development or habilitation training. Day Services (sometimes called Day Habilitation) is a broader category that may include skill development, training, and support activities in both community and facility-based settings. Many organizations seek Community Integration accreditation to validate the community-based, integrated participation aspects of their day service model. Some organizations hold both designations. IHS clarifies which applies to your program model during the discovery session.

Question 3

What does CARF mean by 'natural supports' in Community Integration?

Accepted Answer

Natural supports are the informal relationships, connections, and assistance that exist in community settings independent of paid support staff — neighbors, co-workers, club members, community friends, faith community members. CARF's Community Integration standards require that services actively work to develop persons' natural supports and community connections, reducing reliance on paid support over time. Documentation requirements include: natural support development goals in individual plans, evidence of relationship-building activities and outcomes, documentation of community roles and connections developed, and evidence that support staff are facilitating community connections rather than serving as a social buffer between the person and the community.

Question 4

Does CARF Community Integration accreditation address HCBS Settings Rule compliance?

Accepted Answer

Yes, substantially. CMS's HCBS Settings Rule requires that HCBS settings be integrated in and support full access to the greater community, ensure individual choice regarding activities and daily schedules, and optimize individual initiative and autonomy. CARF's Community Integration standards require integrated settings, individual choice, natural support development, and genuine community participation — creating significant overlap with HCBS Settings Rule requirements for non-residential day service settings. Organizations simultaneously working toward HCBS Settings Rule compliance for day services and CARF Community Integration accreditation can address both through an integrated engagement. IHS designs preparation processes that satisfy both frameworks simultaneously.

Question 5

What are CARF's individualized community participation plan requirements?

Accepted Answer

CARF requires individualized plans for each person served that specify community participation goals — not a group activity calendar. Plans must: identify specific community activities reflecting the person's interests, preferences, and goals; be developed through a person-centered process with meaningful participation; include goals related to relationship building and natural support development; be reviewed and updated regularly based on evolving interests and outcomes; and reflect the diversity of community settings the person accesses. Plans must be driven by individual preference, not program convenience or group scheduling.

Question 6

What does CARF require regarding integrated vs. segregated settings?

Accepted Answer

CARF's Community Integration standards require that activities occur in integrated settings — alongside persons without disabilities — rather than in segregated or disability-only settings. Surveyors assess where activities take place, the ratio of persons with and without disabilities in activity settings, whether activity patterns demonstrate genuine commitment to integrated participation, and whether persons have individual choice about which settings they access. Organizations whose activity documentation reveals a predominance of disability-only group settings will face CARF deficiencies on integrated settings requirements. CARF does not prohibit all on-site activities but requires that integrated community settings predominate.

Question 7

How long does CARF Community Integration accreditation take?

Accepted Answer

10 to 14 months from initial consulting engagement to successful survey outcome for most organizations. Organizations with existing person-centered day service models and established community partnership networks move faster. Organizations transitioning from facility-based to community-based day programs may require longer timelines to build the community presence, partnership network, and documentation history CARF requires. Unlike some CARF behavioral health programs, Community Integration does not have a mandatory minimum operational period — but CARF will review samples of individual plans and participation records, so sufficient documented history is needed.

Question 8

Who pursues CARF Community Integration accreditation?

Accepted Answer

Organizations providing non-employment day services focused on community participation: day support and day habilitation providers transitioning to community integration models; community access programs; social and recreational program providers; Medicaid HCBS waiver day service providers under Community First Choice or HCBS waiver programs; and state DD agency contractors for community-based day services. State DD agency contracts and Medicaid waiver enrollment are the most common drivers — CARF accreditation is increasingly required or preferred for community-based day service provider enrollment.

Question 9

How much does CARF Community Integration accreditation cost?

Accepted Answer

CARF direct fees: $995 non-refundable application fee plus $1,525 per surveyor per day (including all surveyor travel, lodging, and administrative expenses). Published by CARF — verify current fees with CARF at carf.org/accreditation/apply. No annual maintenance fees. IHS consulting fees are scoped to each client's organizational size, accreditation history, and complexity. Contact us for a tailored proposal following a complimentary discovery session.

