There are several different alternative programs to residential (inpatient) programs that can provide intensive treatment for people who are attempting to recover from a substance use disorder. Inpatient treatment programs are full residential treatment programs where the person remains on the treatment site 24 hours a day, receives intensive treatment 4-6 hours daily, and eats and sleeps on the premises. Residential programs are designed to help individuals with severe issues to be able to return to functioning in the outside world; however, not everyone can become involved in these types of programs due to personal commitments (e.g., work, family, etc.) or the expense involved. In addition, many individuals who are transitioning from residential treatment programs still require both intensive treatment and the opportunity to begin to adjust to independent functioning. One approach to serve these groups of individuals is a partial hospitalization program.
What Are Partial Hospitalization Programs (PHPs)?
The designation between a partial hospitalization program (PHP) and an intensive outpatient treatment program (IOP or IOT) is determined by the number of hours of treatment. According to the American Society of Addiction Medicine (ASAM), interventions that provide six hours of treatment per day or more qualify as PHPs, whereas interventions that provide fewer than six hours of treatment per day are designated as IOPs.
- Most PHPs provide six hours of treatment per day for five days a week.
- IOPs provide up to six hours of treatment per day 3-5 days a week (with most of these programs providing three hours of treatment per day for three days per week).
- Treatment in both of these programs is typically administered during the day, and individuals are allowed to return home in the afternoons or evenings and continue with their normal lives.
PHPs as Step-Down Programs
According to ASAM, one useful application of the partial hospitalization program is as a step-down approach from a formal residential program to a program that allows the individual to begin to adjust to the rigors of daily living while still receiving intensive treatment.
- Initial residential treatment for 30-90 days
- A step down to a PHP for 30-90 days after the acute issues that were addressed in the inpatient program have stabilized and the person has made significant progress
- A step down to an IOP after the individual has made steady progress in the PHP
- A step down to normal outpatient treatment procedures
The length of time that an individual will remain at any level of treatment and then be allowed to step down depends on the individual’s progress and goals as well as evaluation by the individual’s treatment professionals.
Can They Act as an Alternative to Residential Treatments?
In addition to providing step-down services for individuals transitioning from residential treatment programs, partial hospitalization programs can also be alternatives to residential treatment programs.
These programs are typically considered as an alternative to inpatient treatment in the following circumstances:
What Services Are Available?
The services available in PHPs parallel the available services in residential treatment programs. According to the book The Clinician’s Guide to Partial Hospitalization and Intensive Outpatient Practice, these services include:
- Assessments and professional evaluations: These include assessments of the severity of the substance abuse, co-occurring mental health disorders, co-occurring medical conditions, psychosocial conditions, and current level of functioning and ability to function independently. If the person was initially admitted to an inpatient treatment program, the formal assessment would have already been performed; however, continued assessment of the individual’s functioning occurs in any substance use disorder treatment program and is ongoing throughout treatment.
- Medication management: Clients in PHPs have access to all medically assisted treatments that are suitable for their situation. These include medications for any co-occurring mental health conditions, medical conditions, for withdrawal management, to control cravings, etc.
- Treatment with empirically validated forms of therapy: Individuals in PHPs should receive substance use disorder therapy, which is the foundation of any treatment program for a substance use disorder. The therapy should be based on empirically validated findings (research evidence) and follow a general blueprint that is applicable to the specific substance use disorder as well as personalized to fit the needs of the individual. Therapy is often performed at both the individual level and in therapy groups to allow the client the benefits of both approaches.
- Peer support groups: Participation in social support groups, such as 12-Step groups, is also available in PHPs. These groups are not formal therapy groups as they are not supervised by a trained therapist and often do not use empirically validated techniques; however, they are extremely useful to individuals in recovery and should be considered adjunctive forms of treatment.
- Family therapy: Family support and participation are important factors in successful recovery for any substance use disorder. PHPs should provide opportunities for family, peers, and even employers to become involved in treatment if appropriate. This can be done through family therapy, other group therapy sessions, targeted interventions, etc.
- Psychoeducation: An important aspect of treatment is to provide the client with a solid psychoeducation program that instructs them in the issues associated with substance use disorders. These issues include understanding how these disorders are currently conceptualized, basic neurobiological mechanisms of substance abuse, and relapse prevention.
- Case management services: These services should be available for individuals who need assistance with housing, training, education, finding social support, etc. Other support services should also be provided, such as ambulatory services, mentoring, sponsorship, etc.
- Complementary therapies: Other associated services should be available, including the opportunity to become involved in complementary and alternative interventions (e.g., art therapy, music therapy, animal-assisted therapy, etc.), occupational therapy, physical therapy, vocational rehabilitation, etc.
- Customized services: PHPs should follow a general treatment plan and design personalized treatment plans for their clients. Treatment plans should include all of the above services, but they should be adjusted to suit the individual’s cultural background, level of functioning, expected discharge conditions, etc.
A typical PHP allows an individual to return to their own home or some other living environment that is removed from the hospital or clinic where treatment services are provided.
One specific type of PHP, the Florida Model, offers individuals intensive treatment in a hospital setting and then provides them with a residence removed from the hospital but still within the hospital campus.
Are There Any Requirements for Admission?
The requirements for a program to be formally defined as a PHP will vary somewhat from state to state. However, in general, a formal PHP program requires the following:
This documentation is typically provided by a physician, such as a psychiatrist, and insurance companies generally require a copy of the formal assessment, the physician’s recommendations, formal progress notes, and documentation of all forms of intervention in order for coverage to be granted.
