BEHAVIORAL HEALTH-INTENSIVE OUTPATIENT PROGRAM

Prgram Descriptins, Disclsure Statement, & Participant Guide BEHAVIORAL HEALTH-INTENSIVE OUTPATIENT PROGRAM Participant Guide/Prgram Descriptins/Rules/Disclsure Statement INTRODUCTION Welcme t the Intensive Outpatient Prgram, part f the Centura Health system. It will be referred t as IOP fr the remainder f this guide. IOP is primarily a grup therapy prgram led by Licensed Clinicians, Mental Health Cunselrs, and ther clinical staff. This is a three (3) hur, half-day behaviral health treatment prgram. We accept referrals frm utpatient surces including psychiatrists and ther utpatient prviders and ther facilities, in additin t serving referrals frm within the Centura health netwrk. This is nt an alternative t inpatient hspitalizatin This is nt a Crisis Stabilizatin Prgram This is nt a Chemical Dependency Prgram (althugh there is a separate CD-IOP available) THIS IS A VOLUNTARY TREATMENT PROGRAM. WE DO NOT ACCEPT INVOLUNTARY PARTICIPANTS UNDER ANY CIRCUMSTANCE. PARTICIPANTS ARE FREE TO DISCONTINUE TREATMENT AT ANY TIME. TREATMENT PROGRAM TRACKS All treatment tracks are designed fr adults age 19 and lder wh are either stepping dwn frm an acute hspitalizatin r as a step up frm an utpatient level f care. It is an active, directive, structured prgram designed primarily t treat md disrders and ther behaviral health difficulties. Participants start attending each Prgram Day fr the first 2 weeks r s, and then taper dwn gradually t assess their ability t functin with gradually decreasing levels f supprt and t give them an pprtunity t practice their new skills prir t discharge frm the prgram and transitin t a lwer level f care (utpatient services). Participants may als start t return t wrk n a limited basis when nearing discharge frm the prgram. The average length f stay is apprximately six t eight weeks. ELIGIBILITY CRITERIA The IOP treats adults age 19 and lder with significant behaviral health difficulties. The mst cmmn cnditins we treat are Md Disrders (Majr Depressin, Biplar Disrder), but we als treat Anxiety Disrders, Schizphrenia, Schizaffective Disrder, and many ther disrders. Because this is essentially a grup therapy prgram, all participants must be able t functin as a member f a grup withut behavirs disruptive t the milieu. Participants in this prgram d nt require acute/inpatient treatment (due t imminent safety cncerns r severe impairment in functining) but d require a higher level f care than regular utpatient visits. The basic criteria fr admissin t this prgram include: 1 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide Significant distress caused by increased symptms (severe depressin, hypmania/mania, suicidal thughts, impairment in thinking, etc.) Significant impairment in functining (ccupatinal, familial, scial, activities f daily living, etc.) wrse than baseline level f functining Sufficient supprt at hme t functin in an utpatient setting (safe, stable living envirnment, scial supprt, etc.) Ability t stay safe, take meds as rdered, abstain frm alchl/drugs, and fllw Plan f Care Admissin cannt be fr supprt r scializatin nly SCHEDULING AN INTAKE ASSESSMENT Fr participants referred t IOP frm an inpatient stay at Prter Hspital, an admissin screening will be scheduled by yur inpatient Scial Wrker prir t yur discharge. Yu will meet with the IOP Staff prir t yur discharge fr a screening t make sure yu wuld be an apprpriate candidate fr IOP. Details abut the admissin prcess will be reviewed and a date (usually the Prgram Day after discharge but within three days f yur inpatient discharge) fr admissin will be set at that meeting. All ther prspective participants in IOP must be screened via telephne prir t an intake appintment being set. Fr referrals cming frm utpatient settings tw things: The prspective participant t call fr a telephne screening. Infrmatin frm yur utpatient prviders, usually in the frm f ur Referral Sheet being faxed t us. Thse withut prviders are may still be eligible fr IOP, but may require additinal steps prir t setting up an intake. Fr referrals frm ther facilities, we need tw things: The prspective participant t call fr a telephne screening. Facility recrds, specifically a psychiatric evaluatin, medical H&P, psychscial assessment, current medicatins, DC summary, and a face sheet. ASSESSMENT & DATA GATHERING All participants in the IOP will