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SAMHSA News - September/October 2007, Volume 15, Number 5


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.”

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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 Is NIATx?).

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 the outcome.

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.”

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