Buffalo River Services, Inc. Acts On What Matters Most in Tennessee

Posted on May 5, 2026

By Brittany Brashaw, CQL Quality Enhancement Specialist

Buffalo River Services stands out as a human services provider deeply committed to the collaboration, growth, and voices of the people they support. Throughout the accreditation process, their team demonstrated a consistent willingness to engage; staff were approachable, responsive, and eager to provide documentation, insights, and thoughtful consideration of recommendations.  

This spirit of teamwork was evident across the organization, with staff working together to share ideas and problem-solve. Their investment in professional development also reflects this commitment, offering meaningful, ongoing training opportunities — including trauma-informed care —that go beyond standard requirements and equip staff to better support people. 

Equally notable is Buffalo River Services’ focus on inclusion and empowerment. The organization actively involved people receiving services at every stage of the accreditation process, resulting in strong participation and engagement, particularly during stakeholder events. Their services and programs, including a Medicaid Alternative Pathways (MAPs) service for youth as well as their Volunteer State People First Self-Advocacy Group, highlight a clear dedication to helping people achieve greater independence, pursue education, and find meaningful employment.  

From incorporating assistive technology to reduce over-support, to fostering self-advocacy through internal initiatives, the agency demonstrates a genuine effort to listen to and act on what matters most to the people they serve. The overarching impression is clear; Buffalo River Services is an organization driven by care, intention, and a desire to continuously improve the quality of support services they provide. 

About Buffalo River Services, Inc.

Buffalo River Services, Inc., founded in 1972, is a nonprofit organization dedicated to empowering people with intellectual and developmental disabilities to live meaningful, inclusive lives within their communities in Tennessee. Offering a range of services in residential support, day programs, employment assistance, and community-based activities, their team works closely with people and their families to promote independence, dignity, and inclusion. 

This organization partners with state and local agencies through advocacy, collaboration, and education to ensure high-quality, compassionate care that adapts to each person’s needs and goals. They align closely in values with CQL – respecting the dignity of every person and promoting true community inclusion. One of their core beliefs is that every person deserves respect, opportunity, and a voice in shaping their own life. 

Buffalo River Services recently achieved Person-Centered Excellence Accreditation. We asked Phillip Garner, Buffalo River Services CEO, a series of questions about who they are as an organization, along with their experience with the CQL Accreditation process.  

What are some notable changes in your organization over recent years?

Buffalo River Services has undergone meaningful transformation in how we define and deliver quality supports. We have strengthened our commitment to person-centered practices, ensuring that services are increasingly individualized and focused on community inclusion, relationships, and meaningful outcomes for the people we support. 

We achieved SHIFT Employment First accreditation and have actively embraced SHIFT Technology First principles, expanding opportunities for people to engage in competitive employment and use technology to increase independence and connection. 

We have also made significant investments in our workforce, including the development of a DSP career ladder, participation in NADSP credentialing, and implementation of recognition and retention strategies that support a more stable and skilled workforce. 

Through our partnership with CQL, we have strengthened our use of data and internal quality systems, aligning our practices with the Basic Assurances® and Personal Outcome Measures® in a way that connects our values to measurable outcomes. 

Additionally, we have grown in our role as a system partner and advocate, actively contributing to statewide workforce and policy initiatives to improve sustainability and access across Tennessee’s long-term services and supports (LTSS) system. 

Overall, while our mission has remained the same, our expression of it has become more intentional, data-informed, and focused on what truly matters to people. 

What are your goals as an organization?

Buffalo River Services’ organizational goals are grounded in person-centered excellence and informed by our Basic Assurances® and Shared Values assessments, along with ongoing input from people supported, staff, and community partners.

A central goal is to help advance the industry in Tennessee by advancing innovative, values-driven supports. We are committed to expanding competitive, integrated employment through our SHIFT Employment First accreditation and continuing to embed Technology First practices that increase independence, access, and connection for the people we support.

We are intentionally working to expand and diversify our service array, positioning Buffalo River Services as a comprehensive, community-based provider for people with disabilities and their families in our region. This includes developing new service models, strengthening existing programs, and improving access to coordinated supports across the lifespan. 

