Participant Stories

Using any one of three ACTIONs collectively identified as among the most effective -- providing rapid access to services; improving client engagement; or creating a seamless transition between levels of care -- can improve treatment access and help keep clients engaged.

Over 600 treatment providers from across the nation are participating. Here are a few in an ongoing series of their stories. (Ready to join the ACTION? Get started.)

Dallas County Juvenile Probation Department, Dallas, Texas

Posted: June 3, 2008

The Dallas County Juvenile Probation Department is unique in that it provides all levels of substance abuse counseling, including a day treatment program. The Substance Abuse Unit has been in existence for over 10 years and has changed dramatically as the needs of the community have changed. Currently, we are staffed by 25 counselors and support staff and provide services for juveniles that include assessments, education/intervention, and all levels of treatment, including residential drug treatment.

The Walk-Through
As we performed our walk-through we were stopped immediately by the first referral/intake process, and decided to address that process. Our referral process is initiated at the time of a court hearing. It often is done at the same time the child is being released from detention, a process that also includes explaining the conditions of probation, reporting instructions, community service opportunities and fee requirements.

The amount of information that is given at this time is enormous, particularly coupled with the fact that the child is being released from detention where he has been away from family and friends for some time. A great amount of information is provided at a stressful time. It is obvious that several pieces of information can be lost or forgotten all together.

Prior to the walk-through, 50% of the clients were not attending their treatment intake appointments. After polling what happened to that group, it was determined that they didn't remembered being given the information, and that the probation officer was never informed of the appointment.

Plan
We decided to continue to give the client the information at the usual time in the process (to answer any questions they might have), but in addition made these changes:

1. Placed an appointment calendar for the day treatment program on a secured drive in our network. Access was given to the detention liaison and supervisors as well as secretaries.
2. Requested the detention liaison officer to contact the family the week of the appointment to remind them of when and where the intake would be held.
3. The detention liaison officer would also make sure the supervising Probation Officer was aware of the appointment so that at their initial reporting time (usually within 48 hours after release) they could be reminded a second time and given directions if needed.

Results
During the three weeks that this strategy was piloted, the amount of missed intake appointments were reduced from 50% to 16%. We will continue to utilize this strategy while polling the absent intakes to see if an additional pattern emerges that we need to address.

Crooked River Counseling, Norway, Maine

Engaging the client on the first call | The Walk-Through | Summary

Engaging the client on the first call

I called our agency on Monday Feb 4 to set up an appointment, acting as if I were a consumer. I was pleased that a live person* answered the phone; she was very polite and pleasant. However, I discovered that our "screening process" that determines "appropriateness and eligibility" could use some improvement. I found that the person doing the screening asked me questions, such as the name of my employer, that seemed to have nothing to do with why I was calling and that were too personal to be asking on my first call for help.
 
I was told that a clinician would get back to me within 24 hours to schedule an appointment. I wasn't given an appointment time or the name of a counselor who would call me back. As a consumer, I didn't feel very important. When I hung up the phone I thought about calling other places.

I had also presented myself as a self-pay client. I was told what the fee would be, but replied that I couldn't afford that much. She told me that they had a sliding fee scale but that I should discuss that with the clinician who will call me back. As a consumer, I didn't like that; it felt confusing.

Plan: Implement the following changes immediately:

1. Script the screening process for everyone that might answer the phone. Implement NIATx suggestions: congratulate people for taking the first step, ask about needs and time frames, streamline the screening sheet, removing unnecessary questions / information that are not consumer-friendly for the first phone call.
2. Change the scheduling practices. Insure that anyone who answers the phone has the ability to answer questions and schedule intakes. It is preferable to schedule the client within 48 hours.
3. Develop an incentive program for self-pays and keep it standard throughout the agency; make it clear on the first call when the question is asked.

____________
*It should be noted however, that the person who conducted this screening is new with the Agency. We plan to have all people within the agency go through this process and evaluate the changes.

The Walk-Through

My appointment was set for February 6 at noon. There were some things that I really liked. The clinician gave me directions to the facility and told me which door to arrive in. That was good and as a consumer cut down on wondering where I was going.
 
However, when I arrived, I entered a big waiting room. I looked around a bit, and wondered if I was supposed to "check in" with someone or not. It felt a little awkward. But the surroundings were comfortable.

The clinician greeted me almost immediately, brought me into her office and gave me the agency's welcome letter that outlines rights and responsibilities. She left me alone in her office for a few minutes to read it privately. As a consumer I felt my privacy was being respected, and it felt as though my confidentiality was secure. I wasn't asked any personal questions in the public area.
 
The clinician made me feel very comfortable and didn't jump into the assessment questions right away; she let me talk, which I liked. We were able to transition into talking about rights and responsibilities, fee's, etc., but it didn't seem abrupt or out of place. However, at one point, she did begin to ask a couple of questions from the assessment sheet, such as questions about abuse. This felt very invasive for my first session. At the end of the session she asked me if I thought it would work out and if I wanted to come back; I felt comfortable enough to say yes. All in all this was a fairly pleasant process. But there were a few areas to be improved.

Plan:

1. Make it standard for all clinicians to have the consumer in their office and review the rights and responsibilities, giving the consumer a few minutes of privacy.
2. Change the placement of the abuse assessment questions.
3. Hang up a sign in the waiting room large enough that lets the consumer know their counselor will be right with them and to please make themselves comfortable, taking the mystery out of "if" or "where" to check in.

Summary

For us, these two change projects go hand in hand. We will implement these changes immediately and study them over the course of the next couple of months. We will have another clinician do a walk through with the changes implemented and review the results, continuing with the change process as necessary.
 
All in all this process was very eye-opening. This is information that we would likely not have known without doing this study, and we would have continued to wonder why people don't come in for their first appointment, or don't come back. This has provided us with incredibly valuable information on how to better serve our consumers and make the process much more user friendly for a person seeking treatment. I am looking forward to having the other clinicians experience what the consumer experiences and hearing their feedback.
 
Catherine Bell, LADC, CCS
Crooked River Counseling, PA
Norway, ME 

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