Stanley Street Treatment and Resources (SSTAR): Increased Admissions

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: SSTAR (Stanley Street Treatment and Resources) provides a range of services to residents of southeastern Massachusetts and Rhode Island, including inpatient detoxification, substance abuse treatment, treatment for people dually diagnosed with substance abuse and mental health problems, women's services, primary health care, family interventions and services for people with HIV/AIDS.

SSTAR has always relied on its inpatient detoxification unit for a significant portion of its annual revenue. By 2004, however, this core program was losing $300,000 per year, creating serious budget problems and worries for staff.

Nancy Paull, SSTAR chief executive officer, was looking for a way to make improvements without draining staff resources. She turned to the Robert Wood Johnson Foundation (RWJF) Paths to Recovery national program. Paull wanted to focus on reducing the number of people who left inpatient detox against medical advice after only two or three days. When people leave that early, they are more likely to relapse and it is hard for staff to keep beds occupied. Variations in occupied beds—the average daily census—affect the financial viability of the agency.

The "revolving door" of clients in SSTAR's regular detox unit and in its detox unit for people dually diagnosed with substance abuse and mental health problems created a chaotic atmosphere for staff and clients alike.

Synopsis of the Work: From September 2003 to June 2006, PTS participated in Paths to Recovery. 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.

SSTAR decided to continue its focus on the core inpatient detox program.

Key Results: SSTAR increased its average daily census, increased admissions and strengthened the bottom line.