Process improvement for behavioral health

Establish Attendance Policy


Clients don’t know what is expected of them.


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 establishing a clear attendance policy. Feedback from clients revealed that they wanted the same participants to consistently attend group, led by the same two counselors, from week to week. Previously clients were allowed to attend either the 5:30 pm or 6:30 pm group. Clients were assigned to a specific session and then were held accountable for attending. If they had 2 unexcused absences in a row, they had to fill out a group absentee form and were required to meet with their counselor to problem solve about attendance barriers such as transportation and childcare. They communicated the new policy to clients and staff, which helped counselors treat all clients consistently. Group cohesiveness and abstinence increased.
Related resources:
Connections Group Absentee Form
Connections Change Project Protocol

CAP Quality Care of Westbrook, Maine, decreased no-shows to opioid treatment groups by 11.5% by limiting sign-ups to just one group at a time. Formerly, clients were signing up for multiple groups without really expecting to attend them all. Staff communicated the new policy to clients in writing.
See the case study, CAP One Group at a Time.

Lessons Learned

  • Clients benefit from clear expectations and consistency.
  • Opioid treatment clients may benefit from more structure and consistency.

Tracking Measures

Cycle Measure

  • No-show rate to assessment appointment or treatment sessions

Data Collection Forms



1. Decide on attendance policy.

2. Collect baseline data on attendance at treatment sessions.


1. Announce attendance policy.


1. Check the fidelity of the change. Was it implemented as planned?

2. Track attendance.

3. Evaluate the change.

    • Did the no-show rate decrease?
    • What was the clients’ reaction to the attendance policy?
    • What was the staff’s reaction to the attendance policy?


1. Adjust the attendance policy if needed and re-test.

Repeat this series of steps until you have refined your attendance policy for all groups.