Strengthening Treatment Access and Retention-Quality Improvement (STAR-QI)

(Formerly known as STAR-SI)

Key DFM Personnel

Richard L. Brown, MD, MPH - Principal Investigator
Deanne Boss, MS - STAR-QI Program Director

Collaborators

Joyce Allen, Director, WI Bureau of Mental Health and Substance Abuse Services
Michael Quirke, Program Evaluation Coordinator, Bureau of Mental Health and Substance Abuse Services

Funding

Wisconsin Department of Health Services (DHS)

Program Summary

The Wisconsin STAR-QI Program began in October 2006 as a three-year grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of the grant was to use the Network for the Improvement of Addiction Treatment (NIATx) Quality Improvement Model to improve organizational processes at the State and treatment agency level to impact client access to and retention in outpatient substance abuse treatment services. The STAR-QI Program has been so successful, that DHS has continued to fund it through September 2016.

The STAR-QI quality improvement projects aim to:

  1. Reduce the wait time between a client's first request for service and the first treatment session
  2. Reduce client no-shows
  3. Increase addiction treatment centers' admissions
  4. Increase the treatment continuation rate between the first and fourth treatment sessions

Collecting and reporting data is central to the NIATx model. Provider agencies collect baseline data before beginning a change. During the rapid-cycle quality improvement cycle, the agency continues to collect data, which they study to determine how the change impacted services. Change Teams at the provider agencies use their data to decide whether to adopt, adapt, or abandon their change project and to decide which quality improvement projects to pursue next.

Spread and sustainability are important concepts in the NIATx model. Initially ten Provider Organizations were participants in the first grant year. As we begin our eleventh year, 42 agencies are currently participating and outreach efforts are continuing. 

In the Spotlight: Shorehaven Behavioral Health 

Lynn Godec, MSW, is the Executive Director for Shorehaven Behavioral Health, Inc.  Lynn is also the Executive Sponsor and Change Team Leader for the Strengthening Treatment Access and Retention-Quality Improvement (STAR-QI) Program.  From October, 2013, through September, 2014, Lynn and her change team chose the Admissions Focus Area so that they might concentrate their efforts on Excellence in Customer Service in their clinic,  which is located in Brown Deer, Wisconsin, and provides behavioral health services to Milwaukee County residents. 

The Admissions goal that Lynn and her change team chose was that Excellence in Customer Service should be the standard of all of their interactions from the first call fielded by the Clinic Support Staff (CSS) to every future interaction with Shorehaven staff.   Under Lynn’s leadership, the Change Team experimented with a number of customer-focused process improvements utilizing the Network for the Improvement of Addiction Treatment (NIATx) quality improvement model, and the involvement and support of the Wisconsin STAR-QI program. 

The first process improvement the Change Team implemented was in response to many clients who utilize public transportation during frigid January Wisconsin winters.  The Change Team thought offering a hot beverage and snack upon arrival would be a nice way to welcome clients to the agency.  CSS stocked small water bottles, hot chocolate, coffee and snack options, and noted client’s responses via a simple tally sheet.  The offering of a snack became an immediate way to build a caring relationship.  Based on patient feedback that snacks were more desired than beverages, and a therapist suggestion to offer fruit as a snack option, the change team continued to improve their welcoming process.  Shorehaven has since adopted this Excellence in Customer Service change based on client comments such as, “Thanks so much, I missed breakfast this morning” and “It has been a long time since I had peanut butter cookies.” 

A second Excellence in Customer Service change project involved a responsiveness of the agency to the implementation of the Affordable Care Act.  Collecting copays/deductibles was difficult with 80% of clients having Medicaid as their funding and many times struggled to pay copays.  In addition, therapists and staff also felt uncomfortable asking clients to pay their bills.  The change team developed a script that the Clinic Support Services staff would follow with additional steps taken by the billing department to update client files with appropriate financial information.  This change has resulted in almost a 100% improvement in the collection of co-pays, co-insurance, deductibles, and private pays. 

The third Excellence in Customer Service change project was implemented in response to increasing numbers of clients utilizing electronic devices to communicate.  Therefore, Shorehaven leadership wanted to experiment with automating text and e-mail appointment reminders through their Electronic Medical Records (EMR) system.  Through a series of rapid cycle process improvements such as rewriting consent forms and having clients update their consent forms, and data entry into the EMR, Shorehaven reduced appointment cancellations by an average of 6% in six short months.  The Change Team is continuing to improve this process by addressing with clients those e-mails that bounce back to the system.     

In summary, through a commitment to Excellence in Customer Service, Lynn and her change team have improved the Admissions experience for customers by creating a welcoming environment, and adapting appointment reminders to reflect current customer choices.  They have also improved their business case so that they can continue to be financially viable in the changing behavioral health delivery system and keep their doors open to provide services to clients who need services.

Archive: Spotlight On...

2015

2014

2013 2012 2010 2009

Our current participants include:

  • Adams County Health & Human Services Department
  • AIDS Resource Center of Wisconsin AODA Treatment Program
  • AMRI Counseling
  • Arbor Place, Inc
  • ARC Community Services-Madison
  • Behavioral Health Services of Racine County
  • Brown County Human Services Department
  • Center for Quality Community Life
  • Center Point Counseling
  • Compass Counseling-Wausau
  • Connections Counseling
  • Coulee Council on Addictions
  • Dane County Department of Human Services
  • Driftless Recovery Services
  • Family Services of Northeast Wisconsin Inc.
  • Genesis Behavioral Services Inc.
  • Green Lake County Department of Health and Human Services
  • Hiawatha Valley Mental Health Center
  • Holy Family Memorial Behavioral Health
  • Iron County Department of Human Services
  • Jackie Nitschke Center
  • Jefferson County Human Services
  • Journey Mental Health Center
  • La Crosse County Human Services
  • LSSWomen’s Way        
  • Mayo Clinic Health System La Crosse
  • Meta House
  • New Horizon’s North
  • North Central Health Care
  • Oakwood Clinical Associates
  • Omni Enrichment
  • Open Door Center for Change
  • Polk County HHS
  • RockValleyCommunity Programs
  • Rusk County Health and Human Services
  • Shorehaven Behavioral Health, Inc.
  • Taylor County Human Services Department
  • Tri-County Women’s Outreach  
  • Waukesha Community Health Center 
  • Waukesha County Health and Human Services
  • West Central Wisconsin Behavioral Health Clinic
  • William S. Middleton Veteran’s Hospital
  • Wood County Human Services Department

To promote sustainability, the staff members at participating Treatment Agencies are trained in the principles of the NIATx Improvement Process through an annual face-to-face learning session. They also participate in monthly group provider teleconference calls to support and promote continued rapid cycling quality improvement projects and network with other providers. 1:1 coaching calls are an additional option in an effort to support the quality improvement practices providers are implementing.

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