This Door Leads to Treatment, Not Back to Detox

The BCI Alpha outpatient program and Kirkwood Detox have significantly increased the percent of patients who leave Detox and complete an evaluation for treatment at BCI. In January 2009, 17 of 19 people referred here successfully completed their evaluation, compared to only 3 of 21 in January 2008. The project is the latest success story in our Paths to Recovery process improvement effort.

For years, we’ve struggled with how to engage people recently discharged from Detox. Typically, they’ve stopped using drugs, but haven’t stabilized their lifestyle, particularly their living environment. They were being discharged from Detox with only the instructions to go to BCI for an intake, and more often than not, they never showed up. Later, many would relapse and return to Detox in a revolving door cycle.

About a year ago, BCI and Kirkwood Detox went to work developing a personalized approach for these clients. We realized they are a unique population with unique needs. The solution we found was to give them more personal attention, and go above and beyond the normal referral process to ensure follow-through.

Detox staff began driving patients to our door upon their release. BCI began sending one of our counselors to Detox once a week to speak to patients about our treatment program, establish rapport, and motivate them to attend. Patients could start their intake paperwork at the time if they wanted to, and many chose to do so. Once someone was admitted to BCI, we offered them incentives to return for their first session. Over time, BCI and Detox fine-tuned our timing of discharge and orientation, exchanged patient lists to track who did or did not get to where they should be, and discussed individual cases as needed. As a result, we strengthened our collaborative relationship to the point where today, referrals are nearly seamless.

Coordination among agencies is so important when a client is moving from one to another. Since we've found a way to make it work, more people now have a chance at long-term recovery rather than being caught in a revolving door between addiction and Detox. Great job to everyone who played a part in this success.

Practice-Based Evidence?

In today's New York Times, Benedict Carey looks at whether evidence-based practices improve patients' success rate in treatment. Programs like BCI are increasingly accountable for showing our effectiveness, yet few have the stats to do so and there's no universal standard for success. Delaware is one of the states taking part in the Advancing Recovery project, in which we implement -- and track the results of -- techniques that science says are effective.

In 2001 the Delaware Division of Substance Abuse and Mental Health began giving treatment programs incentives, or bonuses, if they met certain benchmarks. The clinics could earn a bonus of up to 5 percent, for instance, if they kept a high percentage of addicts coming in at least weekly and ensured that those clients met their own goals, as measured both by clean urine tests and how well they functioned in everyday life, in school, at work, at home.

By 2006, the state’s rehabilitation programs were operating at 95 percent capacity, up from 50 percent in 2001; and 70 percent of patients were attending regular treatment sessions, up from 53 percent, according to an analysis of the policy published last summer in the journal Health Policy.

Carey suggests these Performance Based Contracts are an example of “‘Practice-Based Evidence,’ the results that programs and counselors themselves can document, based on their own work.” Why has this worked for Delaware? We focus on getting people in the door and keeping them here, because length of time in treatment is associated with successful outcomes. We’re rewarded financially when we do a good job at this, and penalized when we don’t.

But we also use many of the Evidence-Based Practices mentioned in the article, like motivational interviewing and cognitive behavioral therapy. Sometimes our results are great, and sometimes they’re not. You can read more about our work here.

This topic generates lots and lots of questions within the addictions field and the recovering community. Here’s just a few:

• What should be the definition of success in treatment?
• How do we provide individualized treatment within a treatment curriculum?
• What kind of evidence are we most interested in – evidence that comes from science, or from practice?
• And, how do we collect data to measure success in treatment without increasing costs?

5 Questions for James Harrison, Site Director

5 Questions is our ongoing feature where we introduce you to the people who make Brandywine Counseling run, spotlighting a different staff member every two weeks.

Name: James Harrison
Job: Site Director, Lancaster Avenue
Time with BCI: 20 years

1. How did you get started working in the addiction treatment field?
I think mine was a unique situation. I was actually finishing up a three [year] mandatory prison term, and Kay Malone and Linda DeShields came to the Plummer Center in 1988, and at the time, the American Red Cross was providing HIV education in the prison. They had a gentleman that came in, and none of the inmates would respond to him. They were rowdy, they were disruptive. And so, the warden asked me if I would co-facilitate the group. And I agreed to it. And after his first presentation, I actually took control of the presentation.

