IOP group curriculum: 4 weeks of topics, a facilitator guide and the Texas-required topics

We run a licensed Texas PHP, IOP and outpatient program and wrote the curriculum outline below for the programs we help open. It's original: it names evidence-based approaches but doesn't copy any purchased curriculum, and you shouldn't either. If you want a published, packaged curriculum, license it from its publisher; SAMHSA's own manuals, like the Matrix Model IOP counselor's manual for stimulant use disorders, are free.

How a program curriculum is built

• Rolling admission needs a rotation. Clients start on different days, so a fixed 12-week course doesn't work. A 4-week rotation of 20 day-topics means no one waits to start, and a PHP client who attends five days a week for four weeks gets the whole cycle.
• A topic sets direction, not a script. The facilitator adapts the material to the people in the room.
• Practice beats lecture. Spend most of each group practicing the skill, not talking about it. Payers and surveyors read "discussed coping skills" as weak; "practiced a refusal script in a role-play" shows a service.
• Every topic maps to a plan area (an ASAM dimension for substance use; symptoms, safety, functioning or relationships for mental health), which is what lets each client's note name their own goal.
• Trauma-informed, not trauma-telling. Groups teach about trauma and coping; no one is asked to tell their trauma story in group.

Pair the rotation with the weekly schedule: in our templates the first morning block is a process group and the second is the skills group on the day's topic, so the rotation drives one group a day and the process group follows what clients bring.

The five kinds of group

SAMHSA's TIP 41 on group therapy describes five models that work in substance use treatment. A good program day uses more than one.

Group type	What it does	Where it fits in the day
Psychoeducational	Teaches facts: how substances affect the brain and body, how medications work, health risks	The required health topics; family education
Skills development	Builds a specific skill: refusal, urge surfing, distress tolerance, assertive communication	The daily skills group
Cognitive-behavioral	Changes thinking and behavior patterns that lead to use or symptoms	Skills group; relapse prevention
Support	Peer encouragement, accountability, recovery community	Mutual-help topics; OP aftercare group
Interpersonal process	Works with what happens between members in the room	The daily process group, led by an experienced counselor

The 4-week substance use rotation

The plan-goal area uses the six ASAM dimensions as most payers still name them: 1 intoxication and withdrawal, 2 biomedical, 3 emotional, behavioral or cognitive, 4 readiness to change, 5 relapse or continued use potential, 6 recovery environment. The 4th edition of the ASAM Criteria reorganizes the dimensions; if your payers use it, rename the column to match.

Week / day	Topic	Skill practiced in the room	Plan area
1 Mon	Mapping my use: triggers, high-risk situations, early warning signs	A personal trigger map	Dim. 5
1 Tue	Cravings: what they are and how they pass	Urge surfing; delay, distract, decide	Dim. 5
1 Wed	Thinking traps that lead to use (CBT)	Thought record: situation, thought, feeling, action	Dim. 3
1 Thu	How addiction changes a family: roles and patterns	Family pattern map	Dim. 6
1 Fri	Building a recovery week: routine, sleep, structure	A weekly plan with protected recovery time	Dim. 6
2 Mon	Stress and the body	Paced breathing and muscle relaxation	Dim. 3
2 Tue	Getting through a crisis without making it worse (DBT distress tolerance)	A personal crisis-survival plan	Dim. 3
2 Wed	Saying no: refusal skills	Refusal role-plays for each client's real situations	Dim. 5
2 Thu	Trauma and substance use: how they connect (trauma-informed)	Grounding with the five senses	Dim. 3
2 Fri	Mutual-help paths: 12-step, SMART Recovery, faith-based and secular groups	Choose a meeting to try and report back	Dim. 6, 4
3 Mon	Ambivalence: my reasons to change and not to (motivational interviewing)	Decisional balance	Dim. 4
3 Tue	Saying what I need: assertive communication	I-statements and active listening practice	Dim. 6
3 Wed	Understanding and changing emotions (DBT emotion regulation)	Check the facts; opposite action	Dim. 3
3 Thu	Boundaries and rebuilding trust at home	Write and rehearse one boundary	Dim. 6
3 Fri	Health in early recovery: food, movement, sleep	One personal wellness goal	Dim. 2
4 Mon	A lapse is not a relapse: the first hour	A written emergency plan with support contacts	Dim. 5
4 Tue	Medications in recovery, including for opioid and alcohol use disorder: facts and myths	Questions to bring to the prescriber	Dim. 2, 4
4 Wed	Shame, guilt and self-compassion	A self-compassion practice	Dim. 3
4 Thu	Working the steps or another recovery path of my choice	One step or recovery task for the week	Dim. 4, 6
4 Fri	My relapse prevention plan	Finish the plan and present it to the group	Dim. 5

