Process improvement for behavioral health

Follow Up with No-shows


Clients don’t show for appointments and no one finds out why or tries to reschedule another appointment.

Follow up with clients when they miss an appointment to find out why and to reschedule another appointment.


Follow up with clients when they miss an appointment to find out why and to reschedule another appointment.

Featured Stories

Acadia Hospital in Bangor, Maine increased the continuation rate by 15 percent by making follow-up calls for no-shows. They found a staff person with a nice telephone voice and manner; she said “We were worried that you didn’t come. Is something wrong? Can we help? Ask for me and I’ll help you get oriented to the program and help you get going.”

Axis 1 in Barnwell, South Carolina reduced the no-show rate from more than 60 percent to just above 40 percent by using a new case manager position to focus on outreach to and contact with clients. This case manager, who was knowledgeable about the surrounding community and experienced in addiction treatment, made appointment reminder calls, followed up with no-shows, and helped clients work around logistical barriers to treatment such as transportation and childcare. The case manager also visited some clients at home and sought them out in various places to invite them back to treatment. This personal interest and attention has brought several people back to treatment and may have even saved the life of one woman how received essential medical help as the result of a visit from the Axis 1 case manager. For more information, see the Axis Change Bulletin.

Lessons Learned

  • Follow-up to find out why the client did not show up and address barriers to continuing with treatment.
  • Use the information you gather for other change ideas that could help other clients.
  • Start by following up with the first missed appointment, so clients realize that someone will notice and cares if they don’t show, right from the very beginning. Continue this practice to follow up no-shows to assessment, orientation, individual sessions, and group sessions.
  • Have counselors make follow-up calls and use Motivational Interviewing to help reengage clients.
  • If clients do not show up on time, call or start looking for them 10 to 15 minutes after the scheduled appointment time.
  • Follow up with clients who canceled assessment appointments and never rescheduled.

If you decide to implement this promising practice to follow-up with no-shows to the assessment appointment as well as treatment sessions, implement the changes as two separate Change Projects, focusing on two separate aims:

  1. Reduce no-shows to assessment appointment.
  2. Increase continuation during treatment.

This approach will make it easier to determine what kind of follow-up communication works best for a client who has never been to your agency as opposed to a client who is returning. The type of conversation is likely to be different.

Tracking Measures

Cycle Measure

  • Reschedule rate for clients who do not show for an appointment
  • No-show rate for rescheduled appointment

Data Collection Form



1. Depending on the aim you’re focusing on, collect baseline data for the reschedule rate for clients who did not show for assessment appointments or treatment appointments, without any follow-up.

    • Number of clients who did not show for appointment
    • Number of clients who rescheduled
    • Reschedule rate (the percentage of clients who rescheduled after not showing for an appointment)

2. Identify a staff member who will follow up with clients who miss an assessment appointment or treatment appointment.

3. Create an outline or guide to find out why the client didn’t show, to discuss possible solutions, and to reschedule the missed appointment.


4. Use the guide to follow up with the next forty no-shows or all of the no-shows during the next two weeks, whichever happens first. (Do not follow up with clients who rescheduled appointments without any follow-up.)

5. Track these clients and calculate the no-show rate for the rescheduled appointments.


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

7. Evaluate the change:

    • What percentage of the clients that you tried to follow up with were you actually able to reach to reschedule another appointment?
    • What percentage of the clients you reached rescheduled?
    • What percentage of clients did not show for the rescheduled appointment?
    • Do you have the most appropriate staff member following up with noshows?


8. Adjust the outline, the staff members following up with no-shows, or the way that you reach clients who do not show for an appointment and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you are following up with all of the clients when they miss or cancel the first appointment. You may want to spread this change idea to follow up with no-shows to group sessions or individual sessions during treatment as well.

Note: Following up with clients who have already begun treatment may require a different conversation than for clients who have not been to your agency at all.

More Stories

The Center for Drug Free Living in Orlando, Florida, had counselors call outpatient clients who failed to attend the first appointment within 24 hours to encourage them to return to treatment. Of the clients who failed to attend the first appointment, 70 percent returned and completed at least four treatment sessions.

Connecticut Renaissance, Inc. in Bridgeport, Connecticut, decrease the no-show rate by 17 percent by implementing a protocol whereby the clinician made phone contact with clients within 24 hours of missing an individual or group session. For more information, see ConnRen NoShow Protocol

Daybreak Youth Services in Spokane, Washington reduced no-shows from 28 percent to 16 percent by having counselors monitor no-show rates for their clients; this helped raise awareness and allowed them to intervene. See the Daybreak Activity Log used to track each client’s attendance and the overall no-show rates for clients, by counselor. For more information, see the Daybreak Change Bulletin.

Mid-Columbia Center for Living in The Dalles and Hood River, Oregon, decreased no-shows from 16.1 to 7.5 percent at The Dalles and from 15.6 percent to 8.4 percent at Hood River by requiring clients who canceled twice or no-showed once for their assessment appointment to speak to the screener before scheduling another appointment. The screener used Motivational Interviewing techniques to explore the client’s barriers to treatment.