No appointment necessary

August 21, 2013

Maureen Fitzgerald
ATTC Network Coordinating Office and NIATx

Walk-ins are often welcome at hair salons and restaurants. Can they work at your treatment organization?

Just ask
Lynn M. Madden, CEO of the  APT Foundation, a non-profit substance abuse and mental health treatment organization in New Haven, CT. The APT Foundation has eliminated scheduled appointments completely for all outpatient programming.

“We’ve created a single front door to help our clients get into treatment as quickly as possible,” says Madden.

When Madden joined the APT Foundation in 2006, the average waiting time from evaluation to first treatment was 22 days. One of the first things she did was change the screening process to create an “access center,” combining all the screening functions that existed across five locations into a single unit. A committee that included Madden, members of the APT board, and staff improved the work flow, changing the order of the administrative and clinical processes. With a single front door in place, APT began to offer walk-in hours.

“In the first year, our average time to treatment decreased to 8 days. By the second year, it was down to 2 days, and today most people receive their first treatment or medication, or both, on the same day they walk in.”
The change in the intake and admission process aligned with changes in the clinical processes as well.  “That initial evaluation ends with a treatment plan that’s based on client input and preferences,” she explains. “The clinician then invites the person to enter treatment that day, and if a physical is required, that can also happen on the spot.”

Client involvement in the treatment plan is key. “People who are seeking care know the most about what they need,” says Madden. “Rather than prescribing, we invite clients to select what they need in terms of treatment.”

Outpatient group therapy offerings
are updated regularly on the agency’s website and include traditional 12-step groups along with groups on topics such as mindfulness, job seeking skills, and relapse prevention.

“Prioritizing offerings based on client preferences has improved clinical outcomes, increased staff efficiency, and our stabilized our finances,” says Madden. In fiscal year 2013, the APT Foundation treated 6,792 patients, completed 2,954 walk-in evaluations, gave away almost $2 million in reduced rate or free care, and ended with an operating gain of a half a million dollars. “And that was after returning cash incentives to our employees,” adds Madden.

Overall, the APT Foundation has found that streamlining the admissions process brings in more clients. “The people who come in on a walk-in basis are typically those most in need of care. And we have a data set now of thousands that shows they are getting as well or better than clients who were less acute, but who entered care under the old system with appointments and prescriptive practices.”

Madden encourages other organizations to consider adopting a no-appointment-required system. “By putting administrative and clinical processes in a different order, we were able to meet our goal to get clients into care as quickly as possible.”
Lynn Madden, CEO, APT Foundation

Want to know more about how the APT Foundation eliminated scheduled appointments?  How they overcame barriers to open scheduling? What reducing waiting times would mean at your organization? Post your comment or question below!  

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