Universal Counseling Services
Tracy Schulden, Executive Director
Mid Atlantic Node


Certified Outpatient Mental Health Clinic
Certified Outpatient Substance Abuse
Treatment Program
◦ Level I OP
◦ Level II IOP

April 2007
◦ First Annual NIATx Summit held in San Antonio,
Texas.


Energized around process improvement.
Already had a problem identified but stuck on
how to resolve

April 2007
◦ First Annual NIATx Summit held in San Antonio,
Texas.


Energized around process improvement.
Already had a problem identified but stuck on
how to resolve

Streamlined orientation paperwork
Client
Bill of
Rights
Financi
al
Policy
Confidentia
lity Rights
Dischar
ge
Policy
HIPAA
Privacy
Practice
s
Client
Responsibilit
ies
Grievan
ce
Policy
Reduced signatures required from 14 to 2
By my signature below, I consent to treatment at Universal
Counseling Services, acknowledge receipt of this orientation packet,
and understand the following policies outlined in the packet:
Client Bill of Rights
Financial Policy
Confidentiality Rights
Client Grievance Procedures
Client Responsibilities
Discharge Policy
Notice of Privacy Practices
_______________________________________________
Patient or Legally Authorized Individual Signature and Date
_______________________________________________
Print Patient’s Full Name and Date
________________________________________________
UCS Witness Signature and Date

Streamlined TB, HIV/AIDS, and Hepatitis
Screening
TB
HIV/AI
DS
Hepatiti
s
Reduced signatures required from 6 to 2
INFECTIOUS DISEASES
RISK ASSESSMENT AND EDUCATION FORM
UCS is committed to providing up to date education and referral information on HIV/AIDS, Tuberculosis, and
Hepatitis B and C in order:
To reduce client risk of contracting HIV, Tuberculosis or Hepatitis;
To encourage individual assessment of risk related behavior;
To prevent the spread of infectious diseases in general; and,
To ensure that individuals who have contracted an infectious disease receive the help they need.
In addition to the information video, we have provided you with an information & resource packet on
HIV/AIDS, Tuberculosis, and Hepatitis B and C, and other Sexually Transmitted Diseases;
If you would like more information or assistance, please talk to your individual counselor.
We can meet with you individually, or with you and your partner to discuss questions/ concerns regarding your
risk assessment, risk reduction behaviors, or treatment and testing resource information.
Please sign and date below:
I have completed the informational video which focused on general HIV/AIDS, Tuberculosis, and Hepatitis risk
assessment information, risk reduction behaviors and testing and treatment information. I will talk with my
counselor if I want more information or assistance on this topic.
_____________________________________________________________
Patient Signature Date
_____________________________________________________________
UCS Staff Signature Date

ASI-MV
 Reduce time to complete intake process from 2 to 3
hours to 1 hour.
 3 to 4 intakes per staff versus 6 to 7 intakes per staff a
day.

Open Access Scheduling – All calls received
during the week are given an appointment for
Monday.
 Reduce wait time to 4.3 days (from 53.6
days)
 Increased staff satisfaction.
 Eliminated scheduling conflicts.
 PTO, trainings, etc.

Physician Availability by Demand
 Reduced time to first medicated to 3.3 days
(from 11 days)
 Further reduced to =/< 48 hours.
Active Clients at the End of the Month
250
200
150
100
50
0
Monthly Revenues
80000
70000
60000
Axis Title
50000
40000
30000
20000
10000
0
$25,000.00
$21,937.50
$20,000.00
$15,356.25
$15,000.00
$10,000.00
$5,000.00
$0.00
351 intakes pre change
351 intakes post change
Hours to Complete
1000
900
877.5
800
700
600
526.5
500
400
300
200
100
0
351 intakes pre change
351 intakes post change
As barriers to access to care decrease, acuity
level of clients increase…
Month
43.4
Aug-08
Jun-08
Apr-08
Feb-08
Dec-07
Oct-07
67.7
Aug-07
Jun-07
Apr-07
73.2
Feb-07
Dec-06
Oct-06
66.7
Aug-06
Jun-06
Apr-06
80
70
60
50
40
30
20
10
0
Feb-06
Dec-05
Percentage
90 Day Retention
68.4
46.5
44



Staff had been exposed to other MI projects
Staff had participated in a web based study
through NERI on motivational incentives
Group Selection Process

Staff Burden
◦ What type of MI program could be implemented
with minimal work added to staff.

