1. Council on Chiropractic Education (CCE)® Federation of Chiropractic Licensing Boards 90 th Annual Educational Congress Accreditation & Regulation Promoting Competence and Improving Safety… What is an accrediting agency supposed to do?

2. Council on Chiropractic Education (CCE)® CCE accredits 15 Doctor of Chiropractic degree programs at 18 locations within the United States. Recognized by the United States Department of Education (USDE) Recognized by the Council for Higher Education Accreditation (CHEA) One of only 15 agencies (out of 78) to be recognized by both USDE & CHEA LCME, AOACOCA, ARCEPA not recognized by both; NANP not recognized by either. Malcom Baldrige National Quality Awards Program Recipient Arizona Performance Excellence Program Award for Site Team Academy Development Member of the Association of Specialized and Professional Accreditors (ASPA) CCE endorses and complies with the ASPA Code of Good Practice

3. Role of Accreditation Council on Chiropractic Education (CCE)® The purpose of accreditation is to promote continuous improvement, and to provide assurance of educational quality through a system of peer review. The quality of higher education provision is judged by how well it meets the needs of society, engenders public confidence and sustains public trust. It is the responsibility of higher education providers and accreditation bodies to sustain a strong commitment to accountability and provide regular evidence of quality. Accreditation bodies, working with higher education providers and their leadership, staff and students, are responsible for the implementation of processes, tools, benchmarks and measures of learning outcomes that help to create a shared understanding of quality.

4. Accreditation & Regulation: Role in Patient Safety Council on Chiropractic Education (CCE)® Higher Quality Fewer Errors Less Harm

5. Accreditation & Regulation: Role in Patient Safety Council on Chiropractic Education (CCE)® Accreditation & Regulation are NOT identical Regulation: Rules that MUST be followed Accreditation: Seal of Approval after meeting specific Standards

6. Accreditation & Regulation: Role in Patient Safety Council on Chiropractic Education (CCE)® Accreditation & Regulation are NOT identical Rules against clearly unsafe practice must be clear Rules for higher quality by far less clear

7. Council on Chiropractic Education (CCE)®

8. The overall performance of the education program in the context of its mission and measured by the extent it achieves its intended student learning and student success outcomes. Student Learning Outcomes Assessment of Skill Assessment of Competency Attainment Student Success Outcomes Student Retention Employment or Placement Board Scores and Licensing Success Student, Graduate and Employer Satisfaction

9. Accreditation & Regulation: Role in Patient Safety Council on Chiropractic Education (CCE)® Deciding on the minimum level of quality Best practices and procedures How to assess & monitor success or failure How quickly to raise Standards Accreditation: Observed to be more effective in Good Safety practices Best practice of creating ACCOUNTABLE and MEASURABLE Standards/Outcomes

10. Competency: Accountable & Measurable Council on Chiropractic Education (CCE)® “Accountable”: An applicable statement that is a directive or requirement aimed at ensuring a specific education or learner outcome that the accrediting body could reasonably hold the college or school accountable to, based on the statement itself or the language preceding it

11. Competency: Accountable & Measurable Council on Chiropractic Education (CCE)® “Measurable”: an action by the student that must be observable, measurable and able to be demonstrated!

12. Examples of accreditation standards categorization: Accountable Council on Chiropractic Education (CCE)® Standard 2–19, page 25: “Graduates must be competent in communicating and collaborating with other members of the health care team to facilitate the provision of health care” (CDA, 2010) Essential VI, page 22: “The baccalaureate program prepares the graduate to... demonstrate appropriate teambuilding and collaborative strategies when working with interprofessional teams” (AACN, 2008) Curricular content – CC-4, page B-29: “The physical therapist professional curriculum includes clinical education experiences for each student that encompass... opportunities for involvement in interdisciplinary care” (CAPTE, 2011)

13. Examples of accreditation standards categorization: Non-Accountable Council on Chiropractic Education (CCE)® Educational environment – collaboration with other health care professionals, page 12: “Health care professionals educated to deliver patient-centered care as members of an interdisciplinary team present a challenge for educational programs” (CDA, 2010) Essential VI – rationale, page 22: “Interprofessional education is defined as interactive educational activities involving two or more professions that foster collaboration to improve patient care” (AACN, 2008) “The needs of patients and society must be considered by the ARC-PA, the sponsoring institutions and the programs. Education should be provided in a manner that promotes interprofessional education and practice” (ARCPA, 2010)

14. Examples of accreditation standards categorization: Non-Applicable Council on Chiropractic Education (CCE)® Standard B.4.8, page 8: “Interpret the evaluation data in relation to accepted terminology of the profession, relevant theoretical frameworks, and interdisciplinary knowledge” (ACOTE, 2010b) Introduction – master’s education in nursing and areas of practice, page 5: “... further development of the knowledge and skills embedded in Essential IV... will prepare the nurse to manage research projects for nurse scientists and other healthcare researchers working in multi-professional research teams” (AACN, 2011) Educational policy M2.2 – advanced practice: “Advanced practitioners refine and advance the quality of social work practice and that of the larger social work profession. They synthesize and apply a broad range of interdisciplinary and multidisciplinary knowledge and skills” (CSWE, 2010)

15. Council on Chiropractic Education (CCE)® If a competency is mapped does this lead to equivalence and endorsement?

16. Council on Chiropractic Education (CCE)® If a competency is mapped does this lead to equivalence and endorsement?

17. Council on Chiropractic Education (CCE)® If a competency is mapped does this lead to equivalence and endorsement?

18. Council on Chiropractic Education (CCE)®

20. USDE Advances Transparency Agenda Administrative Publishing each accreditor’s standards for evaluating student outcomes Increasing transparency in accreditation process Eg: WASC publishing final decisions for each school Increasing coordination with DOE, other accreditors, other agencies to improve oversight Publishing key student and institutional metrics by accreditor Promoting greater attention to outcomes with current accreditor review process Legislative Drive accountability through outcomes driven and differentiated recognition DOE wants Congress to repeal the statutory prohibition to set and enforce expectations regarding student achievement Require robust teach-out and reserve funds for high risk institutions

