The Role of Outpatient Treatment for Teens with Mental Health and Substance Abuse Issues

How Outpatient Treatment Helps Teens

If you’re the parent of a teen who receives a diagnosis for a behavioral, mental health, or alcohol/substance use disorder, it’s important to know you’re right at the beginning of a process that’s different for everyone. While there are effective, evidence-based treatments for almost every mental health disorder we know about, and the course of treatment for each is similar, what happens next depends on circumstances specific to your teenager, your family, and the nature of the diagnosis itself.

This article will introduce the idea of levels of care in adolescent treatment. We’ll focus on one level of care in particular: outpatient treatment. Understand the levels of care is not hard. They’re exactly what they sound like. The phrase level of care to the frequency, intensity, duration, and location of the treatment your teen receives. Generally speaking, there are four levels of care in treatment for teen mental health disorders:

  • Outpatient Treatment
  • Intensive Outpatient Programs (IOP)
  • Partial Hospitalization Programs (PHP)
  • Residential Treatment Centers (RTC)

The first two levels of care on that list are officially considered outpatient programs. That brings us to the first thing you need to know about outpatient treatment. It occurs in a typical office setting, or an office located in a specialized adolescent treatment facility. And now, in the pandemic/post pandemic era, many treatment centers and individual psychiatrists, counselors, or therapists also offer virtual care. They provide care through video conference or via the telephone.

In either case – at an office or via virtual/telehealth – teens in outpatient treatment live at home, go to school, and participate in almost all aspects of family, school, and social/extracurricular life, as allowed by the symptoms or behaviors associated with their mental health or substance use disorder, and with the advice and input of a psychiatrist, therapist, or mental health/addiction counselor.

Which Teens Benefit Most From Outpatient Treatment?

The big-picture answer to that question is this: teens who benefit most from outpatient treatment are those who are not in crisis and whose symptoms are neither severe enough nor disruptive enough to prevent them from living at home, going to school, and engaging in the typical activities associated with teen life. In most cases, teens in outpatient treatment continue socializing with friends, playing sports, or participating in other extracurriculars like band, drama, academic clubs, or service-oriented clubs.

That previews what we want to talk about next: how a mental health professional determines what level of care your teen needs.

The first step is a complete biopsychosocial evaluation. A full biopsychosocial is the best known approach for either diagnosing or ruling out a mental health disorder. According to the American Psychological Association (APA):

“…the biopsychosocial approach to psychological assessment presumes that there are varying levels of physical, cognitive, emotional, behavioral, and environmental factors that contribute to the overall clinical assessment and conceptualization of every individual case.”

When a mental health professional determines the presence of a mental health disorder, they’re not done. Next, they need to determine two things: level of acuity and level of severity.

Acuity means how serious the symptoms of the disorder are right now. For instance, a teen actively engaging in suicidal ideation and has a suicide plan and the means to carry it out is a high acuity teen in crisis and needs immediate inpatient intervention at the most intensive level possible. On the other hand, a teen with depressive symptoms who feels sad every day, and is beginning to withdraw from friends and family, but can still participate in all the typical activities of teen life – albeit with less enthusiasm and engagement than usual – is most likely a low acuity teen who may need outpatient treatment.

Severity refers to the level of disruption the symptoms of the diagnosed disorder cause. Clinicians divide most mental health disorders into three levels: mild, moderate, and severe:

Mild

  • Symptoms clinicians classify as mild may be uncomfortable, painful, hard to handle, and disruptive. In most cases, though, despite the difficulties they cause, mild symptoms do not prevent your teen from functioning at home, school, work, or in their social life. Clinicians most often refer teens with mild symptoms to outpatient treatment.

Moderate

  • Symptoms clinicians classify as moderate are more uncomfortable, painful, and disruptive than mild symptoms. Moderate symptoms may prevent your teen from functioning at home, school, and during social activities, but they may not. Some teens with moderate symptoms find those things difficult, but not impossible. If your teen has moderate symptoms, they may receive a referral for outpatient office care – but likely two times a week rather than one – or they may receive a referral for an intensive outpatient program.

Severe

  • Symptoms clinicians classify as severe – in most cases – impair and/or prevent your teen from participating in even the most basic elements of home, school, or social life. A teen with severe depression may not be able to get out of bed or attend to personal hygiene. A teen with severe anxiety may not be able to attend school or socialize at all. And a teen with a severe substance use disorder may prioritize drug use over family life, school, and their former social life. In almost all cases, teens with severe symptoms need intensive care, and will not receive a referral for outpatient treatment.

Based on this information, the answer to the question in the heading of this section is that teens with mild or moderate symptoms, who are not in crisis, who can participate in family, school, and social life, may benefit from treatment at the outpatient level of care.

Next, we’ll talk about the two levels of outpatient care that may be appropriate for your teen, if they have mild or moderate symptoms and are not in crisis: outpatient treatment (in-person or virtual) and intensive outpatient (in-person or virtual).

Outpatient and Intensive Outpatient Programs for Teens

By now you understand that outpatient care is the least immersive level of care available for teens with mental health or substance use disorders. Typical outpatient care occurs once or twice a week. Session last around an hour each. They take place in an office with a psychiatrist or therapist. That simple description, though, undersells both the importance of this level of care and the commitment it requires.

Here’s what you and your teen need to know.

Outpatient Treatment

A Positive Therapeutic Relationship

Teens need to be open, honest, an up-front with their therapist. This is not always easy and can take time. Good therapists build a safe environment, establish a rapport, and find a way to get your teen talking.

