Promising Practices

Promising Practices are changes that were tested and shown to be actual improvements by various behavioral health organizations.

Use the promising practices as inspiration for change in your organization—re-invent them, improve on them and be creative—and let us know what happens so that we can continue to enrich and expand the library of change ideas available to the entire NIATx network.

*Priority

Expected Benefit: A = High, B = Medium, C = Low

Ease of Implementation: 1 = Easy, 2 = Requires some time and resources, 3 = Requires significant time and resources

Promising Practices

Reduce Wait Time:

Reduce No-Shows:

Increase Continuation:

Increase Admissions:

Promising Practice	Excerpt	Priority	Reduce Wait Time	Reduce No-Shows	Increase Continuation	Increase Admissions
Become a Certified Medicaid Provider	Problem: Some providers do not have a process in place to bill for Medicaid. Solution: Become a certified Medicaid provider in order to get reimbursed for clients who qualify for Medicaid.
Become the Preferred Provider for Selected Referrers	Problem: Funding from current payer sources is saturated. Solution: If your agency has excess capacity and can accommodate more clients or you want your agency to expand or change the payer mix, build your relationship …
Ask Clients to Participate in Treatment Planning	Problem: Clients without a personal stake in their own treatment are less likely to stay engaged and continue treatment. Solution: Ask clients to participate in creating their own treatment plans with goals and objectives and …	A1
Assign Appropriate Clinician	Problem: Each third-party payer may have different credential or licensing requirements for the clinician who is providing services. Solution: Make sure you know what each third-party payer’s requirements are for credentials and licensing for different …	A1
Assign Counselor within 48 Hours of First Treatment	Problem: Clients do not connect with their counselor soon enough after their first treatment. Solution: Assign a counselor and meet with them within 48 hours of their first treatment. Featured Stories CAP Quality Care of Westbrook, …	A1
Avoid Friday Admissions	Problem: Clients leave treatment if they start just before the weekend, when residential treatment provides too little structure and support. Solution: Avoid admitting clients to residential treatment on Friday. Featured Stories Fayette Companies in Peoria, Illinois …	A1
Become a “Preferred Provider”	Problem: Some managed care companies or insurance companies will only pay for services provided by “preferred providers.” Solution: Contract with and become a preferred provider for desired third-party payers in order to get reimbursed for …	A1
Centralize Appointment Scheduling	Problem: When counselors schedule their own appointments they spend too much time making appointments and may also cause delays. Solution: Centralize appointment scheduling so that counselors can focus on seeing clients instead of scheduling, making …	A1
Collect Client Co-pays	Problem: Client co-pays are never collected, reducing potential revenue. Solution: Incorporate collecting client co-pays in the process of delivering treatment to ensure that you collect revenue that is due from clients. Featured Stories The Counseling …	A1
Dedicate a Staff Member to Each Payer	Problem: Each third-party payer may have different requirements for reimbursement. Solution: Dedicate a staff member to know what the requirements are for each third-party payer to ensure compliance and maximize reimbursement. Featured Stories Liberty Center …	A1
Eliminate Responsibilities during the First Two Weeks of Treatment	Problem: Clients feel overwhelmed when they first start residential treatment and leave. Solution: Eliminate responsibilities during the first two weeks of treatment so clients can rest, if needed. Featured Stories Didi Hirsch Community Mental Health …	A1
Eliminate the Blackout Period	Problem: Clients leave treatment because they feel isolated from family and friends. Solution: Eliminate “blackout” period for phone calls and visitors. Featured Stories Fayette Companies in Peoria, Illinois reduced the percentage of discharges against medical advice …	A1
Encourage Referrers to Make the First Appointment while the Client is Present	Problem: Clients are not ready, willing or able to make initial contact or appointment on their own. Solution: Schedule the first appointment before the client leaves or is discharged from the referring agency. Begin treatment …	A1
Establish Attendance Policy	Problem: Clients don’t know what is expected of them. Solution: Establish a clear attendance policy. Featured Stories Connections Counseling in Madison, Wisconsin increased attendance in its evening opioid treatment group sessions from 62% to 81% by …	A1
Find Out What Insurance Clients Have and/or For Which They are Eligible	Problem: Clients don’t know if they have insurance or are eligible for services. Solution: Ask clients what insurance they have to increase possible billings to third-party payers. Research other sources of information about insurance coverage. …	A1
Get Clients to Commit to Attend the First Four Treatment Sessions	Problem: Clients don’t know that attending the first four sessions is expected. Solution: Get a commitment from clients to attend the first four sessions. Featured Stories The Jackie Nitschke Center in Green Bay, Wisconsin increased attendance …	A1
Get Pre-Authorization	Problem: You don’t know if the third-party payer will cover treatment and some third-party payers require pre-authorization. Solution: Get pre-authorization for treatment to verify what will be covered and to ensure that you are following …	A1