We also prioritize building and sustaining a high-quality workforce through career pathways, credentialing, and a culture that supports accountability, flexibility, and professional growth. 

In alignment with the CQL framework, we are strengthening our use of data to drive decision-making, improve outcomes, and ensure consistency across services. 

Finally, we are committed to system leadership; actively contributing to statewide workforce, policy, and transformation efforts to improve sustainability, access, and quality across Tennessee’s LTSS system. 

What organizational values or practices are you most proud of?

What I am most proud of is that our values actually show up in how we operate, not just in what we say. We make decisions every day that put people ahead of convenience, systems, or tradition. That means supporting real lives in real communities, not creating services that keep people separated or dependent.

We have been willing to challenge long-standing practices in this field. Whether it’s pushing employment as a real expectation, using technology to increase independence, or rethinking how services are structured, we are not content to maintain the status quo. We want to raise the standard for what quality looks like in Tennessee. 

I am also proud of how we treat our workforce. Direct support professionals are the backbone of everything we do, and we have worked to build a culture that respects them, invests in them, and expects excellence from them at the same time. That balance matters. 

Finally, I am proud that we don’t just operate within the system — we try to influence it. We speak up, we stay engaged, and we take responsibility for helping move the field forward, not just our own organization. 

At the end of the day, our goal is simple; do the right thing, even when it’s harder, and build something better than what we inherited. 

How do you measure quality at your organization?

We measure quality through a combination of data, direct feedback, and ongoing oversight of our services. We track key indicators such as health and safety outcomes, incident trends, service delivery, and documentation timeliness to ensure consistency and compliance.

Equally important, we measure quality through the lived experiences of the people we support. This includes regular conversations, formal reviews, and the use of Personal Outcome Measures® interviews to understand whether people are achieving outcomes related to choice, relationships, community inclusion, and independence. 

We also rely on supervisory oversight and internal review processes, including routine review of documentation, service implementation, and staff performance. These processes help us identify risks, address gaps, and reinforce expectations across teams. 

Quality is not defined by a single measure, but by the alignment between our values and daily practice. We use data and feedback together to identify trends, make improvements, and ensure that what we say matters is reflected in people’s actual experiences. 

Why did you decide to pursue CQL Accreditation?

We pursued CQL accreditation because we wanted an external standard that aligned with our values and challenged us to be better—not just to meet minimum requirements. 

Like many providers, we could demonstrate compliance. What we were looking for was a framework that focused on outcomes, relationships, and what truly matters to the people we support. CQL provided a way to evaluate whether our practices matched our intentions. 

We also recognized that growth requires honest reflection. Accreditation gave us a structured way to examine our systems, identify gaps, and strengthen consistency across our organization. 

Finally, we saw it as a way to lead. We wanted to be part of moving the field forward in Tennessee by demonstrating that quality is not just about compliance, but about measurable, person-centered outcomes and continuous improvement. 

How did you prepare for your CQL Accreditation?

We approached accreditation as an extension of the work we were already doing, not as a one-time event. Preparation was not about creating something new—it was about making sure our practices were consistent, intentional, and visible. 

We completed our self-assessments thoroughly, using them as a tool for honest reflection rather than simply checking boxes. This included reviewing policies, practices, and documentation to ensure they aligned with what was actually happening in people’s lives. 

We engaged leadership and staff across the organization in ongoing conversations about expectations, values, and daily practice. Rather than relying on a few individuals, we worked to ensure that teams understood how their roles connected to quality and outcomes. 

We also reviewed data, documentation, and service implementation to identify gaps—particularly around consistency, communication, and timeliness—and made targeted improvements where needed. 

Overall, our preparation was less about preparing for a review and more about reinforcing a culture of accountability, clarity, and follow-through. 

What is the impact of accreditation on your organization as a whole?

As a team, we would describe the impact of accreditation as something that sharpened us as an organization. 

In our discussions, we kept coming back to the idea that we already had strong values and practices in place, but accreditation pushed us to be more consistent and intentional across all teams and locations—not just in pockets where things were working well. 