Question 10

What is the most common reason Community Integration programs fail CARF surveys?

Accepted Answer

The most consistent deficiency is group activity schedules substituted for individual participation plans — organizations with a program calendar that all persons follow, without individualized plans reflecting each person's interests and community participation goals. Other common failures: community presence documented without community participation (recording location visited but not engagement quality); natural support development absent from plans and records; segregated settings dominating the activity pattern; choice documentation absent; and HR file deficiencies.

Question 11

What participation outcome data does CARF require?

Accepted Answer

CARF requires systematic documentation and quality improvement use of community participation outcomes including: types and frequency of community activities for each person served; progress toward individual community participation goals; natural support development outcomes (relationships and community connections developed); and reasons when goals are not achieved. This data must feed into the organization's quality improvement process — reviewed in quality improvement meetings with documented decisions. Organizations that collect participation data for reporting purposes only, without organizational review and improvement use, do not satisfy CARF's quality improvement standards.

Question 12

How does CARF assess whether community integration is genuine vs. superficial?

Accepted Answer

CARF surveyors distinguish genuine community integration from supervised outings through multiple evidence sources: individual plan review (do plans include specific community participation goals beyond activity attendance?); contact record review (do notes document engagement quality and interactions, or just location?); staff interviews (can staff describe each person's natural community connections and how they support relationship building?); and person-served interviews (what community relationships and connections does the person describe?). The clearest indicator of genuine community integration is evidence of relationships and community connections that exist independently of the paid support relationship.

Question 13

Does CARF require that all activities occur outside the provider's facility?

Accepted Answer

No. CARF Community Integration standards require that services facilitate genuine community participation — integrated community settings must predominate in the activity pattern, but CARF does not prohibit all on-site activities. Organizations whose activity patterns are predominantly facility-based will face deficiencies on integrated settings requirements. The standard is whether the program genuinely facilitates community integration, not whether every activity occurs off-site. Surveyors review activity documentation to assess the overall pattern of settings — the proportion of activities that occur in integrated community settings vs. segregated or facility-based settings.

Question 14

Can Community Integration be accredited alongside other CARF ECS designations?

Accepted Answer

Yes. CARF's modular architecture allows multi-designation accreditation in a single survey. An organization providing Community Integration, Supported Living, and Community Employment Services can pursue all three designations in a single application. IHS designs integrated multi-designation engagements that build the shared organizational infrastructure once (governance, HR systems, quality improvement, rights protections) while addressing the program-specific standards unique to each designation. This is common for comprehensive DD service providers with diverse program offerings.

Question 15

What is the role of transportation in CARF Community Integration surveys?

Accepted Answer

Transportation is a practical enabler of community integration, and CARF assesses whether the organization's transportation arrangements support or constrain genuine community participation. Key issues: Are persons served able to access community locations of their choice, or are they limited to destinations determined by group transportation schedules? Does the organization support persons in developing community mobility skills and using public transportation when appropriate? Are transportation challenges documented as barriers addressed in individual plans, rather than accepted as limits on community participation? Transportation is not separately accredited but is assessed as part of the Community Integration service delivery model.

Question 16

How does IHS prepare Community Integration programs for CARF accreditation?

Accepted Answer

IHS provides end-to-end CARF Community Integration accreditation consulting led personally by Thomas G. Goddard, JD, PhD — former URAC COO and General Counsel, with over 25 years of accreditation consulting experience. IHS's engagement sequence: (1) Gap assessment covering individual participation plan quality, activity setting integration, natural support development documentation, outcome tracking, HCBS Settings Rule compliance, and HR compliance. (2) Policy and documentation system build — individualized participation plan template, natural support protocol, activity setting documentation standard, participation outcome tracking, choice documentation standard. (3) Competency-based staff training. (4) Interim plan and record audits. (5) Mock survey including community site visits, staff interviews, and person served interviews. (6) Remediation support and application review.

CARF Community Integration Accreditation (ECS) — Frequently Asked Questions