21. USDE Changes to Strengthen Accreditation Council on Chiropractic Education (CCE)® BACKGROUND Focus on outcomes and transparency, to better ensure quality and protect students and taxpayers Actions announced in November 2015 and January 2016  Better information and greater transparency  Increased use of flexibility for risk-based reviews  More rigorous oversight to identify problem and protect students and taxpayers

22. Current Reporting System: Uses of Information Council on Chiropractic Education (CCE)® Confirm agency compliance with statutory/regulatory reporting requirements Inform FSA program compliance activities (required by GAO) Update public accreditation status database & college comparison tool  http://www.ed.gov/accreditation http://www.ed.gov/accreditation  http://nces.ed.gov/collegenavigator http://nces.ed.gov/collegenavigator

23. Current Reporting System: Challenges Council on Chiropractic Education (CCE)® Variety of terms and definitions Difficult to know what happened-especially for the public Justifications for actions not consistently provided Difficult to know why it happened Variety of submission formats Difficult to assemble information, assure accuracy, and act on information

24. Planned Requirements to Address the Problems Council on Chiropractic Education (CCE)® Common terminology and categories Loss of accreditation, Probation Student Achievement Program length and Objectives Student Complaints Accreditation with Reporting Requirements o Conditions, Contingencies, Stipulations Heightened Monitoring Goal: Make it easier for the ED and the public to understand Why the action was taken How serious the situation is Accreditors may also develop tiers of recognition, with some institutions or programs denoted as achieving the standards at higher or lower levels than others

25. Council on Chiropractic Education (CCE)®

26. CCE’s Focus on Fairness & Consistency Council on Chiropractic Education (CCE)®

27. CCE’s Focus on Fairness and Consistency One Site Visit- Multiple Reviewers Differences in Training Interpretations of the Standards Role of the Reviewer Consensus Process Processes to be followed During the Site Visit Site Visit Follow-Up

28. Council on Chiropractic Education (CCE)® Dressgate Is the dress A. White and Gold B. Black and Blue C. Blue and Brown D. Blue and Gold

29. Council on Chiropractic Education (CCE)® Dressgate

30. Council on Chiropractic Education (CCE)® How does CCE Focus on Fairness and Consistency in its decision making? Training, Training, Training Act in a fair and impartial manner Base actions & decisions on objective standards and procedures Maintain strict adherence to Conflict of Interest In Site Team Academy Selection In Decision Making Body Consensus process in accreditation decision-making

31. Council on Chiropractic Education (CCE)® How does CCE Focus on Fairness and Consistency in its decision making? Meeting tracking CCE Staff monitor these elements and may call attention CCE Councilors police as well All issues and decisions are reviewed following the meeting Issues are tracked in a database Compliance trends can be analyzed

32. Council on Chiropractic Education (CCE)® Consistency & Fairness Orientation Training ToolsCalibration Feedback 19

33. Council on Chiropractic Education (CCE)®

34. Foundation for Accreditation Council on Chiropractic Education (CCE)®

36. Revised election policies regarding # of votes Revised election policies regarding slate of candidates Modified complaint policy and processes Moved competencies from Appendix into the Standards Added New Competency for Chiropractic Adjustment/Manipulation Added Subluxation into Required Components & Outcomes Recent Outcomes Summary:

37. Council on Chiropractic Education (CCE)® Improved external communication processes Changed bylaws to enact hard term limits of 3 (3) year terms; eliminating opportunity for return to Council Changing election of 2 practicing DC’s to CCE Members Changed Standards Review Task Force activity to request input at the beginning of the standards revision process Recent Outcomes Summary:

38. Council on Chiropractic Education (CCE)® Performed thorough review of administrative functions Performed thorough review of governance with reforms Performing thorough review of Council Effectiveness In the process of a comprehensive strategic planning process Recent Outcomes Summary:

39. Council on Chiropractic Education (CCE)® Fairness….Case Study CCE 2017 Standards GOAL: To achieve adoption of Standards remaining CONSISTENT with revision process and to promote FAIRNESS by continuing to bring all parties to the table.

40. Council on Chiropractic Education (CCE)® Steps Taken Invitation from Council for Public Comment prior to Task Force activity Standards Review Task Force thoughtfully considers all input Discussion in SRTF group and subgroups Council deliberation with opportunity for public comment on Drafts 1, 2 and 3 prior to Council decision Ensuring Consistency in Process Multiple Viewpoints Staff review for consistency Committee review Public opinion Council feedback Fairness….Case Study CCE 2017 Standards

41. Council on Chiropractic Education (CCE)® Adding nomenclature for “laws” &“patient information” to Ethics & Integrity  Completed, in Draft considered by the Council in January, 2016 Adding nomenclature for informing students on legal requirements to practice in their intended state  Completed, in Draft considered by the Council in January, 2016 Change nomenclature regarding comparable to either similar or consistent  Considered, and amendment proposed for Draft 3 to be considered by SRTF and Council in July, 2016 Considered 15 suggestions for changes to nomenclature in meta- competencies  Considered, and amendment proposed for Draft 3 by ACC Accreditation and Assessment workgroup to be considered by SRTF and Council in July, 2016 FCLB’s Most Recent Concerns & Suggestions for CCE Standards:

42. Council on Chiropractic Education (CCE)®

43. Questions Council on Chiropractic Education (CCE)®