Intensive Outpatient Program Research Articles

Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative.

The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings.

Investigating the effects of a daily multidisciplinary intensive outpatient rehabilitation program on innovative biomarkers in people with Parkinson's disease: Study protocol for a phase III randomized controlled clinical trial.

To date, there has been no medication that has prevented the progression of Parkinson's disease (PD). Many benefits of intensive and multidisciplinary rehabilitation program for PD are supported by clinical, epidemiological, and experimental data. The main question is whether high-intensity motor and cognitive exercises have an effect on the disease's biological mechanisms. This study protocol is a Randomized Controlled Trial (RCT) designed to determine the efficacy of an experimental, intensive, and multidisciplinary treatment in comparison to a home-based self-treatment in improving biomolecular and functional parameters in PD. A total of 72 participants will be randomly allocated to two different groups, experimental (n = 36) and control group (n = 36). The rehabilitation program will last 6 consecutive weeks and will involve the execution of a total of 30 sessions, one for each day of the week from Monday to Friday. Participants allocated to the control group will carry out a home-based self-treatment program that includes muscle-stretching and active mobilization exercises for 40'/day for 6 consecutive weeks. The primary outcome measure is the effects of both treatments on a new set of molecular biomarkers such as oligomeric alpha-synuclein and neurotrophic factors measured in peripheral neural derived extracellular vesicles (NDEVs). Secondary outcomes will include changes of motor and non-motor symptoms, balance and gait performance and cognitive functioning. This RCT has been registered as "Intensive Multidisciplinary Rehabilitation and Biomarkers in Parkinson's Disease" on 30 May, 2022 to ClinicalTrials.gov with the Study ID number: NCT05452655. This rehabilitation program is believed to be crucial in modifying biomolecular and functional parameters in people with PD. We expect that this study will provide additional evidence to understand the impact of an aerobic and intensive rehabilitation program on brain plasticity in patients with PD.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BackgroundDespite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.MethodsAdolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.ResultsResults suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.ConclusionsData from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Effectiveness of Residential and Intensive Outpatient Programs for the Treatment of Post-Traumatic Stress Disorder in Active Military Personnel and Veterans: A Meta-Analytical Review

ABSTRACT The care and services offered in the treatment of active military personnel and veterans with PTSD take a variety of forms, ranging from residential to outpatient treatment programs. The differences in the organization of care between these programs make comparisons difficult; however, an intermediate alternative exists in the form of intensive outpatient programs (IOPs), whose organization and range of care are closer to that offered in residential programs. This review compares and evaluates the effectiveness of residential programs to that of IOPs in the treatment of PTSD in active military personnel and veterans. Nine databases were searched from September/November 2022 to include primary studies evaluating the treatment of PTSD in active military personnel and veterans in residential programs and IOPs. Results were summarized in a narrative synthesis. A meta-analysis using a random effects model examined changes in standardized mean differences in PTSD symptom scores at baseline and discharge. Thirty-two studies in 41 publications were included. There was a notable decrease in PTSD symptom scores at the end of treatment in both programs, and no significant difference was found between them. However, IOPs effectiveness may be influenced by patient type (active military personnel or veterans). Regardless, our results suggest a positive effect of both types of programs on reducing PTSD symptoms. It is essential to be aware of the constraints inherent in the literature on the subject, including the lack of comparative studies, the potential impact of comorbidities, and the differential response of active military personnel and veterans to similar treatments.

Intensive Outpatient Programs for Pediatric Feeding Disorder: A Qualitative Study of Current Challenges and Future Directions.

