Aftercare Planning

Discharge is where a lot of plans quietly fail, not because clients “don’t care,” but because we underestimate how fast structure disappears and triggers return. We walk through aftercare planning the way we want you to think on a licensing exam and the way we want you to practice as a therapist: as a clinical process that starts early, stays collaborative, and keeps working after the final session.

We unpack a simple four-phase framework (assessment, goal setting, resource matching, and implementation with follow-up) and then zoom in on the stance that makes it work. We lean on motivational interviewing so clients buy into the plan instead of tolerating it, and we keep it strengths-based so aftercare feels achievable. We also talk harm reduction and systems thinking, because “meet the client where they are” is not a soft option, it’s the clinically appropriate one when real life includes family dynamics, housing instability, employers, and neighborhoods that can either support recovery or pull someone backward.

Then we get concrete and exam-ready: continuing care and recovery management checkups, Critical Time Intervention (CTI), Assertive Community Treatment (ACT), and the growing evidence for peer support. You’ll also hear practical tools you can use tomorrow, including relapse prevention planning, warning sign hierarchies with clear crisis steps like 988, support network mapping, behavioral rehearsal, warm handoffs, and the Stanley Brown Safety Plan. We close with the assessment instruments exam writers love: ASAM criteria, WHODAS 2.0, the Recovery Capital Scale, and the Columbia Suicide Severity Rating Scale (C-SSRS).

If you found this helpful, subscribe, share it with a classmate or consult group, and leave a quick review so more therapists can find the show. What aftercare question do you want us to tackle next?

Want to know if you're ready for your Licensing Exam. Take our free exam today!

If you need to study for your national licensing exam, try the free samplers at:  LicensureExams


This podcast is not associated with the NBCC, AMFTRB, ASW, ANCC, NASP, NAADAC, CCMC, NCPG,  CRCC, or any state or governmental agency responsible for licensure.

Transcript

SPEAKER_01 0:05

Hey there, therapist. Welcome back to the podcast. I'm Dr. Linton Hutchinson, and today Eric and I are tackling something that shows up on your licensing exam more often than you'd think. So, Eric, what's on the menu today?

SPEAKER_00 0:22

Well, Dr. Hutchinson, we're talking about aftercare planning. I'm Eric Talkman, by the way, and I'm pretty excited about this one. You know, aftercare gets treated like an afterthought sometimes, but the research tells us that it's actually one of the biggest predictors of long-term recovery. That's important. That's right. And if you're prepping for the exam, you've got to pay attention because questions about discharge and aftercare planning love to trip people up.

SPEAKER_01 0:52

Right. That's true. And there's this thing aftercare isn't just about handling a client a list of meetings and saying, hey, good luck. Right. It's not like saying, hey, I'll meet you at the sushi bar in Publix.

SPEAKER_00 1:09

And you just know where to go and what to order. You gotta do some pre-work to figure it out.

SPEAKER_01 1:15

So anyway, it's a whole clinical process. So, Eric, let's break it down.

SPEAKER_00 1:20

All right. So when we talk about aftercare planning in a session, what are we actually looking at? Linton, why don't you start us off?

SPEAKER_01 1:28

Yeah, sure thing. Aftercare planning is a structured process where you and the client really map out what comes next after the primary level of care terminates. That might be after inpatient treatment, residential, intensive outpatient, or even regular outpatient therapy that's wrapping up. The presentation in real practice looks like a collaborative conversation. So you want to be talking with them and not at them. And it usually starts a couple of weeks before discharge. That's when you need to start identifying needs, support systems, and potential relapse triggers.

SPEAKER_00 2:17

So it's like you're integrating it into your regular therapeutic session, not just tacking it on at the end. Yeah, exactly. So the clinical picture really shifts depending on where the client is coming from, which you know makes sense. For somebody leaving a 30-day residential program, you've got a lot of structure suddenly disappearing. But for an outpatient client who's just stabilized, the aftercare plan might look more about maintenance and regular check-ins. Point is you're meeting a client where they are. Uh-huh. Yeah, exactly.

