When Outpatient Care Isn't Enough: Ethical Decision-Making Across the Continuum of Care - Background Image
Live Event

When Outpatient Care Isn't Enough: Ethical Decision-Making Across the Continuum of Care

Sat, Apr 25th, 2026
11:00am – 2:15pm US Eastern Time
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About the Event

Many therapists experience a quiet but persistent tremor when a client’s needs begin to stretch beyond the protective container of traditional outpatient work. This moment—often felt long before it is spoken—marks an ethical and clinical threshold where continued outpatient care may no longer be sufficient to ensure safety, stabilization, or therapeutic integrity.

This 3-hour training is designed to support clinicians at that threshold by grounding level-of-care decisions in ethical clarity, clinical judgment, and a nuanced understanding of the care continuum. Participants will explore the ethical responsibilities inherent in assessing acuity, recognizing the limits of outpatient treatment, and determining when a higher level of care is clinically and ethically indicated.

Through a blend of didactic teaching, reflective discussion, and applied frameworks, clinicians will learn to identify key clinical and behavioral indicators that signal increased risk, differentiate among levels of care (IOP, PHP, residential, inpatient), and navigate the emotional, relational, and systemic barriers that can delay necessary transitions. Particular attention is given to ethical decision-making under uncertainty, scope-of-practice considerations, consultation, documentation, and the risks of both premature referral and delayed action.

Clinicians will also gain practical language for conducting compassionate, transparent referral conversations that engage clients collaboratively while maintaining appropriate boundaries and preserving the therapeutic alliance. The overarching goal is to help therapists feel less alone—and less paralyzed—at the edge of the bridge, and more equipped to guide clients toward the level of care that can most safely and effectively hold them.

This training emphasizes ethical practice as an active, relational process rather than a checklist, supporting clinicians in making decisions that protect client welfare, reduce risk, and sustain professional integrity across the continuum of care.

Live Event This is a live online event. It will be conducted via Zoom Webinar.

Live Event Instructors

Sarah Buino

Sarah Buino

Sarah Buino is a therapist, teacher, speaker and the founder of Head/Heart Therapy, Inc. She is a licensed clinical social worker, certified addictions counselor, NARM Therapist, and Certified Daring Way facilitator. She holds a masters degree from Loyola University in Chicago and specializes in shame, substance use disorders, and trauma. She has trained in a variety of therapy modalities including: NARM (neuro-affective relational model), sensorimotor psychotherapy, comprehensive energy psychology, psychodrama/experiential therapy, and shame-resilience. She uses each of these modalities as a framework to support resilience within her clients and create a space for self-knowledge and growth. Sarah became part of Loyola University’s School of Social Work adjunct faculty in 2015 and Fordham University’s adjunct faculty in 2019. She is committed to supporting the newest generation of social workers to become passionate about and competent in working with substance use disorders.

Livia Adia Budrys, AM, LCSW, C-IAYT, SEP

Livia Adia Budrys, AM, LCSW, C-IAYT, SEP

Livia is a psychotherapist, social worker, yoga therapist, Somatic Experiencing practitioner, and spiritual activist. She is the founder of the Yoga-Informed Model and is an advocate of the mind + body paradigm shift. She implemented one of the first yoga therapy programs for mental health treatment in a nationally renowned residential treatment center. There she developed a clinical residency program to train the next generation of psychotherapists to weave yoga into their treatment of complex mental health and trauma. She is passionate about best practices and the integration of neurobiology, somatics, yoga and psychotherapy for the healing of addiction, eating and mood disorders and the often underlying acute and chronic traumatization. Livia’s psychotherapeutic experience includes training in Dialectical Behavioral Therapy (DBT), Acceptance and Change Therapy (ACT), DBT- Prolonged Exposure (DBT-PE), Exposure and Response Prevention Therapy (ERP), anti-oppressive psychodynamic psychotherapy.

Livia’s engagement with yoga and meditation began with a two-year residency at the Himalayan International Institute of Yoga Science and Philosophy where in 1999 she was initiated into the tradition of the Himalayan Masters. She has completed over a decade of advanced and therapeutic yoga certifications along with becoming a Reiki Master in 1998. She has been deeply influenced by the mindfulness training that she has received from Vietnamese Zen Monk, Thich Nhat Hanh.

Today she works to educate healthcare organizations, conducts research and presents nationally on the benefits of yoga for mental health and trauma awareness to reduce systemic burnout. She partners to implement therapeutic programs, training and protocols that utilizes the Yoga-Informed model and community-based, accessible Somatic Experiencing. She has enjoyed several clinical leadership roles in inpatient settings, most recently as Director of Trauma-Informed Care at a national treatment center - always with her hope to serve clients while supporting the system’s greater capacity for sustainable wellbeing.

