1. Re-Entry and Recovery Tennessee A program of Volunteer Behavioral Health Care System Project Participants Robert Edmonds, Director of Quality Management Randi Finger, Project Director Vickie Harden, Sr. Vice President of Clinical Services Greg Lewis, Sr. Vice President of Quality and Utilization Management Phyllis Persinger, Chief Information Officer Kim Rush, Center Director of test site

2. Who Are We? Volunteer Behavioral Health Care System is a non-profit organization serving 31 counties of middle and east Tennessee. Volunteer Behavioral Health Care System is a non-profit organization serving 31 counties of middle and east Tennessee. Re-Entry and Recovery Tennessee serves 11 county jails in the Volunteer service area. (10 rural, 1 urban) Re-Entry and Recovery Tennessee serves 11 county jails in the Volunteer service area. (10 rural, 1 urban) Target adults with substance abuse or co-occurring disorders. Target adults with substance abuse or co-occurring disorders. Provide services in jails and transition to community based treatment upon release. Provide services in jails and transition to community based treatment upon release. Interface with probation and parole, VBHCS mental health centers and other community support agencies. Interface with probation and parole, VBHCS mental health centers and other community support agencies.

3. AIM The NIATx aim for our program was to increase continuation in treatment after intake. The NIATx aim for our program was to increase continuation in treatment after intake. Rate for return appointments after intake was previously measured at three different intervals. The average of these three measures was That became our baseline. Our goal was to increase that mark to Rate for return appointments after intake was previously measured at three different intervals. The average of these three measures was 62% That became our baseline. Our goal was to increase that mark to 80%.

4. CHANGE We developed a four item questionnaire that was administered at the end of our intake process. The questions were; PLAN: We developed a four item questionnaire that was administered at the end of our intake process. The questions were; 1. What was the best part of your visit today? 2. What was the worst part of your visit today? 3. What could we do to make the worst part of your visit better? 4. Are there any problems that might prevent you from keeping your next appointment? This questionnaire was administered to clients the day of intake after they completed their intake process. DO: This questionnaire was administered to clients the day of intake after they completed their intake process. Retention at first office-based appointment was measured. STUDY: Retention at first office-based appointment was measured. Abandoned the intervention. ACT: Abandoned the intervention.

5. RESULTS Baseline return appointment retention rate was. Baseline return appointment retention rate was 62%. Post intervention retention rate was Post intervention retention rate was 57%.

6. NEXT STEPS After looking at the data we abandoned the intervention. The return appointment retention rate actually dropped from a baseline of to a post intervention rate of However a closer analysis of the data showed- After looking at the data we abandoned the intervention. The return appointment retention rate actually dropped from a baseline of 62% to a post intervention rate of 57%. However a closer analysis of the data showed-

7. IMPACT As a result of the NIATx project we identified a new target goal for our organization. All post intake follow-up appointments must be scheduled within ten days. As a result of the NIATx project we identified a new target goal for our organization. All post intake follow-up appointments must be scheduled within ten days. The opportunity for change does not occur simply at end of the process but presents itself in each step along the way. The opportunity for change does not occur simply at end of the process but presents itself in each step along the way.

8. Next Steps Based on findings from the initial project, we have begun another small test of change. Based on findings from the initial project, we have begun another small test of change. We are implementing Illness Management and Recovery groups within 10 days of initial appointment at one location within our system. We are implementing Illness Management and Recovery groups within 10 days of initial appointment at one location within our system. This project will improve retention by engaging clients within the 10 day window. This project will improve retention by engaging clients within the 10 day window.