The mission of the Intensive Outpatient Programs at Mental Health Resources, PLLC is to prove a cost effective yet financially viable, high quality of mental health care in the least restrictive setting to psychologically distressed or substance abusing individuals. MHR’s IOPs were developed expressly for the purpose of accommodating the trends toward reduced hospital stays and providing an intensive therapeutic environment in an outpatient setting. We are committed to preventing hospitalization and treating the individual in their natural environment, if the patient can be safely treated in an outpatient setting. Most individuals who enter IOP do so in the midst of a crisis and require frequent, “intensive”, contact.
Our IOP’s consist of three hours of programming per day, conducted in our private offices. To accomplish our goals of providing treatment in the least restrictive setting, preventing hospitalization and addressing the needs of the individual, our IOP provides traditional group psychotherapy, skills training, and focused psycho-educational groups led by licensed providers that are designed to meet the needs of the individuals in treatment. MHR's IOP meets up to five times per week. Additionally, we may supplement IOP with other treatment modalities available in the community, such as individual, couples or family therapy, support groups, church, AA, Al-Anon, Nar-Anon, etc. We recognize that our program is only one of many in our community and that other programs and/or continuums of care may be better suited for particular individuals requiring services beyond our scope (e.g., those who need, dextoxification, are in imminent danger, require hospitalization, etc.). When necessary, we will draw upon these community resources to aid us in meeting our stated objectives.
Our IOP is the only one in Memphis that is based in a private practice, office setting. We are also the only psychiatric program in Memphis that has empirically validated outcomes, which have passed the rigor of peer reviewed publications. Our outcomes have been published in peer reviewed journals published by the American Psychological Association, including the American Psychologist, Psychotherapy: Theory, Research and Practice, Professional Psychology: Research and Practice, as well as in the multidisciplinary journal, American Journal of Orthopsychiatry, and in the Behavioral Outcomes and Guidelines Sourcebook. A description of our IOP also appeared in the American Psychiatric Association’s journal, Psychiatric Services.
 Psychiatric IOP Programming
When a patient starts IOP, they usually come on a daily basis for the first week or so. As they stabilize, they attend fewer visits. It is not unusual for a patient to come every day for the first week, 4 days the following week, and then 3 days for several weeks, and as they approach discharge, 2 and then 1 day a week. The average number of visits attended is 17, but this occurs over an average of 6 – 7 weeks.
The core components of the IOP consist of four primary areas targeted to: 1) Emotion 2) Thoughts 3) Physical symptoms and when appropriate, 4) Addictions. The Emotional component consists of learning to identify and express feelings, finding safe and appropriate outlets for avoided feelings, and tolerating high levels of emotion without becoming overwhelmed. As in the traditional group psychotherapy context, difficulties with feelings or change are addressed and interpersonal problems are identified. Repetitive relationship themes that adversely affect an individual's current daily level of functioning are also identified. Individuals are assisted in labeling their emotional experience and expressing it in meaningful ways. Difficulties with anger, fear or sadness are addressed in this context. For example, grief work may assist people in understanding the process of grief, examining blocks to grief and exploring unresolved losses.
The Thought or Cognitive aspect of the program consists of teaching rational behavior problem solving skills. Cognitive behavioral therapy is one of the most well validated approaches to psychotherapy and is considered to be a main component of our IOP. Core Psycho-educational groups are organized around Cognitive Behavior Therapy; Assertiveness Training; Anxiety Management; Anger Management; Problem Solving; Crisis Management; Grief Work; Setting Boundaries; Identification of Feelings; Co-dependency; Pain Management; and Coping with Depression. Crisis situations or conflictual relationships are anticipated, action plans developed, behavioral deficits identified, and adaptive coping behavioral strategies are rehearsed and strengthened.
The Physical aspects of the program are concerned with bodily processes that may exacerbate symptoms or be misinterpreted by patients in their recovery. Relaxation exercises, stress management, coping with chronic illness, and pain management are some of the typical subject areas addressed. Psychotropic medication may also be helpful in addressing biochemical contributions to your condition and may be prescribed by one of our psychiatrists.