All the inmates were extremely receptive. It was like hearing it from one of their peers. And this was a time when HIV and AIDS was at truly epidemic proportion in our city, and folks were dying within five years. And so I hollered out, “Listen up, people! I have some life-saving information!” And people were quiet. People listened. And that kind of opened the door for me to start doing some prevention education, after I was released. Of course, Kay and Linda DeShields agreed to hire me after I was released, waited five months for my release, and I’ve been here ever since.

Many people would be surprised to know that I’ve actually had a 30 year history with Brandywine. So, many folks, especially newcomers, oftentimes will not realize that I’ve spent ten years on the other side of the fence. And so, I’ve seen the changes we’ve made as an agency, particularly around process improvement and access, and just being kinder and gentler to the addict. I think what folks will not realize is that ten years as a consumer embedded an advocacy in me that will never leave. And so I carry with me, day to day, having to straddle both fences. I’m still in recovery, I will say that. I can always see the client’s view clearer in my head as I’m also trying to move our agenda, and move the agency to the next level. So when you first look at me, you don’t see the old James, and so that’s the piece that I carry with my job that many folks don’t know about.

2. What changes have you seen in your 30 years with BCI?
Part of what I’ve seen is a growing trend, that we’re seeing a younger, sicker population. And I look at all of the old-timers, for loss of a better analogy. They are the dying breed. I recall one consumer I saw yesterday, who has been with Brandywine [for] a 30 year history, is actually wheelchair bound, and blind. And that same person, I used drugs with, I hustled with, I participated in drug addict behavior with. And now this person is barely struggling to survive.

And I see on the other spectrum, young white females and young black males chronically addicted to opiates, but now struggling with HIV, mental illness, and addictions. And I think the most obvious change has been the severity of folks’ addictions and their problems, coupled with the social ills as well: increased gas prices, food, housing shortage. All those other issues, where I think years ago, folks could make it off of a year’s income of about $12,000, but now, that’s starving. And so, couple that with addiction that’s more severe in its nature, we’re seeing sicker and more violent individuals as well.

3. BCI was in the news last week because of the challenge of reaching black drug users with the needle exchange. What do you think it will take for this population to access these services?
There was a workshop I went to, years ago, that addressed this very issue. The name of it was, “Beyond Tuskegee.” And if you remember the Tuskegee experiments, blacks historically had a fear of public health systems, and the whole notion that, “This is suspect, in terms of, the government has its hands on it, and that law enforcement may use this as a vehicle to further disenfranchise us.” So getting beyond Tuskegee would say that, “No, this is not true. There’s not a great conspiracy theory around accessing needle exchange, or providing services in an outreach effort.”

I think we have to build a comfort zone for African Americans. It’s like, if they see me drink the water, then the water’s okay. But until they see it and watch me be okay, many times they won’t access. So I think the most valuable tool we’re going to have is our African American peers who currently work on the [needle exchange] van. For [drug users] to see, again for loss of a better analogy, that they too have drunk the water and the water’s okay. So there’s got to be a comfort level in saying, “You know what? Needle exchange is a good thing. It saves lives, it’s not connected to law enforcement, it’s not some sort of drug inside the syringes.” The belief that it is a good thing has to be kind of penetrated throughout the community.

And accessibility -- going into what we call the “red light district” of the city of Wilmington is challenging, especially with all the shootings. I don’t know if African Americans are truly the population who are now injecting at an alarming rate. Certainly we do have some folks injecting, but I also believe that this is a dying population as well. And more people, because of drugs being purer, are smoking and sniffing. And so, there may not be as great a need for syringes as we first thought. So I think a collective kind of effort with our Senator Margaret Rose Henry, who’s birthed this project, our community leaders, our naysayers, our people who advocate for this population, we all have to collectively come up with a strategy to keep pushing the message that the water’s okay.

4. You can tell a lot about a person from their office. Tell us what you have in your office.
My office is very eclectic. I sometimes am embarrassed about it! But I have jazz artwork here. I have New Orleans. The Nanticoke Indians, which never really got recognized during Mardi Gras, but they too decorated, and had the same kind of celebration, but never recognized. But then I also have one section that’s dedicated to family. I have pictures of my son who graduated from Villanova. I also have a collection of articles of the work we’ve done here at Brandywine, the projects where I grew up in as a kid, and articles saying, “A $10 bag of heroin approximate to the 95 exit [for] sale,” “Fewer resources spent on prevention,” and then one of Basha [Silverman] and a syringe-filled shooting gallery, which reminds me of the work that we do. And that’s in addition to the Comprehensive Accreditation Manual from Joint Commission, books around licensure, and policy and procedure manuals.

