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

STAR-SI in Action: South Carolina

As a would-be client, Carl Kraeff posed as a distraught man seeking substance abuse treatment at a local agency. His story: Because of his drug use and serious drinking problem, his “wife” was leaving him. He couldn’t pay his rent. His life was ruined.

But no matter how melodramatic he made his tale, the agency’s intake staff didn’t seem interested.

“Everybody was very friendly and helpful, but every time I tried to interject a comment, they would ignore me and go on to the next question,” said Mr. Kraeff. In real life, he is a management consultant in South Carolina’s Department of Alcohol and Other Drug Abuse Services. “They were trying so hard to be efficient, but I felt like I was being processed. I wasn’t treated like a person.”

Fortunately, the agency involved is 1 of 21 in the state currently participating in SAMHSA’s Strengthening Access and Retention–State implementation (STAR-SI) initiative (see Reducing Wait Time Improves Treatment Access, Retention).

Both the state as a whole and individual agencies are identifying problems like the one that concerned Mr. Kraeff, brainstorming solutions, and evaluating the results in a rapid-fire process of quality improvement.

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Taking “Small Bites”

At the state level, one easy step was to streamline the intake forms that the state’s network of treatment facilities are required to use.

Excessive paperwork was the number-one complaint of agency executive directors, explained Mr. Kraeff. With tweak after tweak, the mandatory paperwork shrank. By the time the process was over, the state had reduced the number of intake forms by 85 percent. The amount of time the intake process took had been halved. And the providers were happier.

But STAR-SI’s impact is even more dramatic out in the field. Consider the example of the Lexington and Richland Alcohol and Drug Abuse Council (LRADAC), the Behavioral Health Center of the Midlands in Columbia.

Broken appointments were the first problem the center set out to tackle: Forty-four percent of would-be clients never made it to their first treatment session after they’d been assessed.

Simple changes helped solve the problem. Training in motivational interviewing techniques, for example, helped staff engage clients. The agency also made the waiting room more private. And the staff produced an orientation packet that included a welcome letter from the agency president, a “what to expect today” piece, and a booklet about the treatment program. “STAR-SI encourages you to take small bites,” said Change Leader Gayle Aycock, M.Ed., Director of Quality Assurance at LRADAC.

For more information on STAR-SI, visit SAMHSA’s Web site at

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