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

Reducing Wait Time Improves Treatment Access, Retention (Part 2)


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 of paint.

Dramatic Results

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 and retention.

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 state-specific measures.

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Collaborative Learning

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 outpatient treatment.

“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

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