Support Systems, Inc. provides Intensive Outpatient Services that are designed to address negative patterns of substance use, co-occurring disorders, and behaviors that cause difficulties with daily living activities and the ability to live independently in the community.  We provide clinical services, life and independent living skills, family therapy, creative therapies, holistic therapies, group therapy, and ongoing education through the provision of a structured program of skilled treatment services for adults.

Specific Services Provided:

  • A structured program consisting of 3-5 days weekly and 3 hours per day or evening. Support Systems, Inc. will offer at least 1 evening group to ensure that we are providing services to the population who may be working during day time hours.

  • Medical, psychological, psychiatric, laboratory, and toxicology services, which are available through consultation or referral. Support Systems, Inc. will ensure that there are available and open resources to provide the above listed services, specifically with substance use screens, medical needs and psychiatry needs, as well.

  • Psychiatric and other individualized treatment planning.

  • Individual and group counseling, medication management and psycho-education, which includes education to assist individuals and their family members or caregivers to access clear and concise information about substance disorders and mental health disorders.

  • Occupational and recreational therapies, motivational interviewing, enhancement, and engagement strategies to inspire an individual's motivation to change behaviors.

  • Support Systems, Inc. will access and contract with outside resources and services (acupuncture, nutritionists, pet therapy, etc.) to ensure that clients are receiving a well rounded type of care for best possible progress and chance for recovery.

  • Psychiatric and medical consultation, which shall be available within 24 hours of the requested consult by telephone and preferably within 72 hours of the requested consult in person or via telemedicine, if available based on resources in the area.

  • Psychopharmacological consultation.

  • Addiction medication management and 24-hour crisis services.

  • Medical, psychological, psychiatric, laboratory, and toxicology services.

A multidimensional, 15 point initial assessment shall be completed that is an individualized, person-centered assessment that includes the following six dimensions:

Acute intoxication or withdrawal potential, or both;

Biomedical conditions and complications;

Emotional, behavioral, or cognitive conditions and complications;

Readiness to change;

Relapse, continued use, or continued problem potential; and

Recovery/living environment.

Individualized Treatment Plan

For substance use intensive outpatient the licensed Credentialed Addiction Treatment Professional(s), including Residents in Counseling or Psychology and Supervisees in Social Work shall develop and document the ISP along with the client.

Any medical concerns or symptoms shall be documented and will include the physician who will also be included in the authorization for service. 

If a mental health history is noted the ISP will include regular contact with the psychiatrist or psychiatric nurse practitioner which is medically necessary. 

The ISP shall be reviewed with the member at least every 90 calendar days by the licensed Credentialed Addiction Treatment Professional(s) including Residents in Counseling or Psychology and Supervisees in Social Work to determine that services being provided are or were required at ASAM Level 2.1 and to recommend changes in the plan as indicated by the member's overall adjustment during the placement.

The ISP shall be updated at least every 90 calendar days and as the member's needs and progress change. An ISP that is not updated either every 90 calendar days or as the member's needs and progress change shall be considered outdated. If the ISP review identifies any changes in the member’s progress and treatment needs, the goals, objectives, and strategies of the ISP must be updated to reflect any changes in the member's progress and treatment needs as well as any newly-identified problems. The ISP shall include the signature and date from the member, parent, or legally authorized representative, credentialed addiction treatment professional(s) and the physician and/or physician extender, as necessary.

Individual, group and family therapy shall be provided as directed by the member’s ISP and based on the member’s treatment needs as identified in the multidimensional assessment.

Therapy shall be provided by credentialed addiction treatment professionals within the scope of their practice, and will be documented in the ISP and progress notes in accordance with the ASAM requirements.

Family engagement, for the benefit of the member, shall be provided in addition to family therapy/counseling as appropriate and outlined in the ISP.

The family or legally authorized representative shall be part of the family engagement strategies in the ISP. Family engagement activities are considered to be an intervention and shall occur based on the treatment and visitation goals and scheduling needs of the family or legally authorized representative. Interventions shall be documented on a progress note and shall be outlined in and aligned with the treatment goals and objectives in the ISP.