Although intensive multidisciplinary interventions (IMIs) provide benefits for patients with pediatric feeding disorders (PFD), access to these programs is limited and challenges faced by the programs remain unclear. To better understand the barriers faced by existing day programs that provide IMI, disparities in patient care, and areas for improvement to better inform policy and improve access to treatment for PFD. Semi-structured interviews were conducted with a leader of outpatient programs providing IMI in the United States. Data regarding leader's perspectives on disparities in patient care, barriers faced by the intensive multidisciplinary feeding day programs, and future goals and directions for their programming were collected. Afterward, a qualitative content analysis was conducted to consolidate and categorize information related to patient care, access, and barriers faced by day programs and patients with PFD. Barriers and challenges were identified at the patient, program, and systems levels. Patient-level barriers included familial resources or socioeconomic status, geographic distance from the program site, and difficulty with the time commitment, whereas program-level barriers included limited site personnel and capacity and long wait times. System-level barriers primarily center on insurance, with inconsistent coverage of services and limited payer knowledge about PFD and IMI. IMIs are effective in managing PFD; however, a variety of patient-level, program-level, and systems-level factors serve as barriers for patient access to care and program success. Further research, improved reimbursement, and consensus statements on effective treatments can help improve access to and coverage for care, allowing for the development and sustainability of more programs.

Virtual-reality exposure treatment for first responder PTSD: a pilot investigation

Introduction: There is increasing recognition that first responders’ exposure to multiple traumatic events puts them at risk for the development of emotional distress, including depression, substance misuse, posttraumatic stress disorder (PTSD), and suicide. Despite this increased risk and higher prevalence of PTSD and other trauma-related disorders, there are few data on treatment for first responders.Method: This investigation describes the outcome of an intensive outpatient program (IOP), initially developed for military trauma, as applied to the treatment of first responders with PTSD. This treatment is unique in that it utilizes virtual reality to enhance the immersion into the exposure scene. Furthermore, we assessed the utility of both fixed-length and unbounded-length exposure sessions.Results: The results indicate that the intervention was feasible to implement and did not produce iatrogenic effects. Participants reported significantly reduced symptoms of PTSD and related emotional distress, reduced disability, and improved daily functioning. These positive outcomes were maintained at 3-month follow-up. There was no difference in outcomes between the fixed- and unbounded-length sessions.Discussion: These results suggest that an efficacious, short-term intervention incorporating virtual reality has the potential to quickly return first responders to their profession.

The Association of Mental Health Symptoms to Post-Traumatic Nightmares Among Treatment Seeking Active Duty Service Members.

Posttraumatic nightmares (PTNs) are common among service members with a history of combat or mission-related trauma and are associated with decreased well-being. Unfortunately, beyond establishing an association between mental health symptoms and PTNs, the existing literature fails to provide a more comprehensive understanding of factors associated with PTNs. The effectiveness of current recommended treatments is frequently debated, with the literature varying in levels of support. Treatment of PTN is complicated, given their association with a number of mental health difficulties including posttraumatic stress disorder (PTSD), anxiety, and depression. The present study sought to better delineate the association of these difficulties with PTNs, in an effort to inform and improve treatments for the nation's service members. This study utilized de-identified data collected during standard procedures for an interdisciplinary intensive outpatient program for service members with a history of traumatic brain injury and/or psychological health conditions (N = 1,550). Study analyses were performed under a Walter Reed National Military Medical Center institutional review board-approved protocol. Three cross-sectional forward likelihood ratio logistic regressions predicting the presence of PTNs were conducted while controlling for the alpha-blocker prazosin, as it is recommended for the treatment of PTSD-associated nightmares. Separate models were created for posttraumatic stress symptoms (PTSS), depression, and anxiety because of multicollinearity concerns. Additional variables considered for inclusion were psychological symptoms (e.g., suicide ideation, postconcussive symptoms), satisfaction with life, sleep (e.g., pain that disrupts sleep, early awakenings, sleepiness), demographics (e.g., sex, race/ethnicity, marital status, age), and military characteristics (e.g., rank, branch, special operator status, time in service). PTSS (odds ratio [OR]: 1.13), anxiety (OR: 1.19), and depression (OR: 1.19) were associated with increased odds of PTNs when controlling for prazosin. Each of the final models accounted for a significant amount of variance in the presence/absence of PTN. The included variables differed across models. The PTSS model included pain that disrupted sleep, postconcussive symptoms, special operator status, and early awakenings. The anxiety model included postconcussive symptoms, pain that disrupted sleep, special operator status, and prazosin use. The depression model included postconcussive symptoms, pain that disrupted sleep, special operator status, difficulty falling asleep within 30 min, and prazosin use. Although most variables were associated with an increased odds of PTNs, postconcussive symptoms in the PTSS model and special operator status in all 3 models were associated with decreased odds of PTNs. These findings are illustrated in Tables2 to 4. Findings support the association of PTSS, anxiety, and depression to PTNs, and, importantly, suggest that other factors may be equally or more important in understanding PTNs. Notably, increased odds of PTNs were observed among patients with pain that disrupts their sleep. The cross-sectional nature of the study allows examination of these co-occurring symptoms as they would present in the clinic, potentially informing assessment and treatment strategies; however, it precludes consideration of temporal relationships. Results highlight the importance of considering comorbid symptoms and relevant military characteristics to gain a more complete understanding of PTNs. Future research utilizing longitudinal methods are needed to inform the temporal/causal aspects of these relationships.

