Process improvement for behavioral health

Build Community Among Clients


Clients do not build new communities to replace their old ones.


Build a sense of community among clients to foster support and engagement in treatment so they can experience what it’s like to be part of a healthy community.

Featured Stories

Bridge House in New Orleans, Louisiana, re-established a more client-centered program serving 75 men and 25 women when they re-opened their doors after Hurricane Katrina. They created a therapeutic community clients make decisions about how the entire community functions.

Gosnold, Inc. in Falmouth, Massachusetts, maintained continuation rates consistently above 80 percent by incorporating music and art into treatment activities. Residential patients collaborated to support each other as they pursued their personal (Plan-Do-Measure-Act) change cycles. They also offered meditation, yoga, and daily exercise programs. For more information, see the Gosnold Change Bulletin.

Lessons Learned

  • Create a supportive treatment environment with fun and varied group activities—along with the hard work of treatment and recovery—to help reinforce the message that sobriety is preferable to using drugs and alcohol.
  • Use the treatment community as a model for how to stay on the path to recovery when clients complete treatment.
  • Arrange for clients to participate in mutual support groups such as AA and NA.

Tracking Measures

Cycle Measure

No-show rate for treatment sessions

Data Collection Form




  • 1. Select one group in which to test this change.
  • 2. Collect baseline data to track the no-show rate for the selected group.
  • 3. Generate ideas for building a sense of community:
    • Hold focus groups with clients to brainstorm and discuss ideas.
    • Consider ideas from the stories included in this promising practice.


  • 4. Select one way to build community among clients and implement it with the selected group for two weeks.
  • 5. Track and calculate the no-show rate for the selected group after implementing the change.


  • 6. Check the fidelity of the change. Was the change implemented as planned?
  • 7. Evaluate the change:
    • What additional ideas about building community did your clients provide? Your staff members?
    • Did the no-show rate decrease?


  • 8. Adjust or add to the types of community activities and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you have developed a supportive, healthy community with varied activities for all of your clients.

More Stories

Fayette Companies in Peoria, Illinois turned role-playing into an entertaining activity and used drawing for prizes for completing stages of treatment as an activity that reinforced positive connections with others. For example, they give prizes that allowed someone to take one of their peers to lunch or a movie. For more information, see the Fayette Change Bulletin.

Sinnissippi Centers in Dixon, Illinois offered recreational activities for adolescents, including experiential adventure therapy that stresses challenges.

Axis 1 in Barnwell, South Carolina, allowed participants to direct their own group sessions. A number of the women also decided to share a weekly meal with each other. They arrived at the agency early to eat together, socialize, and support each other. For example, the women’s group went with the counselor and case manager to see an inspirational speaker who talked about the potential for better lives.

Wood County Unified Services in Wisconsin Rapids, Wisconsin, increased continuation rates through the first five sessions from 70 percent to 90 percent over the course of nine months. They welcomed new intensive outpatient clients to group sessions and asked group members to introduce themselves and explain why they were in the program. Patients were matched with a more senior patient who assisted the new patient by showing them restrooms and break areas. They also asked new patients if they were willing to commit to returning to treatment the next day. If not, they discussed what kind of support or what else the patient needed to return.