Do The Work

Teen in outpatient care will have treatment homework, like journaling, that they should complete in order to get the most out of treatment.

Practical Skills

Teens in outpatient care learn coping mechanisms, stress management techniques, and coping tools specific to their disorder and their level of need. A therapist can help them practice these techniques in the office setting through role play and scenarios, but it’s up to the teen to apply these new skills out in the world, irl, as they might say. Putting these skills in action to manage their symptoms may not be easy and may take time.

The coping skills/stress management skills/symptom management skills your teen learns during outpatient treatment are theirs and theirs alone. That’s why we say it may take time to learn how to apply them out in the world: it’s trial and error. But that’s okay. That’s how it’s supposed to work. That’s the process. The therapist can’t apply the skills for them, and neither can you, as a parent. The goal of treatment is for your teen to learn to manage their symptoms independently. If one approach doesn’t work, they try another, and go back to their therapist to explore why one worked and one didn’t. Then they make changes, and try again.

Intensive outpatient (IOP) care is similar to outpatient care, but it’s one level up in intensity, and perhaps two levels up in actual time-in-treatment per week. If your teen receives a referral for an IOP program, they’ll most likely participate in treatment for a half-day, three to five days a week. Teens in IOP programs receive similar treatment to those in outpatient treatment, with several important differences.

Here’s what you and your teen need to know.

Intensive Outpatient Treatment

Group and Individual Therapy

Your teen will be in treatment with other teens, since most IOP programs include both individual and group therapy.

Multiple Modes

They may experience more than one therapeutic modality. For instance, a teen in outpatient treatment may engage in cognitive behavioral therapy (CBT), and a teen in an IOP program may engage in dialectical behavior therapy (DBT), which is a CBT-derived technique designed to support teens with high emotional reactivity.

Classes/Workshops

They’ll participate in educational workshops on mental health, the science behind mental health disorders, the science of addiction if applicable, and various other topics.

Practice and Peer Feedback

They’ll get to practice their coping skills and stress/symptom management skills and techniques with recovery and treatment peers. This is very helpful because they can get instant feedback from peers and therapists.

One good thing about IOP programs is the frequency: if your teen tries out a coping skill one day at school and it doesn’t help, they can ask for feedback that same day and be ready to try again the next day. Teens in typical outpatient program get to do this as well, but in most cases they need to try to modify they approach themselves, or wait until their next appointment.

When is Outpatient or Intensive Outpatient Treatment Appropriate?

This next sentence may seem like a dodge, but it’s not. Outpatient treatment might be the right choice at the beginning, the middle, or toward the end of a treatment plan. That ‘s true for a mental health or substance use disorder. With this disclaimer: there is truly no end to recovery from/treatment for a mental health or substance use disorder. The movement of a treatment plan is toward independence, empowerment, and the day a teen can manage the symptoms of their disorder without external input. However, the end of formal treatment does not mean the disorder disappears. The end of formal treatment means that the responsibility shifts to the patient – your teen, in this case – who can return to treatment at any time if they wish.

But we will clarify what we mean by beginning, middle, and toward the end.

Beginning

If your teen receives a diagnosis for a mild/moderate mental health or substance use disorder with mild/moderate symptoms, outpatient treatment or IOP may be their first step. During this phase, you, your teen, and your therapist may learn that the disorder is more severe than you first thought. In that case, your teen might step up – treatment term – to a more immersive level of care. They may go from outpatient to IOP, or IOP to PHP or RTC. Where they go depends on what the clinician recommends and what you, as a family, decide works for you.

Middle

In some cases, teens start in residential treatment, complete a program, and then return to life at home and in school. These teens may step down to IOP or PHP first, but they may also try life at home with once or twice a week outpatient treatment. If they’re successful, then that means their outpatient experience happens toward the end of formal treatment. If stepping down form RTC to outpatient does not work for them, they may return to an IOP program or a PHP program. In that case, outpatient treatment would be somewhere in the middle of their formal treatment process.

Toward the End

In some cases, teens begin in crisis. They start in an RTC program and step down slowly and carefully through the levels of care. Their path is directed by their progress and the advice and input of their treatment team. They go pro forma through the levels, from RTC to PHP to IOP to typical once-a-week outpatient care. Then, if all that goes well – meaning their therapist thinks they’re ready – they may achieve total independence, and see a therapist once a week or once a month – if at all.

Recovery For Life

We need to reiterate something before we close this article.

A mental health disorder does not go away. Neither does a substance use disorder. What happens, when they appear to have gone away – to others, from the outside – is that your teen learns to manage the symptoms of their disorder with such efficiency and independence that the symptoms no longer disrupt their daily functioning.

This does not mean their personal work has ended.

They still hurt. They still have uncomfortable emotions. People with addiction issues might still want to use alcohol or drugs and they may still experience cravings. When things approach unmanageable, then, quite often, a community support group, an honest talk with a friend or recovery peer, or some time refocusing on recovery and symptom management skills may be what they need.

However, sometimes they might need more support – and one of the best places to get that, for someone who’s been through the process, is in outpatient treatment. In fact, many people continue outpatient treatment for years – not because they’re in constant crisis – but because they can use their appointments to check in with a professional, who can tell them, “Let’s add a couple of sessions this month to make sure you stay on track, or “Yes, you’re on track, doing great.”

If they need the extra support, an outpatient therapist can give them that support. And if they don’t need that support, and they’re doing great, it’s invaluable for them to receive external validation from a licensed professional that they are, indeed, on track, and thriving in recovery.