The trap for a 3-day IOP: if topics are pinned to weekdays, a Mon/Wed/Thu client never sees the Tuesday and Friday topics, however long they stay, and an evening Mon/Tue/Thu client never sees Wednesday's or Friday's. Pin topics to the track's session order instead: each track works down the same list, one topic per session, and starts again at the top after the twentieth. A 3-day track then takes about 7 weeks to cover all 20; if most of your IOP stays are shorter, trim that track's list to the 12 topics that matter most for it.

The 4-week mental health rotation

For a mental health IOP or PHP, the plan areas follow what reviewers ask about under the payer's medical-necessity criteria: symptoms, safety, functioning, relationships and health.

Week	Topics, Mon to Fri	Main approaches
1	How depression works and why action comes before motivation · the anxiety cycle and avoidance · thinking traps · sleep and mood · my safety plan	Behavioral activation, CBT, safety planning
2	Being present (mindfulness) · getting through a crisis · lowering emotional vulnerability · asking for what I need · values	DBT skills, values work
3	Grief and loss · trauma responses (trauma-informed) · anger: the signal and the choice · the inner critic · medications and talking with the prescriber	CBT, grounding, psychoeducation
4	Boundaries · solving problems one step at a time · facing what I avoid (an exposure ladder) · early warning signs · my wellness plan after the program	Problem-solving, graded exposure, relapse prevention

Repeat a safety-plan group at least once a cycle, and review each client's own plan in individual sessions too.

Texas-required topics, and how to schedule them

A licensed Texas chemical dependency treatment facility must provide this education and access, under 26 TAC 564.901:

Requirement	Rule	How we schedule it	Proof a surveyor looks for
Education on TB, HIV, hepatitis B and C, and STDs	564.901(d)	One health-topic group a month, on a day every track attends	A dated group note with the topic for each client in the episode
Tobacco and nicotine: health risks	564.901(e)	A second monthly health-topic group, including quitting help and the free quitline	The same
Access to TB screening and HIV, hepatitis C and STD testing, with referral for positives	564.901(f)	Offer testing in the health-topic group and in the assessment; keep a partner list	A documented offer or referral; a referral for any positive result
Risk screen for TB, HIV and STDs in the assessment	564.803(a)(4)	A required field in the assessment template	No blank or "N/A" answer

The rule says to provide the education; it doesn't set a frequency. We run each topic monthly so no client finishes an episode without it (adding them to the schedule is a standard step in our Texas program launch), and we add overdose prevention and naloxone at least monthly too, which isn't in the rule but saves lives. HIV information is confidential under Texas Health and Safety Code §81.103, so keep test results out of group. Direct-care staff also need training on these topics: 3 hours at first and yearly updates (564.603(d)).

A facilitator guide you can copy (90 minutes)

Write one page like this for every topic. It keeps quality the same when a different counselor covers the group, and it's the "written curriculum" a Texas surveyor asks for.

Tying every group to plan goals

A group note has to show why this client was in this group. Our program launch sets up the standard we use: before group, the facilitator glances at each expected client's treatment plan. In each client's entry, they name the goal or objective that client worked on and how. If the day's topic doesn't fit a client's plan, the note says how the client applied it to a goal they do have, or the plan gets updated. Texas requires group, education and life skills notes to include the topic, and individual notes to include the goals addressed (564.804(l)); payers go further and want the link in every note. Our guide on discharge planning shows how those goal links pay off again in the discharge summary.