Impact of Referring High-Risk Patients to Intensive Outpatient Primary Care Services: A Propensity Score-Matched Analysis.

Many healthcare systems have implemented intensive outpatient primary care programs with the hopes of reducing healthcare costs. The Veterans Health Administration (VHA) piloted primary care intensive management (PIM) for patients at high risk for hospitalization or death, or "high-risk." We evaluated whether a referral model would decrease high-risk patient costs. Retrospective cohort study using a quasi-experimental design comparing 456 high-risk patients referred to PIM from October 2017 to September 2018 to 415 high-risk patients matched on propensity score. Veterans in the top 10th percentile of risk for 90-day hospitalization or death and recent hospitalization or emergency department (ED) visit. PIM consisted of interdisciplinary teams that performed comprehensive assessments, intensive case management, and care coordination services. Change in VHA and non-VHA outpatient utilization, inpatient admissions, and costs 12months pre- and post-index date. Of the 456 patients referred to PIM, 301 (66%) enrolled. High-risk patients referred to PIM had a marginal reduction in ED visits (- 0.7; [95% CI - 1.50 to 0.08]; p = 0.08) compared to propensity-matched high-risk patients; overall outpatient costs were similar. High-risk patients referred to PIM had similar number of medical/surgical hospitalizations (- 0.2; [95% CI, - 0.6 to 0.16]; p = 0.2), significant increases in length of stay (6.36; [CI, - 0.01 to 12.72]; p = 0.05), and higher inpatient costs ($22,628, [CI, $3587 to $41,669]; p = 0.02) than those not referred to PIM. VHA intensive outpatient primary care was associated with higher costs. Referral to intensive case management programs targets the most complex patients and may lead to increased utilization and costs, particularly in an integrated healthcare setting with robust patient-centered medical homes. PIM 2.0: Patient Aligned Care Team (PACT) Intensive Management (PIM) Project (PIM2). NCT04521816. https://clinicaltrials.gov/study/NCT04521816.

Innovative outpatient treatment for veterans and service members and their family members.

In 2009, Massachusetts General Hospital and the Red Sox Foundation launched Home Base, a nonprofit dedicated to providing care to veterans, service members, and their loved ones who struggle with the invisible wounds of war free of charge. Significant needs exist for mental health services in each of these populations, and a need for innovative approaches to address shortcomings in existing treatment models. Three inventive components of our programming are highlighted herein: a Veteran Outreach Team, which helps to engage patients in care, programming, and services specifically for family members, and an intensive outpatient substance use treatment program. More than 4,000 patients, 3,031 veterans and service members, and 1,025 family members have engaged in treatment at Home Base. Patients were asked to complete post-treatment self-measures, including a satisfaction questionnaire via an electronic data collection system. The vast majority of individuals who engaged in our treatment model were satisfied with the care they received (>92%) and would refer their peers to the Home Base program (>75%). Data from 78 individuals who completed the dual diagnosis services demonstrated large effect sizes in reductions in alcohol use and comorbid mental health symptoms. These data suggest that novel components to the standard outpatient mental health model might provide substantive benefits for the patients served. While internal data is prone to a lack of generalizability, these additional offerings help ameliorate patients' expressed shortcomings with existing models; present literature that describes the benefits that these additions provide is also reviewed. The lessons learned and limitations are discussed.

