Process improvement for behavioral health

Use the Spirit of Motivational Interviewing during the First Contact


Clients are stuck between wanting to change and, at the same time, not wanting to change so they miss appointments if not adequately engaged.


Use open-ended questions and empathetic conversation to welcome and connect with clients during their first contact.

Featured Stories

Sinnissippi Centers, Inc. in Dixon, Illinois reduced the noshow rate to the assessment appointment from 58 percent to 14 percent by using a conversational approach for gathering information and engaging clients during the pre-admission process with outpatient and intensive outpatient clients. For more information, see the Sinnissippi MI Outline.

PROTOTYPES in Pomona, California reduced no-shows to the first face-to-face outpatient appointment from 36 percent to 10 percent by asking open-ended questions during the first contact to find out the most important things the client wanted to get out of treatment and by talking about a plan to assure that these needs would be met. For more information, see the PROTOTYPES Spirit of MI Protocol and their .

Boston Public Health Commission in Boston, Massachusetts reduced the no-show rate by 41 percent by using Motivational Interviewing during the intake conversation with outpatient clients.

Lessons Learned

  • Make the first contact personal.
  • Find out why they are calling, what they need, and what concerns they have about treatment.
  • Express empathy and concern.
  • Expect and honor resistance.
  • Help motivate prospective clients to engage in treatment.
  • Invite callers to talk about what they feel is most important to them and explain how treatment can help.
  • Create discrepancy to point out that the client seems to want to change and not want to change, at the same time.
  • Summarize their needs and concerns so that they know they have been heard.
  • The spirit of Motivational Interviewing (MI) can be incorporated into all conversations that staff have with clients, whether on the phone or in person.
  • Encourage referrers to use the spirit of Motivational Interviewing.

Note: The communication practices described in this promising practice are based on the principles of Motivational Interviewing (MI); however, formal training in MI is not required to implement this practice.

Tracking Measures

Cycle Measure

No-show rate for assessment appointments

Data Collection Form

No-show Tracking Spreadsheet



  • 1. Select a staff member who answers phones and is willing to experiment with this practice.
  • 2. Develop an outline or guide to use when clients first make contact with your agency. Review the guides attached to stories in this promising practice for ideas.
  • 3. Calculate the baseline no-show rate for assessment appointments.


  • 4. Have the selected receptionist practice using the guide by role-playing until the staff member feels comfortable connecting with clients without strict use of the outline.
  • 5. Have the staff member use the guide to connect with the next forty clients or for all prospective clients during the next two weeks, whichever happens first.
  • 6. Track and calculate the no-show rate for assessment appointments for the clients who were welcomed using the guide.


  • 7. Check the fidelity of the change. Was the change implemented as planned?
  • 8. Evaluate the change:
    • How did the no-show rate at the assessment appointment change for clients welcomed with the spirit of MI guide?
    • Did the staff member use the spirit of MI guide consistently?
    • Did the guide help the staff member connect with clients?
    • Did the guide flow smoothly?
    • Did many clients reschedule or cancel prior to their first appointment?


  • 9. Adjust the spirit of MI guide so that it flows more smoothly and so that it takes into account the reasons clients cancel or reschedule before their assessment appointment and re-test this promising practice for an additional two weeks.

Repeat this series of steps until you are satisfied with the guide and then expand the number of staff members trained to use it until the approach described in the guide is used to connect with all clients during first contact.

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