It also strengthened accountability. Expectations are clearer, follow-through is stronger, and we are more proactive in identifying and addressing issues. At the same time, there was a shared sense that the process validated the work we were already doing—it didn’t change who we are, but it helped us align and reinforce it. 

Overall, we see the impact as becoming more focused, more consistent, and better equipped to sustain quality over time while staying grounded in what matters to the people we support.

What is the impact of accreditation on people you support?

From our team’s perspective, the impact of accreditation on the people we support comes down to greater consistency, stronger relationships, and more intentional outcomes. We talked a lot about how, before accreditation, we had many strong practices—but they weren’t always consistent across teams. As we tightened expectations around documentation, communication, and follow-through, it created more stability for the people we support. Plans are clearer, supports are more consistent, and there is less variation in how services are delivered day to day.

We have also become more intentional about listening. Through ongoing conversations and structured approaches like Personal Outcome Measures® interviews, we are better at understanding what truly matters to each person and adjusting supports accordingly. That has led to more meaningful goals related to community participation, relationships, and independence.

Overall, accreditation helped us move from “good in places” to “consistent across the organization,” which has made a real difference in the daily experiences and long-term outcomes of the people we support. This agency has had 3 people supported when it was created in 1972, and we continue to support them, walking their life paths with them. Accreditation validates even those individual stories and helps to write the narrative for what we stand for. They have great lives. 

How have the Personal Outcome Measures® (POM) affected person-centeredness at your organization?

As a team, we recognized that we have always valued person-centered practices, but the POM framework pushed us to go beyond what we thought we knew and actually verify outcomes through direct conversations with people. It challenged us to listen differently—not just to plans or documentation, but to each person’s lived experience.

One of the biggest shifts has been moving from focusing on services to focusing on outcomes. The POM interviews helped us identify gaps between what was written and what people were actually experiencing, especially in areas like relationships, community inclusion, and choice.

It also created greater accountability. It’s not enough to say we are person-centered—we have to demonstrate it through measurable outcomes and consistent practice across all teams.

Overall, the POM process has helped us sharpen our understanding of what person-centered really means and ensure that the voice of the person is driving decisions more clearly than before. 

How have the Basic Assurances® (BA) improved your systems and practices?

The Basic Assurances® process significantly strengthened our systems by bringing greater structure, clarity, and accountability to how we operate. 

As a team, we recognized that many of the right practices were already in place, but they were not always organized or consistently applied across services. The BA framework helped us align policies, practices, and oversight in a more intentional way, ensuring that expectations are clear and consistently followed. 

One of the most meaningful improvements has been in how we connect systems to daily practice. We moved beyond having policies on paper to ensuring that staff understand them, implement them, and are held accountable through supervisory review and internal monitoring. 

The process also improved how we identify and respond to risk. By organizing our systems around key areas like health and safety, rights, and services, we are better able to track issues, recognize patterns, and take corrective action more quickly. 

Overall, the Basic Assurances® helped us move from having strong individual components to having a more coordinated, reliable system—one that supports consistency, reduces gaps, and strengthens the quality of services across the organization. 

How do you envision the future of your partnership with CQL?

We view our partnership with the CQL as a strategic alignment with the future of our industry.

As the system continues to move toward value-based models, we don’t see participation in outcome-focused frameworks as optional—it is essential. The ability to demonstrate measurable outcomes, consistency, and accountability will define long-term sustainability for providers.

Going forward, we see this partnership as a way to strengthen our internal systems, better leverage data, and more clearly demonstrate the value of the supports we provide. It positions us to not only respond to changes in the system, but to compete and lead within it.

Ultimately, we envision this partnership as part of our broader strategy to ensure that we remain relevant, effective, and sustainable in a system that is increasingly driven by outcomes and performance.

Have questions about CQL Accreditation?

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Since 1969, CQL | The Council on Quality and Leadership has been a leader in working with human service organizations and systems to continuously define, measure, and improve quality of life and quality of services for youth, adults, and older adults with intellectual and developmental disabilities, and psychiatric disabilities. CQL offers accreditation, training, certification, research, and consultation services to agencies that share our vision of dignity, opportunity, and community for all people.