The positive impact of identity-affirming mental health treatment for neurodivergent individuals.

The medical and social definitions of neurodivergence have become a common topic of discussion in recent years, and the ways that we define, measure and report on conditions within the neurodivergent umbrella are changing. The objective of this study was to analyze differences in mental health symptom presentation at intake and compare treatment outcomes among three groups: clients with an affirming neurodivergent diagnosis, clients without an affirming diagnosis, and neurotypical clients. Data were collected at intake and discharge. Clients self-reported neurodivergent identity, neurodivergent diagnoses, as well as the severity of depression symptoms, anxiety symptoms and self-harm frequency. One-way multivariate analysis of variance tests were run to assess differences in mental health symptoms at intake and discharge based on neurodivergent identity and corresponding diagnosis. When MANOVAs indicated significant differences, follow-up univariate one-way ANOVAs were conducted for each dependent variable. Neurodivergent clients reported significantly worse mental health symptoms at intake than neurotypical clients, regardless of diagnosis status. Additionally, clients who identified as neurodivergent but did not report an affirming medical diagnosis reported significantly worse mental health symptoms than those who did report an affirming medical diagnosis. By discharge from IOP treatment, no significant differences were found in symptom change scores between neurodivergent and neurotypical individuals, or neurodivergent individuals with an affirming diagnosis and those without. These findings highlight the importance of acknowledging client identity as a key component of mental health treatment. The act of validating symptoms and experiences, allowing accommodations when requested, and exploring identity formation regardless of diagnosis, allowed all clients who identified as neurodivergent to benefit from treatment.

Changes in Service Use After Participation in an Intensive Outpatient Program Among Adults With Posttraumatic Stress Disorder.

Intensive outpatient programs (IOPs) have been shown to reduce posttraumatic stress disorder (PTSD) symptoms in veteran populations. The aim of this study was to examine the association between IOP participation and inpatient psychiatric and mental health-related emergency department (ED) encounters among patients with PTSD. This is a retrospective cohort study among 258 adults with PTSD who participated in the IOP at Kaiser Permanente Oakland Medical Center between January 1, 2017, and December 31, 2018. The authors compared changes in inpatient psychiatric hospitalizations and mental health-related ED encounters from the year before vs after the first IOP engagement. Bivariate analyses comparing ED and inpatient utilization pre- and post-IOP engagement, stratified by sociodemographic variables were conducted using paired t-tests and McNemar's test. Conditional multivariable logistic regression was performed to assess the odds of psychiatric utilization. Participants were more likely to have ≥ 1 inpatient psychiatric encounter (28.7% vs 15.9%; p < 0.01) and ≥ 1 mental health-related ED encounter (24.8% vs 18.2%; p = 0.04) pre-IOP vs post-IOP. The authors' multivariable analysis demonstrated that patients experienced a 56% reduction in the odds of inpatient psychiatric encounters (adjusted odds ratio = 0.42, 95% confidence interval: 0.26-0.68, p < 0.01) and a 35% reduction in mental health-related ED encounters (adjusted odds ratio = 0.63, 95% confidence interval: 0.40-1.00, p = 0.05) post-IOP vs pre-IOP. This study demonstrated a significant reduction in inpatient psychiatric hospitalizations and mental health-related ED visits among patients with PTSD in the year following participation in an IOP. These findings support the use of IOPs for patients with PTSD to reduce the likelihood of intensive service use.

A Tailored Virtual Program for Alcohol Use Disorder Treatment Among Liver Transplant Candidates and Recipients Is Feasible and Associated With Lower Post-Transplant Relapse.

