By Deborah Rasso, LMHC, CAP, ICADC, LPC, NCC, QS, CH
Partial Hospitalization Programs are considered an “outpatient” level of care, offered to clients who have achieved stability and no longer need inpatient/residential services. It is also offered when clients who were at a lower level of care fail to meet the treatment objectives and need more intensive interventions. The recommendation at this level is to attend treatment five days per week for a minimum of five hours per day (or night). When not in treatment programming, clients are allowed to return to a less structured environment or to their homes. Clients at this level of care are no longer offered 24/7 medical and clinical support.
Prior to the rise of Managed Care in the early 1980s, outpatient care was not promoted by insurance companies. They held the belief that in order for an alcoholic or addict to recover, a residential or hospital setting was required. Managed care emerged to create “gatekeepers” for what occurred inside treatment institutions and to match the client’s needs with the most cost effective treatment services. Residential/inpatient treatment approval and reimbursement dropped from an average of 28 days to 18-21 days, to 14 days to 5-7 days, and then to a few days of detoxification. (White, 1998)
Most often clients will be encouraged to begin treatment at an outpatient level of care, which could be simply starting individual counseling. If they continue to struggle with their addiction, they will be encouraged to try an intensive outpatient level of care (usually three days a week for three hours in a group setting). If the client continues to use substances at that level, he will then be encouraged to try a partial hospitalization program. To be considered for this level, the client must either be free from intoxication and withdrawal symptoms or be able to manage the symptoms safely without medical intervention. Additionally, to qualify for partial hospitalization, the client must meet criteria in one of the following areas:
- Emotional, Behavior, or Cognitive conditions (i.e.: a history of mild-to-moderate psychiatric decompensation when they discontinue drug use)
- Readiness to change (i.e.: they have failed at a lower level of care due to being resistant to change but have a desire to change)
- Potential for relapse/continued use (i.e.: they will most likely continue using or relapse if they are not closely monitored)
- Recovery environment (i.e.: their home, school, or work environment makes it difficult for them to remain abstinent without the support of this level)
The demand for this level of care led to the formation of what is often referred to as “The Florida Model” of treatment. This model provides community housing to the client who is attending treatment. The majority of addiction treatment centers offer this style of treatment in the current environment of care. Clients live together in either apartments or houses and commute daily to their treatment program located off site. They usually are required to shop and prepare their meals, clean their houses, and do their own laundry. The housing is usually staffed 24 hours per day by Behavioral Health Techs (BHT) to ensure the clients are following the rules, are safe, and are not using any mind altering substances. This is the only outpatient level of care that can provide housing that is included in the cost of treatment. Not all partial hospitalization programs will provide housing, and those that do may make it a requirement for regular attendance in their program. This protects clients from exposure to outsiders who might bring substances into the program. The advent of this model was an important one. Without the ability to provide housing to clients, many would have to return home from treatment long before they were fully prepared to face their triggers and remain sober.
When clients are on a partial hospitalization program level of care, they no longer have access to medical staff on a regular basis. Most programs have a doctor on staff that will be able to meet with the client once a week for follow up after their initial history and physical and psychiatric evaluation. Clients are responsible for taking their medications at designated times and continue to be monitored by staff to make sure they are taking them as prescribed. On the weekly follow up, the physicians can determine if the medications are working properly and make adjustments as needed.
If a client begins treatment by going through detox and then residential programming, partial hospitalization is the next logical step. The clients are given an opportunity to test whether they have the coping skills needed to remain sober in a less restrictive environment. Most programs incorporate daily trips to (Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings so that clients can begin to build a sober support network and embrace a program of recovery.
Treatment at the partial hospitalization program level requires that the client is offered and participate in a minimum of 25 hours of treatment per week including groups and individual sessions. The group topics offered include addiction education, relapse prevention, life skills, spirituality, anger management, coping skills, art, music, stress management, cognitive behavior therapy, and other specialized topics. Individual therapy will be focused on the client’s identified problems and may utilize many therapeutic modalities.
Delphi Behavioral Health Group treatment centers feature Master’s level clinicians to work with individuals on their addiction issues as well as co-occurring disorders such as depression, anxiety, and Bipolar disorder. Case Managers are available to help with any legal and employment issues. All of our treatment programs use a multidisciplinary approach to treatment. The average length of stay at this level of care is four to five weeks. When the client has met the criteria and treatment plan goals at this level of care, he is prepared to step down to an Intensive Outpatient level of care.
Are you or a loved one struggling with addiction?
It’s important to always understand that you are never alone. The members of Delphi Behavioral Health Group are ready to provide a caring and professional environment for recovery. Call us now at 844-899-5777 and tell us how we can help.