SPEAKER_01 2:49

And one thing I want you to remember for the exam aftercare planning isn't a single document. It's a living plan that you are working together with the client. You're assessing their readiness, you're looking at biopsychosocial factors, and you're factoring in things like important stuff, like housing, employment, their family dynamics, and of course any medical needs that they may have.

The Four Phases Of Aftercare

SPEAKER_00 3:21

Right. So if they're getting out of a 30-day program and they have nowhere to live afterwards, that's really going to affect things. And if you haven't checked it out, then you're really setting them up to fail. Absolutely. So the model itself usually moves through a few phases. First phase is assessment, where you're gathering the information about a client's current functioning and risks. Second, goal setting, where you and the client identify specific measurable outcomes. And the third phase, resource matching, lining up the right level of care, who the providers are, and what kind of community supports are there. And the fourth phase, implementation and follow-up, where you actually put the plan in motion and check on how it's going. So it's not just, oh, you're out the door, I'm going to forget about you. Right.

SPEAKER_01 4:10

Well, you know, that's the problem, is a lot of times this follow-up piece is often skipped totally, or it's just tacked on at the end. So you get busy, you have more clients, client moves on, and no one circles back and checks with them. That's when things have a potential of falling apart.

Collaboration, Strengths, Harm Reduction

SPEAKER_00 4:31

Exactly. So, how do you actually approach aftercare in a clinical setting? What's your stance when you sit down with a client?

SPEAKER_01 4:41

Well, I think collaboration is the word. You're not dictating a plan to a client, you're co-constructing it. You're leaning heavily on motivational interviewing principles. Remember that for the exam. Uh-huh. Because a client has to buy into the plan, or it's just something on a piece of paper. Right. So I'm asking open-ended questions, reflecting what I heard, and rolling with resistance when it shows up. And it will show up. Rolling with resistance.

SPEAKER_00 5:15

There you go. I like that. Did you just make that up? No. Oh. Okay. That was good. That's a really important point. And I'd add a strengths-based approach to that. When you're planning aftercare, it's tempting to focus on everything that can go wrong. But if you frame the conversation around what a client already has accomplished, what strengths they have, what resources you both can draw on, the plan feels more achievable. The client walks out feeling like they're capable of doing something instead of fragile with the whole world ready to crash down on.

SPEAKER_01 5:49

Really, totally. And there's the harm reduction approach, which is different. And it's something that's really underused. Not every client is ready for total abstinence or full symptom remission. Sometimes the realistic plan is to reduce harm, just reduce it, increase safety, and keep the client engaged in care. And for your exam, remember that meeting a client where they are isn't lowering the bar. It's being clinical and clinically appropriate. Right.

SPEAKER_00 6:31

Meeting them, which makes total sense. Yeah. Right. And I'd throw in a systems approach on top of that. Aftercare planning that ignores family or partners, employers, or the general culture that the neighborhood they're going back into. Because if they're abstinent in a 30-day program with no one around, and then they go back to the same people who were just selling to them, you know, a month ago, it's a totally different context. So you're looking at the client in context, not in a vacuum. Right, exactly.

Research Behind Continuing Care

SPEAKER_01 7:03

Okay. Let's get into some research because that's the kind of stuff that really shows up on an exam, Eric. What evidence does it say about effective aftercare?

SPEAKER_00 7:18

Well, the strongest evidence we have is for a continuing care model. Studies on substance use treatment, particularly the work by McKay and others, show that extending the duration of contact with treatment providers, even just brief check-ins, dramatically improves the outcome. Yeah, but you probably won't have to know uh McKay and colleagues. Well, probably not, although the the yeah, it's not so much the name as recognizing the uh the fact that even just the quick touch-ins can bring back the whole clinical experience to the uh client. Right. So even uh telephone um recovery management checkup or uh more assertive continuing care, they aren't just uh in interventions for the sake of interventions, they're consistent contact over time.

SPEAKER_01 8:14

Okay, and then don't forget about the recovery management checkup model. The idea is that you are treating addiction more like a chronic condition. Right. Instead of a one-shot accurate treatment, you're checking in quality every six months, reassessing, and bringing the client back in for care if they've slipped. The data on this is really solid.

