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 2013.

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 seventh year, 50+ agencies are currently participating and outreach efforts are continuing.

In the Spotlight: Mayo Clinic Health System La Crosse

Two of the Five Key Principles from the NIATx Model are to understand and involve the customer, and get ideas from outside the organization or field. 

To assist Wisconsin STAR-QI Provider Agencies with their fidelity in implementing the NIATx model, we routinely have other NIATx agencies who have successfully implemented the NIATx model, present during our monthly Focus Area Group calls and Annual Learning Session.  In August of 2012, Rick Treleaven, LCSW, Director, BestCare Treatment Services in Redmond, Oregon presented a breakout session entitled:  What Would Nordstrom’s Do?  A Culture of Customer Service Critical to Success with the NIATx Model.  After that presentation, we had a number of Wisconsin STAR-QI providers choose “Nordstrom’s Customer Service” as their Focus Group.  The objective of this Focus Group was for agencies to implement appropriate principles that made Nordstrom Department Store #1 in customer service among retailers.  STAR-QI providers could choose from the Nordstrom’s Customer Service principles such as creating an inviting atmosphere, offering client’s choices, teamwork, “hiring the smile”, or they could choose other principles that the change team leader and team came up with.  Their goal was to increase client satisfaction by 5 percentage points.   

One of those agencies who realized success in implementing change projects that addressed customer service issues, was Mayo Clinic Health System Franciscan Healthcare in La Crosse.  Mayo Clinic provides inpatient and outpatient Behavioral Health Services.  Julie Conway, MS, LPC, is the Change Team Leader for the STAR-QI Process Improvement Change Team.   

With the support of the monthly STAR-QI Nordstrom Customer Service Focus Area conference and coaching calls, Julie and her change team succeeded in increasing treatment admissions and attendance through creating an inviting environment, better handoffs from inpatient to outpatient services, offering group counseling focus options, and starting two more treatment groups.

Julie began the change project with a staff retreat to solicit feedback on staff interest in addressing AODA service issues and to build buy-in with staff. 

The first suggestion that change team members offered was to improve the physical appearance of the group rooms.  The agency accomplished this by painting the group rooms, putting up new pictures, and installing a new wall-mounted television set. 

The second suggestion that was implemented was to increase treatment group options offering gender specific groups and expanding the times the groups were held, including an evening treatment group.  Wait time for services decreased from 22 days to 14 days, and admissions increased from 325 clients to 349 clients.

The third suggestion that was implemented was to have a member of the staff meet with hospital referrals within three days of the client’s discharge from the hospital.  As a result, hospital referral no-shows decreased by 50%.         

Julie was an effective Change Team Leader by engaging the team members in small, implementable changes, having a team member responsible for the change and also having a manner in which to measure the change.  As a result, more clients are being seen for services sooner.

Our current participants include:

  • Adams County Health & Human Services Department
  • AIDS Resource Center of Wisconsin AODA Treatment Program
  • Alarus Healthcare, LLC
  • AMRI Counseling
  • Arbor Place, Inc                                         
  • ARC Community Services-Madison
  • Beacon House
  • Behavioral Health Services of Racine County
  • Benedict Center:  Milwaukee
  • BridgeHealth Clinics & Research Centers, Inc
  • Brown County Human Services Department
  • Center for Quality Community Life
  • Center Point Counseling
  • Connections Counseling
  • Coulee Youth Center
  • Dane County Department of Human Services
  • Family Services of Northeast Wisconsin Inc.
  • Forward Choices
  • Genesis Behavioral Services Inc.
  • Hiawatha Valley Mental Health Center
  • Holy Family Memorial Behavioral Health
  • Jackie Nitschke Center
  • Jefferson County Human Services
  • Journey Mental Health Center
  • La Casa de Esperanza
  • 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
  • Rock County Human Services Department
  • RockValleyCommunity Programs
  • Shorehaven Behavioral Health, Inc.
  • St. Croix County Health & Human Services
  • Tri-County Women’s Outreach   
  • 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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