Alcohol-associated liver disease (ALD) is a leading indication for liver transplant (LT) in the United States. Rates of early liver transplant (ELT) with less than 6 months of sobriety have increased substantially. Patients who receive ELT commonly have alcohol-associated hepatitis (AH) and are often too ill to complete an intensive outpatient program (IOP) for alcohol use disorder (AUD) prior to LT. ELT recipients feel alienated from traditional IOPs. We implemented Total Recovery-LT, a tailored virtual outpatient IOP specific for patients under evaluation or waitlisted for LT who were too ill to attend community-based alcohol treatment programs. The 12-week program consisted of weekly group and individual counseling delivered by a master's level Certified Addiction Counselor trained in the basics of LT.Treatment consisted of 12-Step Facilitation, Motivational Interviewing, and Cognitive Behavioral Therapy. We report on program design, implementation, feasibility and early outcomes. From March 2021 to September 2022, 42 patients (36% female, 23 in LT evaluation, 19 post-transplant) enrolled across five cohorts with 76% (32/42) completing the program. Alcohol relapse was more common among noncompleters versus those who completed the program (8/10, 80%vs. 7/32, 22%, p = 0.002). History of trauma or post-traumatic stress symptoms were associated with lower likelihood of completion. Patients' desire for continued engagement after completion led to the creation of a monthly alumni group. Our integrated IOP model for patients with high-risk AUD in LT evaluation or post-transplant is well-received by patients and could be considered a model for LT programs.

Reducing barriers to promote engagement and retention in adolescent substance use treatment: results from a quality improvement evaluation

IntroductionAlthough research on the development and efficacy of adolescent substance use treatment has made recent strides, many models do not translate into practice, especially when working with underserved youth who often face barriers to treatment. Meal incentives, rolling admission, and transportation assistance may be promising approaches to decrease barriers, thereby increasing treatment engagement, retention, and completion. The purpose of this evaluation was two-fold: (1) to examine treatment engagement amongst diverse, underserved youth in an intensive outpatient program for substance misuse in an urban metropolitan area, and (2) to investigate the role of meal incentives, rolling admission, and transportation assistance in youth engagement.MethodsThe intervention was 8 weeks of Acceptance and Commitment Therapy and trauma-focused group intervention, combined with contingency management, meal incentives, and transportation assistance. Treatment engagement, retention, and completion was compared against selected demographic variables (i.e., race and insurance coverage) and at three phases of program implementation: cohort admissions with transportation assistance (phase 1); rolling admissions with transportation assistance (phase 2); and rolling admissions with transportation assistance and meal incentives (phase 3). Data was analyzed using two-way ANOVAs; identified interactions were probed.ResultsParticipants were 110 adolescents (ages 13–17) consecutively admitted to an intensive outpatient substance treatment program. Racial identities of participants were 40.0% Latinx, 3.6% Black, 0.9% American Indian or Alaska Native, 6.4% two or more races, and 49.1% White. A total of 67 of 110 (60.9%) youth had state-funded Medicaid or no insurance. Of the youth that engaged in treatment across all implementation phases, 68.7% were provided transportation assistance. Analyses illustrated no difference in outcomes based on selected demographic variables. The percentage of youth completing treatment was 22.7% and the average number of groups attended was 6.32 (SD = 6.49). Results showed a significant improvement in outcomes with the implementation of incentives such that engagement and retention in treatment was significantly higher for those in phase 3 compared to those in phase 1 (p &amp;lt; .001) and phase 2 (p = .021).DiscussionThis evaluation shows that previously documented health disparities in substance treatment engagement and retention are not found when certain barriers are addressed.

An opt-out tobacco treatment group intervention within an intensive substance use disorders treatment program: Initial outcomes in the Veterans Health Administration.