SPEAKER_00 8:44

And uh outside of substance use, there's also strong evidence for mental health aftercare as well. Uh, critical time intervention or CTI was designed for people transitioning out of psychiatric hospitalization or homelessness. It's a nine-month time-limited intervention that focuses on building community ties during a high-risk transition period. The research shows reduced hospitalization rates and better community functioning.

SPEAKER_01 9:23

Yeah, so if you saw something on the exam that said CTI, that would mean that's right, critical time intervention. Right. So you'll know that in case that shows up on your exam. What if ACT shows up on ACT? Okay. Well, that stands for assertive community treatment. Ah yes. And that's where for clients with severe and persistent mental illness. Okay, so ACT assertive community treatment. And this, of course, will require intensive multidisciplinary support in the client's environment. It's not technically aftercare, but it functions as a permanent support system for clients who otherwise will cycle through hospitalizations.

SPEAKER_00 10:24

So it's like aftercare in the sense that it continues on in their community setting after more intensive uh inpatient care has happened. So it looks like aftercare, even though it's a continuing model.

SPEAKER_01 10:36

But it's basically for people with persistent mental illness.

SPEAKER_00 10:40

Right. Severe. Yes. And don't forget, peer support. The evidence base for peer recovery support specialists has grown a bunch in the last decade. Right. Clients who connect with peers who've been through similar experiences show better engagement, reduced isolation, and improved long-term outcomes. So when you're building an aftercare plan, peer support should not be an afterthought. Right.

SPEAKER_01 11:09

Exactly. And on the exam, you're gonna possibly see questions on continuing care models of the CTI, critical time intervention, ACT, assertive community treatment, and peer support. These are the bread and butter of evidence-based aftercare. I love bread and butter.

Relapse Plans, Warm Handoffs, Safety

SPEAKER_00 11:33

I prefer sushi myself. Oh well, yes. But saying these are the sushi of evidence-based aftercare just doesn't carry the same ring. Does it? You're right. Well, let's talk about specific interventions you'd actually use when you're sitting in a session doing aftercare work. Uh-huh. Linton, where do you stop? Okay.

unknown 11:55

Okay.

SPEAKER_01 11:56

First intervention. I always use it as a relapse prevention plan. Okay. It's more than just identifying triggers that uh a client will set them off. You and the client are basically mapping out high-risk situations, early warning signs, coping strategies, and emergency contacts. Very important. I like to have a client write down them down themselves. And that way they have sort of a feeling of ownership of what's going on. They wrote it down, so they own it. Exactly. And if I write it down, then it becomes my plan, not their plan. Right. So if they write it down, like you said, it's theirs. Makes perfect sense.

SPEAKER_00 12:47

Which goes along with using a warning signs hierarchy. So you have early warning signs, middle warning signs, and crisis level signs. And for each level, you work up a specific action plan.

SPEAKER_01 13:01

Say those again, would you? Sure.

SPEAKER_00 13:03

Early warning signs, middle warning signs, and crisis level. Okay. And so early warning signs might need a phone call to a sponsor or a self-care activity. Middle warning signs might be calling their therapist back for an emergency session. And of course, crisis uh signs trigger going to the ER or calling 988 or the uh suicide hotline. Ah, that's what that is. Yes. And it gives the client a graduated response system instead of uh just an on or off, I'm fine, or I'm totally in crisis. Because our lives are, you know, really uh a gradation of things from mild to full-on I need care. And this recognizes that. I thought you were going to say call 911. Well, you could do that too. 911 would be if you're actually needing to be hauled off to uh emergency room. The 999, I mean the 988 is a national That's right, the national uh suicide hotline that's uh actually been shown to have reduced the incidence of um of suicide interventions uh in actual data. So it's it's really been an effective system.

SPEAKER_01 14:20

Okay. Another intervention that I use a lot is the support network mapping exercise. You sit down with the client and you literally physically draw out on a piece of paper who's their support system. So does this go on like a genogram? Sort of like a genogram, yeah. You use family, friends, providers, peer support, community resource, and faith communities. Then you assess each one. Is this person reliable? Can I rely on Eric to give me a call at two o'clock in the morning if I call him up? Will he answer the phone? Depends on how deeply he's asleep. Right. Is the person safe? Can you actually call him? And it surfaces many of those gaps that otherwise you wouldn't uh you wouldn't get unless you actually drew it out.

