Problem:
Clients don’t know that attending the first four sessions is expected.
Solution:
Get a commitment from clients to attend the first four sessions.
Featured Stories
The Jackie Nitschke Center in Green Bay, Wisconsin increased attendance in their Aftercare program over the first five sessions from 38 percent to 83 percent by creating a policy that requires clients to attend the first five treatment sessions without any absences. They analyzed their own data and discovered that clients who attended the first 5 sessions without any absences tended to complete treatment. They developed a contract that describes attendance expectations. Clients were then required to sign this contract when beginning treatment. Of the clients who attended the first five sessions, 63 to 79 percent went on to complete all 16 sessions. For more information, see the change bulletin as well as the Attendance Contract.
Community Concepts in South Paris, Maine developed a script recommending that clients try attending four sessions before deciding whether to stay. They suggested that counselors say, for example: “Johnny, I want to ask you to attend 3 or 4 sessions with me before you decide whether counseling is ok with you. You need to get to know me, I need to get to know you. I may be having a bad day today, and I want you to get a good chance to see if counseling can help you. Will you make a commitment to attend 3 or 4 sessions before deciding?” During the wrap up of the session, the counselor reminded the client of the idea of attending 3 or 4 sessions before deciding: “Johnny, I want you to try a few more sessions before you decide whether counseling is working for you. Can you commit to coming back 3 more times? Great! I look forward to getting to know you more and how I can help you with your goals.”
Lessons Learned
- Use your own agency’s data to demonstrate to clients the importance of attending the first four sessions for successful treatment completion.
- Ask clients to reconfirm their commitment to come back at the end of each session.
Tracking Measures
Cycle Measure
No-show rate for treatment sessions
Data Collection Form
ActionSteps
Plan
- 1. Select a group to test this change.
- 2. Collect baseline data for the no-show rate at the selected group.
- 3. Create a script to document how you will ask clients to make a commitment to attend the first four sessions.
Do
- 4. Ask clients who will be entering the selected group to make a commitment to attend the first four sessions for the next two weeks.
- 5. Track and calculate the no-show rate at the selected group for the same two-week period.
Study
- 6. Check the fidelity of the change. Was the change implemented as planned?
- 7. Evaluate the change:
- Did the no-show rate decrease?
- What was the clients’ reaction to making the commitment?
- Were you able to resolve barriers for clients who were unable to make the commitment?
Act
- 8. Adjust the script used to get commitment to attend the first four sessions based on the experience of this group of clients and re-test this practice for two more weeks.
Repeat this series of steps until you have refined the process for getting a commitment and expand this practice until all of your clients are doing so.
More Stories
ARC Community Services in Fond du Lac, Wisconsin increased continuation from the first to fourth session from 54 percent to 90 percent by explaining to clients the importance of attending the first four sessions without absence. They required clients to sign off on the commitment as part of the intake signature process and asked if there were any barriers that would prevent them from attending. They ensured that all of their staff implemented this change consistently by printing the script on purple paper and making it a standard part of the intake paperwork.
ARC in Madison, Wisconsin increased attendance at group sessions from 68.3 percent to 78.3 percent by asking clients to make a verbal and public commitment to attend the next group session. This provided an opportunity to identify clients who might quit treatment and to address any concerns that the client might have had about continuing in treatment.