Process improvement for behavioral health

Offer Groups that Remain Open to New Members


Too many groups with open slots are closed to new members, limiting the number of people who can enter treatment.


Offer groups that remain open to new members, rather than closing groups until the entire curriculum is complete.

Featured Stories

Prairie Ridge Addiction Treatment Services in Mason City, Iowa reduced the waiting time for treatment from 24 days to 15.7 days by offering open groups that did not require the group to complete an entire series of sessions before new members could join. A few of their specialty groups remained closed. This made it possible to offer same-day assessments and admissions for residential and outpatient treatment.

Unified Community Services of Grant and Iowa Counties in Lancaster, Wisconsin reduced the waiting time from assessment to treatment from 54 days to 26 days by switching from closed to open groups. Whenever group enrollment fell below 8 people, the next person on the waiting list was invited to begin treatment. They increased the group size from 8 to 10 people after the state approved a variance allowing STAR-SI participants to increase their group size from 8 to 10 people. This change decreased waiting time further, to 17.5 days.

Gosnold, Inc. in Falmouth, Massachusetts designed a 16-session curriculum that can be started at any session. The curriculum includes standard elements that increase skills of selfmanagement in early recovery and elements that support building motivation, including multiple versions of decisional balance exercises. Ongoing group affiliation and problem solving support these and other elements.

Lessons Learned

  • Create continuous entry programs for clients.
  • Design the curriculum to allow for continuous entry as opposed to closed groups that begin at the same starting point.
  • Offer some groups that welcome new members.

Tracking Measures

Cycle Measures

Number of days until the next available treatment session

Data Collection Form

Next Available Appointment Tracking Spreadsheet



  • 1. Collect baseline data for number of days until next available treatment session.
  • 2. Decide which one closed group could be offered as an open group for clients starting treatment.
  • 3. Adjust the curriculum for the selected group so that new clients can join.


  • 4. Offer the open group to new clients for the next two weeks.
  • 5. Re-check the number of days until the next available treatment session.


  • 6. Check the fidelity of the change. Was the change implemented as planned?
  • 7. Evaluate the change:
    • Were counselors able to adjust the curriculum to integrate new clients?
    • Did the older clients welcome the new clients?
    • Did the number of open groups that were offered increase?
    • Did the number of days until the next available treatment session decrease?


  • 8. Adjust the curriculum for the open group(s) or the number of open groups that are offered and re-test this promising practice for an additional two weeks.

Repeat this series of steps until the as many groups as possible are open to new members.