Perinatal Treatment Services: Increasing Admissions 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: Perinatal Treatment Services (PTS) of Seattle provides residential and outpatient substance abuse treatment program for pregnant and parenting women. Many of the women also have mental health problems, a history of domestic violence and a need for parenting education and support in addition to treatment for addiction.

Kay Seim, the PTS executive director, wanted to increase admissions, reduce no-shows for treatment sessions and increase retention.

Synopsis of the Work: From September 2003 to June 2006, PTS participated in the Robert Wood Johnson Foundation (RWJF) Paths to Recovery national program. Participating agencies used process improvement strategies originally developed by private industry to improve business operations. These strategies emphasized incremental changes that were tested, revised, retested and adopted in a series of rapid-cycle change exercises.

NIATx (Network for the Improvement of Addiction Treatment) served as the national program office for Paths to Recovery. NIATx staff provided participating agencies with technical assistance, learning sessions and coaches to help them design and implement their process improvement changes.

Seim and an in-house change team focused on increasing admissions to the women's residential programs. They wanted to reach 95 percent of capacity. To achieve this goal, beds would have to be filled by a new woman shortly after a resident was discharged, transferred or left against medical advice.

Key Results/One Story: The following story describes how PTS used rapid-cycle changes to increase admissions in its women's and adolescent programs.

Seim and the PTS in-house change team created a process for ensuring that the residential treatment counselor or clinician notified the Placement Coordinator immediately whenever a resident left.

Next, they introduced Treatment Readiness Groups to prevent women on the wait list from changing their minds about entering treatment. Potential clients met with counselors in small Treatment Readiness Groups twice each week. Counselors used the groups to provide basic education about drug dependence, to receive personal updates from the women and to create strong and trusting relationships.

Agency staff noted, "By the time a person's name comes up on bed list they are already connected to us, so there are few no-shows."