Process improvement for behavioral health

Include Family and Friends


Clients do not strengthen their commitment to treatment by telling family and friends. Families and friends are not included in treatment, even though addiction is a “family disease.”


Include family and friends in the treatment process right from the start, so that they understand how treatment works, how to support the person in treatment, how the recovery process will continue after treatment at this level of care ends, and so that they can get help as well. Include family and friends in the admission process as well as when planning for discharge.

Featured Stories

STEPS at Liberty Center in Wooster, Ohio, found that clients with family support had higher completion rates. Of the clients who indicated that they had support from their families, 77.3 percent completed six sessions, whereas those who did not, had a completion rate of only 45.5 percent.

Gosnold, Inc. in Falmouth, Massachusetts has a member of the admissions staff greet the family in the lobby. The admissions staff person explains what to expect, answers questions, and instructs family and friends to inform the counselor if the client wants to leave treatment. Gosnold also provides a fact sheet to explain who’s who in the treatment process and to provide facts about addiction. They also developed a curriculum for families based on feedback obtained from the families and friends of clients.

Lessons Learned

  • Clients often report that they have no family. However, research from the National Institutes on Drug Abuse (NIDA) indicates that the family is often aware of the client’s predicament but unsure about how to proceed.
  • Families want to help; they don’t know what to do.
  • Invite family members and friends to the client’s first appointment.
  • Educate the client’s family and friends so that they know what to expect and how to provide support for the client in treatment.
  • Offer support groups for the family and friends of clients in treatment.
  • Keep family and friends informed about the client’s progress in treatment.
  • Offer a direct family program phone line for family members to call.
  • For ideas about ways of engaging the family, see Gosnold Family Informed Engagement

Tracking Measures

Cycle Measure

  • No-show rate to assessment appointment or treatment sessions
  • Percentage of referred clients who were admitted

Data Collection Forms




  • 1. Select one referral source.
  • 2. Decide how you will include family and friends at admission, during treatment, or during discharge planning.
  • 3. Depending on the aim you’re focusing on, collect baseline data for the:
    • No-show rate
    • Percentage of referred clients who were admitted


  • 4. Test including family and friends at admission, during treatment, or during discharge planning, for several clients during the next two weeks.
  • 5. For the selected clients, track the no-show rate or the percentage of referred clients who were admitted.


  • 6. Check the fidelity of the change. Was the change implemented as planned?
  • 7. Evaluate the change:
    • Depending on the aim you’re focusing on:
      • For the selected clients, did the no-show rate decrease?
      • For the selected clients, did the percentage of referred clients who were admitted increase?
    • Did the client’s family and friends attend when invited?
    • How did clients and their family members and friends react to being included?


  • 8. If this change was an improvement:
    • Adopt this change or adapt it for more improvement and re-test it with more clients or more referral sources.
    • Explore other ways of including family and friends during admission, discharge, or treatment.
    • Document the processes that resulted in an improvement so that you can continue to use them efficiently.
    • Test other, related promising practices that apply to your setting.

If this change was not an improvement and you can’t make it work, abandon this practice and test other promising practices that might be more successful in your setting.

More Stories

Fayette Companies in Peoria, Illinois, encouraged family and friends to take part in the admission process. See the Fayette Change Bulletin.

Women’s Recovery Association in Burlingame, California, offers sessions for friends and family who are required to attend before they are allowed to visit a client in residential treatment.

The Jackie Nitschke Center, Inc. in Green Bay, Wisconsin, includes family and friends in admission planning and discharge planning. Prior to admission, when agency staff members talk with family members to obtain collateral information, they also make sure the family members understand the admission requirements and what will happen if these are not in place. These include, for example, that the client been through detoxification, is medically able to participate and has seen a doctor. Discussion about discharge planning begins in family sessions and on family day, to make sure that everyone has realistic and consistent expectations about what will happen after discharge. Family members also write letters about how they have been affected by the client’s recovery; these letters are presented in group therapy sessions.

Daybreak Treatment Services in Spokane, Washington, includes parents in their adolescent clients’ treatment sessions.

Prairie Ridge Treatment Services in Mason City, Iowa, offers a group for family members called “Living in Balance,” which uses a unique open, nonthreatening environment to ask questions, understand how to help, and understand how actions can help or hurt the process of recovery. This group is intended for family and friends of persons that struggle with substances, and clients in recovery who are open to understanding how their substance use affects the people that they love.