Treatment Programs and Appropriate Levels of Care
There are many kinds of evidence-based treatments. There are also a variety of levels of care for particular issues. What level of care that a client needs is dependent in part by 1) how able they are to productively participate in outpatient treatment (e.g., complete exposure homework outside of sessions), the level of impairment that symptoms are causing, and the complexity of the clinical picture.
The most frequently offered levels of care are:
1) Inpatient: Acute crisis stabilization (e.g., immediate danger of harm to others). Care only lasts a few days in most cases and typically focuses mostly on stabilization, not curing the issue that led to the crises.
2) Residential: Residential level services are for individuals with very severe symptoms and those with poor insight or ability to resist the behaviors that continue their problems. These treatment programs tend to involve living on-site at the treatment facility, often because the client cannot resist engaging in maladaptive behavior during the night or throughout the full day without on-going supervision. At times, residential treatment may be offered as an option for those who are geographically isolated from appropriate treatment. Generally, insurance does not pay for residential level treatment unless this level of treatment is deemed clinically necessary. Clients who seek residential level treatment due to travel distance alone are likely to find that it is more affordable for them to seek hotel accommodations near the treatment facility.
3) Partial Hospitalization (PHP) or Day Treatment: PHP level treatment is for individuals who are experiencing a high level of symptoms, high levels of impairment, and may need a higher degree of supervision to effectively engage in treatment procedures for a brief period of time (often 4 to 6 weeks).
4) Intensive Outpatient (IOP): IOP level treatment is provided for individuals whose symptoms and impairment are severe and who need extra assistance to participate effectively in therapy procedures. They often do not require a higher level of supervision or involvement needed at the PHP level but will tend not to make treatment gains at the outpatient level.
5) Outpatient: Outpatient treatment is seeing a therapist one or more times per week. Most of the therapeutic work is to be done by the client’s practice of ‘homework’ or assignments outside of the therapy hour. Many clients are able to make treatment gains at this level; however, for those that are not able to make treatment gains at the outpatient level during a normative time period for their condition. For most anxiety disorders, less than 6-8 months in treatment should result in significant changes. If you find that you continue to be in the same place in therapy or, as a therapist, that your client is unable to make progress between sessions for long periods of time – you are ethically required to refer your client to a more appropriate treatment level or match.
Clients, and even many clinicians, struggle to determine the appropriate level of care for a client. If you are unsure what level of treatment you may need, please feel free to contact us for a brief evaluation. Often, an initial in-person evaluation is required to truly determine the appropriate level of care.