What Is the Average Length of Stay?
When considering the length of stay at a partial hospitalization program, you must remember that any average duration is only a rough estimate. Time spent in a PHP can vary widely because the needs of each client are so uniquely different.
PHPs are time-limited, meaning that the program is not intended to go on indefinitely and discharge planning is considered right from the beginning. PHPs will often last for a period of time between 2 and 3 weeks.
This general range will be affected by insurance coverage, available space in the program, and various other factors, including:
- Severity of addiction or physical dependence.
- Presence of mental health or physical health issues that require more comprehensive treatment.
- Available supports and community engagement.
- The need to return to other responsibilities such as caring for a dependent child.
The treatment team will work with the individual to assess their unique situation and decide the most appropriate duration of treatment. Someone whose substance use disorder is relatively mild, who has no other mental health issues, low stressors, and a healthy support network will likely have a shorter period of PHP treatment. Someone with a severe addiction, compounding mental and physical disorders, high stress, and a lack of support may benefit from a longer duration of care.
The required time commitment for any given course of PHP treatment will also be contingent on the recommended number of hours of treatment per day. People with greater treatment needs may not only attend more days of treatment, they may attend more hours per day. Since PHPs can be attended in full-day or half-day blocks, someone making substantial recovery progress may decrease their hours per day as coordinated by their treatment team.
No matter the length of stay, an essential function of the treatment team is to effectively transition the individual to another level of care. This could be an IOP, standard outpatient, or even a step up to inpatient rehab if the individual needs a more intensive course of treatment.
Can I Afford This Option?
The fees associated with partial hospitalization programs can vary greatly. Total program cost may be affected by the:
- Special populations served within the program (e.g., women with children, people with co-occurring substance use disorders and mental health issues).
- Variety of services provided.
- Intensity of services provided.
- Types of substance addictions treated in the program.
- Location and amenities of the program.
Cost of a PHP will differ from program to program; however, an estimated average is between $350 and $450 per day. The thought of paying for treatment may seem frightening, but you cannot put a price on your health, happiness, and overall well-being.
The fees for treatment usually represent the self-pay rate before any insurance plans or discounts are applied. The health insurance plan you already have could cover all or most of your PHP care.
If you want to learn more about the benefits included with your plan, contact your provider by calling the number on the back of your card. A representative should be able to explain your coverage and may even point you towards participating providers in your area.
PHPs are covered under many insurance programs, so this level of care may be more affordable than you think. For a realistic cost assessment, gather information about your insurance deductibles and copay amounts and discuss payment with prospective programs.
If you do not have insurance currently, call your county’s assistance office to explore your eligibility for available options like utilizing the Affordable Care Act to access coverage. They can also suggest area agencies that offer reduced fees for people based on their income and level of need.
People without insurance may still be able to access PHP treatment by:
- Working with the PHP to finance treatment.
- Asking about sliding scales (cost adjustment based on need).
- Looking into loans from banks, healthcare companies, or friends.
- Utilizing crowdfunding websites.
Money will often be a factor in addiction treatment, but getting the help you need is priceless. For many, PHPs are the best fit given their treatment needs, the severity of their stressors, and the strength of their support network (or lack thereof), making the cost worth it.
Show Me a Sample of a Typical Schedule
Even though there is tremendous variety in the length of stay and cost of partial programs, the hours and schedule of events are fairly standard. Many programs begin between 9 a.m. and 10 a.m., with a brief check-in followed by a half-day to a day’s worth of treatment. Full-day programs typically end 6 hours after the starting time—between 3 p.m. and 4 p.m—while half days last approximately 3 hours. Groups and therapies may shift from day to day, for example, some days might include family therapy whereas others will focus on individual therapy.
Sample Schedule:
- 10 – 10:50 a.m. – Community meeting.
- 11 – 11:50 a.m. – Individual therapy.
- 12 – 12:50 p.m. – Skills Group.
- 12:50 – 2:00 p.m. – Lunch.
- 2:00 – 2:50 p.m. – Skills Group.
- 3 – 3:50 p.m. – Community meeting.
Conclusions
Partial hospitalization programs provide a formal step-down treatment intervention for individuals who are being released from a residential program, and they provide intensive treatment for individuals who do not require or need to be placed in inpatient treatment programs. These treatment programs typically provide six hours of therapy per day for 5-6 days a week. This intensive treatment helps individuals with serious issues related to substance abuse to receive the intensive treatment they need, but at the same time, it allows them to function independently and carry on with their normal lives.
Sources
1. Department of Health and Human Services: Nebraska. (n.d.). Partial Hospitalization – MH – Adult (Managed Medicaid only Service).
2. Substance Abuse and Mental Health Services Administration. (2015). Detoxification and Substance Abuse Treatment.
3. French, M. T., Popovici, I., & Tapsell, L. (2008). The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement. Journal of Substance Abuse Treatment, 35(4), 462–469.
4. American Addiction Centers. 2018.
5. Centers for Medicare & Medicaid Services. (2017). Medicare & Your Mental Health Benefits.
6. PA.gov. (n.d.). Health Care/ Medical Assistance.
7. Virginia Health System – Dominion Hospital. (n.d.). Adult Partial Hospitalization Program (PHP).
8. University of California, San Francisco. (n.d.). PHP/ IOP Hours and Schedule.