Process improvement for behavioral health

Transition Clients to the Next Level of Care as Soon as They are Ready


Too many clients are not moving to the next level of care when they are ready, filling slots that could be used by others. Too many clients drop out of treatment because they are in an inappropriate level of care.


Move clients to the appropriate level of care as soon as they are ready.

Featured Stories

STEP 2 in Reno, Nevada reduced the waiting time for treatment from 15 days to 10 days by reviewing treatment plans to ensure that clients were at the appropriate level of care. Eligible clients were then transitioned to the next level of care to increase the number of openings for new clients.

Fayette Companies in Peoria, Illinois allowed clients to decide when it was time to leave treatment and used this opportunity to normalize what might have otherwise been considered an early departure. This increased the chances that clients would stay in treatment at some level of care instead of leaving treatment completely. For more information, see the Fayette business case.

St. Croix County in New Richmond, Wisconsin reduced the waiting time from first contact to treatment from 77 days to 43 days and reduced the waiting list from 30 to 11 by offering brief treatment using TIPS (#34) criteria for intoxicated drivers instead of requiring them to undergo a complete treatment process. They established criteria to determine whether clients would benefit from brief treatment, including whether the client had a dual diagnosis, resources for prolonged treatment, strong familial, peer, or community support, previous treatment episodes, and/or a history of abuse or less severe substance abuse.

The Patrician Movement in San Antonio, Texas instituted a more aggressive case management system to better track scheduled and completed discharges to ensure that clients remained in treatment the appropriate length of time and that clients ready for discharge were discharged on a timely basis. This change made it possible for clients on the waiting list to access treatment more quickly.

Lessons Learned

  • Coordinate efforts between the referring and receiving levels of care and encourage joint participation in treatment during client transitions.
  • Offer brief treatment, if appropriate.

Tracking Measures

Cycle Measure

  • Number of days until next available appointment
  • Percentage of referred clients who were admitted

Data Collection Form



  • 1. Identify the criteria for moving clients to the next level of care.
  • 2. Depending on the aim you’re focusing on, collect baseline data for:
    • Number of days until next available treatment session
    • Percentage of referred clients who were admitted


  • 3. Ask two or three counselors to apply the placement criteria to each of their clients for the next two weeks. Make sure that the counselors also keep track of any barriers to moving clients to the next level of care.
  • 4. Re-check the number of days until the next available treatment session or track and calculate the percentage of referred clients who were admitted.


  • 5. Check the fidelity of the change. Was the change implemented as planned?
  • 6. Evaluate the change:
    • Did the placement criteria correctly identify patients ready to be moved to the next level of care?
    • Were barriers to appropriate transitions reduced?
    • Did moving clients to the next level of care reduce the waiting time for new clients?
    • Did moving clients to the next level of care increase the number of clients who continued in treatment and who transitioned to the next level of care?


  • 7. Adjust the placement criteria, the number of counselors, or the type of client to which the criteria is applied and re-test this promising practice for an additional two weeks.

Repeat this series of steps until the placement criteria are consistently applied and methods for appropriately moving clients to the next level of care are in place.