The foci of the Core groups take on different content areas, depending on the individual needs of the group participants. For example, dealing with loss, out of control teens, work place problems, coping with chronic illness, conflict management, and self defeating behavioral patterns, are some of the topics that may be addressed. In teaching coping skills, identified problem areas are utilized to teach skills that provide new strategies or solutions. Cognitive behavior therapy, anger management, anxiety management, assertiveness training and skill generalization are used throughout the program. Daily homework assignments, self-monitoring, dairies, etc. are frequently used to develop and maintain coping strategies. :: Back to top
 Dual Diagnosis / Substance Abuse IOP
When a patient starts IOP, they usually come on a daily basis for the first week or so. As they stabilize, they attend fewer visits. It is not unusual for a patient to come every day for the first week, 4 days the following week, and then 3 days for several weeks, and as they approach discharge, 2 and then 1 day a week. The average number of visits attended is 17, but this occurs over an average of 6 – 7 weeks.
The core components of the Dual Diagnosis / Substance Abuse IOP consist of four primary areas targeted to: 1) Addictions; 2) Emotion 3) Thoughts 4) Physical symptoms.
The co-occurrence of substance use and psychiatric disorders is the norm, not the exception. In fact, it has now been shown that people exposed to stress are more likely to abuse alcohol or drugs, continue using, or to experience a relapse. This means that for a successful recovery, both disorders must be adequately treated. Given the complexity of substance abuse and psychiatric disorders, it is not likely that there is a single method of treatment that is best for everyone. It is more likely that certain common factors underlie effective substance abuse and psychological treatments. To help substance abusers who want to change, it is important to understand where they are in the change process.
People who are not considering, or do not desire to change, are in the Precontemplation stage. They are not even thinking about the idea of change and will not go for treatment. People who are beginning to think about change are in the Contemplation stage of change. They are considering that they may have a problem that requires change, but are very ambivalent about whether they want to change or not. Those in the Determination stage have weighed the pros and cons of their behavior and have made a decision to change. Once they begin to take steps to modify this behavior, such as going for treatment, they are in the Action stage of change. After the successful implementation of Action strategies that have resulted in the desired behavior change, one moves into the Maintenance stage, where behaviors designed to sustain the change are used. As with most chronic conditions, relapses are to be expected and do not constitute failures. Following a lapse, patients are encouraged to learn from their behavior and then enter the change cycle again, only this time they will likely progress more rapidly and move farther along the change process. Using this Stage model of change, one can see that the goal is to join with the patient and help them develop the tools they need to progress from one stage to the next. In this model, it makes sense that simply confronting the patient about his/her use is insufficient for change to occur. Instead, the therapist must join the patient where they are in the process of their recovery and attempt to facilitate their progression from one stage to the next. Similarly, one can see that most patients will require time and ongoing treatment to move from one stage to the next, and that they cannot simply stick to a decision they are not emotionally ready to make. For most people, several cycles through the stages are necessary to learn to sustain the changes successfully.
Even with Determination and Action, however, most substance abusers have additional psychiatric problems that must be addressed if they are to maintain abstinence. For example, learning how to manage anger, analyze high risk situations for relapse, and cope with internal triggers must all be solved if a patient’s motivation to change is to remain strong. Coping with depression, anxiety and relationships that the patient finds stressful must also be addressed. Various psychosocial treatment approaches have been proven to remedy these problems and contribute to a successful outcome.
Coping Skills Training teaches new ways of thinking and behaving in problem situations that contribute to relapses. Coping Skills Training addresses the emotional, cognitive and situational factors that could contribute to relapse by teaching skills necessary to cope with these issues.
The Addictions Core groups are coping skills training groups and are organized around Stages of Change; Pros & Cons of Using; Goal Setting; Relapse Prevention (a. Confidence and Temptation; b. Managing Cravings; c. Managing Thoughts; d. Managing Emotions; e. Managing Criticism; Effective Refusals); Learning from & Managing Relapse; Functional and Dysfunctional Relationships; Role Expectations; Healthy Behaviors, Building Support Systems; Rewarding Successes; and Action Plans.
The “Coping with Emotions” component of the Dual Diagnosis / Substance Abuse IOP consists of learning to identify and express feelings, finding safe and appropriate outlets for avoided feelings, and tolerating high levels of emotion without becoming overwhelmed. As in the traditional group psychotherapy context, difficulties with feelings or change are addressed and interpersonal problems are identified. Repetitive relationship themes that adversely affect an individual's current daily level of functioning are also identified. Individuals are assisted in labeling their emotional experience and expressing it in meaningful ways. Difficulties with anger, fear or sadness are addressed in this context. For example, grief work may assist people in understanding the process of grief, examining blocks to grief and exploring unresolved losses.