receive initial and nging assessment f their cnditin, including medical-psych-scial-emtinal-behaviral screening. Sme data may be in the frm f self-reprt surveys, clinical interview by IOP staff t gather Medical-Psych-Scial-Emtinal-Behaviral data, bservatin in the prgram, amng ther assessments. Initial assessments and screening will typically be dne the day f intake t the prgram by the assigned prgram staff that will serve as their Clinician fr the duratin f the prgram, and will be cmpleted and dcumented within 3 Prgram Days attended. Prgram physicians will als perfrm their wn assessment within 3 Prgram Days f attendance. An Initial Safety Assessment & Safety Plan will be dne with each participant n the day f intake t the IOP. TREATMENT PHILOSOPHY This is Skills-Based treatment. We d nt d traditinal psychtherapy r extensive talk-therapy abut prblems; we instead fcus n teaching and practicing better cping skills (using a DBT and CBT skills) t better handle current stressful situatins and manage emtins; treatment is mre like a classrm than ther traditinal frms f therapy. Grups fcusing n Cping Skills are the main treatment mdality in this prgram. There are three therapy grups daily. Yu will usually meet 1:1 with yur IOP Clinician weekly, with the fcus n using new cping skills in an effective manner. Fr 2 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide thse with PTSD, we fcus n Cntainment Skills and d nt d histrical explratin r prcessing f trauma. The verall treatment philsphy has fur main pints: Cping Skills Training (primarily DBT) t better manage stressrs and cntribute t adaptive lifestyle changes Behaviral Interventins fcused n increasing structure, supprt, and activity level, and effective practice and use f new cping skills Cgnitive Interventins aimed at changing the thughts that lead t and maintain depressin, anxiety, etc. Medicatin t help manage md, behavir, and thinking We use what is knwn as Evidence Based Treatment (EBT) as much as pssible. EBT emphasizes the use f treatment methds with a prven track recrd f rigrus research methdlgy and effectiveness in clinical practice. The three methds f treatment that seem t best meet the needs f ur participants include DBT, CBT, and Medicatin: Dialectical Behavir Therapy (DBT) We use a skills training mdel f treatment in the IOP. The main treatment mdality we utilize fr this purpse is DBT. There are fur main skill mdules in DBT: Mindfulness, Interpersnal Effectiveness, Emtin Regulatin, and Distress Tlerance. The fcus f DBT is n practicing and using better cping skills t manage current prblems. Each f these skill grups has specific cping skills assciated with it. The grups are presented in a psych-educatinal frmat emphasizing practice as an integral part f the skill-acquisitin prcess. Audi recrdings n CD are available t supplement treatment. Cgnitive Behavir Therapy (CBT) CBT is a scientifically prven methd f treatment fr depressin, anxiety, and many ther psychiatric disrders. It is cnsidered the treatment f chice fr many psychiatric disrders, and has a track recrd f fast, effective treatment with a decreased risk fr relapse nce treatment is finished. Hmewrk and practice is an integral part f CBT. This can include Activity Scheduling, Sleep Hygiene, and Cgnitive Restructuring, and behavir therapy. Audi recrdings n CD and a CBT Manual are available t supplement treatment. Medicatin Medicatin is a required cmpnent f treatment in IOP. The IOP includes initial and nging medicatin cnsultatin as part f the prgram. Medicatin is an essential part f treatment in IOP. Sme disrders require medicatin fr successful treatment, and participants benefit frm the cnsistent and apprpriate use f medicatin. Medicatin is a standard part f the prgram; all participants will be n medicatin, with very few exceptins. Medicatin cmpliance is required fr prgram admissin. The first visit with the prgram psychiatrist is usually dne in the early afternn, and usually within three prgram days f admissin. Mst participants will be seen during prgram hurs, sme participants may need t return in the afternn depending upn the psychiatrist s schedule. SCREENING & ADMISSION GUIDELINES The first step in being admitted t the prgram is fr yur utpatient treatment prvider (therapist r psychiatrist) t leave a detailed vicemail with the IOP Crdinatr r fill ut a Referral Frm and fax that t 303-765-3701. We can