Clinical Quality Improvement through a Pre-enrollment Group for Active-duty Service Members in an Intensive Outpatient Program

Introduction Unavailability and delays to mental health care are a significant problem that can lead to worsening psychological symptoms and less effective treatments. Within the intensive outpatient setting, pre-enrollment care is recommended to address delays to care. Although pre-enrollment care is intended to support at-risk individuals awaiting program entry, there remains a lack of clarity regarding structure, implementation, and impact on clinical outcomes. This article examines the impact of a pre-enrollment group on the access to care and outcomes of participants in a Military Treatment Facility Intensive Outpatient Program (IOP). Materials and Methods This retrospective Quality Improvement (QI) project examined access to care and outcome data from participants in an IOP during calendar year 2023. Groups of patients who did and did not receive the pre-enrollment group were compared before and after treatment using repeated-measures analysis of variance. Results Analysis showed pre-enrollment group patients showed more improvement in both anxiety and depression symptoms over IOP treatment. Additional analysis by diagnostic group showed that these effects differed depending on the patient’s primary diagnosis. Among patients with a trauma-related diagnosis engagement in pre-enrollment group was protective against increased anxiety and depressive symptoms although patients with a chronic adjustment disorder diagnosis showed a more significant decrease in both anxiety and depression symptoms. Finally, delay to care was generally associated with worse outcomes, which engagement in pre-enrollment decreased, although therapeutic alliance positively influenced treatment response. Conclusions This QI project demonstrates that engagement in pre-enrollment care can reduce delays to treatment and improve behavioral health outcomes. These findings support formalizing pre-enrollment programming as a core component of IOPs.