Financial Burden
◦ New funding approach through core service agency
provided a 5% bonus for meeting performance
measures.
Purpose: The purpose of this policy is to establish guidelines for
implementing a contingency management plan for the substance abuse
treatment program. The overall goals of this plan are to increase
attendance and retention of clients.
Policy: UCS recognizes the importance of providing positive reinforcement
for attendance, program participation and other client accomplishments
as part of the treatment process. Hence, UCS’ CMP will include the use of
incentives and rewards throughout the course of treatment, but will
focus primarily on the first three months of program participation.
During the first 90 days, clients will be provided program incentives. The
incentives will be provided at first session, first individual session, and
then weekly. Additionally, clients will be rewarded incrementally for their
attendance and participation efforts by non-monetary recognition and
support to include the use of a personalized Identification Card or Photo
and Honor Board, initial welcome and periodic refreshments, Certificates
of Completion, and Affirmation Cards.






Staff received training on Motivational Incentives
used resources from CTN and ATTC
select staff participated in computerized
incentive program study
received consultation and guidance from CTN
during implementation and assistance from CTN
with data collection.
Check list was used
Attendance Data from Practice Management
System was compared to raffle tickets collected.

Client Identification Card/Photo – personalized,
template and supplies provided. Clients will have a
choice of using their picture for the ID card or
developing something meaningful to them as their ID
Card. Clients would be able to make the card during
first individual session with counselor or can create
their card at home. A template would be provided in
Welcome Packet with instructions and examples. Their
original ID card would be laminated to preserve
throughout Treatment and for use on Honor Board.
Copies would be made however and kept in designated,
secure place for use when eligible, or when a raffle
prize is awarded. Staff could have the opportunity to
personalize their Picture ID on UCS Welcome & Resource
Info Board with a unique symbol or design, which would
provide examples too.

Fishbowl Drawing - Clients are provided incentives to
attend treatment as defined on their treatment schedule
on a weekly basis with a raffle ticket for entry in the
Fishbowl drawing each week. Primary counselor will
provide the ticket for OP clients at the time the client
attends their weekly treatment (one ticket earned per
week). Primary counselor will provide IOP clients a ticket
each day they attend treatment (maximum of three
tickets earned per week). The client will then put their
name on the card and place it in the appropriate
fishbowl (one for OP and one for IOP). At 4:00 p.m. each
Friday, two raffle tickets will be selected from each bowl
for a $25 gift card. The “winners” will be acknowledged
on the Honor Board each week with a weekly
affirmation/encouragement added to the Board for all.

UCS Client Honor Board – The Honor Board
will represent the “road to recovery” for
clients, using the design of a mountain. Their
ID cards would be moved up the mountain
each month they complete treatment.


