Process improvement for behavioral health


Minnesota Change Team Learns to Use Data for Decision Making

NUWAY Counseling Centers offer an affordable extended care treatment continuum that includes residential and outpatient with recovery residence support at multiple locations in the Twin Cities and greater Minnesota communities. After attending the NIATx Change Leader Academy hosted by Minnesota Association of Resources for Recovery and Chemical Health in 2019, NUWAY staff returned to the St. Paul Counseling Center inspired and ready to launch a change project.

Walk-Through Results

Kris Kelly, Program Manager for the Great Lakes ATTC, MHTTC, and PTTC served as NIATx coach for the NUWAY change team. She joined the team’s spring  meeting to review the results of their walkthroughs and discuss next steps.

“We found that the intake and assessment process is pretty solid,” said Kris. “The average length of time from first contact to first day of treatment is 24 to 48 hours.”

A review of the walk-through results helped the change team define their change project aim: to reduce the number of atypical discharges within the first 30 days of an Intensive Outpatient Program. An atypical discharge can happen when a client chooses not to complete treatment or leaves treatment without being referred to another program.


The team then turned to the next tool in the NIATx toolbox, flowcharting, to map out the treatment process from the customer perspective once they complete intake.

Nominal Group Technique

The NUWAY team also used another essential NIATx tool, the Nominal Group Technique (NGT), to identify where in the process they could embed a Peer Recovery Specialist to support continuation in treatment.

Kris explains, “Peer recovery support services were added to the Minnesota Medicaid benefit set in 2018 and are part of the state’s substance use disorder reform. Providers are now working on ways to embed peers effectively into the clinical treatment team.”

(The peer recovery specialist workforce is an emerging workforce, with peer support now part of the Medicaid benefit set in 41 states. However, there has not yet been much analysis of best practices in embedding peers.)

In the discussion that followed the NGT, the group had an “aha!” moment: they presumed that most of the atypical discharges were from clients not living in one of NUWAY’s recovery residence partners. Clients with less connection to the recovery community, they believed, would be more inclined to leave treatment.

Collecting and Analyzing Data

But what did the data say? Collecting and analyzing data is a key activity in NIATx change projects. The team went back to the discharge data to test their theory.

“Once we reviewed the data, we found that the majority—60%—of atypical discharges live in recovery residences, while only 40% of atypical dischargers were not in recovery residences at time of discharge,” Kris explained.

“This showed us the importance of turning to the data, rather than making decisions based on an assumption.”

The change project aim

“The change project will test using peer support to reduce atypical discharges, and will measure if that decreases atypical discharges within a specific group living in NUWAY recovery residences,” said Kris.

In defining their change project aim, The NUWAY change team used several NIATx tools: the walk-through, flowcharting, the nominal group technique, and data collection. For Kris, collecting and examining atypical discharge data was especially instructive.

“Direct service behavioral health providers don’t get a lot of training on the value of data to their work,” added Kris. “NIATx offers an approachable way for a behavioral healthcare provider to make decisions based on data versus perception.”