Process improvement for behavioral health

Orient Clients


Clients don’t know what to expect and feel uncertain and anxious about entering treatment or continuing treatment at another level of care.


Orient clients about what they can expect at the first appointment, what they can expect during treatment, and what is expected of them. Orientations may begin before admission and prior to discharge from a referring level of care.

Featured Stories

First Appointment

Kentucky River Community Care in Jackson, Kentucky reduced no-shows for assessment appointments from 65 percent to 39 percent by describing the first visit to new outpatient clients over the phone and by following up with appointment letters and reminder calls.

During Treatment

Brandywine Counseling in Wilmington, Delaware developed an orientation video for clients to view on the day of their intake. This video replaced group orientation sessions that were only held twice each week. For more information, see the Brandywine change bulletin.

Mid-Columbia Center for Living in The Dalles, Oregon increased continuation from 59 percent to 84.5 percent by having clients attend a pre-treatment group after assessment to teach them the rules and expectations of group and the stages of change. The clients discussed their motivations for being in treatment and created their treatment plans.

Next Level of Care

Acadia Hospital in Bangor, Maine increased continuation from detoxification to intensive outpatient treatment (IOP) from 55 percent to 75 percent and increased admissions from detox to the IOP program by 45.5 percent by having from their intensive outpatient (IOP) program visit clients in inpatient detoxification to explain the IOP program and personally invite them to attend.

The Partnership for Advancing Recovery in Kentucky (PARK) created video orientation for the outpatient program that they show clients before they leave the hospital. The video was filmed from the client’s point of view. For more information about this change and all of the changes implemented by PARK, see the PARK Continuum of Care and the PARK article.

The Patrician Movement in San Antonio, Texas increased continuation from residential to outpatient treatment from 10 percent to 30 percent by inviting alumni to present their experiences to clients in residential groups, in combination with other changes.

Lessons Learned

  • Create a script to start orienting clients, during the first contact. This helps facilitate training new staff as well.
  • Use a video orientation.
  • Provide expectations or checklists for clients to refer back to.
  • Have counselors from the next level of care or alumni orient clients.

Tracking Measures

Cycle Measure

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

Data Collection Forms



  • 1. Decide how you will orient clients.
  • 2. Depending on the aim you’re focusing on, collect baseline data for:
    • The no-show rate at the sessions immediately following the orientation session. For example, if orientation is held after the assessment appointment, calculate the no-show rate at the first few treatment sessions.
    • The percentage of referred clients who were admitted.


  • 3. Orient the next forty clients or all prospective clients for the next two weeks (whichever happens first).
  • 4. Track these clients and calculate their no-show rate or the percentage that were admitted.


  • 5. Check the fidelity of the change. Was the change implemented as planned?
  • 6. Evaluate the change:
    • How did clients respond to the orientation?
    • Did the no-show rate at the sessions following the orientation decrease?
    • Did the percentage of oriented clients who were admitted increase?


  • 7. Adjust the method of orienting clients, the content of the orientation, or the timing, and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you have refined your method for orienting clients and this method has been made available to all of your clients.

More Stories

First Appointment

The Jackie Nitschke Center, Inc. in Green Bay, Wisconsin created an information sheet for the person who answered the phone to use to ensure that clients received consistent information about what to expect.

During Treatment

The Jackie Nitschke Center, Inc. in Green Bay, Wisconsin developed a contract that describes attendance expectations. Clients were required to sign this contract before beginning treatment. For more information, see the change bulletin as well as the Informed Consent and Attendance Contract documents.

VIP Community Services in New York, New York allocated staff and scheduled time to provide one-hour, small-group sessions to explain different aspects of their intensive outpatient program, including policies and procedures, as well as special offerings such as Metro cards and meals.

Fayette Companies in Peoria, Illinois developed checklists for different phases of treatment. For more information, see the Fayette business case.

Connecticut Renaissance, Inc. in Bridgeport, Connecticut gave clients a letter explaining attendance expectations.

Next Level of Care

Palladia, Inc. in New York, New York has outpatient counselors explain outpatient services to residential clients once a month. For more information about this and other changes that Palladia made, see Palladia’s case study.