Streamline Admissions

There have been many studies looking at predictors of treatment entry. (Hser et al, 1998; Hu et al, 1997; Joe et al, 1998; Ryan et al, 1995; Weisner et al, 2001). And although the results are often varied as far as the variables examined, one factor consistently surfaces as the main reason for entering into treatment. The clients’ own internal motivation to seek help is time and again listed as the number one reason for engaging in treatment. As seen in the research examining first contact, the clients’ motivation will not always stay at a high level for a very long time. Therefore it is very important to be able to engage clients in treatment in a timely manner. Streamlining the assessment process is one way in which facilities can accelerate intake and more effectively engage clients’ in treatment.

Woody et al (1975) reviewed a rapid intake procedure implemented at the Philadelphia VA Drug Dependence Treatment Center. Normally, intake appointments were scheduled on Mondays and Thursdays. At the initial appointment the client would meet with an intake counselor, complete paperwork and give a urine sample. The client was then told to return on the next intake day where they would be evaluated by a “vocational rehabilitation counselor, informed of VA benefits, given a short battery of psychological tests, and seen by a physician.” The clinic decided to modify its’ procedures to enable a quicker response. Scheduling was eliminated as intake became a walk-in process. The entire intake process was reduced to one day. Psychological testing was continued but on a twice a week scheduled basis. With this new process clients were now able to enter treatment the same day as the intake appointment. The results show that clients entering through the rapid intake procedure actually had higher retention rates at two months then the group entering through normal procedures (55% to 30%). This clinic was dealing with heroin addicts and the ability of the staff to prescribe methadone treatment on the same day the client walked in was seen as a “treatment glue” that increased the likeliness of the patient to continue treatment. As seen in previous research, overall attrition was not adversely affected by rapid intake.

Dennis et al (1994) evaluated a government sponsored waiting list reduction program at a community based methadone treatment center in Pittsburgh. The initiative attempted to streamline the admission process and reduce wait time from 49 days to two days. In order to achieve these goals the assessment process was shortened from two weeks to two days. Generally clients were entered into treatment at the end of the second day of assessment. They were also hoping that this would increase overall admissions by 25%. Before the study the percentage of clients who entered treatment held steady at approximately 44% of those who made an initial contact. After the process change, the percentage of kept appointments increased to a mean of 63%.

Engaging adolescents in treatment is another area where retention rates are historically poor. Szapocznik et al (1988) documented that out of 650 adolescents who made an initial contact for treatment, only 22% were admitted and only 11% completed treatment.

Garner et al (2002) evaluated an attempt by an outpatient substance abuse treatment program for adolescents to streamline its admission procedures. The hope was that by reducing the amount of time from intake to treatment a higher number of adolescents would actually engage in treatment. The assessment process was compressed into one day and clients would leave with an appointment scheduled. Previously the assessment process was scheduled over two days, a treatment recommendation would then be made and the clinic would attempt to contact the client to schedule an appointment for initial treatment. The results in this study were mixed. They were able to reduce the amount of time from intake to treatment and the raw number of adolescents admitted did increase by 16% but there was not a statistically significant higher percentage of clients entering treatment when compared with the control group. The authors believe that one explanation for this is that adolescents often have much higher external motivation levels for entering treatment such as family pressure and legal coercion.