Process improvement for behavioral health

Offer More Groups Instead of Individual Sessions


Too many clients are seen individually when more could be seen in groups.


Offer groups in place of individual sessions, so that counselors can see more clients during the same amount of time.

Featured Stories

The Center for Drug Free Living in Orlando, Florida decreased the waiting time for treatment from 24 days to 8 days and increased the number of assessments from 43 to 52 per month by using a group format instead of individual appointments for the initial appointment. At first, the assessment group was limited to 10 clients, but they soon eliminated this limit because many of the clients registered for this group did not show up anyway.

STEPS at Liberty Center in Wooster, Ohio reduced the waiting time for treatment from 62 days to less than 15 days and increased admissions by 40 percent by implementing a weekly assessment clinic for all new clients. During the first half of the meeting, the staff welcomed participants and provided an orientation to the agency; during the second half, each participant met with an agency therapist for a diagnostic assessment. While some clients were undergoing assessment, the others participated in an information session for clients new to treatment. Attendance for this group increased significantly when they changed the name from “Assessment Clinic” to “Assessment Group”.

Lessons Learned

  • Groups require more work and energy than individual sessions so balance the number of groups and individual sessions that each counselor leads each week.
  • Orientation: Use a group to orient clients to your program, either with a counselor alone or in combination with a video.
  • Assessments: Assess clients by combining a group informational session with brief individual assessments that are private and confidential.
  • Treatment: Provide treatment in a group setting instead of or in addition to individual sessions.

Tracking Measures

Cycle Measure

Number of days until the next available treatment session

Data Collection Form

Next Available Appointment Tracking Spreadsheet



  • 1. Collect baseline data for the number of days until next available assessment appointment and/or treatment session.
  • 2. Plan a group to offer in place of individual sessions.


  • 3. Select a small group of clients—either for orientation, assessment, or treatment—and schedule one or two group appointments during the next two weeks.
  • 4. Re-check the number of days until next available assessment appointment and/or treatment session.


  • 5. Check the fidelity of the change. Was the change implemented as planned?
  • 6. Evaluate the change:
    • Did clients prefer group appointments to individual appointments?
    • Were counselors able to provide the appropriate level of care?
    • Were group sessions scheduled at the appropriate times?
    • Did the number of days until the next available appointment decrease?


  • 7. Adjust the number of clients, the number of group sessions, or the type of group and re-test this promising practice for an additional two weeks.

Repeat this series of steps until the desired number of counselors and clients are scheduled in groups for orientation, assessment, and treatment.

More Stories

Cornerstone Counseling Center in Salt Lake City, Utah reduced the waiting time for intensive outpatient (IOP) treatment from 14 days to 7 days or less by implementing a skills group focused on topics such as relapse prevention for clients new to intensive outpatient treatment. After completing the skills group, the clients join the main IOP group. If a client has to wait more than a week to begin the IOP skills group, they are scheduled with at least one individual therapy session to address readiness-to-change issues. This change also reduced the dropout rate from 17 percent to 5 percent during the first four weeks, and then to 3 percent after they made further improvements during the implementation of four more IOP skills groups.

TERROS, Inc. in Phoenix, Arizona increased counseling capacity and access to treatment by adding extra therapy groups on weekdays and Saturdays.