STAR-SI

Strengthening Treatment Access and Retention
State Implementation
Wisconsin STAR-SI Project

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About STAR-SI

The Wisconsin STAR-SI project which began in October 2006, is a three-year $885,000 federal grant initiative of the Wisconsin Department of Health Services (DHS) to improve outpatient treatment for alcohol and other drug use disorders. Funded by the federal Center for Substance Abuse Treatment, and in partnership with University of Wisconsin Network for the Improvement of Addiction Treatment (NIATx), University of Wisconsin Department of Family Medicine, Wisconsin Association on Alcohol and Other Drug Abuse, Wisconsin Alcohol and Drug Treatment Providers Association, and participating addiction treatment providers, STAR-SI intends to:

• Reduce waiting times and waiting lists
• Increase admissions to substance abuse treatment
• Reduce appointment no-shows
• Improve transfers among levels of care
• Increase successful treatment completion

These access and retention indicators are some of the greatest predictors of successful recovery. With support from project staff, participating treatment providers use a variety of proven quality improvement (QI) tools and approaches developed by engineers such as W. Edwards Deming of Toyota fame. Tools such as walk-throughs, consumer interviews and focus groups, Plan-Do-Study-Act rapid cycle testing, flow-charting, root-cause analysis, nominal group technique, customer window, and other activities are used to plan and achieve measurable improvements. The DHS will also review and remodel state policies that pose barriers to achieving these aims.

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Participating Treatment Agencies

Participating Treatment Agencies

First Grant Year (2006-2007)

• ARC Community Services, Madison (from the '05-'06 pilot)
• Dennis Hill Harm Reduction Center, Milwaukee
• Family Services of Northeast Wisconsin Inc., Green Bay (from the '05-'06 pilot)
• Genesis Behavioral Services Inc., West Bend
• Grant/Iowa Counties Unified Community Services, Lancaster
• Meta House, Milwaukee
• Oakwood Clinical Associates, Kenosha (from the '05-'06 pilot)
• Racine Psychological Services Inc., Racine (from the '05-'06 pilot)
• Tamarack Behavioral Health Center, Manitowoc (from the '05-'06 pilot)
• Wood County Unified Services, Wisconsin Rapids (from the '05-'06 pilot)

Added in Second Grant Year (2007-2008)

• 7C's Community Counseling Clinic, Milwaukee
• Arbor Place, Menomonie
• ARC Fond du Lac, Fond du Lac
• Jackie Nitschke Center, Green Bay (also an original NIATx agency since 2004)
• St. Joseph's Hospital, Alcohol and Drug Recovery Services, Marshfield
• ThedaCare Behavioral Health, Menasha
• Tri-County Women's Outreach of the Human Service Center, Rhinelander
• Human Development Center and Women in Transition of Douglas County Health and Human Services, Superior
• Women's Way of Lutheran Social Services, Eau Claire

Added in Third Grant Year (2008-2009)

• ACCESS, Inc. (Aurora Community Counseling), Spooner
• Ashland Area Council on Alcoholism and Other Drug Abuse, Ashland
• Benedict Center, Milwaukee
• Brown County Human Services Department, Green Bay
• Koller Behavioral Health, Woodruff
• La Crosse County Human Services, La Crosse
• Mental Health Center of Dane County, Madison
• Polk County Human Services Department, Balsam Lake
• St. Croix County Health and Human Services, New Richmond
• Waukesha County Department of Health and Human Services, Waukesha

Map of the STAR-SI Providers in Wisconsin (PDF, 56KB)

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Selected STAR-SI Success Stories

Alcohol and Drug Recovery Services of St. Joseph Hospital, Marshfield, reduced the no-show rate for service appointments from 33% to 14% using reminder call variations.

Arbor Place, Menomonie, reduced the no-show rate for all service appointments from 25% to 15% using reminder call variations and counselor contacts after no-shows.

ARC Community Services, Madison, reduced the overall no-show rate to sessions in the intensive outpatient program from 31.7% to 15.8%. The effective change ideas included asking each client to make a verbal and public commitment to other women in the therapy group to attend the next session and after each group session respond to the question, “What was most helpful tonight?”.

ARC-Fond du Lac, increased attendance at the first four day-treatment sessions for clients living in non-structured settings from 65% to 100% by informing clients of the studies showing that attendance at the first four scheduled sessions significantly increases the likelihood of staying clean and sober; asking clients, “Can you make a commitment to attend all of your first four scheduled days of treatment?”; “Are there any problems that may keep you from getting here your first four days?”; and ”What can we do to help you with those problems so that you can get to treatment?”

Dennis Hill Harm Reduction Center, Milwaukee, reduced the no-show rate to treatment sessions from 52% to 46% using a “fish bowl” raffle incentive.

Family Services of Northeast Wisconsin, Inc., Green Bay, increased attendance across three groups from 55% to 73% by offering small gift incentives ($5 value) to clients for attending three consecutive group sessions.

Genesis Behavioral Services, West Bend, increased the percentage of client co-pays collected from 37% to 92% by developing a weekly payment tracking form and having Counselors collect client co-pay fees at the front desk prior to the start of group. Genesis increased their revenue from a deficit of $13,000 to a surplus of $17,900.

Grant/Iowa Counties Unified Community Services, Lancaster, reduced clients’ waiting time to start of treatment from 54 to 15.7 days by increasing group sizes to 10 people and maintaining open groups.

