The Journey to Excellence with NIATx: First Step Home

Submitted by: 04/08/2015 by Maureen Fitzgerald

First Step Home is a residential and outpatient treatment program for women in recovery and their children in Cincinnati, Ohio. Founded in 1993, First Step Home was created as a residential treatment facility that would allow children up to age 12 to live with their mothers during treatment. 

The organization added its first transitional housing option in 2005; today it manages 11 housing units that can accommodate 80 women and their children. In the outpatient and transitional housing program, women attend aftercare sessions for up to 18 months.

In 2010, the agency received a grant from Interact for Health (formerly known as the Health Foundation of Greater Cincinnati) to implement NIATx tools and practices to streamline systems and improve services.

“When we first started NIATx our big issue was no-show rates for both assessment and intake, says Vice President Terry Schoenling. “I had attended a NIATx seminar and was interested in how we could to address some of the problems that were associate with the growth of our organization.”

After all First Step Home were trained in the NIATx model, Schoenling assembled the first NIATx change team. “We focused on tackling our no-shows for assessments,” says Schoenling. After a walk-through of the process, the team decided to do a rapid-cycle change using call-backs.  (See the NIATx Promising Practices page for ideas on changes to test.) “We contacted clients at least once a day to check-in and address any barriers like transportation or child-care that would prevent them from making the assessment,” says Schoenling. As a result, the no-show rate dropped tremendously.

Since receiving the grant in 2010, eight First Step Home change teams have conducted multiple change projects. Change teams have included staff members, board members, and clients. Schoenling says that the NIATx Change Bulletin and the NIATx website have been great resources for his teams. “The Change Bulletin was great because it gives details on other organization’s change projects that we could model at First Step Home,” says Schoenling.

At First Step Home, NIATx projects focused on the four original NIATx aims. Projects to increase admissions and continuation involved studying our capacity and what we need to do to meet increased demand for services. “NIATx change projects led to the expansion of our housing program,” says Schoenling. “We turned to our customers for insight on how to keep them in treatment longer, and that led to extending treatment at mid-point to concentrate on maintaining recovery and relapse prevention. In the final phase we work on helping women integrated back into the community.”   

The multiple NIATx change projects conducted over the past five years have yielded significant improvements in show rates, continuation, and retention:

Figure 1: First Step Home NIATx Based Outcomes 2010-2014

Other dramatic improvements include:

  • Client intakes rose by 138%, from 135 in 2011 to 322 in 2014
  • Housing units increased by 188% from 18 in 2010 to 52 in 2014
  • Operating cash increased by $219,000 in three years (2011-2013)
  • Fee-for-service revenues increased by $833,000 in four years (2011-2014)

In addition, inviting all staff to participate in NIATx change projects has improved staff morale at First Step Home. “Staff now feel that they have a direct input in forming policy and in the direction of the company,” adds Schoenling. A new NIATx team that has just been assembled will target retention in maternal programs.

Schoenling is confident that the NIATx approach will continue to guide improvement efforts at First Step Home. He says, “NIATx really sustains itself through the revenues you generate and the costs you save by focusing on the customer and making improvement that increase efficiency.”

For more information about First Step Home at its NIATx projects, contact Terry Schoenling at

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