Asian Counseling and Referral Service: Reducing Wait Time from First Contact to Treatment

Paths to Recovery: Changing the Process of Care for Substance Abuse Programs

Field of Work: Increase access to substance abuse treatment by improving the quality and efficiency of the delivery system.

Problem Synopsis: Patients requesting substance abuse treatment encountered barriers such as difficult admission procedures, poorly designed telephone systems and an un-engaging reception staff. Instead of an appointment, they often received a request to "call back later."

The Seattle-based Asian Counseling and Referral Service's (ACRS) substance abuse treatment program began in 1999. Yoon Joo Han, M.Ed., M.S.W., program director of behavioral health recalls, "We were getting lots of inquiries asking for substance abuse treatment delivered in Asian languages. Lots of people needed help but there was no linguistically and culturally relevant treatment in this area." The agency assigned one staff to provide these services; in three years, the number of clients had doubled.

A review of ACRS's records showed that it was taking about 28 days for staff to complete its assessment summaries. This delayed treatment and placed additional stress on individuals and families. Staff determined that a big reason for delay was an agency requirement that workers collect collateral contact information from others to supplement data provided by the client. With no clear guidelines about how many people to contact or how many attempts to make, staff was spending an average of two to three weeks trying to reach these collateral contacts.

Synopsis of the Work: Under RWJF's Paths to Recovery national program, ACRS staff wanted to focus on reducing the gap between the time a worker first interviewed a client and the time the counselor wrote the assessment summary. ACRS experimented by limiting contact attempts to three within three business days—later dubbed the "three in three" policy. If they could not reach collateral contacts within three days, staff finished the summary and created the treatment recommendation with available information.

Key Results: After the "three in three" policy was in place, ACRS completed summaries in less than five days, compared with only 29 percent of summaries completed in less than five days under the prior system.

Armed with this evidence that a simple change tripled the number of clients who could receive their summaries within five days of assessment, the agency incorporated the "three in three" policy into its policy and procedure manual.

By March 2005, the average wait time for sevices had dropped from 87.7 days to 46.5 days. By December, it fell to 13.5 days. This change allowed the agency to increase admissions to outpatient treatment from 96 in 2004 to 150 in 2005. Revenues increased by about 15 percent.