SPEAKER_00 15:17

Well, that makes perfect sense. Yeah. I also use a lot of behavioral rehearsal during aftercare planning, which is sort of a you know take off on what you just said. Um, so we're not just talking about what you'll do when your old drinking buddy calls you, you actually role-play it. You go through the the behaviors that are going to happen. Practice the words, you practice hanging up on the person, you practice the breathing exercise afterwards. Behavioral rehearsal builds the actual skill, not just the intention to do the right thing.

SPEAKER_01 15:48

Okay. All right, and then there's the warm handoff. Instead of giving a client a phone number of a community provider, you're calling that provider together during a session. Oh, wow. Okay. You introduce the client, you schedule the first appointment while you're there with the client in the same room. You're not just uh, you know, showing something on a piece of paper.

SPEAKER_00 16:14

Another intervention I use is what I call ambivalence exploration. Uh-huh. Clients often have mixed feelings about leaving treatment. Some are happy as clams, but there are others that are really that scared of the fact that they're going to be losing that regularity of contact. So part of you is ready, part of you is terrified. If you don't work on uh that ambivalence, if you don't bring it out, then it leaks out as no shows later on, or failing to call the aftercare people, or disengagement. So you and a client talk openly about both sides, happy that you don't have to show up every week, but terrified that you're going to relapse. Basically, uh motivational interviewing applied to the discharge process. Oh, that's good.

SPEAKER_01 17:00

That comes in very handy. So the last thing I'll mention is the safety planning intervention, especially for clients with suicidal risk history. The Stanley Brown safety plan is the gold standard here. So if you hear Safety Brown, you'll know what they're talking about. It has six steps. It's collaborative and it's evidence-based. You should know this one cold for your exam. All six steps. Um, they're going from warning signs to internal coping, to social contacts and settings for distraction, to people you can ask for help, to professional and agencies to contact. And finally, means restriction. The last step on means restriction is something exam writers love to put in because no one knows what the heck it means. I certainly don't. Okay. Well, you're not going to tell us.

SPEAKER_00 18:10

No, no. I'm no better than the uh exam writers. Okay, so you that's something you need to look up. Absolutely, I do.

SPEAKER_01 18:17

Means restriction.

SPEAKER_00 18:18

So you're not just jumping straight to crisis lines. You're walking down a graduated response that builds the client's feelings of autonomy, that there's something they can do besides just calling 911. Okay.

SPEAKER_01 18:32

All right. Do we want to go through specific techniques or is that enough for everyone today? What do you think?

SPEAKER_00 18:39

I think we should talk about some of the assessment instruments.

SPEAKER_01 18:43

Okay.

SPEAKER_00 18:45

It's all yours, Eric. Well, so we're going to talk about some tools that you might see on the exam.

SPEAKER_01 18:56

Uh-huh. I see. Okay, let's do it. A big one for substance use is the AS AM criteria.

SPEAKER_00 19:10

Ah, the old ASAM, yes.

SPEAKER_01 19:13

It's not a single instrument, but multidimensional assessment framework that helps you determine the appropriate level of care. Six dimensions covering acute intoxication.

SPEAKER_00 19:25

I used to listen to the sixth dimension. Would you like to write in that group? Yeah.

SPEAKER_01 19:31

I remember that.

SPEAKER_00 19:32

That was good stuff.

SPEAKER_01 19:33

Okay. Intoxication, biomedical conditions, emotional and cognitive conditions, readiness to change, relapse potential, and recovery environment. So the ASAM criteria is exam goal. Know what those six dimensions are. You probably never covered this when you went in your graduate program, did you?

SPEAKER_00 19:56

No, that didn't happen way back then when I did, and certainly not back in the stone ages of when you did love. And for general aftercare uh health, I used the HUDAS 2.0. You don't use that. I use the HUDAS all the time. As a matter of fact, somebody knocked on my door the other day and I said, HUDAS.

unknown 20:21

Okay.

