BEHAVIORAL HEALTH-INTENSIVE OUTPATIENT PROGRAM
Participant Guide/Program Descriptions/Rules/Disclosure Statement
I
NTRODUCTION
Welcome to the Intensive Outpatient Program, part of the Centura Health system. It will be referred to as “IOP” for the remainder of this guide. IOP is primarily a group therapy program led by Licensed Clinicians, Mental Health Counselors, and other clinical staff. This is a three (3) hour, “half-day”
behavioral health treatment program. We accept referrals from outpatient sources including
psychiatrists and other outpatient providers and other facilities, in addition to serving referrals from within the Centura health network.
This is not an alternative to inpatient hospitalization This is not a Crisis Stabilization Program
This is not a Chemical Dependency Program (although there is a separate CD-IOP available)
THIS IS A VOLUNTARY TREATMENT PROGRAM. WE DO NOT ACCEPT INVOLUNTARY PARTICIPANTS UNDER ANY CIRCUMSTANCE. PARTICIPANTS ARE FREE TO DISCONTINUE TREATMENT AT ANY TIME.
T
REATMENT
P
ROGRAM
T
RACKS
All treatment tracks are designed for adults age 19 and older who are either stepping down from an acute hospitalization or as a step up from an outpatient level of care. It is an active, directive, structured program designed primarily to treat mood disorders and other behavioral health difficulties. Participants start attending each Program Day for the first 2 weeks or so, and then taper down gradually to assess their ability to function with gradually decreasing levels of support and to give them an opportunity to practice their new skills prior to discharge from the program and transition to a lower level of care (outpatient services). Participants may also start to return to work on a limited basis when nearing discharge from the program. The average length of stay is approximately six to eight weeks.
E
LIGIBILITY
C
RITERIA
The IOP treats adults age 19 and older with significant behavioral health difficulties. The most common conditions we treat are Mood Disorders (Major Depression, Bipolar Disorder), but we also treat Anxiety Disorders, Schizophrenia, Schizoaffective Disorder, and many other disorders. Because this is essentially a group therapy program, all participants must be able to function as a member of a group without behaviors disruptive to the milieu.
Participants in this program do not require acute/inpatient treatment (due to imminent safety concerns or severe impairment in functioning) but do require a higher level of care than regular outpatient visits. The basic criteria for admission to this program include:
Significant distress caused by increased symptoms (severe depression, hypomania/mania,
suicidal thoughts, impairment in thinking, etc.)
Significant impairment in functioning (occupational, familial, social, activities of daily living,
etc.) worse than baseline level of functioning
Sufficient support at home to function in an outpatient setting (safe, stable living environment, social support, etc.)
Ability to stay safe, take meds as ordered, abstain from alcohol/drugs, and follow Plan of Care Admission cannot be for support or socialization only
S
CHEDULING AN
I
NTAKE
A
SSESSMENT
For participants referred to IOP from an inpatient stay at Porter Hospital, an admission screening will
be scheduled by your inpatient Social Worker prior to your discharge. You will meet with the IOP Staff prior to your discharge for a screening to make sure you would be an appropriate candidate for IOP. Details about the admission process will be reviewed and a date (usually the Program Day after discharge but within three days of your inpatient discharge) for admission will be set at that meeting. All other prospective participants in IOP must be screened via telephone prior to an intake appointment being set.
For referrals coming from outpatient settings two things:
o The prospective participant to call for a telephone screening.
o Information from your outpatient providers, usually in the form of our Referral Sheet being faxed to us.
o Those without providers are may still be eligible for IOP, but may require additional steps prior to setting up an intake.
For referrals from other facilities, we need two things:
o The prospective participant to call for a telephone screening.
o Facility records, specifically a psychiatric evaluation, medical H&P, psychosocial assessment, current medications, DC summary, and a face sheet.
