Clients don’t show for appointments and no one finds out why or tries to reschedule another appointment.
Follow up with clients when they miss an appointment to find out why and to reschedule another appointment.
Follow up with clients when they miss an appointment to find out why and to reschedule another appointment.
Acadia Hospital in Bangor, Maine increased the continuation rate by 15 percent by making follow-up calls for no-shows. They found a staff person with a nice telephone voice and manner; she said “We were worried that you didn’t come. Is something wrong? Can we help? Ask for me and I’ll help you get oriented to the program and help you get going.”
Axis 1 in Barnwell, South Carolina reduced the no-show rate from more than 60 percent to just above 40 percent by using a new case manager position to focus on outreach to and contact with clients. This case manager, who was knowledgeable about the surrounding community and experienced in addiction treatment, made appointment reminder calls, followed up with noshows, and helped clients work around logistical barriers to treatment such as transportation and childcare. The case manager also visited some clients at home and sought them out in various places to invite them back to treatment. This personal interest and attention has brought several people back to treatment and may have even saved the life of one woman how received essential medical help as the result of a visit from the Axis 1 case manager. For more information, see the case study and the change bulletin.
If you decide to implement this promising practice to follow-up with no-shows to the assessment appointment as well as treatment sessions, implement the changes as two separate Change Projects, focusing on two separate aims:
This approach will make it easier to determine what kind of follow-up communication works best for a client who has never been to your agency as opposed to a client who is returning. The type of conversation is likely to be different.
Cycle Measure
Data Collection Form
Plan
Do
Study
Act
Repeat this series of steps until you are following up with all of the clients when they miss or cancel the first appointment. You may want to spread this change idea to follow up with no-shows to group sessions or individual sessions during treatment as well.
Note: Following up with clients who have already begun treatment may require a different conversation than for clients who have not been to your agency at all.
The Center for Drug Free Living in Orlando, Florida had counselors call outpatient clients who failed to attend the first appointment within 24 hours to encourage them to return to treatment. Of the clients who failed to attend the first appointment, 70 percent returned and completed at least four treatment sessions.
Connecticut Renaissance, Inc. in Bridgeport, Connecticut decrease the no-show rate by 17 percent by implementing a protocol whereby the clinician made phone contact with clients within 24 hours of missing an individual or group session. For more information, see their no-show protocol and the business case.business case.
Daybreak Youth Services in Spokane, Washington reduced no-shows from 28 percent to 16 percent by having counselors monitor no-show rates for their clients; this helped raise awareness and allowed them to intervene. See the forms used to track each client’s attendance and the overall no-show rates for clients, by counselor. For more information, see the case study.
Mid-Columbia Center for Living in The Dalles and Hood River, Oregon decreased no-shows from 16.1 to 7.5 percent at The Dalles and from 15.6 percent to 8.4 percent at Hood River by requiring clients who canceled twice or no-showed once for their assessment appointment to speak to the screener before scheduling another appointment. The screener used Motivational Interviewing techniques to explore the client’s barriers to treatment.