Specific Requirements of the ISP:

The Comprehensive ISP shall meet all of the following criteria:

Be developed by licensed Credentialed Addiction Treatment Professional(s) including Residents in Counseling or Psychology and Supervisees in Social Work and the physician and/or physician extender, as necessary,

Be based on the multidimensional assessment including ASAM Dimensions 1-6 and a diagnostic clinical evaluation that includes examination of the medical, psychological, social, behavioral, and developmental aspects of the member's situation and must reflect the need for the ASAM Level of Care;

Be based on evidenced based assessment tools to gather clinical information such as, but not limited to: Addiction Severity Index (ASI) or Global Appraisal of Individual Needs (GAIN);

Describe any prior treatment information and testing that the member has received;

Shall state treatment objectives that includes the member’s goals that shall include measurable, evidence-based, short-term and long-term goals and objectives, family engagement activities (as appropriate), and the design of community-based aftercare with target dates for achievement;

Describe the ASAM Dimensional Admission Criteria rules for the appropriate ASAM Level of Care being requested

Type and Role of Staff:

Intensive outpatient services (ASAM Level 2.1) shall be provided by Support Systems, Inc., a provider licensed by DBHDS as a substance abuse intensive outpatient service for adults, and contracted with the BHSA or MCO to provide this service.  Support Systems, Inc. will contract with at least 2 individuals who have CSAC certification in the state of Virginia and will also employee at least 1 licensed or licensed eligible mental health professional to provide clinical supervision and oversight of the IOP program and groups. The LMHP or LMHP-E will have at least one year of experience working with individuals who have a diagnosis of a Substance Use disorder and also extensive experience in the mental health field. Support Systems, Inc. staff will also make contact with and utilize at least one peer support recovery specialist to aid in providing groups with the oversight and support of a licensed or licensed eligible mental health professional. This will allow for peer to peer support, healing and progress toward recovery for clients who are in the IOP program.

Intensive outpatient service providers shall meet the ASAM Level 2.1 service components and staff requirements as follows:

1. Interdisciplinary team of credentialed addiction treatment professionals shall be required.

2. Generalist physicians or physicians with experience in addiction medicine are permitted to provide general medical evaluations and concurrent/integrated general medical care.

3. Staff shall be cross-trained to understand signs and symptoms of psychiatric disorders and be able to understand and explain the uses of psychotropic medications and understand interactions with substance use and other addictive disorders.

4. Emergency services, which shall be available, when necessary, by telephone 24 hours per day and seven days per week when the treatment program is not in session.

5. Direct affiliation with, or close coordination through referrals to, higher and lower levels of care and supportive housing services.

C. Intensive outpatient services (ASAM Level 2.1) co-occurring enhanced programs.

1. Co-occurring capable programs offer these therapies and support systems in intensive outpatient services described in this section to individuals with co-occurring addictive and psychiatric disorders who are able to tolerate and benefit from a planned program of therapies.

2. Individuals who are not able to benefit from a full program of therapies will be offered enhanced program services to match the intensity of hours in ASAM Level 2.1, including substance use case management, program of assertive community treatment (PACT), medication management, and psychotherapy. "Program of assertive community treatment" or "PACT" means the same as defined in 12VAC30-105-20.

Admission Criteria and Characteristics and needs of the population served:

Prior to admission into IOP, individuals will receive a thorough substance use evaluation following the American Society of Addiction Medicine (ASAM) criteria.  This evaluation will assess:

  • Individuals must have a Substance Use disorder or individuals who are diagnosed with a Substance Use disorder co-occurring with a Mental Health disorder.

  • Individuals with a history of psychosis must be stabilized

  • Individuals must be high functioning enough to provide informed consent to treatment

  • Individuals must be a good fit for IOP, therefore clinically at risk if they were to receive treatment in a lower level of care

  • Individuals who receive medication assisted treatment are welcome

  • Individuals 18 and above

  • Individuals who have Medicaid insurance

In order to receive Intensive Outpatient services, the member shall be enrolled in Virginia Medicaid and shall meet the following medical necessity criteria below:

1. The member shall demonstrate at least one diagnosis from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for Substance-Related and Addictive Disorders with the exception of tobacco-related disorders, caffeine use disorder or dependence, and nonsubstance-related addictive disorders; or be assessed to be at risk for developing substance use disorder (for youth under the age of twenty-one using the ASAM multidimensional assessment).

2. The member shall be assessed by a credentialed addiction treatment professional acting within the scope of their practice, who will determine if he/she meets the severity and intensity of treatment required for the service and shall be based on the outcome of the member’s documented multidimensional assessment.

For persons with co-occurring psychiatric and substance use conditions, there will be an integration of the treatment needs with concurrent authorizations for psychiatric services and substance use disorder services if medical necessity criteria are met for the requested service. Collaboration and coordination of care among all treating practitioners shall be documented.

Continued Stay

To receive Intensive Outpatient Services with Support Systems, the client must be an active client, which means an assessment has been completed which documents the need prior to initiation of the services and has an active plan of care in effect at the time services are rendered. 

An active client for Intensive Outpatient Services shall mean an individual for whom an individualized ISP has been developed and is in effect which requires regular direct or client-related contacts or communication or activity with the client, family, service providers, significant others and others deemed necessary.  Substance Abuse Case Management authorizations are required prior to services beginning.