Despite steadily declining rates of tobacco use in the United States, individuals suffering from substance use disorders (SUD) and other mental illnesses continue to use tobacco at alarmingly high rates, resulting in increased mortality. Given the synergistic consequences to those who suffer from both tobacco use disorders (TUD) and other SUD, embedding tobacco treatment into structured SUD programs using an opt-out approach may yield a greater impact. The current study compares clinical outcomes (i.e., quit attempts and prescription of tobacco cessation medications) for an opt-out versus opt-in approach to tobacco treatment. Tobacco use information was collected prior to and after implementation of an opt-out, eight-session, tobacco group treatment intervention. Patient self-report and medical chart review were utilized to identify individuals who began a tobacco cessation medication during treatment as well as those who reported quitting tobacco, defined as sustained tobacco abstinence for at least seven days. The analysis includes a total of N = 332 Veterans who enrolled in the Intensive Outpatient Program (IOP). Those enrolled in the opt-out tobacco treatment group reported a significantly higher rate of quitting tobacco (24.57%) than those in the opt-in group (2.55%; p <.001). Likewise, the opt-out group was prescribed tobacco cessation medications at a significantly higher rate than the opt-in group (55.00% compared to 14.65%; p <.001). An opt-out treatment approach to TUD in SUD treatment settings produced improved outcomes, including significantly more patients engaged in TUD treatment and a higher overall rate of SUD treatment completion. Given the disproportionately high rate of tobacco use among those seeking treatment for SUD, enhanced tobacco cessation interventions could result in both improved tobacco as well as other substance use outcomes. The implementation of an opt-out tobacco treatment intervention embedded into SUD programming is supported by our findings of reduced tobacco use among patients.

Novel CHATogether family-centered mental health care in the post-pandemic era: a pilot case and evaluation

BackgroundThe COVID-19 pandemic impacted children, adolescents, and their families, with significant psychosocial consequences. The prevalence of anxiety, depression, and self-injurious behaviors increased in our youth, as well as the number of suicide attempts and hospitalizations related to suicidal ideation. Additionally, parents’ mental health saw increasing rates of depression, irritability, and alcohol use combined with worsening family function, child-parent connectedness, positive family expressiveness, and increases in family conflict. In light of these statistics, we created CHATogether (Compassionate Home, Action Together), a pilot family-centered intervention using multi-faceted psychotherapeutic approaches to improve familial communication and relational health between adolescents and their parents. This paper discusses the implementation of the CHATogether intervention at the Adolescent Intensive Outpatient Program (IOP), providing an example of the intervention through an in-depth pilot case, and evaluation of the program’s acceptability and feasibility.MethodsThis paper describes a case in detail and evaluation from a total of 30 families that completed CHATogether in the initial pilot. Each family had 4–6 one-hour CHATogether sessions during their 6-week treatment course at the IOP. Before and after CHATogether, adolescents and their parents separately completed a questionnaire designed to explore their perceived family conflicts. After completion of the program, participants completed a brief quality improvement survey to assess their overall experience with CHATogether. In the reported case, the family completed Patient-Reported Outcomes Measurement Information System (PROMIS) depressive and anxiety symptoms scales, Conflict Behavior Questionnaires (CBQ), 9-item Concise Health Risk Tracking Self-Report (CHRT-SR9), and help-seeking attitude from adults during distress and suicide concerns.ResultsThe pilot case showed a trend of improvement in reported depressive and anxiety symptoms, child-parent conflicts, subfactors of suicide risk including pessimism, helplessness, and despair, help-seeking acceptability from parents for suicide concerns, and the establishment of individualized family relationship goals. Preliminary feedback from participating families demonstrated positive effects on intra-family communication and improvement in the overall family dynamic. Adolescents (n = 30/30) and their parents (n = 30/30) rated “strongly agree” or “agree” that their families had benefited from CHATogether and welcomed participation in future program development.ConclusionThis study presents CHATogether as a novel family-centered intervention to address post-pandemic family mental health stress, especially when a family system was disrupted and negatively affected the mental health of children and adolescents. The intervention facilitated positive child-parent communication on a variety of topics, through tools such as emotional expression and help-seeking behavior. The reported pilot case and evaluation suggested CHATogether’s acceptability and feasibility in a clinical context. We also provided quality improvement feedback to guide future studies in establishing the efficacy of CHATogether and other similar models of clinical family interventions.