Group notes: weak and strong (made-up examples)

Weak	Strong	Why it works
Client participated in group and was engaged.	J.R. named two triggers from her trigger map (payday and calls from an ex-partner) and practiced a refusal script in a role-play with a peer, delivering it on the second try.	Specific to one person; shows the skill was practiced.
Client is making progress toward goals.	Addresses Goal 1, Objective 2 (use a coping step in high-risk situations). J.R. used urge surfing twice since Monday and rated cravings 4 of 10, down from 7 at admission.	Names the plan goal and gives a measure of change.
Client was quiet. Will continue to attend.	M.T. spoke only when asked, said he felt "numb", and denied thoughts of self-harm when checked privately after group. Primary counselor told the same day; individual session tomorrow.	Records the observation, the risk check and the action.

Identical entries for different clients are one of the most common reasons a payer takes back payment. Cima EHR keeps one session record (topic, times, facilitator) with each client's own entry on their own chart, and refuses entries that read alike before the facilitator signs. Our chart audit checklist shows how an auditor reads them.

Texas rules for groups

• Size: group counseling 16 clients at most; education and life skills 35, except multi-family, seminar or large-audience events (564.901(b)).
• Who leads: chemical dependency counseling by a qualified credentialed counselor (QCC), a graduate or a counselor intern; education and life skills by counselors or people with specialized education and expertise (564.901(p)). Read that way, a behavioral health technician with the right expertise can lead an education group, but a counseling group needs a counselor of record.
• Interns work under the direct supervision of a QCC (564.901(q)).
• Written curriculum for education and life skills, with participation and discussion (564.901(c)).
• Adolescents separate from adults (564.905(b)(1)), with age-appropriate materials.
• Notes within 72 hours, with date, nature, duration, topic, and the provider's signature and credentials (564.804(l)).

Questions

What topics should an IOP group cover?

Relapse prevention (triggers, cravings, refusal, lapse plans), CBT thinking skills, DBT distress tolerance and emotion regulation, motivation and ambivalence, communication and boundaries, family roles, health in early recovery, medications for addiction treatment, and mutual-help options, plus the health topics your state requires. Our 4-week rotation above covers all of them in 20 groups.

How many people can be in an IOP group in Texas?

Group counseling is limited to 16 clients and education or life skills groups to 35, except multi-family, seminar or large-audience events (26 TAC 564.901(b)).

Does Texas require a written group curriculum?

Yes, for chemical dependency education and life skills groups, with client participation and discussion (564.901(c)). Write a one-page facilitator guide per topic and keep the set with your program description.

How often do the HIV and tobacco topics have to be taught?

The rule (564.901(d)–(e)) requires the education but doesn't set a frequency. Monthly, on a day every track attends, makes sure every client gets it during their episode. Check the current rule with HHSC.

How do you write a group therapy note for each client?

One session record for the group, then an entry for each client written about that client: what they said or did, how they used the skill, any change in mood or risk, the plan goal it addressed, actual times, and the facilitator's name and credential.

Can we use a published curriculum?

Yes, if you license it. Don't copy a purchased curriculum into your manual. SAMHSA's treatment manuals are free to use, and an original curriculum like the one above, approved by your clinical director, works just as well for surveyors.

Already open? A live training for your facilitators on group notes is $500 per session, and a chart audit of 10 charts is $750 per 10 charts. Or book a free 30-minute call.

Sources

• SAMHSA, TIP 41, Substance Abuse Treatment: Group Therapy: library.samhsa.gov
• SAMHSA, TIP 47, Clinical Issues in Intensive Outpatient Treatment: store.samhsa.gov
• SAMHSA, Counselor's Treatment Manual: Matrix Intensive Outpatient Treatment for People With Stimulant Use Disorders: library.samhsa.gov
• ASAM, The ASAM Criteria: asam.org
• 26 TAC chapter 564 (Cornell LII): 564.603, 564.803, 564.804, 564.901, 564.905