STAR-SIEasier Access, Better Service, Ample Revenue
Strengthening Treatment Access and Retention
Updated October, 2011
The Wisconsin STAR-SI program began in August, 2005, and was later supported by a three-year $885,000 federal grant initiative of the Wisconsin Department of Health Services (DHS) to improve outpatient treatment for alcohol and other drug use disorders. Funding was provided by the federal Center for Substance Abuse Treatment. In partnership with University of Wisconsin Network for the Improvement of Addiction Treatment (NIATx), University of Wisconsin Department of Family Medicine, Wisconsin Association on Alcohol and Other Drug Abuse, Wisconsin Alcohol and Drug Treatment Providers Association, and participating addiction treatment providers, STAR-SI intends to:
These access and retention indicators are some of the greatest predictors of successful recovery. With training and support from project staff, participating treatment providers collaborate using use a variety of proven quality improvement (QI) tools and approaches developed by engineers such as W. Edwards Deming of Toyota fame. Tools such as walk-throughs, consumer interviews and focus groups, Plan-Do-Study-Act rapid cycle testing, flow-charting, root-cause analysis, nominal group technique, customer window, and other activities are used to plan and achieve measurable service improvements. The DHS will also review and remodel state policies that pose barriers to achieving these aims.
Participating Treatment Agencies
Arbor Place, Menomonie, reduced the no-show rate for all service appointments from 25% to 15% using reminder call variations and counselor contacts after no-shows.
ARC Community Services, Madison, reduced the overall no-show rate to sessions in the intensive outpatient program from 31.7% to 15.8%. The effective change ideas included asking each client to make a verbal and public commitment to other women in the therapy group to attend the next session and after each group session respond to the question, “What was most helpful tonight?”.
ARC-Fond du Lac, increased attendance at the first four day-treatment sessions for clients living in non-structured settings from 65% to 100% by informing clients of the studies showing that attendance at the first four scheduled sessions significantly increases the likelihood of staying clean and sober; asking clients, “Can you make a commitment to attend all of your first four scheduled days of treatment?”; “Are there any problems that may keep you from getting here your first four days?”; and ”What can we do to help you with those problems so that you can get to treatment?”
Beacon House, Fond du Lac, increased average monthly occupancy in their residential service from 10 beds to 12 beds by visiting with all referrers.
Dennis Hill Harm Reduction Center, Milwaukee, reduced the no-show rate to treatment sessions from 52% to 46% using a “fish bowl” raffle incentive. The center also reduced no-shows to the intake appointment from 50% to 37% by doing special reminder calls.
Door County Department of Community Programs, Sturgeon Bay, reduced wait times from 150 days to 14 days and increased admissions from 11 per month to 14 per month by streamlining the intake process, implementing a client screening process, starting an orientation group, and expediting client flow.
Family Service of Madison reduced outpatient appointment no-shows from 33% to 21% by using a signed contract with clients and asking clients after each appointment to verbally commit to the next appointment.
Family Services of Northeast Wisconsin, Inc., Green Bay, increased attendance across three groups from 55% to 73% by offering small gift incentives ($5 value) to clients for attending three consecutive group sessions.
Franciscan Skemp Healthcare, La Crosse, reduced intake appointment no-shows for one clinician from 34% to 4%, reduced wait times, and increased revenue by changing their scheduling processes so that clients could obtain an intake appointment within 72 hours after making the request.
Genesis Behavioral Services, West Bend, increased the percentage of client co-pays collected from 37% to 92% by developing a weekly payment tracking form and having Counselors collect client co-pay fees at the front desk prior to the start of group. Genesis increased their revenue from a deficit of $13,000 to a surplus of $17,900.
Human Development Center, Superior, reduced the no-show rate for assessment appointments from 42% to 26% using a mailed invitation and introduction letter from the counselor and increased admissions from 22 per month to 39 per month through special contacts with payers and referrers.
Jackie Nitschke Center, Green Bay, reduced no-shows to the initial intake appointment from 36% to 19% using motivational interviewing techniques during the initial phone contact with the client, adopting a universal schedule, and making reminder calls.
With an emphasis on the Hispanic population, La Casa de Esperanza, Waukesha, reduced no-shows to intake from 23% to 9% by instituting reminder calls.
Lutheran Social Services' Womens Way, Eau Claire, increased retention to the 4th appointment from 42% to 61% by getting clients admitted to services quicker, using reminder calls and offering client incentives. Womens Way has also increased monthly referrals from 6/month to 14/month by sending an e-mail to all potential referrers and other referrer contacts.
