Process improvement for behavioral health

Establish Walk-in Hours


Staff spends too much time making appointments that are not kept. No-shows for assessment appointments prevent other clients from using that time slot.


Establish walk-in hours so that clients are able to see a counselor for an assessment without an appointment.

Featured Stories

The Center for Drug Free Living in Orlando, Florida, reduced waiting times for treatment by implementing walk-in appointments. At first they held walk-in hours from 1-3 p.m. Monday through Thursday and gave clients the choice of scheduling an appointment or using the walk-in hours. Later, they shifted the walk-in hours to 8:30 a.m. Monday through Thursday and eliminated scheduled assessments altogether. They now serve 4-6 clients per day. This change eliminated their waiting list for outpatient treatment and is now an established program policy. Their automated voice messaging system now explains the walk-in procedure in detail.

Central New York Services in Syracuse, New York, eliminated both waiting times (from 36 days) and no-shows for assessments (from 50 percent) by offering walk-in appointments on a first-come, first-served basis. Billable assessments increased from 38 to 71 in the first month. They informed their referral sources about this change, contacted all clients with existing appointments to explain the new process, and posted a description of the process in the clinic.

Lessons Learned

  • Use back-up counselors to make sure there is adequate staff to meet demand.
  • Test walk-in hours on a small scale. Start with one morning or afternoon a week to determine whether the clients you serve will use walk-in hours. Some agencies found that their clients preferred to schedule appointment times.
  • Implement walk-in hours gradually during a transition period to alleviate staff anxiety about capacity to accept walk-in clients.
  • Estimate how many assessments you expect each week so that you have a starting point for how many hours to schedule staff to meet the expected demand.
  • Notify referral sources about the walk-in hours.
  • Accept any clients during walk-in hours no matter how they’ve heard about it.

Tracking Measures

Cycle Measure

  • Number of days until the next available assessment appointment
  • No-show rate for assessment appointments

Data Collection Forms



1. Collect baseline data for the number of days until next available assessment appointment.

2. Decide on a block of time slots during the week that you will offer walk-in hours.

3. Schedule counselors and assign backup counselors to cover the walk-in hours.


4. Test walk-in hours for two weeks by telling clients that they can come for walk-in service during the established hours, unless they would rather make an appointment.

5. Count the number of clients seen during walk-in hours and the number of walk-in clients who are turned away.

6. Check the number of days until next available assessment appointment.


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

8. Evaluate the change:

    • Were more clients seen during walk-in hours than in previously scheduled assessment appointments?
    • Were any clients turned away?
    • Were there enough backup counselors, and did they respond as requested?
    • Did you select the right block of time slots?
    • Did clients prefer walk-in appointments to scheduled appointments?
    • Did the number of days until the next available assessment appointment decrease?


9. Adjust the number of counselors or the number of walk-in time slots and retest this promising practice for an additional two weeks.

Repeat this series of steps to increase the number of counselors and time slots until you are serving your targeted number of walk-in clients.

More Stories

Connecticut Renaissance, Inc. in Bridgeport, Connecticut, eliminated the waiting time for assessments by offering walk-in assessments from 10 a.m. to 6:30 p.m. Tuesdays and Thursdays and 9 a.m. to 12 p.m. on Wednesdays and Fridays. The program director informed the three major referral sources about the new process to expedite admissions to outpatient treatment.

Gateway to Prevention and Recovery in Shawnee, Oklahoma, eliminated the waiting time for assessments (from 14 days) and eliminated their backlog of clients by implementing walk-in assessments. Callers are encouraged to come for assessment on the day they call, or the next day. Assessment appointments are now made only when required by contract or by the caller’s special needs. Counselors have protected time to perform assessments. Support staff has been instructed to offer assessment appointments within one working day of the request. They learned that it’s important to provide clear instructions to the support staff and counselors about new processes; if the instructions aren’t clear, the staff tends to come up with their own interpretation.

Kentucky River Community Care in Jackson, Kentucky, reduced the waiting time for the next available appointment from 21 days to one day by offering same-day/next-day appointments and by establishing specific times each day in the morning and the evening for new admissions. The appointment scheduler noted that most clients declined the next-day appointment and scheduled an appointment that was most convenient for them instead.

Southwest Florida Addiction Services in Fort Meyers, Florida, reduced the waiting time for assessments from 35 days to 7 days by offering walk-in assessments from 11 a.m. to 3 p.m. Monday through Thursday. With this reduction in waiting time, assessments increased from 112 per month to 122 per month, the average outpatient census increased from 269 to 296 clients per month, and revenue increased 7 percent in the first year and another 7 percent at the beginning of the second year. In addition, other programs—detoxification, prevention, etc.—can now transition their clients to outpatient services more quickly.

Acadia Hospital in Bangor, Maine eliminated no-shows for assessment appointments by implementing next-day assessments. They ask clients to come in at 7:30 a.m. on the next day for evaluation. This change resulted in $400,000 in additional revenue per year and eliminated the need to remind clients about assessment appointments.

Heartland Family Services in Council Bluffs, Iowa reduced the waiting time for assessments from 22 days to 5 days by scheduling walk-in assessments from 1-4 p.m. on Mondays and Thursdays and from 9:30 a.m. to 12:30 p.m. on Tuesdays and Wednesdays. This decreased the no-show rate from 81 percent to 19 percent and increased the percentage of clients that paid their fees at the time of service from 66 to 86 percent. In order to smooth the transition to walk-in assessments, they set the date for the switch three weeks in the future, when there were not yet any clients scheduled for assessments.  See the Heartland Case Study.