By Christy Clark, PhD
Many patients do, at some point, need a higher level of care than standard outpatient treatment, but they don’t want or need the options afforded by inpatient, residential or partial hospital programs.
Although it may be hard to believe, the latest research shows that for many individuals, inpatient psychiatric hospitalization is correlated with an increase in suicidal ideation after discharge.[1][2] And while partial hospital settings may allow patients to remain in their own homes, they are typically mainly group therapy based, and the average length of stay is generally only around two weeks, often leaving patients feeling like they didn’t engage in comprehensive therapeutic treatment before being discharged to standard outpatient care. A third option, residential treatment, is often inaccessible to patients due to long wait lists and/or expense.
Center for Anxiety’s Echelon Intensive Outpatient Program offers an excellent alternative.
CFA’s Echelon IOP provides individuals with a patient-centered, customized approach to their intensive treatment. It all begins with the Echelon Intake where one of our senior clinicians, having reviewed the patient’s diagnostic assessment, will meet with the patient and their family to ascertain their clinical and personal needs, preferences, and limitations. From this meeting, together with the patient’s initial Intake, a customized Echelon Treatment Plan is formatted, and the clinical team is determined. The process is collaborative, and the patient and/or family will be consulted throughout.
There really is no “typical” Echelon patient however we do see many patients who come for intensive treatment for OCD or anxiety, and they may also struggle with depressive symptoms. With our highly customized IOP at CFA, we base our clinical team on the patients’ problems we are targeting. So in the type of case I just mentioned, for example, we would likely have one clinician providing evidence-based treatment for OCD (Exposure w/Response Prevention), a second clinician providing evidence-based treatment for depressive symptoms (Behavioral Activation for example), a clinician providing parenting or family coaching to the patient’s family system so they have the tools to support the patient, and a case manager to consult and collaborate with outside and inside providers. Group therapy is always offered as part of the package as well.
As one of the directors of the Echelon Program, I can speak to what a rewarding experience it is to put these teams together and see the benefits of this type of customized treatment. It’s also highly collaborative—every Echelon patient has their own individual Slack channel, so team members are consistently communicating about the case. We also have Clinical Consultation Meetings one to four times per month, for every Echelon case, where all the clinicians on the team come together to collaborate. This is an invaluable ingredient in the Echelon secret sauce!
Of course, the most gratifying part of being involved in Echelon work is watching patients improve in intensive treatment and get that “jump start” they need to get back on course.
[1] Shields, MC et. al. Patient-centered inpatient psychiatry is associated with outcomes, ownership, and national quality measures, Health Affairs Scholar, July 2023; 1 (1)
[2] Ward-Ciesielski EF, Rizvi SL. The potential iatrogenic effects of psychiatric hospitalization for suicidal behavior: a critical review and recommendations for research. Clin Psychol Sci Practice. 2021;28(1):60
