Use the Spirit of Motivational Interviewing during the First Contact
Clients are stuck between wanting to change and, at the
same time, not wanting to change so they miss
appointments if not adequately engaged.
Use open-ended questions and empathetic conversation to
welcome and connect with clients during their first contact.
Sinnissippi Centers, Inc. in Dixon, Illinois reduced the noshow
rate to the assessment appointment from 58 percent
to 14 percent by using a conversational approach for
gathering information and engaging clients during the pre-admission process with outpatient
and intensive outpatient clients. For more information, see the Sinnissippi MI Outline.
PROTOTYPES in Pomona, California reduced no-shows to the first face-to-face outpatient
appointment from 36 percent to 10 percent by asking open-ended questions during the first
contact to find out the most important things the client wanted to get out of treatment and by
talking about a plan to assure that these needs would be met. For more information, see the
PROTOTYPES Spirit of MI Protocol and their .
Boston Public Health Commission in Boston, Massachusetts reduced the no-show rate by 41
percent by using Motivational Interviewing during the intake conversation with outpatient clients.
- Make the first contact personal.
- Find out why they are calling, what they need, and what concerns they have about
- Express empathy and concern.
- Expect and honor resistance.
- Help motivate prospective clients to engage in treatment.
- Invite callers to talk about what they feel is most important to them and explain how
treatment can help.
- Create discrepancy to point out that the client seems to want to change and not want to
change, at the same time.
- Summarize their needs and concerns so that they know they have been heard.
- The spirit of Motivational Interviewing (MI) can be incorporated into all conversations that staff have with clients, whether on the phone or in person.
- Encourage referrers to use the spirit of Motivational Interviewing.
Note: The communication practices described in this promising practice are based on the
principles of Motivational Interviewing (MI); however, formal training in MI is not required to
implement this practice.
No-show rate for assessment appointments
Data Collection Form
No-show Tracking Spreadsheet
- 1. Select a staff member who answers phones and is willing to experiment with
- 2. Develop an outline or guide to use when clients first make contact with your
agency. Review the guides attached to stories in this promising practice for
- 3. Calculate the baseline no-show rate for assessment appointments.
- 4. Have the selected receptionist practice using the guide by role-playing until
the staff member feels comfortable connecting with clients without strict use
of the outline.
- 5. Have the staff member use the guide to connect with the next forty clients or
for all prospective clients during the next two weeks, whichever happens
- 6. Track and calculate the no-show rate for assessment appointments for the
clients who were welcomed using the guide.
- 7. Check the fidelity of the change. Was the change implemented as planned?
- 8. Evaluate the change:
- How did the no-show rate at the assessment appointment change for
clients welcomed with the spirit of MI guide?
- Did the staff member use the spirit of MI guide consistently?
- Did the guide help the staff member connect with clients?
- Did the guide flow smoothly?
- Did many clients reschedule or cancel prior to their first appointment?
- 9. Adjust the spirit of MI guide so that it flows more smoothly and so that it
takes into account the reasons clients cancel or reschedule before their
assessment appointment and re-test this promising practice for an additional
Repeat this series of steps until you are satisfied with the guide and then expand the
number of staff members trained to use it until the approach described in the guide
is used to connect with all clients during first contact.