There are no maximum service limits for IOP.  One unit of service is one day with a minimum of 3 service hours per service day to achieve 9 to 19 hours of services per week for adults. A Maximum of 19 hours shall be billed per week. In cases that a member does not complete the minimum of 3 service hours per service day, the provider should document any deviation from the ISP in the member’s medical record and reason for the deviation and notify the MCO or the BHSA (based on member’s benefit) weekly when the minimum sessions have not been provided. If the member consistently deviates from the required services in the ISP, the provider should work with the MCO or the BHSA ARTS Care Coordinator to reassess for another ASAM Level of Care or model to better meet the member’s needs.

Exclusion Criteria

Individuals who have a history of violence or aggression- Violence or aggression will be identified based on a history of physical aggression or violence toward mental health providers or other professionals. Support Systems, Inc. recognizes that individuals who have a diagnosis of a substance use disorder and/or mental health disorder may have tendencies toward verbal aggression or anger outbursts. Staff will be trained to manage this and provide support toward de-escalation.

Individuals who reside in any domiciliary care facilities or institutions for mental disease/disorders including, but not limited to group homes, or nursing facilities are not eligible for this service.

Individuals who are residents of Psychiatric Residential Treatment Centers—Level C facilities except for assessment code H0032/U8 in the 7 days prior to discharge

Individuals who have organic disorders, such as delirium, dementia or other cognitive disorders of this nature unless a physician issues a signed and dated statement indicating that this service would benefit the individual.

Individuals with any substance use disorder or dependency and those with co-occurring mental health disorders will be included to receive Intensive Outpatient services. Medication assisted services, such as: Suboxone or Methadone treatment will not be provided by Support Systems, Inc. but staff will be able to provide appropriate referrals if necessary for best possible progress and chance of recovery.

Population served will include: individuals who are 18 years of age and above, individuals diagnosed with a substance use disorder, and individuals who have co-occurring disorders of mental health and substance use.Support Systems, Inc. will not exclude individuals who have a Power of Attorney or a Guardian. Support Systems, Inc. staff will work to collaborate with this individual to ensure that the needs of the client are being met appropriately. Support Systems, Inc. will include women who are pregnant in case management services. The staff will ensure that each woman who is pregnant will receive appropriate care and in a timely manner for overall mental and physical health throughout pregnancy while the client is in services. Support Systems, Inc. staff will also ensure appropriate referrals for all populations served upon discharge.

Termination of Treatment and Discharge

Successful termination of treatment is based on goal attainment as noted on the plan of care. Joint decisions with the client and Support Systems staff are made as to the appropriate reauthorization or termination of services.

Termination of treatment criteria may include the following:

  • The maximum allowable units have been billed or authorization for services is denied. 

  • When the client reaches treatment objectives, or has achieved a minimum of 90 percent of treatment goals and is capable of functioning independently without outside community interventions.

  • When other less intensive services may achieve stabilization or the member demonstrates need for a higher level of care

  • When the client has stated that he or she no longer wishes to receive services, or;

  • When the client withdraws from services, moves away or passes away.

Support Systems staff collaborates with the client regarding appropriate discharge, referrals, and/ or needs.

The ISP shall include discharge goals that will enable the individual/client to achieve and maintain community stability and independence.  Reauthorizations for service shall only be granted when Support Systems’ staff and the client are able to demonstrate that the individual is benefitting from the service as evidenced by updates and modifications to the ISP that demonstrate progress toward ISP goals and objectives.

Support Systems, Inc. will work to ensure that each client is a part of his or her treatment planning process and also discharge process (as often as possible).

Transition Criteria

Transitions to other programs/services will occur when required.  This decision is to be made by the active case manager.  Support Systems will provide support as needed to ensure successful transition.  This will include communication collaboration and other reasonable requests by the case manager or the client.  Transition to any other needed or requested services shall include appropriate discharge including maintaining contact, setting up appointment dates and times with providers and appropriate and consented collaboration with referral partners.

Modalities and Topics to be utilized for Substance Abuse Intensive Outpatient:

  • Motivational Interviewing

  • Topics encouraged by the group in order to provide an individualized treatment based on the group needs.

  • Cognitive Behavioral Theory to help increase positive thought process.

  • Empathy, Active Listening and Unconditional Positive Regard

  • Acceptance therapy to allow for closure, forgiveness and coping.

  • Exploration on negative consequences, underlying causes, and triggers.

  • Group topics may include but are not limited to: familial history, relationship issues, mental health symptoms, maintaining sobriety in order to process, cope and maintain progress with regard to substance abuse.

Substance Abuse Intensive Outpatient Groups:

  • Groups will consist of no more than 10 clients at one time in order to maintain an intimate and close environment, but also to allow peer to peer support.

  • Groups will be explored in order to decide if they should remain open to new members or closed.

Substance Abuse Intensive Outpatient Program