Offer Groups for Clients Not Ready to Start Treatment

Problem:

Clients are often expected to begin treatment before they are ready, which leads to no-shows and decreased continuation.

Solution:

Offer pre-contemplation groups for clients not ready to start treatment and address the issues that concern them.

Featured Stories

Note: The following practices have been used at various NIATx agencies without using small-scale rapid cycles to implement them and without tracking the impact on continuation. Please let us know if you test them.

Sinnissippi Centers in Dixon, Illinois meets the clients “where they are at” by offering precontemplation groups. For more information about the group process, see Sinnissippi’s Investigations Group.

Gosnold, Inc. in Falmouth, Massachusetts helps clients become more aware of the stage that they are at using Gosnold’s Stages of Change Timelines.

STEPS at Liberty Center in Wooster, Ohio offers pre-contemplation groups for clients who don’t see the need for treatment. Clients talk about what brought them to treatment and participate in structured exercises. A benefit is that clients who are not motivated do not take the focus away from others in the group. If clients don’t want to make the change, the agency lets the court know. They try to make it a pleasurable experience so that the client feels welcome to return to treatment when ready. These clients may also participate in the following specialty groups, if appropriate.

• 100 level – basic recovery, how to use 12-step groups, stress management, facts about drugs
• 200 level – living straight & sober, relaxation techniques, anger management, dealing with depression, dealing with anxiety, women’s issues, smoking cessation, eating disorders
• 300 level – spirituality, sexuality, parenting, relationships, trauma

Lessons Learned

• Meet the clients where they are.
• The benefit of such groups is that clients who are not motivated do not take the focus away from others in the group.
• Address issues that concern the clients, like how to get clean needles and how to help friends who are overdosing.
• Make the pre-treatment groups welcoming and pleasurable so that clients will feel welcome to return to treatment when ready.

Tracking Measures

Cycle Measure

No-show rate for treatment sessions

Data Collection Form

No-show Tracking Spreadsheet

ActionSteps

Plan

• 1. Select several groups that include clients who are not ready to start treatment.
• 2. Collect baseline data for the no-show rate to the selected groups.
• 3. Decide how you will offer services to clients who are not ready to start treatment.

Do

• 4. Hold groups for clients not ready to start treatment for two weeks.
• 5. Track and calculate the no-show rate separately for the selected groups that no longer include clients who are not ready and for the “not ready” group.

Study

• 6. Check the fidelity of the change. Was the change implemented as planned?
• 7. Evaluate the change:
  • Were clients who were not ready to start treatment interested in participating in the new group?
  • Was the most appropriate counselor chosen to lead the group?
  • Did the no-show rate decrease in the “not ready” groups, when compared with the baseline no-show rate?
  • Did the no-show rate decrease in the groups that no longer included clients who were not ready to start treatment?
  • Did clients who attended the “not ready” group continue in treatment?
  • Did the number of clients who you were able to admit to your program increase because of the new group for clients “not ready”?

Act

• 8. Adjust the curriculum offered, the number of clients or the number of counselors involved and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you are able to provide groups that engage clients who are not ready to start treatment.

More Stories

Acadia Hospital in Bangor, Maine offers an engagement group in which clients who are still using are welcome to attend.

Prairie Ridge Addiction Treatment Services in Mason City, Iowa offers a Talking About Change (TAC) group. The purpose of this group is to provide education for clients to enhance motivation to assist them in making change. The TAC curriculum consists of the following:

• Session 1: Orientation to rules and purpose of group, Stages of Change discussion, health education—including mechanics of addiction and effects of substance abuse.
• Session 2: Phases of addiction and continuum of use, cost analysis, and “who is concerned?” values card sort and identifying how substance use may interfere, pros/cons of use and decisional balance.