frward the Referral Frm if yu prvide yur treatment prvider s fax number r email address. All frms can be fund n the Prter Hspital web site at www.prterhspital.rg. 3 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide PARTICIPATION GUIDELINES All participants are expected t actively participate in grups, cmplete therapy assignments, and hmewrk utside f prgram hurs, actively practice new skills, attend scheduled Prgram Days, and take medicatin as rdered. Yur Clinician and ther prgram staff will cllabratively review yur Care Plan, prvide feedback, and make recmmendatins fr crrective actin. If yu are unable t fllw prgram recmmendatins after an apprpriate perid f time, yu may need t be referred t a different treatment regimen. Because this is primarily a grup therapy prgram, each participant s behavir has a ptential impact upn the treatment f thers individually, and n the treatment milieu as a whle, bth during grups, breaks, and befre and after the treatment day. THERE ARE SOME RULES Any prgram is ging t need sme rules and sme structure; the rules & structure are there t prvide a safe, supprtive, and therapeutic envirnment fr IOP participants and staff. The rules & structure are als in place t help prvide the mst benefit (and relief frm yur symptms) in the shrtest perid f time pssible. I m ging t try t keep things very brief and clear; feel free t ask questins if yu need further infrmatin. Because yur behavir impacts the milieu and the treatment f thers, inability t fllw these rules will result in discharge frm the IOP. Yu have t be able t keep yurself safe; nthing else really matters if yu can t keep yurself safe. Yu ll develp a Safety Plan when yu first start IOP, and yu need t fllw that plan fr the duratin f yur treatment. If yu can t stay safe, let yur IOP Clinician and supprt system knw ASAP. IOP Staff are nt available after prgram hurs; if yu experience a life-threatening emergency, call 911 r g t the nearest Emergency Rm. All firearms and ld medicatin need t be remved frm the hme, and cnfirmed by friends r family, befre yu start IOP. Yu can bring ld meds t IOP fr dispsal thrugh the hspital pharmacy. Yu can t drink alchl r use drugs f any kind during yur treatment in IOP. Yu need t attend the days yu re scheduled t attend. If yu miss a scheduled day withut giving us ne (1) Prgram Days ntice, that s cnsidered an Unscheduled Absence. Give us as much ntice as pssible if yu re nt ging t attend n a scheduled day, please. Yu can have three (3) Unscheduled Absences during the curse f yur treatment. Mre than a few episdes f Tardiness are ging t be prblematic (there s n specific number, but if there s an nging pattern, it will need t be addressed) 4 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide Dn t cme t IOP if yu re sick r running a fever. Yu need t be fever-free fr twenty-fur (24) hurs befre returning t IOP. Be sure t call ASAP if yu re feeling sick and will nt be attending IOP. If yu NO-SHOW n a scheduled day, we re ging t track yu dwn. Anytime we have t track yu dwn, it s a Welfare Check. We start by calling yu; if we can t quickly reach yu, we call yur Emergency Cntact; if we can t quickly reach them, we call yur lcal plice department and ask them t g t yur hme t check n yur safety. Yu get ne (1) Welfare Check; hpefully, yu wn t require a Welfare Check at all. If yu leave IOP early, let yur clinician knw befre yu g. If yu dn t, we have t track yu dwn fr a Welfare Check. When Denver Public Schls clse because f the weather, IOP will be clsed as well. It s yur respnsibility t cnfirm that schls are clsed. The main IOP number (303-778-5770) will be updated by 7AM if IOP is clsed. This isn t a talk-therapy prgram; this is a Skills-Based prgram. Grups will be mre like a classrm than traditinal grups. That means there will be hmewrk and things we want yu t d utside f grup. Yu will need t frce yurself t d these things. Yu are required t make nging imprvements in functining (that is, fllwing yur Plan f Care and practicing the skills); failure t make timely imprvements in yur disrder des nt supprt nging treatment at this level. Taking prescribed meds as directed is a requirement fr treatment in IOP. Yu have t be healthy enugh medically t attend IOP; if yu have any medical cnditins, make sure thse are well managed prir t starting IOP. Yu have t have a safe, stable place t reside in rder t attend IOP. Living in yur