Overview of Intensive Outpatient and Partial Hospitalization Programs

This article provides an overview of both intensive outpatient programs (IOP) and partial hospitalization programs (PHP). It provides client criteria for each level of care, what clients can expect from each level of care, and how therapists can refer clients using Rula’s Care Coordination services. 

Intensive Outpatient Programs

Intensive Outpatient Programs are direct services for people with substance use disorders and/or co-occurring mental and substance use disorders (Dual Diagnosis) who do not require medical detoxification or 24-hour supervision. 

Core services generally include a specified number of hours of structured programming per week. The program consists of individual therapy, group and/or family therapy, and psychoeducation about substance use and/or mental health. The length of time in treatment and amount of hours per week required will depend on the individual’s treatment needs and progression and vary by program.

IOP Criteria

IOPs are a good fit for individuals who meet some or all of these criteria:

  • There is little risk of acute intoxication or withdrawal. 
  • Physical health conditions are manageable and will not distract from treatment participation. 
  • Emotional, behavioral, and cognitive conditions are mild or treatable on an outpatient level but may have the potential to distract from treatment and recovery and therefore require monitoring. 
  • Readiness to change fluctuates, highlighting the need for engagement in a structured treatment environment several times a week.
  • There is a greater probability of continued use, problems, and relapse without support and monitoring throughout the week. 
  • Current environment is not supportive, but added support and structure from an IOP program enables coping.

If clients are appropriately placed in IOP treatment, treatment outcomes are comparable to inpatient treatment, but at nearly half the cost.

Partial Hospitalization Programs

Partial hospitalization programs(PHP) provide a structured program of outpatient psychiatric services as an alternative to inpatient psychiatric care. It's more intense than the more routine type of outpatient care received in an outpatient setting. This program can sometimes act as a transition/step down from inpatient hospitalization for clients who need further stabilization or more intensive continuity of care; can also serve as an alternative to inpatient treatment for clients who don’t need or want inpatient hospitalization. 

There are many variations to the services offered in the program as well as the duration, but typically PHP requires 15-20 hrs per week which is broken down into 5 days of treatment per week. The program can include individual therapy, group therapy, psychiatry services and additional classes/groups that provide educational and coping tools.

PHP Criteria

PHPs are a good fit for individuals who meet some or all of these criteria:

  • The degree of impairment will be severe enough to require a multidisciplinary structured program, but not so severe that clients are incapable of participating in and benefiting from an active treatment program, and able to be maintained outside the program.
  • Difficulty functioning at work, school, or other occupations
  • Not at risk of harming self or others
  • Medically stable
  • Has adequate support at home
  • Motivated to participate in treatment
  • Experiencing co-occurring mental health and substance use disorders.

Virtual IOP/PHP

Virtual Intensive Outpatient and Partial Hospitalization Programs have been proven to be effective forms of treatment. However, there are some limitations when it comes to locating virtual IOP/PHP resources. 

 

Note: Clients can attend virtual PHP programs, depending on the condition of their symptoms and stabilization. If client symptoms worsen while participating in virtual PHP, they will be referred to inpatient care or a hospital for urgent treatment, unless this service is offered by the attended treatment center.

 

Here are a few factors to consider when identifying virtual options:

  • Location: Typically rural areas require in-person treatment.
  • Eligibility Criteria: Some treatment centers assess virtual eligibility based on age restrictions, accommodation needs, and ensuring the client's mental health conditions are stable enough for outpatient care in a virtual setting.
  • Insurance: Insurance coverage can vary based on specific plans and state regulations. client's insurance must cover virtual IOP/ PHP services to be covered under their insurance. While clients are encouraged to inquire with their insurance to ensure these services are covered, most treatment centers will complete verification of benefits during the intake process.

What can clients expect out of IOP/PHP?

The goal of PHP and IOP levels of care is short-term stabilization for clients in a crisis or in need of crisis-level support at the time of admission. Most clients are ‘stepping up’ to a more comprehensive level of care (usually from an outpatient psychiatrist or outpatient therapist) due to needing additional support. Some clients are ‘stepping down’ from inpatient or residential treatment facilities. Regardless of the most recent level of care, the goal is to return clients to their daily functioning with the ability to manage their symptoms more effectively.

In a virtual setting, the program usually follows the same schedule as an in-person IOP/PHP, allowing clients to participate from the comfort of their homes via a secure, HIPAA-compliant teleconferencing platform for convenience. clients can expect to follow a supervised schedule each day of the program (a minimum of 3 days per week for IOP, totaling 9 hours, and a minimum of 5 days per week for PHP, totaling 15 hours) that includes individual therapy, medication management, and group/family therapy. Typically, treatment incorporates DBT, CBT, and EMDR.

Schedule expectations

It's important to note that some treatment centers offer both day tracks and evening tracks to accommodate work/school schedules. However, most treatment centers only offer morning programs and encourage clients to coordinate scheduling directly with their school and/or work in an effort to prioritize their mental health needs.

When to refer a client to IOP or PHP

The decision of whether and when to refer to IOP or PHP lies within the decision of you and your client. While there are certain indicators of clients with high-risk needs, the reasons for referring to these more intensive programs vary based on each client’s needs and your clinical rationale. For guidance on determining your client’s level of care specific to HLOC such as IOP or PHP, please reference the rubric regarding Levels of Care.

How does care coordination support requests for IOP/PHP referrals?

Rula’s Care Coordination team will locate and provide a few options for the client to review based on your clinical rationale provided via the higher level of care request, along with any preferences the client may have. In our efforts to locate referrals, we ensure the options are in-network with the client's insurance if possible. If the client decides to move forward with one of the options, we will initiate a referral for the treatment center to reach out for an assessment, however, oftentimes the client will opt to reach out to the treatment center directly. 

To avoid any delays in your client’s care please ensure the following:

  • You are discussing any and all recommendations for IOP or PHP with your client
  • Your client agrees to follow through with your recommendation
  • Your client is made aware and agrees to engage with a member of Rula’s Care Coordination team
  • You’re clearly documenting clinical rationale in your request and following up with your client; documenting discussions within progress notes

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