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