But I also have a snake to unclog many of the restrooms, and a quart of oil for some of our vehicles. And so, you can find anything from a light bulb to the 2007-2008 Delaware Psychiatric Residency program’s pictures, of which I’m also a part, doing some training with the residency. So I like to think of it as eclectic. I think there’s times when it’s more orderly than others, especially when visitors are around, but for the most part, it really depicts my work here at Brandywine. One minute I might be the janitor, one minute I am the clinical supervisor, the next minute I’m an administrative person, the next minute I am a client advocate. So it really depicts the changing roles I play.

I just recently described my job here at Brandywine to someone, and I said, “I can’t call it work, because it’s something I like to do.” Now, it just so happens I get paid for it, but even [in] absence of money, I would still be doing this type of work. So while the paycheck helps with the mortgage and the car payment and travel, absent of that I would still be doing the same thing I’m doing. So I’m fortunate and blessed that I can come and do something I was going to do anyway for the rest of my life, but get a paycheck for it.

5. If you had $30,000 to donate to BCI what would you do with it?
I think I would go to a learning institution and ask that we start a program specifically for addictions counselors to grow the work field. The major challenge is a workforce that’s declining. [BCI senior staff] will be leaving in a few years. We have a younger workforce, that I think for the most part, is not prepared for the challenges of a more sophisticated system, in terms of licensure, accreditation, and just maintaining a quality level of services.

So I would go to a Lincoln University, a Del State, or University of Delaware, and say, let’s have a name for a program specifically to grow the field. So I think that’s what I would do. While another clinic would be nice, a transitional house for recovering people would be nice, but I think if we don’t grow the field, we’re going to miss the opportunity to help people get better.

Alpha Program Shortens Wait Time, Reduces No-Shows

The BCI Alpha Drug Free Program is seeing our clients engage in treatment more quickly after admission. At the same time, we see the fewest no-shows we've ever had for appointments. These are our latest successes in Paths to Recovery, patient-focused process improvement without additional costs or staff.

In the month of April, our clients progressed from admission to their first unit of service (individual or group) in an average of 9 days, which is the fastest in two years. Our average had been 12 days.

These results came after we introduced a new service called the Meet & Greet. This is the first time the client returns after admission. On average, it's 4 days afterward. They meet their assigned counselor, review the program rules, view a ten-minute orientation video, and schedule their first individual appointment. It’s a much more streamlined version of how we used to do orientation. Previously, clients would not meet their counselor until the first individual, nearly a week later. Knowing how important it is to establish the therapeutic alliance, we made it a priority to push this meeting up as early as possible.

Also in the month of April, our no-show rate dropped to 19%, which is our lowest in two years. This is for individual appointments for all active clients. Our average had been 26%. Client retention is also better, with more people staying in the program past the 45 day benchmark.

This came about because of our new, retooled motivational incentives. Since February 2008, each client draws from the fishbowl once at every individual and every group. They can win credits of $1, $5, $10, or $50 which they can bank and redeem for prizes including gift cards, bus passes, and 12 Step items.

This is a real turnaround after we had used motivational incentives for a year without seeing improved no-shows. Before, there were fewer chances to win since draws were not done in groups. There were also “Good Job” certificates mixed in with the prizes which had no value in dollars, only as motivation. Turns out, they weren’t very motivational! So the “Good Jobs” are now gone, and every draw wins something. And the best part is, the cost to the program is about the same. Banking of credits is also new, giving clients a choice to cash in right away or save up for something they really need.

Both of these projects took a long time to fine tune and perfect. The Alpha change team worked at this week after week at our lunchtime meetings. Our ideas made sense, and we expected them to work, but if the numbers didn’t show it, it was back to the drawing board. In terms of the PDSA cycle, it seemed like we were stuck on "A" for “adapt.” It just shows that process improvement in addiction treatment is hard work. It doesn’t get any easier just because you’ve been working at it for nearly5 years.

So it is all the more rewarding when we do get the great stats we’ve been waiting for. Good Job! I mean, Good Work, team!

