Process improvement needs in substance abuse treatment: Admissions walk-through results

Researchers have questioned whether the addiction treatment infrastructure will be able to deliver high-quality care to the large numbers of people in need. In this context, the Robert Wood Johnson Foundation and the Center for Substance Abuse Treatment created a nationwide network to improve access and retention in treatment. Applicant agencies described results of an admission process walk-through. This qualitative study used narrative text from 327 applications to the Robert Wood Johnson Foundation, focusing on admissions-related problems. We developed and applied a coding scheme and then extracted themes from code-derived text. Primary themes described problems reported during treatment admissions: poor staff engagement with clients; burdensome procedures and processes; difficulties with addressing the clients' complex lives and needs; and infrastructure problems. Subthemes elucidated specific process-related problems. Although the findings from our analyses are descriptive and exploratory, they suggest the value of walk-through exercises for program assessment and program-level factors that may affect treatment access and retention.