When working with clients in the community, we, as clinicians, are frequently reassessing our clients’ mental status and overall state of well-being. Often times, determining the appropriate level of care for clients can be difficult.
As a clinician who has worked in an inpatient psychiatric hospital setting for many years, with both adolescents and adults, along with experience in the community mental health setting, I wanted to provide you with essential information for making the least restrictive recommendation for your clients.
The most common levels of care for either psychiatric treatment or substance use rehabilitation treatment are:
Inpatient hospital setting
Partial Hospital Program (PHP)
Intensive Outpatient Program (IOP)
Criteria for an inpatient hospital setting:
An inpatient hospital setting is a structured hospital-based program which provides:
a) 24-hour/7-day nursing care
b) Medical monitoring and physician availability
c) Assessment and diagnostic services
d) Active behavioral health treatment
e) Specialty medical consultation with an immediacy needed to avoid serious jeopardy to the health of the client or others.
Criteria for admission can include many factors.
Factor #1: client demonstrates imminent or current risk of harm to self, others, and/or property which cannot be safely, efficiently, and effectively managed in a less intensive level of care. Examples include:
a) A life-threatening suicide attempt
b) Self-mutilation, injury or violence toward others or property
c) Threat of serious harm to self or others
d) Command hallucinations directing harm to self or others
Factor #2: the client’s condition cannot be safely, efficiently, and effectively treated in a less intensive setting due to a physical complication. This can include:
a) A physical cause for the client’s signs and symptoms cannot be ruled out in a less intensive setting.
b) A severe medication side effect requires the level of monitoring and intervention available in an inpatient setting.
Factor #3: the client cannot be safely, efficiently, and effectively assessed and/or treated in a less intensive setting due to acute changes in the client’s signs and symptoms, and/or psychosocial and environmental factors. Examples include:
a) Acute impairment of behavior or cognition that interferes with activities of daily living to the extent that the welfare of the client or others is endangered.
b) Psychosocial and environmental problems that threaten the client’s safety or undermines engagement in a less intensive level of care.
Megan Simmons, LCSW
To learn more about the different levels of care such as Partial Hospital Program (PHP), Intensive Outpatient Program (IOP), and Outpatient, please visit PHP Treatment Explained and IOP and Outpatient Treatment Explained.
Megan Simmons is a Licensed Clinical Social Worker who earned her undergraduate and graduate degrees in social work from Texas State University. While in college, she volunteered at Safe Place and was employed as a Hotline Advocate and House Manager. Megan worked at a medical hospital following graduation, where she discovered her passion for mental health treatment. Thereafter, Megan worked with MHMR in Comal County assisting residents in their homes with medication management, building life skills, and equipping them with knowledge and resources within their communities. Her next role was in an inpatient care setting where she specialized in working with adolescents and children conducting group therapy, individual therapy, and family therapy, as well as customizing programming for clients that needed a specialized treatment plan. Megan’s nine years of working in the mental health field has given her experience with a wide range of mental health concerns, including depression, anxiety, trauma, personality disorders, psychosis, Bipolar Disorder, and substance abuse. Megan has also completed Dialectical Behavior Therapy training so she is better able to assist clients with emotion regulation, personality disorders and self-harm issues. Megan takes a holistic approach to therapy and strives to empower her clients by teaching them tools they can utilize long after completing treatment.