car, r cuch surfing isn t cnsidered stable husing. Yu need t get yur husing situatin in place prir t starting IOP. Yu can t scialize r hang ut with ther participants in IOP (r flks that yu met as an inpatient). Dn t share phne numbers, becme Facebk friends, share medicatins, lan mney, prvide transprtatin, live with, r therwise assciate utside f grups. Treatment is cnfidential; dn t discuss anyne else in IOP with anyne else. Turn ff yur phne and all ther electrnic devices while grups are in sessin, and get them ff the table. Ringing/vibrating phnes are disruptive in grups. Dn t answer yur phne in grup, take it utside. D nt make any type f recrding f anyne in IOP. 5 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide Yur first visit with the IOP Psychiatrist will be in the afternn. Plan t be available between Nn and 4PM (it will likely be earlier than that, but make plans t be here regardless). Ask yur IOP Clinician fr mre specific details. Yu can t wrk and d IOP at the same time (regardless f the hurs yu wrk); plan t take at least tw (2) weeks ff wrk. Mst flks are ff wrk at least fur (4) weeks, sme even lnger. This is part f that impairment in functining that s a criterin fr admissin t IOP. We ll gradually get yu back t wrk as yur cnditin imprves. Students will likely need t Medically Withdraw fr the semester. We can help with Shrt Term Disability and FMLA paperwrk. If yu abslutely cannt take time away frm wrk, this prgram will nt wrk fr yu Excessive talking, frequent interruptins, and disruptive behavir are cnsidered grup and treatment interfering behavir and will nt be tlerated. FINANCIAL GUIDELINES Mst insurance plans pay fr the prgram r yu may chse t pay ut f pcket fr yur treatment. T find ut the cst f this ptin, make financial arrangements, and arrange payments prir t starting the prgram, yu wuld need t cntact the Health Benefits Advisr (HBA) ffice at 303-765- 6612. All participants, whether frm inpatient in Prter Hspital r cming frm utside surces will meet with the HBA the day f their admissin t IOP. Yu are respnsible fr paying yur c-pay while yu are attending the prgram. There may be a cpayment due fr each Prgram Day attended. There may be separate c-payments fr each visit with the IOP Psychiatrist. Yu may speak with the HBA ffice abut payment ptins if yu have financial difficulties. T speak with the HBA ffice, call at 303-765-6612. An HBA Office Representative will be n-site in the IOP Suite several days a week t cllect c-pays as yu have them scheduled. Befre we can prvide any infrmatin, written r verbal, t yur utpatient prviders, yu must sign a Release f Infrmatin (ROI). Likewise, we require a ROI t prvide any infrmatin t family. STUDENTS Frm time t time we hst students in Nursing, Pharmacy, and ther Prfessinal Prgrams. Students are bund by the same cnduct and cnfidentiality standards as staff anywhere in the hspital system. FALL PREVENTION GUIDELINES Smetimes medical cnditins r medicatins can cause drwsiness r dizziness, usually when changing frm a lying r sitting psitin t a standing psitin where this can lead t a fall. With sme f the medicatin, the drwsiness r dizziness will g away in a few days r weeks. If the drwsiness r dizziness is uncmfrtable, please let the dctr knw right away. Yu can reduce yur chances f falling by fllwing these recmmendatins: 6 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide When changing frm sitting / laying dwn t a standing psitin, STOP and sit n the edge f the bed r chair fr 2 minutes befre standing up Tense yur leg muscles several times befre standing Rise t standing slwly, keeping a hand n the chair r bed if yu d get dizzy r faint Stay hydrated thrugh the day Eat regular meals Wear nn-skid ftwear Avid alchl, and d nt mix medicatins with alchl COMPLAINTS AND CONCERNS Please bring all cmplaints and cncerns t the attentin f the IOP Crdinatr, s that prblems can be reslved as quickly as pssible. Behaviral Health Crdinatr: Jay Ryser, LPC 303-778-5770 DISCLOSURE STATEMENT AND STAFF CREDENTIALS The Clrad Department f Regulatry Agencies (DORA) has the general respnsibility f regulating the practice f licensed psychlgists, licensed clinical scial wrkers, licensed prfessinal cunselrs, licensed marriage and family therapists, certified schl psychlgists, and unlicensed psychtherapists. The agency within the Department that has the respnsibility specifically fr licensed and