Introduction
Direction’s Intensive Outpatient Programs (IOP) provides mental health care to adolescents in the Greater Nashua Area and the Seacoast Area. As the only programs of their kind in the region, they offers a much-needed “intermediate” level of care for adolescents who have needs that are too complex to be effectively managed in an office outpatient setting, but do not reach the threshold warranting inpatient hospitalization. They offer a new alternative for outpatient providers, emergency rooms, school guidance counselors, primary care physicians, parents, and other local agencies seeking mental health care for their patients, students, clients, and children.
For some adolescents, Direction serves as the point of entry to psychiatric care. For others who already are engaged in treatment, it provides crisis stabilization when outpatient treatment alone is insufficient or ineffective. For those adolescents who do require inpatient level of care, it serves as a step-down program to provide smoother transition back into the community. It appeals to parents, patients, and other providers because of its ability to provide a wide array of services in a relatively short period of time. It appeals to insurance companies for the same reasons, and because it accomplishes its goals in a more cost-effective way than previously had been available in the region.
Simply by being the only IOPs in their regions, our programs are a valuable addition to communities seeking improved mental health care for adolescents. In addition, Direction’s IOPs depart from the traditional IOP model in certain ways that we believe allow us to be even more effective and efficient in offering high-quality care in a time-limited fashion.
Admission to Direction’s IOP
Referrals to the IOP come from a variety of sources. For adolescents not already in treatment, sources include parents, schools, primary care physicians, and local emergency rooms. For those adolescents already in treatment but in need of crisis stabilization, referrals may come from other outpatient treatment providers. Inpatient units, including those at New Hampshire Hospital, Cheshire Medical Center, Hampstead Hospital, and Southern New Hampshire Medical Center, refer patients to Direction for step-down treatment, ensuring a smooth transition back to the community after inpatient treatment.
We accept major private insurance carriers, and we are working with the State of New Hampshire in an effort to bring our services to clients with Medicaid as well. Other potential sources of payment may include the local school system, DJJS, and DCYF.
As part of the admission process, every client receives a comprehensive psychiatric evaluation by Direction’s Child and Adolescent Psychiatrist, typically within 24 hours of admission. This evaluation is reviewed and discussed within the multidisciplinary treatment team, which then formulates the master treatment plan.
Program Operation
Direction’s IOP operates between 3 PM and 6 PM, with other clinical and administrative tasks occurring outside these hours. These hours have been selected to minimize interference with clients’ school obligations. Family therapy is typically scheduled during hours after 5 PM to minimize interference with parents’ own work responsibilities.
Transportation is provided for clients in the Nashua and Seacoast Areas to the program, again minimizing interference in parents’ own schedules. Parents are expected to provide transportation home from the program.
Program length of stay is variable, and dependent on each client’s own particular clinical needs. Discharge planning begins upon admission to ensure suitable aftercare arrangements are made prior to completion of the program. Clients generally attend the program 5 days per week, though frequency of attendance may be reduced as clinically appropriate. Most clients attend the program for a length of time between 1 and 4 weeks.
Direction’s programs typically have between 10 and 20 adolescents attending per day.
The Facility
Direction’s Nashua IOP takes place at a newly-renovated 3500-square-foot suite, located in converted mill space in Downtown Nashua. The Seacoast IOP takes place on the first floor of a historic schoolhouse, in the same building as Seacoast Youth Services. Both sites have a reception area, several large group spaces, several offices, two bathrooms, and a kitchenette.
The Treatment Team
The Treatment Team consists of a multidisciplinary group of clinicians who have been hand-selected because they share certain key characteristics. In particular, as individuals they have acquired extensive clinical experience working both directly with adolescents and with the Nashua-area agencies that serve them; they have demonstrated significant creativity, passion for their work, and an ability to form relationships with even the most “difficult” adolescents; and they have demonstrated an ability to maintain their perspective and their sense of humor – absolutely critical abilities in dealing with adolescents -- even during the most challenging of times.
The Medical Director is a Child and Adolescent Psychiatrist, Board-Certified in Child and Adolescent Psychiatry as well as General Psychiatry. Unlike some other Intensive Outpatient Programs, he is on-site in Nashua during program hours 5 days per week and actively involved in our clients’ care.
Program Structure
Group therapy forms the core component of treatment in Direction’s IOP. It is led by the Program Director, a licensed mental health clinician with years of experience working as a therapist at a Nashua residential program. Over the years, he has developed a model of group therapy called Wholeistic Education® (WED) that has proven extremely effective in engaging and treating even the most challenging children and adolescents. All groups are led by either the Program Director or by another licensed clinician. Other staff members, including Masters- and Bachelors-level clinicians, assist the group leader. There are generally three groups per day, each lasting an hour.
Family therapy is an integral part of Direction’s treatment program, and is provided by licensed mental health clinicians at appropriate intervals.
Case management services, including liaison with other providers, schools, and agencies, is provided by our Director of Operations, who is a veteran licensed social worker with over 25 years of experience. He has worked with Child Protective Services in Massachusetts, provided direct case management and emergency services for Community Council of Nashua, and worked with Area Agency of Nashua.
The Site Psychiatrist (the Medical Director, in the case of the Nashua IOP) oversees all aspects of treatment and provides medication management to those adolescents for whom it is appropriate. One advantage of his strong presence at the program is that it allows him to closely monitor medication effects and respond quickly with changes when indicated. Essentially, it allows him to manage medications in a manner more similar to an inpatient psychiatrist, and to provide more intensive psychiatric services than many other IOP’s provide.
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