Author's School

Brown School of Social Work

Author's Department/Program

Social Work


English (en)

Date of Award

January 2010

Degree Type


Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

J. Curtis McMillen


Accreditation is a growing, worldwide phenomenon and thousands of mental health organizations spend considerable amounts of money and resources towards achieving and maintaining accreditation. Despite its widespread use, the empirical and theoretical literature on accreditation is sparse. This study is the first step towards examining accreditation's potential as an organizational intervention to improve the quality of mental health services. Using a mixed methods multiple case study design, this exploratory study aimed to 1) understand agencies' motivations to pursue accreditation, 2) explore agencies' experiences with the accreditation process, 3) identify mental health care workers' perceptions of how the accreditation process may improve mental health service delivery and outcomes. These issues were explored with five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation: COA) process. Multiple sources of data were collected at each agency, including qualitative data from in-depth interviews and focus groups, as well as quantitative survey data from employees, a review of documents related to accreditation, and limited observations of the agencies. Agencies discussed various factors that motivated their decision to pursue accreditation, including policies recognizing accreditation, funding opportunities, and agencies wanting to professionalize and gain distinction. Regarding the accreditation experience, each agency took different approaches to delegating the work and the length of the process varied according to the recommendations from COA. The self-study was the most time consuming part and most employees described a positive and helpful site visit. Related to the employees' perceptions of the impact of accreditation, meeting COA's requirements for quality improvement efforts was a major focus, though what this entailed varied. It was not always prominent if the accreditation process improved client outcomes. Employees also shared about how accreditation increased or decreased morale at their agency. These findings have implications for how accreditors engage agencies and how agencies engage employees in the accreditation process. There are additional implications for policies regarding accreditation, further theory development about how accreditation is meant to work, and future research to build evidence for accreditation. More research is needed to maximize accreditation's potential to improve services and outcomes for the millions served by accredited organizations.


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