A
SSESSMENT
&
D
ATA
G
ATHERING
All participants in the IOP will receive initial and ongoing assessment of their condition, including medical-psycho-social-emotional-behavioral screening. Some data may be in the form of self-report surveys, clinical interview by IOP staff to gather Medical-Psych-Social-Emotional-Behavioral data, observation in the program, among other assessments. Initial assessments and screening will typically be done the day of intake to the program by the assigned program staff that will serve as their Clinician for the duration of the program, and will be completed and documented within 3 Program Days attended. Program physicians will also perform their own assessment within 3 Program Days of attendance. An Initial Safety Assessment & Safety Plan will be done with each participant on the day of intake to the IOP.
T
REATMENT
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HILOSOPHY
This is Skills-Based treatment. We do not do traditional psychotherapy or extensive talk-therapy about problems; we instead focus on teaching and practicing better coping skills (using a DBT and CBT skills) to better handle current stressful situations and manage emotions; treatment is more like a classroom than other traditional forms of therapy. Groups focusing on Coping Skills are the main treatment modality in this program. There are three therapy groups daily. You will usually meet 1:1
those with PTSD, we focus on Containment Skills and do not do historical exploration or processing of trauma.
The overall treatment philosophy has four main points:
Coping Skills Training (primarily DBT) to better manage stressors and contribute to adaptive
lifestyle changes
Behavioral Interventions focused on increasing structure, support, and activity level, and
effective practice and use of new coping skills
Cognitive Interventions aimed at changing the thoughts that lead to and maintain depression,
anxiety, etc.
Medication to help manage mood, behavior, and thinking
We use what is known as Evidence Based Treatment (EBT) as much as possible. EBT emphasizes the use of treatment methods with a proven track record of rigorous research methodology and effectiveness in clinical practice. The three methods of treatment that seem to best meet the needs of our participants include DBT, CBT, and Medication:
Dialectical Behavior Therapy (DBT) – We use a skills training model of treatment in the IOP. The main
treatment modality we utilize for this purpose is DBT. There are four main skill modules in DBT:
Mindfulness, Interpersonal Effectiveness, Emotion Regulation, and Distress Tolerance. The focus of
DBT is on practicing and using better coping skills to manage current problems. Each of these skill groups has specific coping skills associated with it. The groups are presented in a psycho-educational format emphasizing practice as an integral part of the skill-acquisition process. Audio recordings on CD are available to supplement treatment.
Cognitive Behavior Therapy (CBT) – CBT is a scientifically proven method of treatment for depression,
anxiety, and many other psychiatric disorders. It is considered the treatment of choice for many psychiatric disorders, and has a track record of fast, effective treatment with a decreased risk for relapse once treatment is finished. Homework and practice is an integral part of CBT. This can include Activity Scheduling, Sleep Hygiene, and Cognitive Restructuring, and behavior therapy. Audio recordings on CD and a CBT Manual are available to supplement treatment.
Medication – Medication is a required component of treatment in IOP. The IOP includes initial and
ongoing medication consultation as part of the program. Medication is an essential part of treatment in IOP. Some disorders require medication for successful treatment, and participants benefit from the consistent and appropriate use of medication. Medication is a standard part of the program; all participants will be on medication, with very few exceptions. Medication compliance is required for
program admission. The first visit with the program psychiatrist is usually done in the early afternoon,
and usually within three program days of admission. Most participants will be seen during program hours, some participants may need to return in the afternoon depending upon the psychiatrist’s schedule.
S
CREENING
&
A
DMISSION
G
UIDELINES
The first step in being admitted to the program is for your outpatient treatment provider (therapist or psychiatrist) to leave a detailed voicemail with the IOP Coordinator or fill out a Referral Form and fax that to 303-765-3701. We can forward the Referral Form if you provide your treatment provider’s fax number or email address. All forms can be found on the Porter Hospital web site at www.porterhospital.org.
