Summary: <p>Intensive Outpatient Services:<br> Clinical and Administrative Issues<br> TIPs 46 & 47<br> Dr. Dawn-Elise Snipes, PhD, LMHC<br> Overview IOT<br> ~ Multidimensional/Biopsychosocial<br> ~ Recognizes dual disorders as chronic<br> ~ Values case management<br> ~ Blends evidence-based with community based services<br> Core Features<br> ~ 6–30 contact hours per week<br> ~ Individualized step-up and step-down levels of care<br> ~ Minimum duration of 90 days followed by step-down<br> Core Features cont…<br> ~ Enhanced services<br> ~ Ambulatory detoxification<br> ~ Childcare<br> ~ Outreach<br> ~ Case Management<br> ~ For more detailed information, see TIP 47, pp. 1–6</p> <p>Core Services<br> ~ Screening<br> ~ Assessment<br> ~ Treatment planning<br> ~ Treatment engagement<br> ~ Group, individual and family counseling<br> ~ Psychoeducational programming<br> ~ Integration into support groups<br> Core Services cont…<br> ~ Relapse prevention training<br> ~ Substance use screening and monitoring<br> ~ Vocational and educational services<br> ~ Referral to wrap-around services<br> ~ Mentoring?<br> Principles of IOT<br> ~ Treatment available to a wide spectrum of clients<br> ~ Treatment access<br> ~ Straightforward and welcoming<br> ~ No Wrong Door<br> ~ Enhance existing motivation<br> ~ Trust between counselor and client<br> ~ Client retention priority<br> ~ Individualized assessment and treatment<br> Principles cont…<br> ~ Implements flexible, chronic/episodic care model<br> ~ Monitor abstinence<br> ~ Help clients integrate into support groups<br> ~ Medications to manage co-occurring disorders<br> ~ Educate clients and family members<br> ~ Families, employers, and significant others<br> ~ Evidence-based training and materials<br> ~ Improve program administration</p> <p>Clinical Considerations<br> ~ Challenges in Adolescents and Others<br> ~ Inconsistent ability for abstract /future thinking<br> ~ Impulsive/short attention span<br> ~ Vulnerable to peer influence<br> ~ Frequent emotional fluctuations<br> ~ Lack of involvement in pro-social activities<br> ~ Pessimistic/fatalistic attitudes<br> Treatment Engagement<br> ~ Goals<br> ~ Initiate a treatment contract<br> ~ Resolve acute crises<br> ~ Engage in a therapeutic alliance<br> ~ Involve clients in preparing a treatment plan<br> ~ Duration — A few days to a few weeks</p> <p>Engagement Activities<br> Confirm diagnosis, eligibility, appropriate placement<br> Conduct biopsychosocial assessment<br> Develop treatment plan<br> Develop a relapse prevention plan<br> Provide assessment feedback<br> Explain program rules and expectations<br> Address acute crises<br> Resolve administrative issues<br> Foster therapeutic alliances<br> ◦ Client, counselor, group members<br> Engagement Activities cont…<br> ~ Begin psychoeducational activities<br> ~ Identify sources of social support<br> ~ Initiate family contacts and education</p> <p>Phase 1 Completion Criteria<br> ~ Assessment and treatment plan completed<br> ~ Client completely stabilized<br> ~ Client demonstrates adequate attendance and participation<br> Early Recovery<br> ~ Goals<br> ~ Abstinence<br> ~ Sustain behavioral changes<br> ~ Identify relapse triggers and develop relapse prevention strategies<br> ~ Identify and begin to resolve personal problems<br> ~ Begin active involvement in a 12-Step or other mutual-help program<br> ~ Duration — 6 weeks to about 3 months<br> Counselor Activities<br> ~ Help clients follow their plans to recovery<br> ~ Assist identify and develop strategies for relapse triggers<br> ~ Initiate random drug tests and provide rapid feedback of results if appropriate<br> ~ Help clients and families integrate into mutual-help programs<br> ~ Assist develop and strengthen positive social support networks<br> ~ Continue appro</p>