Walk-Through At North Wilmington, Day 1

Our mock client had her intake this morning, and it actually went really well! My co-worker Nicolle gave an Oscar-worthy performance as "Nicole Jones," a dual diagnosed, divorced mom on Level 2 probation, addicted to alcohol and cocaine. She said afterward her story was a conglomeration of different things she's heard as a BCI assessor at Probation and Parole.

The staff were a little surprised to see us, so they kind of thought it was real at first. Everyone was very welcoming and friendly, and our intake counselor Maria was very thorough and genuinely interested in all that was going on. If that's how they treat a real client, they should pat themselves on the back!

There was not much that jumped out as far as needing process improvement. We thought the initial paperwork took too long, but that was our biggest complaint. "Nicole" signed up for a group next week and scheduled her first individual session, so maybe we will find something on our return trip.

The thing that really struck me as I sat and observed the assessment was how much courage it must take to walk into an office and talk to a stranger about all that is going wrong in your life and all the mistakes you've made. It gives me new respect for anyone who gets up the nerve to come in our door, as well as for the staff who listen to story after story every day. So, good job Maria, and kudos to all the clients who took that first step.

It's Walk-Through Time: A Day In The Life of the Customer

One of the most interesting things I've gotten to do while working at BCI has been a walk-through of our treatment program from the client's perspective. Not only does it give me a point of view I rarely get to see, but it yields all kinds of useful information you just can’t get any other way. It’s been four years since we last did one, but now it is time again.

Tomorrow, at the Alpha North Wilmington Center, one of my co-workers will pose as a client seeking admission, and I will be their family member/observer. The idea is to experience the admissions process in order to more fully understand BCI’s strengths and limitations. Is the process working as intended? How easy is it to get treatment when you want it? Do we do as good a job as we think we do?

When we did this before, the answer has been, sometimes yes, sometimes no. Check out some of our actual findings:

From our methadone program in 2003: “Samantha called the Lancaster office to schedule a methadone intake. The receptionist told her to call back at 12 noon because ‘that’s when I make appointments.’ Samantha called a second time and said ‘I need to get on methadone.’ She was put on hold again, then disconnected.”

From our drug free program in 2004: “Diana attended orientation group at the Alpha Program. The group started fifteen minutes late, and the room was too hot. The facilitator read directly from the client handbook, gave rambling explanations, and did not have control of the group. The clients became frustrated and made disruptive outbursts like, ‘This program will take 10 years – it’s ridiculous!’”

We, the staff, were shocked that things like this were actually happening at BCI, but we went to work to fix it. At the methadone clinic, we shifted the triage process from the receptionist to the nurses, who could pre-screen people over the phone and direct them where to go. The result was that the wait for an appointment was reduced by half. At the Alpha program, we standardized the curriculum for orientation group, reassigned it to a more skilled facilitator, and began a streamlining process that eventually turned a 90 minute group into a ten minute video. This was how we launched the Paths to Recovery process improvement effort that continues today.

These were huge changes, and that is the payoff of going through the walk-through exercise. It is a must for any treatment program that truly wants to better understand its customer’s needs and do a better job at meeting them.

What will we find at North Wilmington? It’s anyone’s guess. Sometimes, the truth hurts, but it is worth it if it leads to real improvement.

Telephone Continuing Care: A Recovery Management Program

Over the past year, the BCI Alpha Program has been using motivational incentives as part of the Advancing Recovery project. We’re about to start our second evidence-based practice, telephone continuing care. The incentives project is not going away; in fact, we’re rolling out a new and improved procedure next month.

Telephone continuing care is intended to prevent relapse and support recovery for clients who have done well in treatment. Our clients who would be successfully discharged will now have the option to remain in extended care. If they enroll, they will call their counselor on the phone at least twice a month for 12 weeks. The counselor will ask them a series of questions to assess their risk for relapse, identify and reinforce protective factors, and assess and refer for case management needs.

The questions include: Have you used any alcohol or drugs? Have you had cravings? Have you spent time around your “people, places, and things?” How many AA/NA meetings have you gone to?

In addition, every client enrolled in extended care will have access to a recovery coach from the 1212 Club who can drive them to appointments, help them with housing, or give them any advice they need. We’re thrilled to be working with 1212 on this, and we know their strong connections to the recovering community will supplement the treatment the clients get at BCI.

