All behavioral health clinicians have experienced it: the clock ticks one minute past appointment start time, then two, then ten. Finally, you call it. Your patient isn’t coming today, and you might as well move on to the next task. No shows are frustrating under any circumstances, but when your goal is to increase group therapy attendance, they can present bigger challenges.
If a patient misses individual therapy sessions, they are only hurting their own progress. If they miss group therapy, they are depriving other patients of their input in an environment specifically designed for interpersonal collaboration. Not only that, they hurt the group dynamics for those who do attend. Inconsistent attendance erodes group cohesion and reduces other patients’ confidence in the program.
You can’t force patients to make their therapy appointments, but you can create an environment that makes attendance attractive and skipping difficult. If you’re struggling to fill the seats every week, try these 7 strategies to increase group therapy attendance.
1. Prepare enrollees with information and expectations beforehand
Develop a clear policy at your practice regarding no shows, late shows, and last-minute cancellations. Explain this policy verbally and in writing before the first group therapy session. Post it in the waiting room and make it available on the patient portal. Review it at your first group session.
Primary questions you’ll need to answer include:
- Will no shows or last-minute cancellations still be charged for the appointment?
- How far in advance should a patient cancel an appointment to avoid being charged?
- Are there any exceptions to this policy (i.e. cancellations due to medical emergencies, bad weather, etc.)?
- Who should a patient contact to cancel an appointment?
- What if a patient arrives late? Will late-arriving patients be allowed into group sessions already in progress?
Don’t just list the rules. Help patients understand the reason for them. Explain to your treatment group that every person’s participation is a vital part of the group dynamic. If an individual misses all or part of an appointment, the rest of the group loses out on their input. Repeat absences may make group members discouraged or frustrated.
This sense of mutual responsibility ups the odds of good attendance.
2. Send group appointment reminders to increase group therapy attendance
Research shows that appointment reminders increase therapy attendance. Automate these reminders through email, text, or patient portal messages. Some EHRs built specifically for behavioral health, such as Valant, allow you to set one reminder to send to the entire group rather than scheduling the same reminder for each enrollee individually.
Respect patients’ privacy in these reminders. Messages sent to phones or opened on laptops may be seen by a third, so stick to the basics: date, time, location, and name of the practice or group.
Remember to send these messages in enough time for patients to cancel if needed.
3. Offer taster sessions pre-enrollment
Taster sessions let potential patients experience a group therapy session as a guest so they can better gauge their comfort level with this method of care. This cuts down on the number of patients who may drop out in the first few sessions. An additional option is to conduct one-on-one screening appointments with potential members to evaluate their readiness for group therapy.
Potential group members can attend a live group therapy session or, if you have videotaped sessions, may be more comfortable watching a video. In either case, every member of the group must consent to a newcomer visiting or watching the session.
4. Focus on the “Why,” not the “Who,” of poor attendance
If group attendance flags, don’t focus on the specific individuals who failed to show up. Rather, ask how you can improve group dynamics to make it a comfortable and motivating space for all members.
A 2018 study researched the barriers to attendance and motivation in group therapy. It found a few common themes:
- Patients didn’t receive good information about the program up-front. Some patients reported wanting more information, while others were overwhelmed by the amount of material they received. When you educate potential patients about your group, make sure to answer all of the most important questions right away—the size of the group, how often it meets, the therapeutic approach you practice, etc. Provide more detailed information for patients to dive into if they want.
- Social aspect of the group. For many people, not just those seeking psychiatric help, opening up to share with strangers feels intimidating. Patients who feel uncomfortable can quickly lose interest in continuing the therapy. Create a supportive, nonjudgmental, calm environment for all group members.
- Accessibility. If the group is not offered at a convenient day and time, members may struggle to show up consistently. Likewise, if you conduct group therapy via telehealth, a slow or glitch-prone tool can be enough to make an exasperated patient give up on attending.
