Day pass protocol: Not a vacation, but a therapeutic opportunity

Patients in the day treatment level of care with on-site housing at the Hazelden Springbrook facility in Oregon have the opportunity to receive day or weekend passes from the center, but these absences are no vacations from recovery work. Instead, they constitute an important component of treatment and recovery planning, with a highly structured schedule and much discussion of the goals behind the off-site experience.

Clinical director Heidi Wallace says of the “therapeutic pass” opportunity in the organization, “I'm a really big fan of it.”

Nearly all of Hazelden Springbrook's day treatment patients moved into that level of care from residential treatment, where they would not have had the same opportunity to leave the premises in the more controlled setting. Now they have demonstrated the ability to make progress under less supervision, but that doesn't mean all requests for therapeutic passes are rubber-stamped. Each patient seeking to be away from the facility for one or several days must state goals of the off-site visit on a form.

“We ask them, 'What are the recovery-focused activities they'll be participating in? What times will these take place? What [12-Step] meetings will they attend?'” says Wallace.

Self-assessment

In another important element of the therapeutic pass, Hazelden Springbrook patients complete a self-assessment of their level of risk for relapse, overdose, and other potential adverse outcomes. This is then compared with their peers' perception of that risk for the patient, says Wallace, and this might result in some changed responses on the form.

She says peers have a say in whether the request for a pass should be approved, though the final decision ultimately rests with a staff member.

The advance planning becomes “a mini relapse prevention plan,” says Wallace. On every Friday in the program, a group engages in weekend preparation discussions, and then on Monday a group will process the past weekend's events and activities, both for those who left campus and those who stayed in the facility. Special passes are not required for off-site meetings or social events that patients engage in as a group.

In the event that a patient experiences a relapse while on a pass, “We would encourage them to call and seek help right away,” says Wallace. It is possible that the patient would move to a more intensive level of care for a brief time, but most likely would remain in day treatment over the long haul.

“This is not a shaming exercise,” says Wallace. “It is important that we recognize that relapse is a part of the [recovery] process.”

She adds, “This is all about preparing for their return home.”

Following rules

Patient requests to be off-site for all or part of a weekend must be submitted by the Monday prior to the weekend, Wallace explains. The pass might be for one day, a weekend, or longer if the activity requires out-of-state travel.

There is no stated limit to the number of times a patient can seek a pass in what typically amounts to a 45-day stay in day treatment with supervised housing. Hazelden Springbrook currently has 18 male and 12 female patients in its day treartment level of care, housed in the same complex with the organization's residential treatment services.

Not all patients jump at the chance to seek a pass, Wallace adds. “Some will say, 'I'm not ready to go home,'” she says. In other cases, a peer might accompany the patient off-site, so that he/she can serve as a buffer against any negative influences to which the patient might be exposed in the home environment.