1. Universal Counseling Services Baltimore, Maryland

2. Advancing Recovery Aim Improve the quality of buprenorphine treatment through increased access to care and improved long-term retention of clients.

4. Barriers to Meeting This Aim Longer and Longer wait time from first contact to first appointment Lengthy wait time from intake (first appointment) to date first medicated Time to complete intake process Baseline showed 2-3 hours to complete intake process.

5. UCS Goals Reduce time from first contact to first appointment Reduce time from first appointment to medication start date. Increase continuation of care.

6. Changes Implemented Walk Thru Immediately identified need to streamline paperwork Reduced signatures required by client and staff 7 to 1

7. 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. 2 to 4 intakes per staff versus 6 to 7 intakes per staff a day.

8. 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)

9. Change as been sustained..

10. 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.

11. Change as been sustained..

12. Performance Based Contracting Utilization at 90% or better 90 day Retention at 65% or better Continuing Care from IOP to OP at 60% or better. Providers receive: 80% of funding with no measures met 90% of funding with one measure met 100% of funding with two measures met 105% of funding with all three measures met

13. Continuing Care

14. Retention and Completion Rates

15. Utilization

16. Recent Change Implemented MI and Individual Sessions

17. Data To Date

18. New/Planned Changes Implementation of Incentive Program Using orientation video and ASI-MV pre intake process. Use the information collected from recent surveys and focus groups.

19. 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

20. Lessons Learned Making process changes and sustaining them requires commitment from entire agency As barriers to admission decrease, acuity level of patients increased. 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.