As with the motivational incentives, the Delaware Division of Substance Abuse and Mental Health is working in partnership with BCI and other Delaware treatment providers to make the changes necessary so we can provide this new level of care. We’ve also had as our consultant Dr. Jim McKay of the University of Pennsylvania, who has done much research on telephone care and its benefits.

How will we know if this is successful? One measure we will look at is our readmission rate. Presently, about 32% of our admissions each month were here previously. If we can reduce recidivism, we should see this number go down. We will also see if average length of stay in the program increases from its current value of 102 days. Our long term goals are to better serve the clients while reducing repeat use of higher levels of care.

Motivational Incentives: Counselors Have the Final Say

If you’ve been following our Advancing Recovery experiment to reward attendance in treatment with motivational incentives, you know it’s been a challenge. While it hasn't yet proven successful at retaining clients in treatment longer, I can say we’ve learned a lot from this project. The number one lesson may be that there must be counselor buy-in for there to even be a chance for this strategy to work. All the focus groups you can offer, or all the detail you put in your training manual, may not make a difference.

To give out a prize at the end of a counseling session seemed so simple, but it turned out to be much more complex. Our counselors are great at what they do because of their own personal philosophy that guides their sessions and their interactions with clients. To implement motivational incentives, they had to alter their preferred way of doing things in a way we might think was insignificant, but to them was not. What if you had five minutes left in your session to do a prize drawing and you were in a middle of a meaningful discussion with a client? What if a client won a “Good Job” certificate but really needed a bus pass?

I believe everyone tried their best to make the project work, but ultimately, counselors will do what they think is in the client’s best interest. This is why our counselors overruled a decision to change the group drawings. We proposed a new random drawing process in which three clients would win a prize at every group, because an immediate reward is the best reinforcer of attendance. But the counselors recognized that not everyone would win. They preferred that every client who attended their required groups get a reward, even if they had to wait days or weeks later to get that reward.

To be fair, many of our counselors do support the incentives and report that their clients enjoy the program. But if we had one suggestion for treatment providers planning to implement motivational incentives, it would be to pilot test with a few counselors rather than all.

There is some good news to report. For the first time, we surpassed our target 5% improvement in retention at one milestone. 90% of clients admitted in the month of July completed their first individual session. We will continue the project at least another two months and see if this improvement can be sustained, and extended to other milestones; namely, the second and third individual sessions.

Confound It! Outside Forces Interfere with Incentives Experiment

The question: Will clients stay longer in addiction treatment if we reward them for attendance? The answer: Well, we don’t know. And I’m not being smart, that is an actual scientific explanation. Let me explain.

Our attendance is still below normal since we changed how we give incentives. We could say the new incentives caused attendance to drop – if that was the only thing that changed. But it wasn’t. Over the same time period, record-high numbers of people came in for an intake, and our census increased by 50. On top of that, two counselors and one supervisor were out for several weeks. (One was stuck on the other side of the world – trust me, you don’t want to know.) There were fewer staff to see more clients. If you were a client, which change would be more noticeable to you?

In scientific terms, we manipulated an independent variable (new incentives vs. old incentives) and measured the effect on a dependent variable (retention). Ideally, we would hold all other conditions constant. But our experiment was in a real treatment program, not a laboratory. And wouldn’t you know it, you can’t control external forces in the real world. A condition that offers an alternative and plausible explanation for the results of an experiment is called a confounding variable.

Census and staffing acted as confounding variables in our experiment. This means we can’t call the incentives a success or failure yet. But now things have stabilized and we will keep going. So bear with us, we may get a real answer to our question soon.

Some new developments to report:

• Our new marketing slogan is in place: Participation = Celebration!
• We’ll be adding prize drawings in groups because the more frequent the reward, the better at reinforcing attendance. Until now, clients got credit for group attendance but had to wait until their next individual session to get their reward.
• Counselors held a focus group to share challenges they had in implementing the program and solutions they had found. Since prize drawings took valuable minutes away from sessions, we moved the prize cabinet closer to counselors’ offices. We also learned that counselors are accustomed to using incentives to reward accomplishments and meet individual needs, so it is a real change to reward participation. A refresher training is planned, and we’ve invited an incentives expert to meet with the staff.

Participation = Celebration!

Our new slogan at the BCI Alpha Drug Free Program. Thanks to Intake Counselor Marc Weisburg for the idea.

