Early Intervention, Outpatient, and Intensive Outpatient Programs for Adults

Early Intervention, Outpatient, and Intensive Outpatient Programs for Adults with a Substance Use Disorder A. Level 0.5 Early Intervention Rules in this section are based on the American Society of Addiction Medicine’s (ASAM’s) established criteria for Level 0.5 Early Intervention Services for At-Risk Individuals. Level 0.5 Early Intervention Services is the provision of secondary prevention services (assessment and education) for at-risk people who do not meet diagnostic criteria for substance use disorder, or a SUD diagnosis cannot be determined (i.e., persons determined to be co-dependent based on the ASAM’s Level of Care [LOC] Placement assessment). Such interventions include Screening, Brief Intervention, Referral, and Treatment (SBIRT), risk advice, and education. B. Level 1 Outpatient Services for People with a Substance Use Disorder Rules in this section are based on the ASAM’s established criteria for Level 1 Outpatient Services. 1. Level 1 Outpatient Services is a low intensity outpatient program designed for adolescents and adults 18 years or older with a SUD or co-occurring disorder not requiring treatment intensity or structure of a Level 2: Intensive Outpatient Program (IOP) or Level 2.5 Partial Hospitalization Program (PHP). 2. This level can be used as the initial or sole level of care or as a step down from IOP or PHP, residential or inpatient treatment. It can also be used as continuing care after completion of a Level 3 Residential Treatment Program to solidify the progress made. This level of care can also be beneficial to people not interested in recovery who are mandated to treatment, and others who previously only had access to care if they agreed to intensive periods of residential treatment. 3. Level 1 Outpatient Services must be less than nine (9) hours a week (i.e., one [1] or more times a week or one [1] time every two [2], three [3], or four [4] weeks). The service may be conducted during the day or at night to meet the person’s need. 4. When utilized as a continuance of care, a group format is preferred (but not required) with groups limited to 12 people a session. Individual therapy sessions may be utilized to monitor progress, address specific issues, and/or provide case management services, as appropriate. 5. Level 1 Outpatient Services must be staffed by appropriately credentialed practitioners (i.e., graduate/master’s level clinician); and/or licensed treatment professionals (including addiction-credentialed physicians, therapists, psychologists, social workers, and others with appropriate credentials) who assess and treat substance-related, mental, and addictive disorders. 6. The duration of treatment in this level of care varies with the severity of the person’s illness and their response to treatment. 7. Persons placed in this level of care must be assessed every 90 days, at minimum, to ensure level of care appropriateness. 8. Level 1 Outpatient Services must be in a physical space which is separate from other substance use services and impermeable to use by other services during hours-of- service operation. C. Level 2.1 Intensive Outpatient Programs for Adults with a Substance Use Disorder Rules in this section are based on the ASAM’s established criteria for Level 2.1 Intensive Outpatient Programs. 1. Intensive Outpatient Services is a program for adults with a Substance Use Disorder (IOP-SUD). It is a community-based outpatient service which provides an alternative to a Level 3 Residential Treatment Service or hospital setting. The service is directed to adults 18 years or older who need services more intensive than traditional outpatient services, but who have less severe substance use disorders, co-occurring emotional, behavioral, or cognitive disorders less severe than those typically addressed in a Level 3 Residential Treatment Service. The Level 2.1 Intensive Outpatient Program for Adults with a Substance Use Disorder allows people to continue to fulfill their obligations to family, job, and community while obtaining intensive treatment. Level 2.1 Intensive Outpatient Program for Adults with a Substance Use Disorder may be conducted during the day or at night in order to meet the needs of the people being served. 2. Level 2.1 Intensive Outpatient Program for Adults with a Substance Use Disorder must be limited to 12 people per session. 3. Level 2.1 Intensive Outpatient Program for Adults with a Substance Use Disorder must provide the following services: (a) Group therapy for a minimum of nine (9) hours a week, usually in three (3) sessions a week. (Session times may vary but cannot be less than one (1) hour and cannot exceed three (3) hours daily). People must receive at least nine (9) total hours of group therapy per week. Groups may be of the following types: psychoeducational groups, skills-development groups, drug or alcohol refusal training, relapse prevention techniques, assertiveness training, stress management, support groups (e.g., process-oriented recovery groups), single-interest groups (can include gender issues, sexual orientation, criminal offense, and histories of physical and sexual abuse), family, or couples groups; (b) Individual therapy at a minimum of one (1) therapy session, for a minimum of one (1) hour, per week; and (c) Involvement of family to include no less than two (2) therapeutic family group sessions, offered to meet the needs of the person and the family. 4. Level 2.1 Intensive Outpatient Programs must be located in their own physical space, separated from other substance use services and impermeable to use by other services during hours-of-service operation. 5. The duration of treatment in this level of care varies with the severity of the person’s illness and their response to treatment. 6. People placed in this level of care must be assessed every 30 calendar days to ensure level of care appropriateness. D. Level 2.1 Intensive Outpatient Programs for Adolescents with a Substance Use Disorder Rules in this section are based on the ASAM’s established criteria for Level 2.1 Intensive Outpatient Programs. 1. An Adolescent-Intensive Outpatient Program (A-IOP) is a community-based outpatient service which provides an alternative to traditional Residential Treatment Services or hospital settings. The service is directed to adolescents ages 12-18 who need services more intensive than traditional outpatient services, but who have less severe substance use disorders or co-occurring emotional, behavioral, or cognitive disorders than those typically addressed in Residential Treatment Services. The Adolescent-Intensive Outpatient Program allows people to continue to fulfill their obligations to family, job, school, and community while obtaining treatment. Adolescent-Intensive Outpatient Programs are primarily conducted in the evening but may be offered at varying locations and times to suit the needs of the adolescents being served. 2. An Adolescent-Intensive Outpatient Program must be limited to 12 people per session. 3. An Adolescent-Intensive Outpatient Program must provide the following services: (a) Group therapy must be offered for six (6) hours per week. Times and locations for groups may vary based on the needs of the adolescents being served. Groups may be of the following types: psychoeducational groups, skills-development groups, drug or alcohol refusal training, relapse prevention techniques, assertiveness training, stress management, support groups (e.g., process-oriented recovery groups), single-interest groups (can include gender issues, sexual orientation, criminal offense, and histories of physical and sexual abuse), family, or couple groups. (b) Individual therapy must be a minimum of one (1) therapy session, for a minimum of one (1) hour, per week. (c) Involvement of family to include no less than two (2) therapeutic family group sessions, offered to meet the needs of the person. (d) Providers utilizing Evidence-Based Practices or best practices in the provision of Adolescent-Intensive Outpatient Program must show verification that employees utilizing those practices have completed appropriate training or independent study as recommended by the developers of the model/practice for the practices being utilized. 4. Level 2.1 Intensive Outpatient Programs and services must be in a separate physical space from other substance use services and impermeable to use by other services during hours-of-service operation. 5. The duration of treatment in this level of care varies with the severity of the person’s illness and their response to treatment. 6. People placed in this level of care must be assessed every 30 calendar days to ensure level of care appropriateness.