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A Brief Overview of PHP and IOP Therapeutic Treatment

November 18th, 2023


Sometimes when pursuing therapeutic treatment for mental health or behavioral health reasons, a person may begin to recognize that weekly outpatient therapy is not satisfying their needs. They may find that between their weekly sessions, they continue to feel the intensity of their symptoms and struggle to cope on their own. If that is the case, it may be time to consider engaging in a higher level of care.

The phrase “higher level of care” can be illusive as it refers to a wide variety of treatment settings. Essentially, higher level of care refers to any treatment setting that is more involved that outpatient therapy. This includes, inpatient treatment settings, residential treatment settings, partial hospitalization (PHP), and intensive outpatient (IOP). While many people recognize that inpatient and residential treatment stays involve living in a treatment setting for a period of time and outpatient treatment is often a weekly therapy, PHP and IOP can be harder to understand. Below I will go over the purposes of IOP, PHP, and how to get connected to care if someone needs more support.

What is Partial Hospitalization?

Partial hospitalization (PHP) is a moderately restrictive level of therapeutic treatment that falls between residential treatment and intensive outpatient on the continuity of care spectrum. To be admitted to a PHP program, a patient is either stepping down from a residential treatment setting or being assessed to start treatment in a PHP due to the severity of their symptoms. Some PHP programs are diagnosis specific such as an eating disorder or substance use disorder program, while others are more broadly geared toward working with anyone with a severe presentation of their mental illness.

A typical candidate for PHP treatment is someone whose mental health symptoms indicate that they are experiencing impairment in social, occupational, educational, and/or daily functioning. Additionally, a PHP treatment candidate is determined to not be able to maintain safety while in a lower level of care such as IOP or outpatient therapy. Someone may also be connected to a PHP if it is believed that engagement in PHP treatment may prevent the patient from needing a higher level of care like residential or inpatient treatment.

While participating in a PHP program, a patient will have access to a wide variety of resources. Some of these resources include: medical and nursing support, psychiatric support, group and individual therapy, family therapy, and other types of resources that may be needed for symptom stabilization such as 12-step groups or dietetics. If someone is engaged in PHP treatment, they will need to attend treatment at least four hours of treatment for four days a week minimally. At maximum, PHP treatment can be up to five or six full days of treatment a week.

What is Intensive Outpatient?

While PHP is a great option for some people, it may be considered too restrictive for what a person needs to stabilize their mental health. If that is the case, when completing an assessment, a person may be informed that they are most appropriate for intensive outpatient therapy (IOP). IOP is a mildly restrictive level of therapeutic treatment that falls between the PHP and outpatient therapy levels of care. Typically, someone is admitted to IOP as a step down from PHP treatment or a step up from outpatient therapy. Similar to PHP, and IOP setting may be specific to a client’s therapeutic needs like substance use or trauma, but it may also be more generalized.

A client or patient who may be a good fit for IOP treatment is someone that is experiencing increased challenges at work, school, and or in social settings, but is still able to maintain some level of routine.

While completing IOP, patients will attend group and individual therapy. Depending on the IOP programming, patients may have access to other services like psychiatry, family therapy, and other clinically indicated resources. If a client knows that they would like specific resources like couples therapy, 12-step groups, etc., the client should seek out programming that offers that kind of support.

Minimally, a patient will need to attend IOP treatment for three hours a day for at least three days a week. The maximum amount of time that someone may spend in IOP is three hours a day for five days a week. If a client needs more support than the maximum amount of support available for IOP, they will likely be transitioned into a PHP program. IOP programming also differs from PHP programming in that clients may be able to continue working with their outpatient therapist while completing IOP treatment. That is not accessible for those who are in PHP.

How can Someone get Connected to a Higher Level of Care?

If someone believes they need more support than outpatient therapy can provide them, they will likely want to consider getting assessed for a higher level of care. There are a few common ways to schedule an assessment. One way to do this is for a client to partner with their current therapist. The client’s therapist can offer recommendations for local IOP and PHP programming and may support in scheduling an assessment.

If the person is not currently connected to an outpatient therapist, they may also be able to get referrals from their primary care provider or identify treatment settings through an online search. An excellent resource for finding local treatment that is compatible with someone’s financial needs is the Substance Abuse and Mental Health Services of America (SAMHSA) website and helpline. If someone calls the help line at 1-800-662-4357, a representative can support them in identifying appropriate resources.

An important note is that a person cannot join an assessment and name what level of care they would like to start at. A trained assessor will complete a treatment assessment and make a recommendation based on what the client is sharing. All clients should be prepared to be recommended any level of care when they undergo an assessment. As with all treatment recommendations, if someone is unsure of what is recommended to they, they are welcome to seek alternative opinions.

What Should Someone do After Completing IOP or PHP?

While many people have questions about how to access PHP or IOP treatment, many also wonder what they need to do after completing treatment. It is normal to feel overwhelmed or uncertain about approaching life with less support than you had while in treatment. When someone completes PHP treatment, they will likely step down to IOP and when someone completes IOP treatment, they will likely step down to outpatient therapy.

It is recommended that any patient completing treatment make a plan with their primary therapist for how they will maintain their learned skills. These plans will likely involve engagement with a therapist and psychiatric provider, but may also include support groups, safety plan, and other tools to support adaptive coping.

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