The Council On Quality and Leadership - History

History

CQL evolved from the work of the American Association on Mental Deficiency-AAMD (now American Association on Intellectual and Developmental Disabilities-AAIDD). In 1952, AAMD published the report of a special committee on standards for institutions serving people with mental retardation. With funding from the National Institute of Mental Health-NIMH, AAMD undertook a major standards development project, culminating in the publication of the Standards for State Institutions for the Mentally Retarded in 1964. In 1966, AAMD and the National Association for Retarded Citizens (now The Arc), the Council for Exceptional Children (CEC) and United Cerebral Palsy (UCP) formed the National Planning Committee on Accreditation of Residential Centers for the Retarded. In 1969 the Joint Commissionon Accreditation of Hospitals invited the National Planning Committee to establish an accreditation council within its structure.

The Accreditation Council for Facilities for the Mentally Retarded (ACFMR) developed accreditation standards and conducted accreditation reviews of facilities serving people with mental retardation over the next ten years. In 1979 the Joint Commission reorganized its administrative structure and terminated its agreements with various accreditation councils, replacing them with professional and technical advisory committees. The ACFMR voted to reorganize as an independent, not-for-profit organization – to be known as The Accreditation Council for Services for Mentally Retarded and Other Developmentally Disabled Persons-ACMRDD. Founding members of ACMRDD were: AAMD (now AAIDD), American Psychological Association, The Arc, Epilepsy Foundation of America, National Association of Private Residential Facilities (now ANCOR), National Association of Social Workers, National Society for Children and Adults with Autism (now Autism Society of America), and UCP. In 1981 the American Occupational Therapy Association and the Council for Exceptional Children also became sponsoring organizations. ACMRDD’s work in updating the standards and review methodology was initially supported by the Administration on Developmental Disabilities in the U.S. Department of Health and Human Services.

During the 1980s and 1990s, the name of the organization evolved from ACMRDD to The Accreditation Council on Services for People with Disabilities-ACD, and in 1997 it became The Council on Quality and Leadership-CQL.

During the 1980s, CQL published new editions of standards and conducted a national accreditation program for organizations providing services to people with disabilities. CQL’s design and dissemination of habilitation standards emphasized the interdisciplinary team process, individualized program planning, behavior intervention, and the promotion of disability rights. The Standards for Services influenced federal certification requirements for the Intermediate Care Facilities for Mental Retardation (ICF/MR) program. The Health Care Financing Administration-HCFA, now the Centers for Medicare and Medicaid Services-CMS, acknowledged that its regulations were based on the 1983 draft CQL standards.

CQL standards were also recognized by the U.S. courts in several landmark cases, including:

• Wyatt v Stickney (State of Alabama, 1972)
• Evans v Washington (District of Columbia, 1978)
• The Arc v Schafer (State of North Dakota, 1982)
• Lelsz v Kavanagh (State of Texas, 1987)
• Baldridge v Clinton (State of Arkansas, 1991)

The courts affirmed that CQL standards represented a reliable benchmark for ensuring that individuals with disabilities were receiving appropriate services and that their rights, safety, and security were assured.

During this period, CQL operated as a standards organization and accreditation organization, with a particular focus on quality in services for people with mental retardation and other developmental disabilities.

In the 1990s, CQL shifted to a broader focus, moving beyond habilitation planning and measures of organizational process. Work began on the Outcome Based Performance Measures, renamed Personal Outcome Measures in 2000. These new measures were a departure from previous editions of standards and redefined quality in services in terms of an organization’s capability to facilitate outcomes for people.

CQL used the term “personal outcomes” in contrast to “process outcomes”. Process outcomes are concerned with an organization’s compliance with norms or regulations. They measure organizational accomplishments, such as number of placements, hours of service delivery, staffing ratios, or number of people served in a program. Personal outcomes focus on the issues that matter most to the person receiving the services provided by the organization. They answer the question of “how well did the organization deliver its services to meet the individual needs and desires of each person?” The CQL accreditation process with the Personal Outcome Measures is built around interviews with people receiving services and learning how each person defines the outcomes for him or herself. From this understanding of what each individual wants, the organization is evaluated on how well it delivered person centered services and support. The Personal Outcome Measures apply to people with mental illness, children, youth and families, and other at risk or vulnerable people in the human service system.

In 2005, CQL published Quality Measures 2005> emphasizing Community Life as the context for quality.

In the Fall of 2010, CQL published the Guide to Person-centered Excellence as the culmination of the What Really MattersItalic text Initiative. CQL developed the Guide to Person-centered Excellence to encourage organizations to provide the supports and services for people that really matter. The Guide utilizes CQL's 8 Key Factors and 34 Success Indicators that promote personal quality of life. CQL developed three different applications, one for each setting: services and supports for older adults, people with mental illness, and people with intellectual and developmental disabilities. The 34 Success Indicators are consistent across all three settings, while the narratives are tailored to apply to the specific audience and service setting.

CQL continues to place the Personal Outcome Measures® at the foundation of work with organizations. One-to-one conversations with people receiving supports are the most powerful source of knowledge and understanding when it comes to defining excellence and person-centeredness.