Process improvement for behavioral health

Give Counselors Regular Feedback on No-show and Continuation Rates


Counselors don’t know to what extent their clients continue in treatment.


Keep track of clients’ no-show rates and continuation rates by counselor and provide feedback to counselors on a regular basis.

Featured Stories

Daybreak Youth Services in Spokane, Washington increased the show rate from 72 percent to 84 percent by providing counselors with feedback about clients’ attendance rates. For more information see the case study Daybreak Change Bulletin and the DaybreakActivityLog.

Palmer House in Tulsa, Oklahoma, increased the total number of direct service hours for adolescent outpatient services from 39 hours a week to 84.75 hours a week and increased the average number of direct service hours from 5.5 hours a week to 14.12 hours a week for each counselor. First, they required counselors to submit a detailed report of direct services provided in place of a timesheet; this provided baseline data on counselor performance and also helped reveal and adjust for the uneven distribution of caseloads. Then, they shared productivity reports for all staff at weekly staff meetings, which helped motivate and challenge staff to improve. Next, they provided individual feedback to counselors about their performance. In these sessions, a supervisor met with a counselor to discuss the week’s caseload and expectations, and brainstorm ideas about how to increase client attendance and reduce no-shows. Counselor reaction to this change was positive, as it allowed them to discuss their own performance and set goals. These changes increased the total program revenue from $1,901 per week to more than $4,924 per week and increased average revenue per counselor from $271.57 per week to more than $820.66 per week.

Lessons Learned

  • Provide data about no-show rates and/or continuation to fourth treatment session by counselor.
  • Present the information to counselors at regular staffing meetings.
  • Provide information about how each counselor’s no-show rates or continuation rates compare with averages for all counselors.
  • Talk about strategies that counselors with lower no-show rates or higher continuation rates are doing that other counselors may be able to utilize.

Tracking Measures

Cycle Measure

No-show rate for treatment sessions

Data Collection Form

No Show Tracking Spreadsheet



  • 1. If you do not have a way of tracking no-show rates or continuation rates to the fourth treatment session by counselor, decide how you will collect this information.
  • 2. Identify a few counselors who are interested in getting information about their clients’ no-show rates.
  • 3. Collect baseline data for no-show and continuation rates for the selected counselors.


  • 4. Present the data to the selected counselors, providing their individual data and the average for all counselors.
  • 5. Track and collect no-show rates for these counselors for the next 2 weeks.


  • 6. Check the fidelity of the change. Was the change implemented as planned?
  • 7. Evaluate the change:
    • Did the information help counselors to become more aware of their clients’ continuation rates?
    • Did no-show rates decrease when counselors got feedback?
    • Did discussion help give counselors new ideas?


  • 8. Adjust the data reporting system or discussion about it and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you have refined your approach to giving counselors feedback about their clients’ no-show and continuation rates. Give feedback to all counselors. Continue to experiment with different ways for counselors to exchange ideas about how to increase continuation rates.