Guide Referrers to Make Appropriate Referrals	Problem: Referrers do not refer clients that are suited to your treatment program. Solution: Guide referrers, especially if they are not providers of addiction treatment services, to screen for substance abuse problems. Guide all referrers …	A1
Hold Joint Staffings	Problem: Not enough timely information is exchanged between referring and receiving levels of care. Solution: Hold joint case consultations (often called “staffings”) that include clinicians from both the referring agency and the program they will …	A1
Keep in Touch with Clients on the Waiting List	Problem: Clients on the waiting list sometimes cannot be reached or are no longer interested in entering treatment when a bed becomes available. Solution: Keep in touch with clients on the waiting list to keep …	A1		Yes
Make Appointments during the First Call	Problem: Staff and counselors spend too much time returning phone calls to make appointments with clients. There are often delays returning phone calls Solution: Make an appointment or get a commitment from the client to …	A1
Tailor Brochures for Each Referral Source	Problem: Referrers do not have written materials with directions and guidance for clients to use to contact addiction treatment. Solution: Create customized brochures for each of your referral sources to provide contact information and descriptions …	A1				Yes
Track and Analyze Denials	Problem: Claims get denied. Solution: Track and analyze denials to identify reasons and correct for them in order to maximize reimbursement. Featured Stories Harbel Prevention And Recovery Center in Baltimore, Maryland reduced the number of entries …	A1			Yes	Yes
Use All Time Slots Including Special Use Time Slots	Problem: When time slots are set aside for special use they are often not used. Solution: Use all available time slots, especially appointments that have been set aside for special use. Featured Stories Sinnissippi Centers …	A1	Yes
Use Cost to Negotiate Rates	Problem: Providers don’t know what it costs to do business. Having this information may help negotiate better rates with third-party payers. Solution: Calculate the cost of providing services so you can use the information to …	A1			Yes	Yes
Adjust Staff Schedules to Meet Client Demand	Problem: There are not enough slots that are convenient for clients or the wrong mix of services is available, making it difficult for clients to schedule an appointment or continue in treatment. Solution: Adjust staff …	A2
Blend Levels of Care	Problem: Clients are waiting for one level of care when they could join existing treatment groups at any level. Solution: Blend other levels of care with outpatient treatment so that clients can develop therapeutic relationships …	A2
Combine Multiple Intake and Assessment Appointments	Problem: Clients spend too much time waiting for and attending multiple appointments before the first treatment session. Solution: Combine multiple intake, assessment, evaluation and admission appointments into a single assessment appointment. Featured Stories The Center …	A2
Cross-train Counselors and Assign Backups for Assessments	Problem: There are not enough counselors available to do assessments and counselors get burned out from doing too many assessments. Solution: Cross-train counselors to both assess and treat clients and assign backup counselors to see …	A2
Eliminate Excessive Paperwork	Problem: Clients and counselors spend too much time on paperwork, which could otherwise be used to decrease the waiting time for intake, assessment, and treatment. Solution: Eliminate excessive paperwork so that the required information is …	A2
Encourage Clients to Use PDSA Cycles to Test Their Own Changes	Problem: Clients are often stuck in ambivalence between wanting to change and at the same time, not wanting to change. Solution: Encourage clients to use PDSA Cycles to pilot test their own personal changes. Featured …	A2
Follow-up with No-shows	Problem: Clients don’t show for appointments and no one finds out why or tries to reschedule another appointment. Follow up with clients when they miss an appointment to find out why and to reschedule another …	A2		Yes
Give Counselors Regular Feedback on No-show and Continuation Rates	Problem: Counselors don’t know to what extent their clients continue in treatment. Solution: Keep track of clients’ no-show rates and continuation rates by counselor and provide feedback to counselors on a regular basis. Featured Stories …	A2		Yes
Help Eliminate Barriers to Treatment	Problem: Clients are unable to overcome barriers to treatment on their own, even when willing, and drop out of treatment. Solution: Help clients anticipate and solve the logistical problems involved with starting and staying in …	A2		Yes
Identify Clients at Risk for Leaving and Intervene	Problem: Clients often threaten to leave treatment and yet there is no follow-up to see what’s wrong and to help solve the problems. Solution: Get feedback from clients regularly so that you can identify clients …	A2
Meet with a Counselor and a Case Manager within 24 Hours of Admission	Problem: Clients do not connect with their counselor and case manager soon enough after admission. Solution: Schedule appointments for each client to meet with their counselor and case manager within 24 hours of admission. Featured …	A2
Offer a Safe, Private, and Clean Physical Environment	Problem: Clients do not feel safe and private in your facility. Solution: Provide an inviting and cheerful physical environment that allows for privacy. Featured Stories Perinatal Treatment Services in Seattle, Washington commissioned a mural of baby …	A2