- Harmful group dynamics. If attendees frequently skip or don’t seem to take the sessions seriously, it can erode other patients’ confidence in the program. If one or more group members are hostile or judgmental, others may be reluctant to return. Pay close attention to negative group dynamics and address them right away. Additionally, make sure that quiet or introverted group members aren’t overlooked in group discussion.
5. End each session with something to look forward to.
Reward the hard work of therapy with fun. Open each session with an activity everyone will enjoy, and preview the next meeting’s activity at the end. Here are some lighthearted activity ideas for your group to try:
- Ask an icebreaker question that gets patients talking about a passion or interest.
- Lead a simple group game like Pictionary or Scattergories. If you lead groups via telehealth, bust out the whiteboarding feature.
- Have attendees show up to the next appointment with something amusing. For example, find a funny headline from the news to show the group, share your favorite (non-offensive) internet meme, or show a funny cat video from YouTube.
- Ask group members to share a favorite memory.
- Ask group members to share a “win” they had this week, and offer congrats and encouragement.
- If you lead group telehealth sessions, have participants show one another something interesting in their homes, such as a favorite possession, favorite room, etc.
Copious resources exist online for group therapy activities. You can also find booklets and card decks designed to provide fast, fun group therapy activities. The sky, and your imagination, are the limit.
6. Consider the group treatment journey and how to optimize weekly flow.
To make participants as comfortable as possible, each session should feel organized and in control. It’s important to consider how the “flow” of each session will go, for the participants and for you as a clinician. Take the following steps to ensure that sessions run smoothly and move participants toward their goals.
- Create smooth processes for scheduling sessions and delivering appointment reminders.
- Decide how you will take notes and integrate those notes into patient records. Some EHRs will allow you to add one set of group therapy notes to the records of each patient in attendance; otherwise, you’ll have to do it for each person manually.
- Choose goals for each session ahead of time so you can guide participants toward them throughout the meeting.
- Consider the location and layout of the meeting. Do chairs need to be set in a circle for effective communication among the whole group? Will group members partner up for special activities or discussions, and is the room large enough to accommodate that?
- How will you take attendance, and where will you keep that record?
- Outline an order for each session: group activity, specific discussion questions and goals, how to conclude, etc.
- Plan ahead for how to draw quiet or hesitant members into the conversation.
- For group teletherapy, make sure participants have instructions on how to sign in, and get training on your telehealth software so you can help participants trouble-shoot any glitches.
7. Incentivize attendance.
Despite your best efforts, some members of group therapy will likely be tempted to skip sessions—they’ll get busy, or have a bad day at work, or feel nervous about confronting the issue your group is trying to address. These are the moments when incentives to increase group therapy attendance come in handy.
One of the most common attendance incentives in the mental health world is financial. If patients know they’ll be charged for missed sessions, they’re more likely to show up—after all, they’re paying for it one way or the other. However, financial incentives can also be used as the carrot, not just the stick. Some practices give small discounts on appointments to patients who attend a certain number of sessions in a row without missing.
Studies have indicated that weekly drawings for small prizes, like gift cards, can motivate participants to show up. You could even consider drawings for larger prizes for any member who’s had a long attendance streak, and reset their record to zero if they miss a week.
For that matter, why not reward everyone for attendance? Arrange for a small prize for each individual, or fun activity for the group, if the group has perfect attendance for a certain number of weeks.
Up your group game with Valant
Valant EHR takes the work out of scheduling, documenting, and billing for group therapy so you can put your focus back where it belongs: on the patients. Our solutions solve the unique challenges of managing group records. Simply create an enrollment list for a cohort and manage all group logistics from there. Easily take attendance, write one set of meeting notes that populates to each patient’s progress note, send appointment reminders to all members with one action, and auto-bill for every person marked present at a given meeting. Valant’s telehealth solution supports group therapy by allowing multiple patients to join a call and giving the clinician control over participants’ microphones, cameras, and view options.
Contact Valant today to learn more about how we can help you increase group therapy attendance and engagement.
