The Case for Access and Retention

It’s reasonable to consider why a quality improvement partnership should focus on access to and retention in treatment instead of, for example, evidence-based practices or client outcomes. The reason for focusing on access and retention lies in national data and research done by the Institute of Medicine.

According to TEDS data, the average time it takes to begin treatment is 32 days. Addiction treatment is still considered a routine service instead of an emergency or acute care service—despite the fact that the majority of people seeking treatment are in crisis physically or emotionally. And, despite the fact that people die while waiting to access treatment.

Because of long waiting times, fewer than 50 percent of people show up for their screening and assessment appointments. This high no-show rate creates inefficiencies in the treatment system. By organizing systems and processes differently, we can make use of this underutilized capacity. We need to eliminate bottleneck at the front end of the process and get people into treatment quickly when they perceive a need for treatment.

To benefit from treatment, clients need to stay past the first session. TEDS data shows that showing up for the screening and intake appointment does not guarantee a follow-through for further treatment. Client engagement needs to be the first priority in any treatment program. Without the client’s active involvement, nothing can be accomplished.

More timely assessments have produced higher attendance rates (Carpenter et al., 1981; Oppenheim et al., 1979; Orme & Boswell, 1991; Raynes & Warren, 1971) and improved treatment initiation by 46 to 83 percent (Festinger et al., 2002; Kirby et al., 1997). Lack of follow-through by people seeking addiction treatment impedes the traditional step from intake and assessment to first clinical treatment session. In one study, 50 percent of applicants approved for admission did not enter the program (Farley & Ebener, 1998). Timeliness is also important. Scheduling the first treatment session within 48 hours of assessment produces greater treatment show rates (Claus & Kindleberger 2002). These research studies suggest that 50 percent of clients attend their scheduled intake session and only 50 percent of those clients attend their first treatment session. Hence, 25 percent of those requesting an intake appointment will attend their first treatment session.

Additional Information

• NIATx Four Aims
• Success Story Database

References

• Carpenter, P.J., Morrow, G.R., DelGaudio, A.C., & Ritzler, B.A. (1981). Who Keeps the First Appointment? American Journal of Psychiatry 138(1):102-5.
• Oppenheim, G.L., Bergman, J.J., & English, C.C. (1979). Failed Appointments: Review. _Journal of Family Practice 8(4):789-796.
• Orme, D.R. & Boswell, D. (1991). The Pre-Intake Drop-out at a Community Mental Health Center. Community Mental Health Journal 27(5):375.
• Raynes, A.E. & Warren, G. (1971). Some Characteristics of Dropouts at First
  Contact With a Psychiatric Clinic. Community Mental Health Journal 7:144-150.
• Festinger, D.S., Lamb, R.J., Marlowe, D.B. & Kirby, K.C. (2002). From Telephone to Office: Intake Attendance As a Function of Appointment Delay. Addictive Behaviors 27(1):131-37.
• Kirby, K.C., Marlowe, D.B., Lamb, R.J., & Platt, J.J. (1997). Behavioral Treatments of Cocaine Addiction: Assessing Patient Needs and Improving Treatment Entry and Outcome. Journal of Drug Issues 27:417-31.
• Farley, D. & Ebener, P. (1998). Exploratory Analyses of Phoenix House Caseload
  Characteristics, and Admissions and Retention Patterns: Report to Phoenix House. Santa Monica: RAND.
• Claus, R.E. & Kindleberger, L.R. (2002). Engaging Substance Abusers After Centralized Assessment: Predictors of Treatment Entry and Dropout. Journal of Psychoactive Drugs 34(1):25-31.