Process improvement for behavioral health

Encourage Referrers to Make the First Appointment While the Client is Present


Clients are not ready, willing or able to make initial contact or appointment on their own.


Schedule the first appointment before the client leaves or is discharged from the referring agency. Begin treatment in the next level of care as soon as possible, preferably offering same day service.

Featured Stories

Acadia Hospital in Bangor, Maine increased the show rate for referrals from the Emergency Department into the intensive outpatient substance abuse program by 15 percent by giving the Emergency Department instructions to give to their patients about when and where to go to get an assessment and begin treatment the following day. See the Acadia Direct Admissions Checklist

Jackie Nitschke Center, Inc. in Green Bay, Wisconsin started outpatient aftercare treatment immediately after discharge from intensive outpatient treatment, without allowing any break in treatment.

Lessons Learned

  • Have the client call or have the referrer call on the client’s behalf, while the client is still in the referrer’s office.
  • For transitioning clients, schedule discharge so that it is the same day as an outpatient session, if possible.

Tracking Measures

Cycle Measure

Percentage of referred clients who were admitted

Data Collection Forms




1. Select one referral source.

2. For the selected referrer, collect baseline data to track the percentage of referred clients who were admitted.

3. Decide how clients will be scheduled for the first appointment before leaving the referrer.


4. Have the referrer schedule appointments for a specified number of clients before they leave the referrer’s office.

5. Track and calculate the percentage of referred clients who were admitted.


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

7. Evaluate the change. Did the percentage of referred clients who were admitted increase?


8. If this change was an improvement:

    • Adopt this change or adapt it for more improvement and re-test it with the same referrer.
    • Make this process available to all of the clients from the selected referrer.
    • Expand the use of this process to other referrers.
    • Document the processes that resulted in an improvement so that you and the referrer can continue to use them efficiently.
    • Test other, related promising practices that apply to your setting.

If this change was not an improvement and you can’t make it work, abandon this practice and test other promising practices that might be more successful in your setting.