1. Universal Counseling Services Baltimore, Maryland

2. History April 2007 BSAS invited three providers to attend First Annual NIATx Summit held in San Antonio, Texas. Providers were energized around process improvement. UCS began by having several walk thrus Started a change team Began to make some changes Joined with two other providers and BSAS for Advancing Recovery.

3. Project Aims Reduce time from first contact to first appointment Reduce time from first appointment to medication start date. Increase continuation of care.

4. Goals and Measures In 2007, UCS’ change team was formed to address the problems of: Increasing wait time for first appointment Baseline data showed 53.6 days. Lengthy wait time from intake to date first medicated Baseline data showed 11 days. Lengthy wait time to complete intake process Baseline showed 2-3 hours to complete intake process.

5. Changes Implemented Streamlined paperwork Reduced signatures required by client from 14 to 1

6. Changes Implemented ASI-MV Staff used demo for training, feedback from customers on ASI process, restructured group room to accommodate the computers, did analysis of old computers to see if usable, Trained staff including office support staff and other counselors in other programs, used three week period to test, ran a test date to make sure all equipment was functioning as required. Reduce time to complete intake process from 2 to 3 hours to 1 hour. 3 to 4 intakes per staff versus 6 to 7 intakes per staff a day.

7. Changes Implemented Open Access Scheduling Rescheduled intake schedule to Mondays Moved IOP treatment hours to Tuesday thru Friday to accommodate Monday Intakes Moved staff hours to have all available on Monday for overflow intakes Trained staff on new procedures. Reduce wait time to 4.3 days (from 53.6 days)

8. Changes Implemented Physician Availability by Demand Physician time allotted to grant was evenly disbursed weekly throughout contract period. For example, the contract paid for 8-10 hours a month. Physician was scheduled for 4 hours every other week but customers came in waves. Discussed with physician ability to be flexible in scheduling understanding that there may be weeks without appointments. Reduced time to first medicated to 3.3 days (from 11 days) Further reduced to =/< 48 hours.

9. Business Case Impact Reduced wait times. Reduced counselor time spent on intakes throughout the week. Decreased wait times makes service marketable. Increased intakes of insurance and other payer groups lead to need for additional staff. Increased Utilization Staff More involved in positive change process resultng in increased job satisfaction Have a voice in making changes and opportunities to be change agents

10. Lessons Learned Making process changes and sustaining them requires commitment from entire agency As barriers to admission decrease, acuity level of patients increased. Senior staff need to model change by working with line staff. Data needs to be reviewed frequently to be of value to staff and to motivate staff as well as to explore successes and identify effect of changes.

11. New/Planned Changes Implementation of MI

12. New/Planned Changes Implementation of Incentive Program Using orientation video and ASI-MV pre intake process.