If your child has anxiety, depression or other behavioral health conditions, regular therapy, medications and other treatments can be very effective.
But what do you do if you think your child needs more help? What if, even with treatment, they’re having more difficulty controlling their anger or other emotions? Or engaging in self-harm, such as cutting, or showing an increased interest in suicide? Maybe they’re skipping – or acting out in – school more often.
“This can be difficult for parents – they know their child needs more help, but they don’t want them hospitalized,” said Sarah Kowalksi, RN, assistant patient services manager for the Children’s Psychiatric Inpatient Service at Yale New Haven Hospital.
What is an intensive outpatient program?
An intensive outpatient program (IOP) might be a good option. As the name implies, these programs provide more frequent, in-depth treatment for a few hours a day, a few times a week. Children continue living at home, going to school and participating in most regular activities.
The Yale New Haven Children’s IOP treats children and adolescents who are experiencing intense difficulties as part of depression, anxiety, relationship problems, trauma, loss and other issues.
“A child with behavioral health issues might exhibit concerning behaviors as part of their diagnosis at any time,” said Yann Poncin, MD, a child and adolescent psychiatrist with the Yale New Haven Children’s Day Hospital IOP and associate professor of Child Psychiatry at Yale School of Medicine. “What distinguishes the need for more intensive therapy is the degree to which they’re exhibiting these behaviors.”
In addition to child and adolescent psychiatrists, the Yale New Haven Children’s IOP team includes licensed clinical social workers, psychiatric counselors and therapeutic recreation specialists. The team also includes a therapy dog specially trained to work with children and adolescents with behavioral health concerns.
How do you access intensive outpatient therapy?
Some parents learn about this type of therapy when their child visits the emergency department after an episode; others when they call 211 looking for information and resources to help.
However, “I don’t think most parents are aware that they can take this additional step,” Dr. Poncin said.
Some intensive outpatient programs require referral from a physician or other healthcare professional; for others, like Yale New Haven Children’s IOP, parents can call directly. Within days after a call or referral, the child receives a thorough assessment to determine whether intensive outpatient therapy is appropriate and, if so, what kind of help they need.
Once the IOP team determines a child can receive this type of care, they’ll set a date for the child to begin group therapy, usually within 24 to 48 hours after the assessment.
What happens during intensive outpatient therapy?
Yale New Haven Children’s IOP is three hours a day, three times a week for eight weeks.
When children are admitted to the program, staff work with them and their parents or family members to come up with goals for treatment. Staff then develop a treatment plan that includes different types of group therapies.
“The group setting helps children and adolescents see that there are other kids like them who are struggling,” Dr. Poncin said. “It allows kids to develop trust, to share their feelings and experiences without as much shame or stigma.”
Yale New Haven Children’s IOP groups include:
- Psychoeducation Group: Teaches children and adolescents coping skills and strategies to help them manage their thoughts and feelings.
- Psychotherapy Group: Encourages children to use these skills and strategies in their daily lives. This group also gives participants a safe space to discuss depression, anxiety, self-destructive behaviors, family situations, relationships, trauma and other topics.
- Social Skills Group: Gives children and adolescents a place to interact with their peers, build connections and practice their interpersonal skills. Here they can also share what’s happening in their lives, including relationships with their parents and peers.
- Therapeutic Recreation group: Play with a purpose, this group may include games, physical activity and art, writing or other forms of expression. Therapeutic recreation promotes psychological and physical health, recovery, and well-being – in a fun environment.
“Our therapy involves a lot of serious discussions, but we also try to make it enjoyable,” Kowalski said. “We always remember that we’re working with kids, and we want to make treatment engaging and fun.”
IOP staff also hold therapy once a week for parents and families, where they discuss the coping strategies their children are learning and how they can help their child, by being both nurturing and firm without going too far in either direction. While many parents blame themselves for their children’s struggles, Kowalski said, “We help parents see the positives in their child’s lives. We talk with parents about what has been going right with their families.”
What happens after intensive outpatient therapy?
“Throughout the eight-week IOP, we’re assessing what’s going on socially, in school and with the family to understand what the child needs in the future,” Dr. Poncin said.
If necessary, the team can add a week or more to the child’s IOP treatment. At the end of treatment, the IOP team meets with the child’s previous therapist to discuss that treatment and any future needs. Some children do require an extension of intensive outpatient therapy, or another eight-week IOP session in the future.
“We want people to know that we can provide immediate, comprehensive support when children – and their parents – are feeling overwhelmed,” Dr. Poncin said