Human Development Center, Superior, reduced the no-show rate for assessment appointments from 42% to 26% using a mailed invitation and introduction letter from the counselor.

Jackie Nitschke Center, Green Bay, reduced no-shows to the initial intake appointment from 36% to 19% using motivational interviewing techniques during the initial phone contact with the client, adopting a universal schedule, and making reminder calls.

Meta House, Milwaukee, reduced no-shows to intake appointments among women referred by Child Welfare agencies from 67% to 45% by confirming the referral with the client and addressing any barriers to attending the first appointment.

Oakwood Clinical Associates, Ltd., Kenosha, reduced the waiting time from first contact to assessment from 15 days to 7 days by scheduling assessment appointments at first contact and offering same day or next day appointments.

Racine Psychological Services, Inc., Racine, decreased their wait-time to first appointment from 17 days to 7 days by adding one group during the week and attempting to fill cancelled OWI assessment appointments.

Tamarack Behavioral Health Center, Manitowoc, increased retention to the third treatment session from 51% to 58.5%. The change idea implemented was to reduce the paperwork so staff can spend more time building rapport with clients.

ThedaCare Behavioral Health, Menasha, succeeded in reducing registration-related appointments for OWI clients from six to three while realizing non-billable cost savings of $15,100. These improvements also resulted in clients receiving services quicker – the days clients waited from first contact to admission were reduced from an average of 48 days to 11 days. Increased client satisfaction also occurred subsequent to the declines in waiting time.

Tri-County Women’s Outreach, Rhinelander, reduced the no-show rate for all service appointments from 51% to 34% using reminder call variations.

Wood County Unified Services, Wisconsin Rapids, increased continuation to the 4th treatment session for one-to-one clients from 31% to 89% by making reminder calls 48 hours before the appointment and asking clients, “How do you plan to get to the appointment?”

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STAR-SI Spotlight on…

Door County Department of Community Programs

Since October 2006, the Wisconsin STAR-SI Project has grown from ten participating substance abuse treatment agencies to 31 by offering trainings, such as the Motivational Interviewing Institute, and collaborating with organizations, such as the Dane County Chemical Dependencies Consortium and Milwaukee's WIser Choice program. In addition, STAR-SI participants have spread the NIATx model as they take positions at new agencies. Tina Marie Baeten first learned about STAR-SI at the initial training in August of 2005, when she was a Clinical Supervisor at Family Services of Northeast Wisconsin. At Family Services, she and her change team implemented change projects that significantly reduced no-shows and increased continuation in treatment. When she was hired by Door County Department of Community Programs to develop and implement programming to reduce their four to six month waiting list for AODA services, Tina felt that the STAR-SI process could help address the problem.

Implementing the NIATx model at Door County presented some new challenges to Tina. At Family Services, she and her team learned the NIATx process together. She worked with a team she knew well to improve an established intensive outpatient program. At Door County, Tina began working with a fairly new team to build an intensive outpatient program. This proved to have some benefits; they were already focused on client needs and were willing to try a new program to better meet them. It was also exceptionally helpful that Tina's new supervisor, Joe Krebsbach - Director of Community Programs was familiar with and in support of the NIATx approach. In addition, Tina's past successes with the NIATx model gave the team confidence that things could improve. Tina described how she and her team were able to begin implementing changes almost immediately because, "I have experience with a process that worked in addressing wait list issues…With my previous experience and data to prove it, I had to spend little time getting "buy in" from those who were carrying out the plan."

The Door County Change Team progressed quickly with their changes and saw dramatic results. Within two months they began an intensive outpatient program, developed and implemented a screening process, established a system for data collection, and started two skills groups to engage clients waiting for an assessment. The new screening process told them which level of care the client needed and allowed them to offer IOP services to appropriate clients immediately. After four months, all 55 clients on the wait list had entered treatment and clients were only waiting two weeks for a screening session!

STAR-SI and the NIATx model have been successfully adopted by substance abuse treatment providers throughout Wisconsin because they effectively help providers improve their services and meet clients' needs. Tina affirms that, "STAR-SI involvement is well worth the effort and time; it is especially helpful in addressing issues for the AODA clients who present a small window of opportunity for treatment readiness." For her, some of the greatest benefits of involvement have been connecting and networking with other agencies and, "having a simple process that really works in making changes that guide us in most effectively serving and helping meet the needs of clients."

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STAR-SI Topic of the Month

[Coming next month]

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STAR-SI Events

October 20-21, 2009
Community of Commitment: Building the Business Case
Madison, WI
For more information go to www.niatx.net or contact:
Amy McIlvaine
Telephone: (608) 262-5999
Email: amy.mcilvaine@chess.wisc.edu

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STAR-SI Links

Description of national STAR-SI activities:
The STAR-SI Initiative

Network for the Improvement of Addiction Treatment (NIATx) at the University of Wisconsin – Madison
www.niatx.net

Let's Take ACTION Together, NIATx's initiative to expand addiction treatment quality improvement nationwide
www.actioncampaign.org

University of Wisconsin Department of Family Medicine
www.fammed.wisc.edu/research/external-funded/star-si

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STAR-SI Resources

NIATx QI Model Key Principles (PDF, 682KB)

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Contact STAR-SI

Need more information?
Contact Deanne Boss
STAR-SI Coordinator
University of Wisconsin Department of Family Medicine
Telephone: (608) 263-0304
Email: deanne.boss@fammed.wisc.edu

Last Revised: November 13, 2009