Process improvement for behavioral health

Re-assign Non-clinical Tasks Performed by Clinicians


Counselors spend too much time on non-clinical tasks that could be performed by others, limiting their time to work with clients.


Reassign non-clinical tasks so that counselors do not perform them. Counselors are typically the most limited resource.

Featured Stories

STEP 2 in Reno, Nevada reduced the waiting time for treatment from 10 days to 5 days by shifting non-clinical responsibilities (e.g., administering urinalysis, giving out bus passes, etc.) from counselors to a client advocate. Several counselors kept track of everything that they did for several days; then they analyzed the results to identify activities that did not have to be performed by counselors.

Perinatal Treatment Services in Seattle, Washington increased available counselor time by inviting nurses to attend staffings, so that counselors didn’t need to spend time giving updates about clients who needed medical attention.

Gateway to Prevention and Recovery in Shawnee, Oklahoma increased available counselor time by shifting some information collection tasks from clinical staff to support staff.

Lessons Learned

Have several counselors keep track of all of their activities each day for several days so that they can evaluate how they’re spending their time. For example:

  • Ask clients to make appointments at the front desk, rather than with the counselor.
  • Ask non-clinical staff to complete essential paperwork.
  • Ask clients to complete essential paperwork if they are able.
  • Ask student interns and volunteers to file and shred paperwork.

Tracking Measures

Cycle Measure

Number of hours per week that counselors spend in direct client time

Data Collection Form




  • 1. Count the number of hours per week that counselors spend in direct client time.
  • 2. Have a few willing counselors keep track of all of their activities on their calendars for several days, to identify non-clinical tasks that they are performing.


  • 3. Discuss ideas for reassigning tasks and/or other ideas for spending time more efficiently.
  • 4. Re-assign one or more of the non-clinical tasks to a non-clinical staff member for two weeks.
  • 5. Re-count the number of hours per week each counselor spends in direct client time.


  • 6. Check the fidelity of the change. Was the change implemented as planned?
  • 7. Evaluate the change:
    • Did each counselor spend less time on non-clinical tasks?
    • Did each counselor spend more time with clients?
    • Did you select tasks appropriate for re-assignment?
    • Did you select the right staff member to whom you re-assigned the tasks?
    • Were you able to identify other ideas for using time more efficiently?
    • Did the number of days until the next available appointment decrease?


  • 8. Adjust the number of counselors, the re-assigned tasks, or the person assigned the tasks and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you have re-assigned as many of the non-clinical tasks as possible to staff members who are not counselors.

Related Tools

To document activities, use the Time Ladder Activity Log.