VIOP-Virtual Intensive Outpatient Programme

The start up of any new programme or service is often challenging as there are any number of unknown variables that can interfere or prohibit the delivery of services, delay start dates, or inflate budget. There is a normal process of trial and error and learning curves to develop more effective and efficient ways to deliver your product. This challenge is certainly magnified when the start up of a new initiative is also precipitated by a global pandemic and an increasing level of urgency to implement. This was certainly the case that Crossroads Centre Antigua encountered.

Crossroads Centre is a residential treatment programme for substance abuse disorder that caters to mostly an international population. Once news hit of Covid 19 becoming a pandemic and international borders quickly closing, Crossroads was faced with mass discharge of clients and closing of our residential programme. This also meant sending home many of our clients prematurely and without proper aftercare plans in place. However, once that task was accomplished we were now faced with the reality of the situation and the long haul ahead to reopen safely. This led to the inception of creating a Virtual Outpatient Programme in order to continue to provide substance abuse counseling to those in need while we await the signal for when we can safely reopen. This also provided us with a platform to reconnect with our alumni and our most recently discharged clients to provide ongoing support services. This covers the “why” we needed to create something. Although an exciting new venture it was certainly met with interesting challenges.

The next step was figuring out the “what” and the “how”

The initial challenges- The “what”

Designing the programme-what specific services would be offered (how many groups and individual sessions per week) and pricing for services. Finding the right formula for what services would be offered took a bit of brain storming. What would be effective, as well as reasonable for clients to commit to? What we came up with is a four to six week programme operating four days a week with two hours of clinical group per day and two individual sessions per week. This allowed for group psycho education, group process and individualized treatment goals to be achieved.

Next was deciding on the “how”

Choosing the right virtual platform- choose a platform that caters to your organizational needs and therapy. We chose ZOOM Health Care. It offered secured HIPPA compliance and multiple hosts for the price, and compatible with internet service providers in Antigua

Getting started –

As soon as the formula was created getting started went pretty smoothly (for the most part). Once all the technology was figured out we were able to assess and enroll clients quite effortlessly and orientate to the programme. The most challenging aspect of this venture was internet accessibility. Poor internet created some delays in connection and interaction within the group.

Teletherapy has some great benefits like remote access, affordability, time efficiency and reduced stigma making it less intimidating to enroll. The reduced stigma was especially noticeable for woman. From our sample we noticed there was significant difference in the gender profile in virtual therapy compared to traditional residential treatment. Traditional barriers for women entering residential treatment are removed in virtual therapy thus increasing the likeliness of enrollment. However there are some drawbacks. Although clients adapted easily to the virtual environment and were able to engage in the therapeutic process there are limitations compared to face to face therapy. In traditional therapy the therapist controls the environment creating a protected and confidential space that is conducive to building trust and safety. In the virtual world the client is in charge of the space and not all spaces are equal. Many have distractions in the background (children, noise, and other activities going on) and some do not provide confidentiality. This proves especially challenging when providing group therapy as each person is in a different space. What we learned in the process was the need to adapt clear boundaries and expectations for participation in the group/individual therapy to maximize the benefits.

Overall the experience has been greatly satisfying as reported by our clients. At Crossroads we are incredibly proud of what we created and look forward to continuing our work with VIOP and adding this service to our existing residential programme once we reopen.

Joanne Gonsalves, MSW, Clinical Director
Crossroads Centre, Antigua

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