Process improvement needs in substance abuse treatment: Admissions walk-through results

Abstract

Researchers have questioned whether the addictions treatment infrastructure will be able to deliver high quality care to the large numbers of people in need. In this context, the Robert Wood Johnson Foundation (RWJF) and Center for Substance Abuse Treatment (CSAT) created a nationwide network to improve access and retention in treatment. Applicant agencies described results of an admissions process "walk-through." This qualitative study used narrative text from 327 applications to RWJF, focusing on admissions-related problems. We developed and applied a coding scheme, then extracted themes from code-derived text. Primary themes described problems reported during treatment admissions: poor staff engagement with clients, burdensome procedures and processes, difficulties addressing the clients' complex lives and needs, and infrastructure problems. Sub-themes elucidated specific process-related problems. Though findings from our analyses are descriptive and exploratory, they suggest the value of walk-through exercises for program assessment and programlevel factors that may affect treatment access and retention.

Using a standardized patient walk-through to improve implementation of clinical trials

“…Walk-throughs are widely applied in initiatives such as the Network for the Improvement of Addictions Treatment (Ford et al, 2007) to address process improvement needs in substance abuse treatment admissions walk-through results. Typically, treatment program personnel conduct these walkthroughs to identify and improve problem areas such as wait times or retention.…”

Improving Care for the Treatment of Alcohol and Drug Disorders

“…admission, intake, transition between levels of care) in order to identify specific service delivery problems. 16 If the change team focus is the intake and assessment process, for instance, they call for an appointment, complete the intake process, and begin care. As they walkthrough the admission process, they note their impressions and reactions to the services as they are delivered and seek input from staff on what they would like to see improved.…”

“…An analysis of admission walkthroughs from 327 NIATx applicants identified four consistent problems: 1) poor staff engagement with clients, 2) burdensome procedures and paperwork, 3) challenges in addressing complex patient needs, and 4) infrastructure barriers. 16 As a result of walkthroughs, programs better align treatment processes with patient needs and, overtime, apply process improvement to a full range of patient concerns.…”

Improving client engagement and retention in treatment: The Los Angeles County experience

“…The walkthrough exercise is critical to understanding how the organization engages a potential new client and shapes the client's "first impression" of the services being offered. The strengths and limitations of the agency's ability to provide timely care, to successfully engage new clients in treatment, and to retain them for an adequate period can be identified during the walkthrough exercise (Capoccia et al, 2007;Evans et al, 2007;Ford et al, 2007). • Change Team: One vehicle for implementing service improvements is the establishment of a Change Team (facilitated by a Change Leader) to identify process barriers and then plan and implement experiments designed to improve the existing process (Langley, Nolan, Nolan, Norman, & Provost, 1996).…”