Offer Groups for Clients Not Ready to Start Treatment	Problem: Clients are often expected to begin treatment before they are ready, which leads to no-shows and decreased continuation. Solution: Offer pre-contemplation groups for clients not ready to start treatment and address the issues that …	A2
Offer Groups that Remain Open to New Members	Problem: Too many groups with open slots are closed to new members, limiting the number of people who can enter treatment. Solution: Offer groups that remain open to new members, rather than closing groups until …	A2	Yes
Offer Help while on the Waiting List	Problem: Clients on the waiting list for a bed do not receive support and treatment. Solution: Provide interim outpatient services or self-help to clients waiting for a bed. Featured Stories WASTAR in Reno, Nevada offers outpatient …	A2	Yes
Offer More Groups Instead of Individual Sessions	Problem: Too many clients are seen individually when more could be seen in groups. Solution: Offer groups in place of individual sessions, so that counselors can see more clients during the same amount of time. …	A2
Offer New, Specialized Services	Problem: Funding from current payer sources is saturated. Solution: Create new niches by offering new and specialized services. Featured Stories St. Christopher’s Inn in Garrison, New York generated an additional $1,400,000 in revenue by offering services …	A2
Orient Clients	Problem: Clients don’t know what to expect and feel uncertain and anxious about entering treatment or continuing treatment at another level of care. Solution: Orient clients about what they can expect at the first appointment, …	A2		Yes
Remind Clients About Appointments	Problem: Clients miss assessment appointments and treatment sessions because they forget about appointments. Solution: Call clients 24-48 hours in advance to remind them about their next appointment. Featured Stories CAB Health and Recovery in Peabody, Massachusetts …	A2		Yes	Yes
Reward Clients for “In-Reach”	Problem: Knowing who to market services to and reaching prospective clients who would benefit from opioid treatment is a challenge. Solution: Have existing clients refer new clients. Featured Stories St. Vincent Catholic Medical Centers in Brooklyn, …	A2				Yes
Screen Callers Live on First Call	Problem: There are delays in screening during the window of opportunity when clients need immediate assistance. Solution: Screen callers live on the first call. Featured Stories CAP Quality Care of Westbrook, Maine connected callers to a …	A2	Yes
Tailor Treatment to Each Client’s Circumstances and Needs	Problem: Clients drop out of treatment that is not relevant to their particular situation. Solution: Tailor treatment based on feedback from clients about what groups and what topics they’re most interested in. Ask them to …	A2			Yes
Transition Clients to the Next Level of Care as Soon as They are Ready	Problem: Too many clients are not moving to the next level of care when they are ready, filling slots that could be used by others. Too many clients drop out of treatment because they are …	A2	Yes		Yes
Use Instant Urine Tests	Problem: Waiting for urinalysis test results delays first methadone dose. Solution: Use a “Quick-strip” or instant in-house STAT urine test to reduce waiting time for urinalysis results. Featured Stories Seven Hills Behavioral Health Services Methadone …	A2	Yes		Yes	Yes
Use Motivational Interviewing During Treatment	Problem: Clients are stuck between wanting to change and, at the same time, not wanting to change and need help focusing on their motivation to change and stay in treatment. Solution: Use open-ended questions and …	A2			Yes
Use the Spirit of Motivational Interviewing during the First Contact	Problem: Clients are stuck between wanting to change and, at the same time, not wanting to change so they miss appointments if not adequately engaged. Solution: Use open-ended questions and empathetic conversation to welcome and …	A2		Yes
Add Beds or Provide Housing	Problem: There are not enough beds to meet demand for residential treatment. Solution: Add beds or provide housing to increase capacity. Featured Stories Perinatal Treatment Services in Seattle, Washington increased the number of licensed beds from …	A3
Establish Walk-in Hours	Problem: Staff spends too much time making appointments that are not kept. No-shows for assessment appointments prevent other clients from using that time slot. Solution: Establish walk-in hours so that clients are able to see …	A3		Yes
Offer a Tour Guide	Problem: Clients are not ready, willing, or able to navigate the addiction treatment maze on their own. Solution: Offer clients and family a “tour guide” who speaks the languages and understands the cultures of both …	A3
Offer Intervention Services	Problem: Family members and friends do not know how to motivate clients to enter treatment. Solution: Offer intervention services to help family members and friends get people into treatment. Featured Stories Gosnold, Inc. in Falmouth, Massachusetts …	A3
Publicize Your New and Improved Services	Problem: People don’t know about the services you offer. Solution: Publicize your new and improved services, including your waiting time and continuation rates. Featured Stories Daybreak Youth Services in Spokane, Washington increased private bed days from …	A3				Yes