SPEAKER_01 20:22

So even though it sounds strange, obsequious, purple, and clairvoyant. Yes, it does. You need to know what the HUDAS 2.0 is for the exam.

SPEAKER_00 20:33

It's the World Health Organization Who disability assessment schedule. Right.

SPEAKER_01 20:39

And we're mentioning it because it's something you hopefully you would use, but it's definitely something you need to know for the exam.

SPEAKER_00 20:47

But could well show up on the exam. It measures functioning across the six domains and help you identify where a client needs ongoing support. Okay. And it's recommended in the DSM, which is why it shows up on the exam.

SPEAKER_01 21:00

Yes, yes. Another one is the recovery capital scale. And it assesses the internal and external resources a client has available to support their recovery.

SPEAKER_00 21:13

Oh, okay. The capital, the resources they have available. Right, right. Okay.

SPEAKER_01 21:17

So physical, human, cultural, all that. The higher the recovery capital, the better the progress. So how would you describe what capital is?

SPEAKER_00 21:31

Well, it's the it's the things you have, uh your internal fund to know. So if your social capital is high, you've got a lot of friends. You have a lot of people you control. That's what they mean. Uh cultural capital, you um you know the culture you're going into well so that you have a feeling of uh competence and being able to deal with the people around you. Okay.

SPEAKER_01 21:55

So if you see anything about recovery capital scale, you you have an idea what it's talking about.

Exam Defaults And Final Takeaways

SPEAKER_00 22:01

Absolutely. And then for suicide risks, especially during transitions, because you recognize that's when the risk for that is highest. The Columbia Suicide Severity Rating Scale, the CSSRS, is the standard. Quick, it has validation, and most settings require it at discharge. So the you know it's used quite a bit. So you should be able to identify the CSSRS on the exam. Right. Okay, let's bring it home. All right. What do you think therapists and pre-test takers should walk away with today?

SPEAKER_01 22:45

Okay. The first thing you should remember is aftercare planning is a clinical process, not a checklist. Not a checklist. Right. Sort of like the exam is not a final exam. You are taking the exam right now, and you're passing. Right. Listening to this podcast is part of the exam. Right. You are passing at this particular time.

SPEAKER_00 23:08

It's all a continuum. Right. So the second takeaway is that the evidence supports a continuing care model. Critical time intervention, CTI, assertive community treatment, ACT, and peer support as the most effective approaches. So when you're answering exam questions about aftercare, default to interventions that involve sustained contact, active engagement, not just passive referral. So if it just says, what do you do in aftercare? Or you meet them in publics to have some sushi. Well, I mean, that's just good practice.

SPEAKER_01 23:48

That's all that is. All right, the third takeaway: specific interventions like relapse prevention planning, warning sign hierarchies, support network mapping, behavioral rehearsal, and warm handoffs are the day-to-day tools that you need to be using with the client. These are the kind of things that you may see on the exam.

SPEAKER_00 24:14

Right. The fourth takeaway: know the assessment instruments. The ASAM, the HODAS, the Recovery Capital Scale, and the Columbia Suicide Severity Rating Scale. Who comes up with these? Uh people that love acronyms. Okay. And they're the ones that will show up most likely on the exam. You don't need to administer all of them, but you, especially for the exam, need to recognize what they are and what they measure. Uh-huh.

SPEAKER_01 24:42

The fifth takeaway is after care planning is where chronic care thinking meets clinical compassion. Substance use, severe mental illness, and many other conditions are obviously very chronic. Treating them like acute illnesses and discharging a client into the wild without ongoing support is what drives readmission rates. Plan for the long haul.

SPEAKER_00 25:14

Plan for the long haul. I like that one. Yes. And one more thing. When you're sitting for the exam and you see a question about aftercare, the right answer almost always involves active, collaborative, and sustained engagement. If you see that answer, gravitate to that one. If a choice sounds passive or one and done, it's probably wrong. Good one. Good one.

SPEAKER_01 25:41

Well, listen, everybody, thanks for hanging out with us today. Study hard, take care of yourselves, and we'll see you next time. And remember, it's in there.