To identify problems, the agencies involved in STAR-SI start the process with a walk-through.
(See STAR-SI in Action: South Carolina.) Putting themselves in the shoes of clients
and family members, staff experience the process of intake and engagement from the other
side of the table.
What they discover can be startling. It may take way too long to get an initial appointment.
There may be an overwhelming number of forms to fill out. The lobby may be unwelcoming
and unappealing. Any of these factors may derail potential clients on their track toward
their first treatment session.
Simple changes can help ensure that doesn’t happen. Based on findings from the walk-through,
a “change team” identifies a problem, brainstorms a solution, puts it into
effect on a small scale, evaluates its impact, and tweaks things if necessary. The solution
may entail allowing walk-ins, calling clients the day before their appointments, relocating
intake interviews to a more private space, or simply giving the lobby walls a fresh coat
One key characteristic of the NIATx model is its basis in data. Instead of making changes
based on gut feelings, participants collect baseline data and then rigorously evaluate
the impact of proposed changes.
During the original NIATx initiative, CSAT’s STAR grantees and their Robert Wood
Johnson counterparts proved that the model substantially increased clients’ access
At the end of the original grants cycle, the 39 founding members (including the STAR program)
reported the following results:
Waiting time between clients’ first request for help and their first treatment session
dropped by nearly 35 percent.
The number of no-shows for appointments dropped by 33 percent.
Grantees reported a 21-percent increase in admissions to treatment.
Grantees saw an increase of more than 22 percent in treatment continuation.
The STAR-SI grantees hope to achieve similar results. They are tracking the number of
treatment providers participating in STAR-SI, the number of clients admitted to treatment,
the length of time clients stay in treatment, and the number of treatment sessions provided
between intake and discharge. In addition, the grantees will collect data on at least two
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One strategy for achieving STAR-SI’s goals is peer-to-peer learning. Grantees and
participating treatment agencies share success stories, ask for advice, and offer feedback
to other STAR-SI participants both within their states and across the Nation. Grantees
also benefit from coaching from NIATx consultants and peer mentors.
When states or agencies find a change to be successful, they put it into effect across
their entire organization. States are gradually increasing the number of agencies engaged
in the effort. And CSAT is exploring the idea of expanding the effort to other phases of
“STAR-SI is currently applying process improvement methods to improving access and
engagement, which is usually defined as the first 30 days of treatment,” said Ms.
Cotter. “Our future plans are to examine the effect of these methods at the next
phase of treatment, which involves hand-offs from one level of care to another or from
the criminal justice system to community-based treatment.”
For more information about SAMHSA’s Strengthening Treatment Access and Retention
grant program and other substance abuse prevention and treatment programs, visit SAMHSA’s
Web site at www.samhsa.gov.
« See Part 1: Reducing Wait Time Improves Treatment Access, Retention
See Also—Reducing Wait Time Improves Treatment Access, Retention
What Is NIATx? »
What Is Process Improvement? »
STAR-SI in Action: South Carolina »
STAR-SI Participants »
ACTION Campaign »
From the Administrator: Striving for Quality…One Step at a Time »
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