Retention Strategies

Considering participation in an intensive intervention program (i.e., recruitment) is different from staying in the program once enrolled, but the two are connected as part of a continuum of interaction with program participants (Anderson, 2004).  Retention is linked to how ready to participate the person is, how valued the person feels, and how well he/she is treated at each point of contact, from the first introductory meeting, to regular sessions throughout the treatment phase.  These are elements of good customer service!  Current thinking supports that essentially, participants of intensive intervention programs want to be treated like customers. Informing clients about the program they are engaging in, explaining their responsibilities as group members, and consistently showing respect increases their sense of belonging and retention. 

A meta-analysis of 125 studies found that clients continued with psychotherapy and behavior change interventions at an average retention rate of only about 50% (Prochaska & Velicer, 1997). In studies on smoking, determining that the tobacco user was not ready to quit, proved to be the best predictor of premature termination.
Some tobacco users who are not ready to quit and those thinking about quitting may participate in your stage-matched interventions as well as join intensive programs. We cannot treat people with a not ready to quit profile as if they were ready for action interventions and expect them to stay in treatment. Relapse prevention strategies should be attempted with tobacco users who are taking action. But those in the not ready to quit or thinking about quitting stages who attend your program are more likely to need dropout prevention strategies. This requires matching the interventions to stages of change.
 

Relapse Prevention Strategies

The relapse prevention strategies reviewed in the Counseling Clients section of this website will help you match the intervention to the tobacco user and increase retention rates.  

Dropout Prevention Strategies

Dropout prevention strategies address roadblocks people may identify during treatment. These "roadblocks" address issues identified in the barriers faced by tobacco users. Lack of childcare, transportation, and culturally appropriate materials and interventions interfere with client retention. When planning intensive services, designing dropout prevention strategies into your program may increase your client retention rates (Prochaska & Velicer, 1997).
 

Dropout prevention strategies include:

• Providing practical problem solving and skills training
  • Recognizing danger situations
  • Developing coping skills
  • Providing basic information about tobacco use and quitting
     
• Providing social support during the treatment
  • Encourage the patient in quitting
  • Communicate caring and concern
  • Encourage the client to talk about the quitting process
  • Invite your program graduates to talk about their quitting experience with your group
     
• Encouraging social support outside the treatment group
  • Talk about communicating with family, friends, and coworkers
  • Establish a tobacco-free home
  • Provide patient with long-term community resources, such as the Arizona Smokers' Helpline
  • Mail "supportive" post cards to clients, if appropriate
  • Set up a "buddy system" or "support partner," if appropriate
    (Fiore et al., 2000)
    

Other strategies include:

• Creating special topic sessions
• Promoting "routine" events as unique, special events
• Encouraging tobacco users to use first-line medications, except for those in special circumstances category
• Using strategies for client participation mentioned in the Group Facilitation section of this website
   

TIME is essential

In retaining clients, the time spent with clients during the highest relapse period (the first four weeks after quit day) is critical.  Use this acronym to help you in your treatment approach: