Clients are unable to overcome barriers to treatment on their own, even when willing, and drop out of treatment.
Help clients anticipate and solve the logistical problems involved with starting and staying in treatment. Such barriers may include transportation, childcare, ability to pay, translation needs, other appointments, the criminal justice system, and work schedules.
Sinnissippi Centers in Dixon, Illinois reduced the no-show rate to the first appointment from 58 percent to 14 percent by using a conversational approach based on the spirit of Motivational Interviewing during the first call. They asked clients, “Do you see anything that may prevent you from making your appointment?” and “Do you have reliable transportation?” See the entire script they used. They found that although they were prepared to offer and pay for a cab ride, that most clients did not need further help. They just needed to think through the logistics in advance.
The Center for Human Services in Seattle, Washington decreased no-show rates from 80 percent to 65 percent and increased admissions by 87 percent by performing assessments at the Community Service Office (the referrer) one day a week. For more information, see the CHS story.
Axis 1 in Barnwell, South Carolina worked with their local Medicaid transportation vendor to change their scheduling policies to make them more customer-friendly. They also worked with the county to find ways to pay for vehicles that the staff used to transport clients. They now have two vehicles to transport patients to and from treatment. This arrangement also allows the Axis 1 staff to spend more time with their clients. For more information, see the case study and their change bulletin.
No-show rate for assessment appointments or treatment sessions.
Data Collection Form
Repeat this series of steps until all of your clients are asked about barriers to attending the first appointment and you are providing whatever services are feasible to eliminate the logistical barriers to treatment. Explore ways of asking clients about barriers on a regular basis, during treatment.
Spectrum Health Systems in Worcester, Massachusetts reduced no-shows from 48 percent to zero and increased revenue by $256 per week ($13,312 per year) for individual client sessions (billed at $64 each) by scheduling a clinician to provide on-site services for 8 hours per week in two parole-populated recovery programs. This eliminated scheduling and transportation issues. For more information, see Spectrum Health Systems success story.
CAB Health and Recovery in Peabody, Massachusetts began offering rides to clients entering detoxification.
Acadia Hospital in Bangor, Maine started asking not only if patients could come in the next day, but if they were able to get to the clinic. They then tried to help the clients figure out how they would get to the clinic, including using state-funded transportation from Medicaid.
TERROS, Inc. in Phoenix, Arizona makes house calls to help their clients complete paperwork.
ACTS in Tampa, Florida connected clients to Alcoholics Anonymous and Narcotics Anonymous, both of which provide free transportation to the agency.
Mid-Columbia Center for Living in Hood River, Oregon increased continuation rates from 70 percent to 80.1 percent by implementing a “Stay and Pay Later” card that allowed clients to delay payment for one week for up to four treatment sessions in a six-month period. Since financial barriers continue to be the single biggest reason that their clients delay entering treatment, they are still working to find ways to balance the needs of their clients with their needs as a business.
BestCare Treatment Services in Redmond, Oregon decreased the no-show rate for the initial intake appointment from approximately 40 percent to 25 percent in two different offices by waiving the fee for the initial intake appointment after learning that clients were not signing up for intake on the night of the orientation due to lack of money. The number of clients who scheduled intake appointments during orientation increased by 30 percent in the Bend office and by 18 percent in the Redmond office. BestCare forecasts an additional 60 percent in revenue in the outpatient program from clients who come for a free initial intake appointment and continue in treatment. For further information, see BestCare’s success story.
PROTOTYPES in Pomona, California offered an outpatient parent-child group that encouraged women and men without childcare to show up for treatment.
Asian Counseling and Referral Service in Seattle, Washington hire staff members who speak multiple languages and also arrange for translators to attend treatment sessions.