Assign Each Referrer a Single Contact Person	Problem: Too few referrals are made, and when they are, too few end in an admission. Solution: Assign one contact person to each referral source to ensure that the needs of the referral source are …	B1
Increase Collection of Client Co-pays	Problem: Client co-pays are never collected, reducing potential revenue. Solution: Increase collections of client co-pays by making information available about how much clients owe and assign responsibility to ask clients to pay. Featured Stories CAB …	B1
Increase Collections from Insurance Companies	Problem: Too much money billed to insurance companies is never collected. Solution: Increase collections from insurance companies by understanding requirements for payment and following up. Featured Stories STEPS at Liberty Center, Wooster, Ohio increased receipts …	B1
Schedule the First Appointment before Researching Financial Arrangements	Problem: Checking financial arrangements before scheduling the appointment delays treatment. Solution: Schedule first appointment and admit clients without checking their financial eligibility. Featured Stories Racine Psychological Services, Inc. in Racine, Wisconsin reduced the waiting time for …	B1	Yes
Assign Peer Buddies	Problem: Clients start treatment without being connected to other people in the treatment community. Solution: Assign peer buddies or mentors to help new clients connect with someone who knows what they’re going through, and to …	B2
Build Community Among Clients	Problem: Clients do not build new communities to replace their old ones. Solution: Build a sense of community among clients to foster support and engagement in treatment so they can experience what it’s like to …	B2
Collaborate with Referrers to Motivate Clients	Problem: Referrers do not use their influence to create natural consequences if the client doesn’t show. Solution: Collaborate with referrers who have the authority to follow up when clients miss an assessment appointment or treatment …	B2		Yes
Double-book Time Slots	Problem: When clients don’t show up for scheduled assessments, too many time slots go unused. Solution: Schedule two clients for the same assessment time slot. Featured Stories Women’s Recovery Association in Burlingame, California increased admissions from …	B2
Include Family and Friends	Problem: Clients do not strengthen their commitment to treatment by telling family and friends. Families and friends are not included in treatment, even though addiction is a “family disease.” Solution: Include family and friends in …	B2		Yes
Map Out Continuing Care	Problem: Clients do not know that recovery continues beyond the current level of care. Solution: Introduce a “roadmap to recovery” at regular intervals to show the treatment choices the client will have to make in …	B2
Offer Telephone Support	Problem: Clients do not have someone to facilitate the journey through addiction treatment and provide support during transitions from one level of care to the next. Solution: Stay in touch with clients during their transition …	B2
Overlap Levels of Care	Problem: Clients leave treatment without knowing where they will need to go or meeting any people at the next level of care.Solution: Overlap outpatient treatment with treatment from the referring level of care so that …	B2
Re-assign Non-clinical Tasks Performed by Clinicians	Problem: Counselors spend too much time on non-clinical tasks that could be performed by others, limiting their time to work with clients. Solution: Reassign non-clinical tasks so that counselors do not perform them. Counselors are …	B2	Yes
Streamline Paperwork between Levels of Care	Problem: Clients and staff spend too much time on paperwork during transitions between levels of care. Solution: Streamline the paperwork process between the referral source and program to eliminate duplication of effort. Featured Stories Central …	B2			Yes	Yes
Use Contingency Management to Collect Client Fees	Problem: Clients do not pay their fees, particularly when they have past due amounts, reducing potential revenue. Solution: Institute a contingency management program to provide an incentive for clients to pay their fees. Featured Stories …	B2				Yes
Use Motivational Incentives	Problem: Many clients need additional incentives to attend assessment, intake, and treatment sessions. Solution: Offer positive reinforcement or rewards to reinforce the desired behavior and to help motivate clients to stay in treatment long enough …	B2	Yes		Yes	Yes
Collaborate with Referrers to Streamline the Process	Problem: The transition process is complicated and referrers don’t participate in simplifying the process. Solution: Collaborate with referrers to streamline the process. Featured Stories The Partnership for Advancing Recovery in Kentucky (PARK) increased the percentage of …	B3
Improve the Payer Mix	Problem: Funding from current payer sources is saturated. Solution: Attract clients that will improve the payer mix. Featured Stories Daybreak Youth Services in Spokane, Washington increased private bed days and revenue by 30 percent by managing …	B3
Use Video Conferencing	Problem: Clients and/or staff have to travel too far for face-to-face appointments. Solution: Use video conferencing so the client can meet with a counselor or doctor while still in treatment at the referring agency. This …	B3			Yes	Yes
Refer Clients Elsewhere	Problem: Clients spend too much time waiting for treatment when they could be in treatment elsewhere. Solution: Refer clients elsewhere so that they can be seen right away. Featured Featured Stories Oakwood Clinical Associates in Kenosha, …	C1	Yes
			Reduce Wait Time	Reduce No-Shows	Increase Continuation	Increase Admissions