Jackie Nitschke Center: Increasing Retention in 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: With just 14 beds, the Jackie Nitschke Center of Green Bay, Wisc. is the smallest of the Robert Wood Johnson Foundation's 23 Paths to Recovery grantees; like other small agencies, it had been isolated from other centers. "We had little contact with the outside world," said William LaBine, chief executive officer. With two-thirds of its funds coming from county contracts, the center had few resources for conferences or employee training, so staff made do with in-house training from manuals.

Synopsis of the Work: Paths to Recovery helped agencies use rapid-cycle changes to make improvements in four key areas—reduce wait time to admission, increase admissions, reduce no-shows and improve retention in treatment. NIATx (Network for the Improvement of Addiction Treatment) served as the national program office for Paths to Recovery. NIATx coaches advised agencies to address one challenge at a time.

When the center received its Paths to Recovery grant in September 2003, its leaders began a several-step process that spanned a client's entire involvement with the program, from the first call for help to joining the alumni group. All the steps aimed to increase the percentage of clients who remained in treatment.

Key Results: Jackie Nitschke staff realized that if the center made it easier for clients to enter intensive outpatient treatment, they would be more likely to remain once they started. Data indicated that patients were waiting up to 10 days between their first call for help and their first outpatient treatment session, and many dropped out before they finished.

The change team started by improving the way staff responded to initial calls from clients. All staff received training in how to make appointments on the spot, rather than asking the client to call back or transferring the call to someone else. Unless clients had a good reason for delay, they were given the first available appointment for an assessment and expected to start treatment that night.

To support this change, the center increased the number of assessment appointments and made more staff available to conduct the assessments. Staff also received training in motivational interviewing in order to convince new patients of the importance of starting their treatment the same night as the assessment.

The result? The time from the client's first call for service to the first day of intensive outpatient treatment dropped from nine days in June 2003 to less than four in August 2004.

A related bonus? Retention for the first four days of treatment also rose and consistently remained around 90 percent during this period. To sustain the improvements, the center created a policy that made the new procedures the "usual way of doing business."