Reducing Wait Time Improves Treatment Access, Retention (Part 1)
Seeking help for a substance abuse problem can be one of the most difficult decisions people ever
make. Whether they’re motivated by a frustrated spouse, a legal problem, or simply a desire
to change their lives, their resolve can often be shaky. Just about anything can become an excuse
to break an appointment or even drop out of treatment altogether.
Now SAMHSA’s Center for Substance Abuse Treatment (CSAT) is helping states and treatment
providers get rid of overwhelming intake forms, long waits for appointments, and other
barriers to efficient services.
Launched in 2006, the 3-year Strengthening Treatment Access and Retention–State
Implementation (STAR-SI) program promotes the use of an approach pioneered in the business
world—“continuous quality improvement”—to get people into outpatient
treatment and keep them there until they’re better.
The grantees include state agencies in Florida, Illinois, Iowa, Maine, Ohio, South Carolina,
and Wisconsin. In addition, three other state agencies have joined STAR-SI. Montana is
funded through the Single State Agency, and Oklahoma and New York are funded by the Robert
Wood Johnson Foundation. “The STAR-SI initiative is based on the idea that small
changes can bring big rewards,” said SAMHSA Administrator Terry L. Cline, Ph.D. “You
identify a problem, test a solution, and move on to the next problem. It’s an incremental
approach that can have a huge impact.”
Back to Top
A “Rapid-Cycle” Process
The STAR-SI program builds on findings from the Network for the Improvement of Addiction
Treatment (NIATx), a joint initiative of CSAT and the Robert Wood Johnson Foundation (see What
That original NIATx initiative began in 2003 to help grantees set an agenda for improving
addiction services and adopting evidence-based treatment practices. A 3-year pilot project,
it included CSAT’s Strengthening Treatment Access and Retention (STAR) program, launched
in 13 states, and the Robert Wood Johnson counterparts. (See SAMHSA
News online, fall 2003.)
In that effort, grantees successfully increased client access and retention by making
simple changes. These changes included everything from streamlining intake procedures and
eliminating unnecessary paperwork to extending clinic hours and using incentives and “motivational
interviewing” to engage clients during the early phases of treatment.
“When treatment providers make these small changes in the ‘process’ of
delivering care, they can substantially improve outcomes,” said CSAT Director H.
Westley Clark, M.D., J.D., M.P.H. “Treatment providers are powerful agents of improvement
and organizational change.”
STAR-SI grantees now use the same model developed by their predecessors.
“We demonstrated the use of this quality improvement technology in treatment settings. But we wanted to move from the treatment level to the state level,” said Frances Cotter,
M.P.H., Quality Improvement Team Lead in CSAT’s Division of Services Improvement.
Called process improvement, the incremental approach championed by NIATx consists of identifying
a problem, setting a goal for improvement, pilot-testing possible solutions, and analyzing
Once one change has proven successful, the organization—whether it’s an entire
state agency or an individual treatment facility—quickly moves on to the next area
that needs improvement.
The changes typically cost little or nothing and are put into effect just 3 or 4 weeks
after a problem has been identified.
“We encourage people to make small, simple changes quickly,” said NIATx Deputy
Director Todd Molfenter, Ph.D. “Even if you’re trying to lose weight or making
other changes in your personal life, you rarely get things right the first time. You have
to try different things and see how they work. That’s what this process encourages.”
Back to Top
Back to Graphic Version