Process improvement for behavioral health

Eliminate Responsibilities during the First Two Weeks of Treatment


Clients feel overwhelmed when they first start residential treatment and leave.


Eliminate responsibilities during the first two weeks of treatment so clients can rest, if needed.

Featured Stories

Didi Hirsch Community Mental Health Center in Pacoima, California, reduced the dropout rate in the residential substance abuse treatment program for women during the first 30 days from 44 percent to 14 percent and increased length of stay from 125 days to 175 days by removing clients’ community responsibilities during the first 15 days of treatment. They also no longer required that the women be “covered” by another peer in the first 15 days of treatment, because clients found the process of finding someone in the program to be with them at all times during the first 15 days of treatment to be humiliating and to add more pressure. They learned from focus groups that clients felt overwhelmed with responsibilities and rules.

Fayette Companies in Peoria, Illinois, helped reduce the percentage of discharges against medical advice within the first 48 hours from 12 percent to 5 percent by giving clients a choice: spend time with staff or a peer, attend groups with a peer, or take time to rest alone.  See the Fayette Change Bulletin.

Lessons Learned

  • Assign chores and other responsibilities after clients have been in treatment for two weeks.
  • Even if not required, many clients will ask to participate in chores as soon as they get settled in.
  • Give clients the choice of participating in group sessions during the first few days if they need to rest.

Tracking Measures

Cycle Measure

Dropout rate

Data Collection Form

Residential Dropout Tracking Spreadsheet



1. Collect baseline data for the drop-out rate within the first 30 days of residential treatment.


2. For the next two-week period, eliminate responsibilities during the first two weeks.

3. Track and calculate the drop-out rate.


4. Check the fidelity of the change. Was the change implemented as planned?

    • Evaluate the change:
    • Did the drop-out rate decrease?
    • How did clients respond to not being assigned responsibilities?


5. Adjust responsibilities and requirements during the first two weeks and retest this promising practice for an additional two weeks.

Repeat this series of steps until you have established clear policies about responsibilities during the first two weeks of treatment.