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."

Synopsis of the Work: The Paths to Recovery: Changing the Process of Care for Substance Abuse Programs program was designed to increase access to substance abuse treatment by improving the quality and efficiency of the delivery system at the provider level. The Network for the Improvement of Addiction Treatment (NIATx) served as the umbrella for Paths to Recovery.

Paths to Recovery created a learning community for participating agencies and guided them in using process improvement strategies to achieve four primary aims: (1) reduce wait time between the first request for help and the first treatment session; (2) reduce no-shows, (3) increase admissions, and (4) increase continuation rates by keeping people in treatment longer.

Key Results: Among the results reported by NIATx:

• The NIATx learning community proved to be an effective structure for teaching treatment agencies to apply process improvement techniques.
• During the first 18 months of the program, participating agencies conducted 127 change projects that involved some 500 rapid-cycle change exercises.
• By 2008, the NIATx learning community had evolved into a national resource center for spreading process improvement to behavioral health agencies nationwide. As of January 2010, over 2,100 organizations had become NIATx members.

Key Findings: An evaluation of Paths to Recovery conducted by the Oregon Health and Science University found that:

• Wait time from first contact to first treatment session dropped from 19.6 days in October 2003 to 12.4 days in December 2004, a 37 percent decrease.
• Retention in care increased. In October 2003, about 72 percent of patients returned for a second outpatient treatment visit or a second week in residential care. By December 2004, nearly 85 percent of patients returned for a second visit.
• The NIATx model is replicable. A second cohort of Paths to Recovery grantees achieved similar improvements as the original group.
• The NIATx model is sustainable. Follow-up data showed that the original group of participating agencies sustained their gains for an additional 20 months.