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IUHR - Staff Training on Access and Retention (STAR) Abstract

Staff Training on Access and Retention (STAR) Abstract

The Entre Familia residential program and the MOM's Project outpatient facility at the Boston Public Health Commission (BPHC) serve African American and Latina women in need of substance abuse treatment. These programs, as most substance abuse treatment programs, face a number of challenges related to access and retention of clients. The Staff Training on Access and Retention (STAR) project focuses on improving clients' access to and retention in substance abuse treatment by using process improvement techniques in which treatment center staff use existing resources to improve services.

We accomplish this by using "change teams" to initiate improvement efforts for the organization's goals. Serving as key members of the change team are: staff from the outpatient and residential programs, a change team leader from the Institute on Urban Health Research at Northeastern University, and the executive sponsors. Each site, Entre Familia and MOM's Project, has its own change team with the same executive sponsors and change leader. These change teams use rapid change cycles, lasting 3 to 6 months, to impact four distinct aims identified by the Network for the Improvement of Addiction Treatment (NIATx): continuation, timeliness, admission, and no show rates. Each of these aims plays a major role in substance abuse treatment. In the last year, the Mom's Project and Entre Familia change teams have been focusing on timeliness with admissions as a secondary gain and continuation rates. Thus, we began a cycle at MOM's focusing on building relationships with clients. The cycle consisted of all active clients, 30 on average, receiving a phone call on Fridays to ask them how they were doing and their plans for the weekend. This phone call was meant to be a non-judgmental manner of reminding clients of the support system available to them. The phone call also encouraged clients to continue making progress towards meeting their goals. The calls were made on Fridays because staff's experience indicated that most clients relapse during the weekends. For clients who were not available to answer the phone, we left a voice mail message.

Results demonstrated the importance of client/staff relationship in a woman's likelihood of continuing substance abuse outpatient treatment. Baseline data from April to June 2006 showed an average continuation rate of 42% at Mom's project. After the implementation of the cycle, the six-month continuation rate, calculated as the average from July 2006 to December 2006, was 81%. Findings suggest staff/client relationship building is an important measure for women to continue in treatment. At Entre Familia a cycle on lowering the wait time between first contact and admission (timeliness) as a primary goal with higher admissions rates as a secondary finding began December 2006. The cycle proposed training staff to use Motivational Interviewing (MI) techniques when conducting the revised phone intake with prospective clients. Baseline data from September to November 2006 showed an average of 6 days between first contact and admission. After full implementation of the cycle including the training of all staff members, in February 2007, only 4 days lapsed between first contact and admission.

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