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New Change Cycle – Internal Adolescent Referrals March 30, 2006

Posted by rredmond in General.

We've been struggling getting people into our adolsecent Chemical Dependency Intensive Outpatient Program (CD IOP) which is remarkable because we have scores of young adults in our CD IOP program.  We've realized that we're not getting referrals from our own adolescent inpatient programs.  The process change we're making (in week #1 currently) is to add 6 substance abuse-related questions and one discharge planning question to the adolescent inpatient psychosocial assessment form.  We're testing to see if this raises awareness and referrals.  If anyone is doing a project that is even remotely similar, I'd appreciate exchanging ideas.  Thanks, Rick (Acadia Hospital, Bangor, Maine)

p.s.  Any of you University Wisconsin folks reading this – University of Maine is looking forward to defeating you next week in the college hockey Frozen Four!



1. pjohnston - April 7, 2006

Vanguard had the same problem getting aftercare referrals to our outpatient program, adult and adolescent. So, the program had an open house for the staff at the residential facility (residential and outpatient are at two different sites). Sometimes, the counselors and referriing staff are in automatic and forget about new resources, even their own. Unfortunately, I was not involved in the change team that tried it and cannot comment on the results, but maybe it will raise their awarenss.

2. Rick - April 7, 2006

Do you know if that intervention improved the numbers? Since then, have you done anything else with trying to improve internal referrals? Thanks, Rick

3. Helen Singh Benn - April 17, 2006

We are working on the same issue. It is difficult to route those appropriate clients from residential into outpatient. We had the counselors talk from each site, but the client moving from one site to another is a different story. We will continue to work on the issue with our adolescents.

4. pjohnston - April 19, 2006

Unfortunately, I cannot comment if the internal open house improved the referrals to our outpatient program. One thing marketing tries to do is bundle services, to not only improve follow-through for aftercare, but to also ensure referrals by insurance companies or jurisdictions. So a reduced price is offered for residential and aftercare services if they attend treatment at our programs. The biggest challenge is our residential programs receive referrals from other states and jurisdictions that are far from the residential program, so the clients cannot receive aftercare with us as they usually return to their jurisdiction and receive afercare there.

5. tracy varner - April 19, 2006

This is amazing – this is similar to the change that I am working on at this time and was just telling my team that I would check the site today to get more information- We are working on increasing the continuation once the youth transfer to “our outpatient” they seem to dissapear until we are re-admitting them to inpatient to stabilize them again and then the cycle continues.. so we are going to really work on identifying what is missing in the transfer..

6. eldon edmundson - April 25, 2006

what has the walk-throughs shown as hurdles for the youths transferring to OP?

7. rredmond - May 15, 2006

I’m glad to know that other sites are dealing with similar issues. Hopefully, we can help one another… Eldon, the walk-through in this case didn’t yield a lot of helpful information. We probably would have had to walk through a full admission and see the referral decision-making througout the inpatient stay. However, by tracing the steps of the referral process, we did come upon the fact that a good concentration of substance abuse questions was not being asked. We’ve completed a PDSA Cycle with moderate success. Avg. daily attendance in Adolescent IOP has gone from 4.7 to 5.5. Overall referrals went from 11 to 18. Referrals from Inpatient went from 1 to 11. We will measure another cycle.

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