P
ARTICIPATION
G
UIDELINES
All participants are expected to actively participate in groups, complete therapy assignments, and homework outside of program hours, actively practice new skills, attend scheduled Program Days, and take medication as ordered. Your Clinician and other program staff will collaboratively review your
Care Plan, provide feedback, and make recommendations for corrective action. If you are unable to
follow program recommendations after an appropriate period of time, you may need to be referred to a different treatment regimen.
Because this is primarily a group therapy program, each participant’s behavior has a potential impact upon the treatment of others individually, and on the treatment milieu as a whole, both during groups, breaks, and before and after the treatment day.
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HERE
A
RE
S
OME
R
ULES
Any program is going to need some rules and some structure; the rules & structure are there to provide a safe, supportive, and therapeutic environment for IOP participants and staff. The rules & structure are also in place to help provide the most benefit (and relief from your symptoms) in the shortest period of time possible. I’m going to try to keep things very brief and clear; feel free to ask questions if you need further information. Because your behavior impacts the milieu and the treatment of others, inability to follow these rules will result in discharge from the IOP.
You have to be able to keep yourself safe; nothing else really matters if you can’t keep yourself safe.
o You’ll develop a Safety Plan when you first start IOP, and you need to follow that plan for the duration of your treatment.
o If you can’t stay safe, let your IOP Clinician and support system know ASAP.
o IOP Staff are not available after program hours; if you experience a life-threatening
emergency, call 911 or go to the nearest Emergency Room.
All firearms and old medication need to be removed from the home, and confirmed by friends or family, before you start IOP. You can bring old meds to IOP for disposal through the hospital pharmacy.
You can’t drink alcohol or use drugs of any kind during your treatment in IOP.
You need to attend the days you’re scheduled to attend. If you miss a scheduled day without giving us one (1) Program Days’ notice, that’s considered an Unscheduled Absence. Give us as much notice as possible if you’re not going to attend on a scheduled day, please.
o You can have three (3) Unscheduled Absences during the course of your treatment. o More than a few episodes of Tardiness are going to be problematic (there’s no
o Don’t come to IOP if you’re sick or running a fever. You need to be fever-free for twenty-four (24) hours before returning to IOP. Be sure to call ASAP if you’re feeling sick and will not be attending IOP.
If you NO-SHOW on a scheduled day, we’re going to track you down. Anytime we have to track you down, it’s a Welfare Check. We start by calling you; if we can’t quickly reach you, we call your Emergency Contact; if we can’t quickly reach them, we call your local police department and ask them to go to your home to check on your safety.
o You get one (1) Welfare Check; hopefully, you won’t require a Welfare Check at all. o If you leave IOP early, let your clinician know before you go. If you don’t, we have to
track you down for a Welfare Check.
When Denver Public Schools close because of the weather, IOP will be closed as well. It’s your responsibility to confirm that schools are closed. The main IOP number (303-778-5770) will be updated by 7AM if IOP is closed.
This isn’t a talk-therapy program; this is a Skills-Based program. Groups will be more like a classroom than traditional groups. That means there will be homework and things we want you to do outside of group. You will need to force yourself to do these things.
You are required to make ongoing improvements in functioning (that is, following your Plan
of Care and practicing the skills); failure to make timely improvements in your disorder does
not support ongoing treatment at this level.
Taking prescribed meds as directed is a requirement for treatment in IOP.
You have to be healthy enough medically to attend IOP; if you have any medical conditions, make sure those are well managed prior to starting IOP.
You have to have a safe, stable place to reside in order to attend IOP. Living in your car, or couch surfing isn’t considered stable housing. You need to get your housing situation in place prior to starting IOP.
You can’t socialize or hang out with other participants in IOP (or folks that you met as an inpatient). Don’t share phone numbers, become Facebook friends, share medications, loan money, provide transportation, live with, or otherwise associate outside of groups.
Treatment is confidential; don’t discuss anyone else in IOP with anyone else.