Experiential suicide prevention training for substance use treatment intensive outpatient program counselors: Stepped wedge cluster-randomized training study

IntroductionThe goal of this study was to evaluate changes in knowledge, attitudes, and other key suicide prevention issues for substance use disorder (SUD) counselors trained to administer the Preventing Addiction Related Suicide (PARS) module as part of a large-scale clinical trial. PARS is a 3-hour, PowerPoint based intervention designed with and for community SUD agencies for their Intensive Outpatient (IOP) group therapy programs. A previous randomized study of 906 patients from 15 community SUD sites showed positive changes in patients' suicide prevention knowledge, attitudes, and help seeking. MethodsCounselor participants completed measures of knowledge and attitudes about suicide and their confidence treating suicidal patients at each step of a large, stepped wedge cluster randomized trial of PARS, including after the final step. Data analysis compared scores in steps prior to counselors' training in PARS with scores in the steps following counselors' PARS training. ResultsA total of 126 counselors participated in the study (89 % of those approached; 89–92 % retention across follow-up). Evaluation of both PARS efficacy and the PARS training by SUD counselors was highly rated. Counselor scores after receiving PARS training (vs. scores prior to PARS training) showed greater suicide knowledge, less maladaptive attitudes about suicide, and greater confidence in working with suicidal patients. ConclusionsBased on this rigorous test of PARS training for SUD counselors working in community SUD intensive outpatient programs, PARS training, as well as doing the PARS intervention, was rated as highly effective and acceptable. PARS offers an integrated, brief, engaging, and effective training method to improve suicide care for both SUD counselors and SUD clients.

The effects of an intensive outpatient treatment for PTSD

ABSTRACT Introduction: Research has shown that combining different evidence-based PTSD treatments for patients with PTSD in an intensive inpatient format seems to be a promising approach to enhance efficiency and reduce generally high dropout rates. Objective: To assess the effectiveness of an intensive six-day outpatient trauma-focused treatment for patients with PTSD. Method: Data from 146 patients (89.7% female, mean age = 36.79, SD = 11.31) with PTSD due to multiple traumatization were included in the analyses. The treatment programme consisted of six days of treatment within two weeks, with two daily individual 90-minute trauma-focused sessions (prolonged exposure and eye movement desensitization and reprocessing), one hour of exercise, and one hour of psychoeducation. All participants experienced multiple traumas, and 85.6% reported one or more comorbid psychiatric disorders. PTSD symptoms and diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and self-reported symptoms were assessed with the PTSD Checklist for DSM-5 (PCL-5). Results: A significant decline in PTSD symptoms (CAPS-5 and PCL-5) from pretreatment to one-month follow-up (Cohen's d = 1.13 and 1.59) was observed and retained at six-month follow-up (Cohen's d = 1.47 and 1.63). After one month, 52.4% of the patients no longer met the diagnostic criteria for PTSD (CAPS-5). The Reliable Change Index (RCI) shows that 73.9% of patients showed improvement on the CAPS-5 and 77.61% on the PCL-5. Additionally, 21.77% (CAPS-5) and 20.0% (PCL-5) showed no change, while 4.84% (CAPS-5) and 2.96% (PCL-5) showed symptom worsening. Discussion: The results show that an intensive outpatient trauma treatment programme, including two evidence-based trauma-focused treatments, exercise, and psychoeducation, is effective for patients suffering from PTSD as a result of multiple traumatization. Subsequent research should focus on more controlled studies comparing the treatment programme with other intensive trauma treatments and less frequent routine treatment.

