Overview of the Retention Toolkit

Research indicates that remaining in substance use disorder (SUD) treatment for at least 90 days is directly correlated with positive outcomes, including a reduction in substance use and criminal justice involvement, increased likelihood of employment, increased earnings, and housing stability.

HCA DBHR logoAs partners in Gov. Jay Inslee’s Results Washington, the Washington State Division of Behavioral Health and Recovery (now part of Health Care Authority) is committed to working with behavioral health organizations (BHOs) and their providers to improve outpatient substance use disorder treatment retention in support of the Results Washington Goal 4: Healthy and Safe Communities. DBHR's goal was to increase the percentage of clients retained in outpatient substance use disorder treatment for at least 90 days from 67% to 70.7% in adult programs and 71% to 73.8% in adolescent programs by July 2017.

One effort on the part of DBHR to support this goal has been partnering with the University of Washington’s Addictions, Drug & Alcohol Institute (ADAI) in this interactive toolkit of strategies to improve engagement and retention in outpatient settings. The toolkit is intended to be easy to use, and includes resources that individual providers, other staff who interact with clients, or entire organizations may use to improve client retention in treatment.


NIATx logoSpecial thanks to the NIATx website, which provided much of the Toolkit’s content.  We also thank the SUD treatment providers and staff who participated in statewide surveys in 2014 and 2017

We also want to Patti Karvel and Shelli Young of Snohomish County Human Services AOD for sharing the "Wheel of Success," and Anthony Floyd of the Alcohol & Drug Abuse Institute for narration in the "Talking with Clients" module.

ADAI Contributors:

  • Sandra M. Radin, PhD
  • Meg Brunner, MLIS
  • Jennifer Velotta, MNPL, NCAC ll, CDP, CPP
  • Nancy Sutherland, MLS

The 2017 Behavioral Health Provider Survey

The Social and Economic Sciences Research Center (SESRC) worked collaboratively with the Division of Behavioral Health and Recovery (DBHR) to conduct the 2017 Behavioral Health Provider Survey. This statewide survey of behavioral health agencies was open to behavioral health treatment agencies who provide DBHR-certified, publicly-funded mental health and substance use disorder treatment services. 358 out of the 550 eligible behavioral health treatment providers in Washington State completed the survey online, giving a response rate of 65%. Some results of this survey relevant to treatment retention can be found here.

The 2014 DBHR Provider Survey

In September 2014, 201 providers and other staff who interact with clients in outpatient substance use disorder (SUD) treatment programs participated in an online survey to inform the development of this Retention Toolkit. Nineteen closed- and open-ended questions inquired about participant characteristics, and client engagement and retention training, practices, and needs. Topics included: feedback regarding client attendance, appointment scheduling and reminders, use of TARGET, client incentives, use of online resources such as NIATx, family involvement, barriers, and needed support. To read more about the survey and see the results, click here.

Resources Related to the Toolkit's Development

Results Washington Goal 4: Healthy and Safe Communities -- This provides a look at Goal Area Four of the Results Washington initiative, where retention in substance use disorder treatment is addressed.

Results Washington Annual Report, January 2018 -- Though this report does not include an update on treatment retention goals, it does have an update on the Results Washingto project overall.

DSHS Outcome Measures for Results Washington (November 2018; pdf) -- This supplemental report includes the goals, data being measured, and action to obtain the goal.

Statewide Summary of Outpatient Retention Goals for 2015 (by County) -- From DBHR.

Client Retention Definition -- Explains the contract language for "retention," as well as performance goals, results, actions, and review.

Substance Use Disorder Treatment "Wheel of Success" -- Developed by Patty Karvel and Shelli Young of Snohomish County Human Services Administration. Each "gear" in the wheel relates to all the others, making the whole wheel turn smoothly (or not), illustrating the concept that success results from coordinated effort.

Additional Resources

WA Recovery Help LineWashington Recovery Help Line -- 24 hour help line providing crisis intervention and referral services for substance abuse, problem gambling, and mental health. Also includes a "Career Center" with a job and resume board for behavioral health professionals and students. Call 866-789-1511.

How Will You Know if a Change is an Improvement? -- This page from NIATx offers six clear steps in evaluating the impact of a change on your organization's goals.