The “Coping with Irrational Thoughts” or Cognitive Behavioral aspect of the program consists of teaching rational behavior problem solving skills. Cognitive behavioral therapy is one of the most well validated approaches to psychotherapy and is considered to be a main components of our IOP. Core Psycho-educational groups are organized around Cognitive Behavior Therapy; Assertiveness Training; Anxiety Management; Anger Management; Problem Solving; Crisis Management; Grief Work; Setting Boundaries; Identification of Feelings; Co-dependency; Pain Management; and Coping with Depression. Crisis situations or conflictual relationships are anticipated, action plans developed, behavioral deficits identified, and adaptive coping behavioral strategies are rehearsed and strengthened.
The Physical aspects of the program are concerned with bodily processes that may exacerbate symptoms or be misinterpreted by patients in their recovery. Medication management, relaxation exercises, stress management, coping with chronic illness, and pain management are some of the typical subject areas addressed. :: Back to top
 Summary of Published IOP Outcome Research Findings 1,2,3,4,5
80% of the patients admitted to this IOP are severely depressed with co-morbid Axis I diagnoses (49%) and 18% of those are related to substance abuse. 80% had already been tried on antidepressants, but these were not enough to return the individual to their baseline level of functioning and additional treatment was warranted. 71% have complicating personality characteristics, 55% have co-morbid medical disorders and 70% of those were pain related. 32% had an average of 2 previous psychiatric inpatient admissions, usually for depression. 25% of those with previous inpatient admissions had more than 3 prior admissions prior to coming to our IOP. 74% of our IOP admissions were experiencing suicidal ideation at the time of Intake, but with careful planning and family involvement, we were able to effectively and safely treat these patients while they remained at home.
Because most of our patients have been depressed, we calculated a dose : response relationship between the average length of time in treatment and the average patients ratings of depressive symptoms each week. As you can see in the dose : response graph below, this treatment is very effective for the treatment of depression and Dual Disorders.
These findings are very remarkable when you consider that on average, MHR’s IOP patients start treatment with more severe symptoms than both locally and nationally hospitalized patients. Also, 79% of MHR’s depressed patients who complete treatment improve, and 90% of these started treatment feeling suicidal 4,5. In fact, Only 3-4% of all treated patients were referred to any higher level of care4,5 due to concerns for their safety . Finally, consumers consistently report extremely high patient satisfaction ratings, averaging 3.7 on a scale of 1 to 4, where 1 = very unsatisfied and 4 = very satisfied.
MHR’s IOP Compared to National IOP’s:
MHR1,2,3,4,5 National6
Average number of IOP visits: 17 21
Drop out rate: 8% 20%
Re-admission rate 7%* 18%
* 13 of the 15 (87%) re-admissions had 35 previous inpatient admissions between them. In light of the fact that 87% of those re-admitted had previously been treated in hospital settings, combined with the facts that only 3-4% of our total samples were sent to any higher level of care from IOP, while the remaining 96% were discharged to a lower level of care, we believe these data support our assertion that our program is breaking the cycle of repeated hospitalizations by delivering effective, cost efficient, intensive treatment, while allowing the patient to remain at home. :: Back to top
References
1) Wise, E. A. (1999). Clinical outcomes, client satisfaction and innovative programming in private practice. In Coughlin, K.M. (Ed). Behavioral Outcomes & Guidelines Sourcebook: A Practical Guide to Measuring, Managing and Standardizing Mental Health and Substance Abuse Treatment (pps. 135-143). Faulkner & Gray, NY, NY.
2) Wise, E. A. (2000). Mental health intensive outpatient programming: An outcome and satisfaction evaluation of a private practice model. Professional Psychology: Research and Practice, 31(4), 412-417.
3) Wise, E. A. (2003). Empirical Validation of a Mental Health Intensive Outpatient Program in a Private Practice Setting. American Journal of Orthopsychiatry, 73(4), 405-410.
4) Wise, E. A. (2003). Psychotherapy Outcome and Satisfaction Methods Applied to Intensive Outpatient Programming in a Private Practice Setting. Psychotherapy: Theory, Research, Practice and Training, 40(3), 203-214.
5) Wise, E.A. (2005). Effectiveness of Intensive Outpatient Programming in Private Practice: Integrating Practice, Outcomes and Business. American Psychologist, 60(8), 885-895.
6.) Scheifler, P., Kiser, L. & Knight, M. (2001). Benchmarks and Critical Indicators for Intensive Outpatient Programs: Results of a National Survey of IOP’s. Assoc. for Ambulatory Behavioral Healthcare, Alexandria, VA.
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