1. 1 Overview Increasing Group Attendance Charles Sellers, New Age Services Corporation, Chicago

2. 2 The Problem In January 2010, NASC offered 6 groups, with 50 clients participating in groups the week of Jan. 1, 2010. NASC would like to increase group participation 100% by June 30.

3. 3 Change Team One director, two supervisors (clinical and nursing), three counselors, receptionist, tox tech and the building supervisor were on the team. One client was on the team (four were invited). Nominal group technique was used to generate ideas.

4. 4 Chosen Option Clients currently involved in a group would formally invite new clients to that group. Several people on the team, including the client, noted that informal groups existed in the lobby, parking lot, etc. lead by “client leaders”. These groups could be positive or negative in nature (discuss resources, discuss counselors, etc.) Peer involvement and direction seemed to be a driving force. The change team decided that we should utilize peer influences that could lead clients might togroups if brought to the group by another client.

5. 5 PDSA Plan –Formal invitations were written for existing group clients to give to new clients. Do –Existing group clients handed out invitations to new clients following each group session –This occurred for 4 weeks in five groups. Study –Average group attendance would be measured after the 4 weeks.

6. 6 PDSA Study –Average group attendance did not change significantly or consistently. First PDSAAverage Clients in Group MonthCareerWomensSWCLBMParenting January10.711.322.711.77.3 February (test month)11.011.520.510.59.0 Change0.3 -2.2-1.21.7 % Change3.13%2.22%-9.56%-10.00%22.73% SWC: Sustain without Cocaine Support Group LBM: Life Beyond Methadone Support Group ACTION: Review implementation process, ID potential changes to implementation plan for better results

7. 7 PDSA Issues identified as barriers to implementation: –Inconsistent delivery of invitation by existing group clients; do they really want to give the invitation? Were all invitations delivered? –Groups may have reached critical mass, can they take on new clients? –NASC had developed new groups since implementation plan was created, are clients being diverted to these groups instead? PDSA Cycle Two Implementation Change: Group Facilitators will deliver invitations to identified clients. Only new, developing groups would be included. Maintain 4 week measurement benchmark.

8. 8 PDSA Cycle Two Results Second PDSAAverage Clients in Group MonthCareerMensRecoveryOrientation Jan-March10.55.86.39.6 April (test month)10.54.878.8 Change0.00.7-0.8 % Change0.00%-17.24%11.11%-8.33% Again, no significant, consistent changes in group attendance.

9. 9 Lessons We thought we had a good idea, created through a good process that involved client input. The data doesn’t demonstrate that the idea will work. There are variables we didn’t account for initially (group facilitator reaction to the proposal, existing group exclusivity) and some we changed midstream (applying changes to different groups in each cycle. We still think we have a good idea, but must let it rest and move on to other pressing issues. Our change team learned the value of repeated cycles, even if we didn’t find success. We have worked the process well, and are motivated to take on the next challenge.