Turn off your phone and all other electronic devices while groups are in session, and get them off the table. Ringing/vibrating phones are disruptive in groups. Don’t answer your phone in group, take it outside.
Your first visit with the IOP Psychiatrist will be in the afternoon. Plan to be available between Noon and 4PM (it will likely be earlier than that, but make plans to be here regardless). Ask your IOP Clinician for more specific details.
You can’t work and do IOP at the same time (regardless of the hours you work); plan to take
at least two (2) weeks off work. Most folks are off work at least four (4) weeks, some even
longer. This is part of that impairment in functioning that’s a criterion for admission to IOP. o We’ll gradually get you back to work as your condition improves.
o Students will likely need to Medically Withdraw for the semester. o We can help with Short Term Disability and FMLA paperwork.
o If you absolutely cannot take time away from work, this program will not work for you
Excessive talking, frequent interruptions, and disruptive behavior are considered group and treatment interfering behavior and will not be tolerated.
F
INANCIAL
G
UIDELINES
Most insurance plans pay for the program or you may choose to pay out of pocket for your treatment. To find out the cost of this option, make financial arrangements, and arrange payments prior to starting the program, you would need to contact the Health Benefits Advisor (HBA) office at
303-765-6612. All participants, whether from inpatient in Porter Hospital or coming from outside sources will
meet with the HBA the day of their admission to IOP.
You are responsible for paying your pay while you are attending the program. There may be a co-payment due for each Program Day attended. There may be separate co-co-payments for each visit with the IOP Psychiatrist. You may speak with the HBA office about payment options if you have financial difficulties. To speak with the HBA office, call at 303-765-6612. An HBA Office Representative will be on-site in the IOP Suite several days a week to collect co-pays as you have them scheduled.
Before we can provide any information, written or verbal, to your outpatient providers, you must sign a Release of Information (ROI). Likewise, we require a ROI to provide any information to family.
S
TUDENTS
From time to time we host students in Nursing, Pharmacy, and other Professional Programs. Students are bound by the same conduct and confidentiality standards as staff anywhere in the hospital system.
F
ALL
P
REVENTION
G
UIDELINES
Sometimes medical conditions or medications can cause drowsiness or dizziness, usually when changing from a lying or sitting position to a standing position where this can lead to a fall. With some of the medication, the drowsiness or dizziness will go away in a few days or weeks. If the drowsiness or dizziness is uncomfortable, please let the doctor know right away. You can reduce your chances of falling by following these recommendations:
When changing from sitting / laying down to a standing position, STOP and sit on the edge of the bed or chair for 2 minutes before standing up
Tense your leg muscles several times before standing
Rise to standing slowly, keeping a hand on the chair or bed if you do get dizzy or faint Stay hydrated through the day
Eat regular meals Wear non-skid footwear
Avoid alcohol, and do not mix medications with alcohol
C
OMPLAINTS AND
C
ONCERNS
Please bring all complaints and concerns to the attention of the IOP Coordinator, so that problems can be resolved as quickly as possible.
Behavioral Health Coordinator: Jay Ryser, LPC 303-778-5770
D
ISCLOSURE
S
TATEMENT AND
S
TAFF
C
REDENTIALS
The Colorado Department of Regulatory Agencies (DORA) has the general responsibility of regulating the practice of licensed psychologists, licensed clinical social workers, licensed professional counselors, licensed marriage and family therapists, certified school psychologists, and unlicensed psychotherapists. The agency within the Department that has the responsibility specifically for licensed and unlicensed psychotherapists is the Mental Health Section, 1560 Broadway, Suite #1370, Denver, Colorado 80202, 303-894-7766.
IN A PROFESSIONAL RELATIONSHIP (SUCH AS THIS), SEXUAL INTIMACY BETWEEN A CLINICIAN AND A CLIENT IS NEVER APPROPRIATE. IF SEXUAL INTIMACY OCCURS, IT SHOULD BE REPORTED TO THE
DORA AT 303-894-7766.
