Increase Continuation within One Level of Care

These promising practices help increase continuation within one level of care—to the fourth treatment session (OP and IOP) or the fourth week of treatment (residential).

Question

How will we rapidly know a change increases continuation within one level of care?

Answer

There are two ways to know whether continuation within one level of care has increased.

1. The percentage of no-shows for treatment sessions will decrease. Use the No-show Tracking Spreadsheet or the Residential Dropout Tracking Spreadsheet , depending the level of care. This option is easier and less costly.
2. The percentage of clients who continue from admission through the fourth treatment session within one month will increase. Use the NIATx Outpatient Spreadsheet (Instructions ) or the NIATx Residential Spreadsheet (Instructions ), depending on the level of care. This option is more accurate, but also usually more time-consuming and more costly.

Promising Practices

Learn what others have done, how they did it, lessons from the field, and how to test each promising practice using rapid PDSA cycles.

Use the following promising practices as inspiration for change in your organization—re-invent them, improve on them and be creative—and let us know what happens so that we can continue to enrich and expand the library of change ideas available to the entire NIATx network.

Promising practices to increase continuation through the fourth treatment session (OP and IOP) or the fourth week of treatment (residential) fall into two categories:

Eliminate Barriers

• Assign Counselor within 48 Hours of First Treatment
• Offer a Safe, Private, and Clean Physical Environment
• Help Eliminate Barriers to Treatment
• Adjust Staff Schedules to Meet Client Demand
• Meet with a Counselor and a Case Manager within 24 Hours of Admission (Residential)
• Eliminate the Blackout Period (Residential)
• Avoid Friday Admissions (Residential)
• Eliminate Responsibilities during the First Two Weeks of Treatment (Residential)

Enhance Motivation

• Increasing engagement of extended family members
• Establish Attendance Policy
• Orient Clients
• Remind Clients about Appointments
• Follow-up with No-shows
• Ask Clients to Participate in Treatment Planning
• Encourage Clients to Use PDSA Cycles to Test Their Own Changes
• Tailor Treatment to Each Client’s Circumstances and Needs
• Offer Groups for Clients Not Ready to Start Treatment
• Give Counselors Regular Feedback on No-show and Continuation Rates
• Identify Clients at Risk for Leaving and Intervene
• Use Motivational Interviewing during Treatment
• Get Clients to Commit to Attend the First Four Treatment Sessions
• Assign Peer Buddies
• Build Community Among Clients
• Include Family and Friends
• Use Motivational Incentives
• Collaborate with Referrers to Motivate Clients