Strengthening Treatment Access and Retention

The Strengthening Treatment Access and Retention Program, known as STAR-QI, promotes the implementation of projects to increase access to and retention in substance use disorder treatment. It is a partnership between the Wisconsin Department of Health Services and the University of Wisconsin. This program intends to:

  • Reduce waiting times and waiting lists
  • Increase admissions to substance use disorder treatment
  • Reduce appointment no-shows
  • Improve transfers among levels of care
  • Increase successful treatment completion
  • Achieve revenue sufficiency

These access and retention indicators are some of the greatest predictors of successful recovery. With training and support from program staff, participating treatment agencies collaborate using a variety of proven quality improvement (QI) tools.

List of participating agencies

(October 2014)

  • Adams County Health and Human Services Department
  • AIDS Resource Center of Wisconsin AODA Treatment Program
  • AMRI Counseling
  • Arbor Place, Inc
  • ARC Community Services-Madison
  • Behavioral Health Services of Racine County
  • Benedict Center:  Milwaukee
  • BridgeHealth Clinics & Research Centers, Inc
  • Brown County Human Services Department
  • Center for Quality Community Life
  • Compass Counseling
  • Connections Counseling
  • Coulee Council on Addictions
  • Dane County Department of Human Services
  • Family Services of Northeast Wisconsin Inc.
  • Forward Choices
  • Genesis Behavioral Services Inc.
  • Green Lake County Department of Health Services
  • Hiawatha Valley Mental Health Center
  • Holy Family Memorial Behavioral Health
  • Iron County Health Services
  • Jackie Nitschke Center
  • Jefferson County Human Services
  • Journey Mental Health Center
  • La Crosse County Health Services
  • LSS Women’s Way       
  • Mayo Clinic Health System La Crosse
  • Meta House
  • New Horizon’s North
  • North Central Health Care
  • Oakwood Clinical Associates
  • Omni Enrichment
  • Open Door Center for Change
  • Polk County HHS
  • Rock Valley Community Programs
  • Rusk County Health and Human Services
  • Sixteenth Street Community Health Center
  • Taylor County Health and Human Services
  • Tri-County Women’s Outreach  
  • Waukesha County Health and Human Services
  • West Central Wisconsin Behavioral Health Clinic
  • William S. Middleton Veteran’s Hospital
  • Wood County Human Services Department


STAR-QI success stories


Arbor Place, Menomonie, reduced the no-show rate for all service appointments from 25 percent to 15 percent 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 percent to 15.8 percent. 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 percent to 100 percent 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 percent to 46 percent using a "fish bowl" raffle incentive. The center also reduced no-shows to the intake appointment from 50 percent to 37 percent bydoing 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 percent to 21 percent 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 percent to 73 percent 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 percent to 4 percent, 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 percent to 92 percent 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 percent to 26 percent 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 percent to 19 percent using motivational interviewing techniques during the initial phone contact with the client, adopting a universal schedule, and making reminder calls.

La Casa de Esperanza, Waukesha, reduced no-shows to intake from 23 percent to 9 percent by instituting reminder calls.

Lutheran Social Services' Womens Way, Eau Claire, increased retention to the fourth appointment from 42 percent to 61 percent by getting clients admitted to services quicker, using reminder calls and offering client incentives. Womens Way has also increased monthly referrals from 6 per month to 14 per month by sending an email 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 percent to 45 percent 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 percent retention to the fourth 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 canceled 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 percent to 58.5 percent. 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 percent to 77 percent by using client incentives (pizza party; gift cards; dose aftergroup) 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 percent to 34 percent using reminder call variations.

Waukesha County Department of Health and Human Services reduced their outpatient clinic's appointment no-show rate from 37 percent to 21 percent 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 percent to 15 percent 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 fourth treatment session for one-to-one clients from 31 percent to 89 percent by making reminder calls 48 hours before the appointment and asking clients, "How do you plan to get to the appointment?"

STAR-QI resources


For more information

To learn more about STAR-QI or to inquire about how to participate in the program, please contact:

Deanne Boss, M.S.
STAR-QI Program Director
University of Wisconsin Department of Family Medicine and Community Health
1100 Delaplaine Court
Madison, WI 53715

Last Revised: September 7, 2016