unlicensed psychtherapists is the Mental Health Sectin, 1560 Bradway, Suite #1370, Denver, Clrad 80202, 303-894-7766. IN A PROFESSIONAL RELATIONSHIP (SUCH AS THIS), SEXUAL INTIMACY BETWEEN A CLINICIAN AND A CLIENT IS NEVER APPROPRIATE. IF SEXUAL INTIMACY OCCURS, IT SHOULD BE REPORTED TO THE DORA AT 303-894-7766. Jhn Batiuchk Dr Batiuchk graduated Cum Laude with his Bachelr s Degree frm Princetn University in 1969 and received his medical degree frm Crnell Medical Schl in 1973. He is a Bard Certified Psychiatrist and has wrked in Mental Heal Centers, private practice, and hspitals, with an emphasis in Inpatient Psychiatry and Intensive Outpatient Prgramming, and has expertise in Skills-Based treatment. Jay Ryser 303-778-5770 jayryser@centura.rg Fax: 303-765-3701 Jay hlds a Bachelr s degree (Psychlgy & English Literature in 1985) and Master s degree (Cunseling in 1987), frm Stephen F. Austin State University in Texas. He has wrked clinically in inpatient and utpatient settings with children, adlescents, adults, and geriatrics, has develped prgrams fr all ppulatins, and run a successful private practice. Jay has received additinal training in Cgnitive Therapy, Behavir Therapy, Ratinal Emtive Behavir Therapy (REBT), and Dialectical Behavir Therapy (DBT). Jay was licensed as a Prfessinal Cunselr in Texas frm 1988 t 2000 and in Clrad since 2000 (LPC #2457). Susan Lerux 303-765-3567 Susan hlds a Bachelr s degree in Medical Science (1991) frm the University f Clrad Health Sciences Center and a Master s degree in Cunseling (2000) frm Denver Seminary, bth in Clrad. She has wrked clinically with a brad-spectrum f inpatient plus utpatient and vlunteer 7 f 8 Revised 3/10/2015

Prgram Descriptins, Disclsure Statement, & Participant Guide ppulatins, individually plus as a bard advisr and part f a cllabrative team, supprting client stabilizatin and therapeutic interventins within daily and lng-term planning frmats. Susan has invested in additinal training, building psychscial alliances within rganizatinal develpment, mediatin, chrnic illness, rgan dnatin, grief recvery, and dialectical behavir therapy arenas. Susan is licensed as a Prfessinal Cunselr (LPC #4242). Vicki Swab 303-765-3752 Vicki has wrked in Mental Health and Substance Abuse fields since 1989. In that time, she has wrked with a variety f peple in hspital, residential, utpatient, and inpatient settings. Vicki has experience with adlescents and adults. She received her Bachelr s frm the University f Clrad Denver in 1992, and her Master s frm Regis University in 1997. She has been licensed as a Prfessinal Cunselr (LPC #2931) since 2001. She is a Certified Addictins Cunselr, Level III (CACIII Certificate #6169) since 2004. Sara Yazdi, LPC 303-765-6540 Sara received her Master s degree in Cunseling Psychlgy & Cunseling Educatin frm University f Clrad at n May 2010 and her Masters degree in Cmputer Infrmatin Systems frm University f Clrad n Fall 1997. Sara is a Licensed Prfessinal Cunselr (LPC # 11175) in the State f Clrad and is a member f Natinal Certified Cunselrs (NCC). Sara has been vlunteering in many nn-prfit rganizatins ver the last few years. Her apprach in therapy is t meet her clients where they are in their lives right nw. Then, based n what clients want t get ut f ur wrk tgether, Sara wuld use the techniques and tls she has learned in CBT & DBT and adjust them t fit her clients need. Sara uses Here & Nw t bring back everything t perspective and reality. Jasn Jhnsn 303-765-6876 Jasn has a Bachelr s Degree in Psychlgy (Minr in Gerntlgy) frm Baylr University (1995) and a Master s Degree in Cmmunity Cunseling frm Denver Seminary (2000). He has wrked with individuals and families f all ages: children, adlescents, adults, and lder adults, in bth utpatient and vlunteer settings. As an utpatient therapist, he has addressed a variety f challenges and prblems with his clients in a safe and warm envirnment t facilitate healthy, meaningful, and psitive change in their lives. Jasn uses many different evidence-based appraches including CBT, DBT, ACT, expressive arts, and play therapies. He has been a Licensed Prfessinal Cunselr (LPC# 3095) since 2002. Other clinicians may prvide services in the IOP frm time t time. Their credentials are available thrugh hspital Behaviral Health services, r by asking the clinician r Behaviral Health Crdinatr directly. 8 f 8 Revised 3/10/2015