John Batiuchok
Dr Batiuchok graduated Cum Laude with his Bachelor’s Degree from Princeton University in 1969 and received his medical degree from Cornell Medical School in 1973. He is a Board Certified Psychiatrist and has worked in Mental Heal Centers, private practice, and hospitals, with an emphasis in Inpatient Psychiatry and Intensive Outpatient Programming, and has expertise in Skills-Based treatment.
Jay Ryser 303-778-5770 jayryser@centura.org Fax: 303-765-3701
Jay holds a Bachelor’s degree (Psychology & English Literature in 1985) and Master’s degree (Counseling in 1987), from Stephen F. Austin State University in Texas. He has worked clinically in inpatient and outpatient settings with children, adolescents, adults, and geriatrics, has developed programs for all populations, and run a successful private practice. Jay has received additional training in Cognitive Therapy, Behavior Therapy, Rational Emotive Behavior Therapy (REBT), and Dialectical Behavior Therapy (DBT). Jay was licensed as a Professional Counselor in Texas from 1988 to 2000 and in Colorado since 2000 (LPC #2457).
Susan Leroux 303-765-3567
Susan holds a Bachelor’s degree in Medical Science (1991) from the University of Colorado Health Sciences Center and a Master’s degree in Counseling (2000) from Denver Seminary, both in Colorado. She has worked clinically with a broad-spectrum of inpatient plus outpatient and volunteer
populations, individually plus as a board advisor and part of a collaborative team, supporting client stabilization and therapeutic interventions within daily and long-term planning formats. Susan has invested in additional training, building psychosocial alliances within organizational development, mediation, chronic illness, organ donation, grief recovery, and dialectical behavior therapy arenas. Susan is licensed as a Professional Counselor (LPC #4242) .
Vicki Swab 303-765-3752
Vicki has worked in Mental Health and Substance Abuse fields since 1989. In that time, she has worked with a variety of people in hospital, residential, outpatient, and inpatient settings. Vicki has experience with adolescents and adults. She received her Bachelor’s from the University of Colorado Denver in 1992, and her Master’s from Regis University in 1997. She has been licensed as a Professional
Counselor (LPC #2931) since 2001. She is a Certified Addictions Counselor, Level III (CACIII Certificate
#6169) since 2004.
Sara Yazdi, LPC 303-765-6540
Sara received her Master’s degree in Counseling Psychology & Counseling Education from University of Colorado at on May 2010 and her Masters degree in Computer Information Systems from University of Colorado on Fall 1997. Sara is a Licensed Professional Counselor (LPC # 11175) in the State of Colorado and is a member of National Certified Counselors (NCC). Sara has been volunteering in many non-profit organizations over the last few years. Her approach in therapy is to meet her clients where they are in their lives right now. Then, based on what clients want to get out of our work together, Sara would use the techniques and tools she has learned in CBT & DBT and adjust them to fit her clients’ need. Sara uses “Here & Now” to bring back everything to perspective and reality.
Jason Johnson 303-765-6876
Jason has a Bachelor’s Degree in Psychology (Minor in Gerontology) from Baylor University (1995) and a Master’s Degree in Community Counseling from Denver Seminary (2000). He has worked with individuals and families of all ages: children, adolescents, adults, and older adults, in both outpatient and volunteer settings. As an outpatient therapist, he has addressed a variety of challenges and problems with his clients in a safe and warm environment to facilitate healthy, meaningful, and positive change in their lives. Jason uses many different evidence-based approaches including CBT, DBT, ACT, expressive arts, and play therapies. He has been a Licensed Professional Counselor (LPC# 3095) since 2002.
Other clinicians may provide services in the IOP from time to time. Their credentials are available
through hospital Behavioral Health services, or by asking the clinician or Behavioral Health Coordinator directly.