The Effectiveness and Tolerability of an Intensive Outpatient Trauma Treatment Program for Adolescents With PTSD

Following the promising effects of an intensive trauma treatment for adults, the question arises whether adolescents suffering from posttraumatic stress disorder (PTSD) can also benefit from a similar treatment program. The objective of this study was to assess the effectiveness and tolerability of an intensive trauma treatment program combining two evidence-based, trauma-focused therapies—prolonged exposure (PE) and eye movement desensitization and reprocessing (EMDR)—with psychoeducation and physical activity for adolescents suffering from PTSD in an outpatient clinic. We used a multiple-baseline study design. Fifteen adolescents aged 12–18 years old with aDiagnostic and Statistical Manual of Mental Disorders(5th ed.) diagnosis of PTSD were included. Participants were randomized to wait 2, 3, or 4 weeks between the start of baseline and the start of the intervention. In the 2-week intervention period, participants received daily PE, EMDR, and physical activity. The social network of adolescents was involved for support. PTSD symptoms and treatment tolerability were assessed daily. PTSD diagnosis was assessed at baseline and at 1 month and 3 months after completion of treatment. In addition, semistructured interviews were conducted after treatment to determine the tolerability. After treatment, we found a diagnostic PTSD remission of 58%–62% and a decrease in PTSD severity compared with baseline. The effects were maintained at 1-month and 3-month follow-ups. The dropout rate was 13%. Participants reported good treatment tolerability. This study provides initial evidence that an intensive outpatient trauma treatment including PE, EMDR therapy, psychoeducation, and physical activity is effective and tolerable for adolescents with PTSD and is associated with low dropout rates.

Weekly links among irritability and suicidal thoughts and behaviors in high-risk youth.

Previous studies demonstrate a link between irritability and suicidal thoughts and behaviors (STBs) in youth samples. However, they have mostly assessed irritability in community samples and as a largely dispositional (i.e. trait-like) construct. Thus, it remains unclear to what extent links between irritability and STBs reflect within-person processes of elevated risk in clinically meaningful time periods. The present study used clinical data from 689 adolescents aged 12-19 years attending a total of 6,128 visits at a specialty Intensive Outpatient Program for depressed and suicidal youth to examine patterns in weekly assessments of irritability and STBs throughout treatment, including associations among trends and fluctuations departing from these trends via multilevel structural equation modeling. Youth completed self-report measures of irritability, depression, and STBs weekly as part of standard IOP clinical care. Overall, two-thirds of variance in weekly irritable mood was accounted for by between-person differences and the remaining portion by weekly fluctuations. After controlling for depression, during weeks when youth were more irritable they experienced increased STBs. Rates of change in irritability and STBs tended to track together at early stages of treatment, but these effects were generally accounted for by depression severity. Our results suggest that although changes in STBs are best accounted for by depression, irritability can be understood as a specific, proximal risk factor for youth STBs that exacerbates youth STBs in clinically informative timeframes above and beyond depression.

Developing a remotely delivered intensive outpatient program adapted for hospitalized patients with opioid use disorder: A qualitative study

IntroductionIndividuals with opioid use disorder (OUD) who inject drugs have an elevated risk of experiencing serious injection-related infections. While such infections can be treated, treatment for the underlying OUD is often limited. One potential strategy for more intensive addiction treatment is to offer a remotely delivered intensive outpatient program (IOP), adapted from an existing remote IOP (“Smart IOP”). We aimed to conduct a qualitative study to gather feedback on Smart IOP and identify adaptations needed for hospitalized patients. MethodsIndividuals with OUD and a history of serious injection-related infections completed a semi-structured interview and were shown samples of the videos and program content. The interviews were transcribed verbatim and coded to conduct a thematic analysis. ResultsSeventeen individuals participated. The mean age was 40.8 years and 70.6 % were men. Participants reported that IOP during the hospitalization would have been helpful to their recovery. The themes that emerged were the importance of medications for OUD, having a relapse prevention plan, engaging with a recovery coach, and ensuring treatment linkage post-discharge. Other themes included the recognition of the severity of one’s illness and the emotional experiences related to the hospitalization. ConclusionsParticipants expressed the value of an IOP during hospitalization and provided insights into the support needed while hospitalized. The tailored IOP is now being developed and will undergo a pilot feasibility trial.