Vote For Our Motivational Incentives Slogan

As many of you know, BCI Alpha has been offering motivational incentives to encourage more people to stay in drug and alcohol treatment for at least three months. It remains a challenge – more on that in an upcoming post. We continue to believe this can work and we want to do whatever we can to make it a success.

We’ve decided we need a marketing slogan. If we want to convince people to stay longer in treatment, we need to change their mindset. We need to “sell” our customers on the benefits of sticking with treatment once they’re here. We want to drive home the point that the first few months can be the most difficult, and BCI offers these prizes to help people through this period.

So we want a memorable catch phrase that will generate word of mouth. Something that clients can be reminded of every time they walk in our door, but also remember when they’re not here, and contemplating whether to show up for their appointment.

Help us choose a great slogan by voting for your favorite below, and also post your own ideas. We’ll announce our choice July 18. Thanks!

		What is the best slogan?
	The more you come in, the more you win.
	Beginners are winners.
	Recovery: Keep your eyes on the prize.
	Recovery is the jumbo prize. Start small. Keep coming back.
	Spend an hour in treatment, win a prize. Spend enough hours, win your recovery.
	Come for the prizes. Stay for recovery.
Free polls from Pollhost.com

Motivational Incentives Update: We Hit Some Barriers On the Road To Change

Two months ago, it looked like all was going well with our motivational incentives project. Given the chance to win prizes for attending their sessions, more clients were staying longer in treatment. It’s now been about four months and 200 people admitted since we began. The results? Retention is either unchanged, or as much as 10% lower.

Yes, you heard me right – this change we made isn’t working. What should we do? Scrap the new process and go back to our old way of doing things? Or do we press on and trust the research that says motivational incentives improve treatment outcomes? The stakes are high; real people with real drug and alcohol addictions are depending on us.

This is precisely why at BCI, we follow the NIATx model of organizational change: Plan, Do, Study, Act. With major change, some barriers are to be expected. Before we jump to any conclusions, we should question why we got the results we did.

Let’s look at the barriers we faced. First, our client volume was up during the last two months, with admissions and discharges both about 25% higher than normal. At the same time, our staff was down by two counselors, leaving us with six instead of eight. Not only were more clients coming in and out, but counselors had to deal with higher caseloads. Bad timing, but this is the real world, and these things happen.

But that isn’t all. The incentives procedure we had carefully planned out and trained our staff in wasn’t exactly going as planned. Sometimes, clients had to wait to get their prize because the counselor ran out of time. Counselors were faced with altering their preferred way of running a session. At least one counselor admitted he discouraged his clients from drawing for prizes because it was against his own philosophy of treatment.

Should we be surprised that the staff was not totally on board with the incentives? NIATx says no. Change is difficult. If we really want our project to succeed, we should acknowledge internal resistance and try to overcome it. We’re already looking at how to do this.

We’re also faced with other difficult questions. What caused our retention to go down? Was it the external things beyond our control, or the logistical issues that arose? Now that our census and staffing are back to normal, will we see better results? How much longer do we continue the incentives before declaring them a success or failure?

We want to hear your thoughts as well. And keep watching along with us to see what happens next.

Rewarding attendance: Does it lead to success in treatment?

What if addiction treatment programs gave out prizes to patients just for showing up to treatment? Some might call this a waste of money, or bribery, or counter-productive to addressing the underlying issues of addiction. Others say it actually helps patients succeed. Brandywine Counseling is studying this very question as part of the Advancing Recovery project.

Since February 15, the Alpha Program has offered motivational incentives to encourage participation early in treatment. Beginning when the patient first returns after admission, they get a chance to win a prize. They could win anything from a “Good Job” certificate up to a $75 gift certificate. Our “prize closet” also includes scented candles, backscratchers, Dunkin’ Donuts cards, and recovery-themed coins.


It’s a simple premise: Show up to your first session with your counselor and you get one draw from the fishbowl. Show up to your second and third sessions and get five draws each time. Sounds easy enough, right? In fact, attendance in treatment is a challenge, particularly early. Before we started this program, 2 out of every 10 patients dropped out before their first session, another 2 by the second, and another 2 by the third. The incentives are our attempt to help them through the most difficult part.

So is it working? Results are just starting to come in, but it appears our retention is improving. As the graph below shows, 5% more patients are completing their first session (89%) and staying at least 45 days in treatment (76%). We are especially keeping our eye on the second and third sessions once the numbers come in. Stay tuned for more updates in the coming weeks.