Improving Engagement of New Patients Entering Family Center Thomas Jefferson University Family Center Philadelphia, PA

Aim: increase treatment hours for new patients to 9 hours/month in 1 st month Many factors interfere with attendance in 1 st month of treatment. Factors were prioritized using nominal group technique: transportation, child care, lack of insurance, legal issues, lack of info about resources at clinic, clinic expectations, delay in counselor assignment Many factors interfere with attendance in 1 st month of treatment. Factors were prioritized using nominal group technique: transportation, child care, lack of insurance, legal issues, lack of info about resources at clinic, clinic expectations, delay in counselor assignment Patients were not showing for assigned groups and therapies due to these issues Patients were not showing for assigned groups and therapies due to these issues Patients were not being assigned to counselors quickly enough for the issues to be addressed Patients were not being assigned to counselors quickly enough for the issues to be addressed New patients averaged only 3.75 hours of treatment in 1 st month New patients averaged only 3.75 hours of treatment in 1 st month

Change: Redesign Orientation Group By identifying the top interfering factors; taking these factors; performing another nominal group technique, we were able to identify Orientation Group as our intervention for change that would address many of these issues and be led by the Case Manager. By identifying the top interfering factors; taking these factors; performing another nominal group technique, we were able to identify Orientation Group as our intervention for change that would address many of these issues and be led by the Case Manager. Unfortunately, there was a unexpected transit strike that occurred just as we were ready to start…and then the SNOW! Unfortunately, there was a unexpected transit strike that occurred just as we were ready to start…and then the SNOW! Led by case manager, the weekly redesigned Orientation Group started on Friday, 11/13/09. Before, the group was inconsistently scheduled, clients did not receive the clinic information in a systematic way; staff was not included in the orientation process; counselor assignment was not structured and timely. Led by case manager, the weekly redesigned Orientation Group started on Friday, 11/13/09. Before, the group was inconsistently scheduled, clients did not receive the clinic information in a systematic way; staff was not included in the orientation process; counselor assignment was not structured and timely.

Change: Redesign Orientation Group More structured and consistent. More structured and consistent. Patients are “on hold” for reminders to attend group “make-up” sessions are available Patients are “on hold” for reminders to attend group “make-up” sessions are available All services are explained in group to increase motivation to attend. Incentives (early med times, medication before group; gift certificates, baby outfits) are part included as a clinical engagement incentives All services are explained in group to increase motivation to attend. Incentives (early med times, medication before group; gift certificates, baby outfits) are part included as a clinical engagement incentives Quickly welcomes new patients and makes them feel a part of clinic Quickly welcomes new patients and makes them feel a part of clinic

Results It took many months to find 20 new patients for data collection due to rate of admissions, residential treatment, incarceration, other factors. This greatly prolonged the process It took many months to find 20 new patients for data collection due to rate of admissions, residential treatment, incarceration, other factors. This greatly prolonged the process SEPTA strike affected all patient attendance which confounded the data and therefore prolonged collection time frame SEPTA strike affected all patient attendance which confounded the data and therefore prolonged collection time frame Once we were able to collect data, treatment hours doubled from 3.75 to 9.28, excellent improvement. Once we were able to collect data, treatment hours doubled from 3.75 to 9.28, excellent improvement.

Next Steps: Adapt We decided to use 10 patients for data collection due to admission rate and stated issues in order to keep the process moving We decided to use 10 patients for data collection due to admission rate and stated issues in order to keep the process moving A new intervention was added to the orientation process: Introduction to counselor during intake meeting or within first 3 days and schedule 1 st session within 7 days. Time between first contact and 1 st session is reduced. A new intervention was added to the orientation process: Introduction to counselor during intake meeting or within first 3 days and schedule 1 st session within 7 days. Time between first contact and 1 st session is reduced. We changed our goal to 9 hours treatment/month to met with IOP group number. We changed our goal to 9 hours treatment/month to met with IOP group number.

Impact Improved attendance=engagement in treatment Improved attendance=engagement in treatment Increased revenue Increased revenue Improved timeliness of meeting mandatory guidelines for paperwork (biopsychosocial, etc) Improved timeliness of meeting mandatory guidelines for paperwork (biopsychosocial, etc) Issues are directed to the correct staff person=more streamlined and appropriate intervention Issues are directed to the correct staff person=more streamlined and appropriate intervention Groups have more impact when more patients attend Groups have more impact when more patients attend Orientation group allows patients to identify concerns early on in treatment and have them addressed more quickly: the concerns were often the issues that prevented attendance for previous patients Orientation group allows patients to identify concerns early on in treatment and have them addressed more quickly: the concerns were often the issues that prevented attendance for previous patients Patients gather necessary documents more quickly (insurance, child care, legal) to allow for speedier entry into treatment Patients gather necessary documents more quickly (insurance, child care, legal) to allow for speedier entry into treatment Expectations are clear to patients Expectations are clear to patients