Certificates of Completion – Clients will
receive certificates of completion at the end
of the intake with the ASI, the end of IOP, and
the end of OP treatment.
Affirmation Cards – All clients who had raffle
tickets in the fishbowl will receive a
affirmation card.
Director
Admin. Asst.
Intake Day 1
Asst. Director
Client
Intake staff
Will purchase and maintain gift cards.
Will ensure that the Honor Board
design is neatly maintained.
Will ensure that Welcome Packets are
prepared for Intake days.
Ensures welcome refreshments are
available for intake clients.
Completes ASI assessment and
Orientation Video.
Congratulates client on completion of
intake, ensures Certificate is printed
and provided to the client, gives client
a rubber bracelet with motivational
statement.
Day 2/ First Individual Session
Client
Keeps their appointment with their
individual counselor.
Counselor Reviews ITP and clients motivation for
treatment.
◦
◦
◦
◦
◦
◦
Provides client with Welcome Packet which will include:
Affirmation card
Resource list
Gift Card to Dunkin Donuts/Baskin Robbins
Program/Schedule overview
Identification Card template/ purpose & instruction
handout
Counselor/Client
Creates personalized ID Card. Counselor will take
instant photo, if needed. Copies are made. Client signs
release for photo to be used on Honor Board, if
applicable.
End of 1st Week
Client
Client attends treatment as indicated
to earn raffle tickets.
Counselor Acknowledges client’s achievement
by rewarding client with a raffle
ticket at each scheduled visit
(maximum one per week for OP and
three per week for IOP).
Director/Designated Staff
Posts ID Cards on Honor Board for First Week
raffle winners and all those who have
completed their first week of treatment.
Monthly
Client
Counselor
As Indicated
Client
Counselor
Client attends treatment as indicated.
Acknowledges client’s achievement by posting
client’s ID card on the Honor Board and moves
those who completed a month in treatment up
the mountain.
Client has accomplishment (job, house, avoids
a use)
Acknowledges client’s achievement by placing
a star sticker on the edge of the client’s ID
Card on the Board with the accomplishment
listed on the sticker.
CHECKLIST Client Name:_________________________ Date:_____________
INTAKE
____Front Desk welcomes client to UCS
____Welcome and congratulate client
____Give client the ASI certificate
____Implement the MI assessment
Step 1: During the initial minutes of the interview the clinician uses MI skills to build rapport and
elicit a discussion of the client's perception of his /her problems. Things such as greeting the
client in a respectful and friendly manner, inquiring about how the client is feeling and what
prompted the request for service helps establish good rapport. It is an excellent time to use
open-ended questions to explore what the client wants from the agency and affirming the
client’s decision and potential for change. During this initial segment of the interview the
counselor gets an idea of where the client is on the stages of change continuum, what kinds of
resistance may emerge, and the client’s readiness for change.
Step 2: Complete the standard assessment y gathering data in the usual manner rather than
trying to artificially integrate an MI style into what typically are semi-structured methods of
data/information collection. When finished, the counselor can summarize the information
obtained or go back to specific items to elicit further discussion, using an MI style before
proceeding to Step 3. For example: "We started out meeting today talking in an open-ended
way about what brought you to treatment. Now for the next 30 minutes or so we need to shift
gears a little to complete some of the clinic forms that will ask for more specific information.
When we are finished, we will shift back to a more open-ended discussion of what you want
from treatment”.
Step 3: At this point the clinician lets the client know that the next portion of the interview will shift
back to a more open-ended format with the purpose being to better understand what the client
wants to achieve during treatment. The counselor utilizes strategies for eliciting change or
dealing with resistance in this phase. The material obtained during the standard assessment
provides the counselor with ideas about questions that might be asked to establish
discrepancies and enhance motivation for change.
Success at this step depends very much on the skill of the clinician. More resistant or precontemplative clients should be approached using techniques designed to manage and reduce
resistance. More openly ambivalent or contemplative clients may benefit from a discussion of the
pros and cons of continuing versus stopping substance use or discussing their level of readiness to
change. More motivated (prepared, determined, ready to act) clients may benefit from the
development of a formal or informal change plan. All of these techniques are discussed in the MI
literature and typically receive considerable attention during MI training. It is expected that
information gathered during Steps 1 and 2 will provide enough information for the MI counselor to
know which of these groups of techniques should receive greater emphasis as Step 3 begins.
____Review the motivational enhancement program at UCS
____Schedule and individual for the next day with primary counselor
____Thank client for choosing UCS to assist them with their SA needs
____Give the client the wristband
____Remind the client to ask their counselor for the $5 gift card
FIRST INDIVIDUAL SESSION
____Welcome the client back
____Take the client’s picture/have client select an ID Card
____Obtain a release to use picture on the HONOR BOARD
____ Give client welcome packet and gift card
EACH CLIENT CONTACT
____Give client in OP a ticket when comes for weekly session (maximum 1 per week)
____Give client in IOP a ticket each day attends appointments (maximum 3 per week)
100.0
90.0
80.0
70.0
60.0
Pre-incentive
50.0
Incentive
40.0
30.0
20.0
10.0
0.0
Returned after intake
Reached 30 days
Reached 90 days
60.0
50.0
40.0
Pre-incentive
30.0
Incentive
20.0
10.0
0.0
Intake only
Less than 30
Between 30 and 90
More than 90
60
50
40
Pre-incentive
30
Incentive
20
10
0
Less than 5
6-10 days
More than 10 days
Overall Retention
70
60
50
pre
40
incentive
30
20
10
0
3/15/2008-9/14/2008
9/15/2008-4/14/2009

See Results
◦ Data
◦ Anecdotally

Integrating MI program within daily practices of UCS
◦ Scripts
◦ Posters

Involving all the staff
◦
◦
◦
◦
U/A techs
Medical
Mental Health
Front Desk

Involving clients
◦ Feedback on design
◦ Promoting with new clients

Tied MI to business case
◦ Reduced intakes
◦ Meet/Exceed Performance Measures





Implementing and sustaining EBP requires
commitment from entire agency
Involve staff/clients in the development and
implementation
Keep the program simple/manageable
Develop mechanisms to collect data to
measure impact.
Data needs to be reviewed frequently to be of
value to staff and to motivate staff as well as
to explore successes and identify effect of the
implementation.