Meta House, Milwaukee, reduced no-shows to intake appointments among women referred by Child Welfare agencies from 67% to 45% by confirming the referral with the client and addressing any barriers to attending the first appointment.
Oakwood Clinical Associates, Ltd., Kenosha, reduced the waiting time from first contact to assessment from 15 days to 7 days by scheduling assessment appointments at first contact and offering same day or next day appointments.
Polk County Human Service Department, Balsam Lake, achieved 100% retention to the 4th continuing care session by starting continuing care while the client was still in primary care.
Racine Psychological Services, Inc., Racine, decreased their wait-time to first appointment from 17 days to 7 days by adding one group during the week and attempting to fill cancelled OWI assessment appointments.
Rock Valley Community Programs, Janesville, decreased their wait list from 60 people to 24 by double-booking intake appointments on Tuesday mornings and Thursday afternoons.
St. Croix County Health and Human Services, New Richmond, reduced waiting time to treatment from 77 days to 44 days (a 43% reduction) by offering briefer treatment options and adding two more counseling groups.
St. Joseph’s Hospital, Alcohol and Drug Recovery Services, Marshfield, reduced the no-show rate for service appointments from 33% to 14% using reminder call variations.
Tamarack Behavioral Health Center, Manitowoc, increased retention to the third treatment session from 51% to 58.5%. The change idea implemented was to reduce the paperwork so staff can spend more time building rapport with clients.
Tellurian UCAN, Madison, improved suboxone group counseling attendance from 60% to 77% by using client incentives (pizza party; gift cards; dose after group) and changes in clinic requirements.
ThedaCare Behavioral Health, Menasha, succeeded in reducing registration-related appointments for OWI clients from six to three while realizing non-billable cost savings of $15,100. These improvements also resulted in clients receiving services quicker – the days clients waited from first contact to admission were reduced from an average of 48 days to 11 days. Increased client satisfaction also occurred subsequent to the declines in waiting time.
Tri-County Women’s Outreach, Rhinelander, reduced the no-show rate for all service appointments from 51% to 34% using reminder call variations.
Waukesha County Department of Health and Human Services reduced their outpatient clinic’s appointment no-show rate from 37% to 21% by sending letters to clients scheduled for assessment appointments, getting accurate, working phone number from clients, and having reception staff do scripted reminder calls.
Wausau Health Services, Wausau, part of the CRC Health Group, provides narcotic treatment services and successfully reduced no-shows to the first in-person service from 35% to 15% and increased revenue by instituting a variety of changes such as an orientation group, changes in scheduling processes, and reminder calls.
Wood County Unified Services, Wisconsin Rapids, increased continuation to the 4th treatment session for one-to-one clients from 31% to 89% by making reminder calls 48 hours before the appointment and asking clients, “How do you plan to get to the appointment?”
Teen Intervene NIATx Change Project
The National Survey on Drug Use and Health shows that there are 19,000 Wisconsin adolescents that need but do not receive treatment in any given year. Both Medicaid and County data show that adolescent substance abuse service admissions are flat or declining. Consequently, the STAR-SI program joined with Susan Endres, MPA, Adolescent Treatment Systems Coordinator for the Division of Mental Health and Substance Abuse Services, to facilitate a change project to increase services to adolescents using the 3-session, Teen Intervene Model developed by Dr. Ken Winters. The effort began with outreach and invitations to adolescent-serving organizations around the state. Eight organizations from Superior to Milwaukee and including schools enrolled in the project. A one-day Teen Intervene and NIATx training event and monthly conference calls were provided. Two of the participating organizations are STAR-SI members, namely, Human Development Center, Superior and La Casa de Esperanza, Waukesha. The Human Development Center AODA services to 49 more youth through formal agreements with three school districts and an agreement from a County Court Commissioner to use Teen Intervene for 1st-time underage drinking violators. La Casa de Esperanza had not before served any adolescents with AODA problems but after informing referring agencies about their new Teen Intervene service, they began providing services to adolescents with AODA problems for the first time. Overall, project participants learned that their respective communities had very limited resources for youth with AODA problems but local organizations, professionals, parents and youth are receptive to Teen Intervene.
Healthcare Reform or Not, Things a Substance Abuse Treatment Agency Can Do
Addiction treatment agencies may want to consider addressing the following:
Network for the Improvement of Addiction Treatment (NIATx) at the University of Wisconsin – Madison
University of Wisconsin Department of Family Medicine
QI Flashcards (PDF, 1.8MB)
Want to participate in STAR-SI or Need more information?
Last Revised: October 28, 2013