Target Audience

This live interactive webinar is intended for behavioral health professionals, including Psychologists, Social Workers, Counselors, MFT's and Addiction Professionals.

Learning Objectives

After taking this activity, you should be able to:

  1. 1 Identify clinical and behavioral indicators that ethically obligate consideration of a higher level of care, including risks related to safety, stabilization, and the limits of outpatient treatment.
  2. 2 Differentiate among levels of care (IOP, PHP, residential, inpatient) and describe the core clinical functions, treatment goals, and ethical fit of each level.
  3. 3 Describe at least three common ethical and emotional barriers (e.g., fear of abandonment, countertransference, rescue fantasies, financial or systemic pressures) that interfere with timely step-up decisions, and apply strategies to navigate them responsibly.
  4. 4 Apply an ethical decision-making framework to assess acuity, determine when outpatient care is no longer sufficient, and support sound clinical judgment through consultation and documentation.
  5. 5 Demonstrate ethically sound, compassionate referral language that engages clients collaboratively while maintaining therapeutic boundaries, informed consent, and professional responsibility.

Disclosure to Learners

CE Learning Systems adheres to the ACCME's Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CE activity – including faculty, planners, reviewers, or others ― are required to disclose all relevant financial relationships with ineligible entities (formerly known as commercial interests).

The following relevant financial relationships have been disclosed by this activity's planners, faculty, and the reviewer:

Planners and Reviewers

The planners of this activity have reported that they have no relevant financial relationships.

Faculty

There are no known relevant financial relationships to disclose.

Commercial support

There is no commercial support for this distance-learning course.

Connecticut Department of Public Health (Counselors)

3 CE credit hours
Eligible until Apr 25th, 2026
CE Learning Systems has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5951. Programs that do not qualify for NBCC credit are clearly identified. CE Learning Systems is solely responsible for all aspects of the programs. 3 NBCC hour(s) awarded.
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National Board for Certified Counselors (NBCC)

3 CE credit hours
Eligible until Apr 25th, 2026
CE Learning Systems has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 5951. Programs that do not qualify for NBCC credit are clearly identified. CE Learning Systems is solely responsible for all aspects of the programs. 3 NBCC hour(s) awarded.
More Info
Logo: Approved Education Provider - NBCC

Event Agenda

Agenda times are listed in US Eastern Time. That is 3 hours later than US Pacific Time. The event starts at 8:00am US Pacific Time.

11:00 – 11:05 AM - Introduction and Orientation
  • Welcome, introduction of speakers, and overview of training purpose
  • Framing level-of-care decisions as ethical and clinical responsibilities
  • Review of learning objectives and structure of the training


11:05 – 11:25 AM (20 minutes) - Opening the Threshold: Naming the Ethical Moment

  • Normalizing clinician uncertainty and the limits of outpatient care in the metacrisis
  • Distinguishing clinical discomfort from ethical obligation
  • Reframing step-up decisions as ethical containment rather than failure or abandonment


11:25 – 11:55 AM (30 minutes) - Ethical Foundations of Level-of-Care Decisions

  • Ethical principles relevant to level-of-care assessment (client welfare, nonmaleficence, scope of practice, competence)
  • Ethical risks of continuing outpatient care beyond its appropriate limits
  • The ethical implications of delayed versus premature referrals


11:55 AM – 12:25 PM (30 minutes) - Understanding the Continuum of Care

  • Overview of levels of care: IOP, PHP, residential, and inpatient treatment
  • Core clinical functions and treatment goals of each level
  • Ethical fit between client acuity and level of care
  • Common misconceptions that interfere with appropriate referrals


12:25 – 12:40 PM (15 minutes) - Break


12:40 – 1:10 PM (30 minutes) - Recognizing the Arc: Clinical Indicators That Outpatient Care Is Reaching Its Limit

  • Behavioral, clinical, and systemic indicators of increasing acuity
  • Patterns over time versus isolated crisis events
  • Recognizing when outpatient treatment no longer provides sufficient containment


1:10 – 1:35 PM (25 minutes) - Ethical and Emotional Barriers to Stepping Up Care

  • Common barriers including countertransference, fear of rupture, and rescue dynamics
  • Financial, systemic, and access-related pressures
  • Ethical risks associated with avoidance and prolonged indecision
  • Consultation as an ethical practice


1:35 – 2:00 PM (25 minutes) - Ethical Decision-Making Framework for Stepping Up Care

  • Applying a structured framework to assess acuity and ethical obligation
  • Role of consultation and documentation in ethical decision-making
  • Supporting defensible and clinically sound recommendations


2:00 – 2:15 PM (15 minutes) - Closing

  • Case Application, Discussion, and Q&A

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