Delivery Tier Implementation Guide

Overview

The WRH Master Curriculum is delivered across three distinct tiers, each calibrated to the acuity level, clinical environment, and participant population. This guide provides detailed implementation specifications for each tier, with particular emphasis on Session 12 (Internal Behavioral Conflict Systems), which mandates minimum Tier 2 delivery standards.

1.0 Tier 1: Community-Based Delivery (Low-Moderate Acuity)

1.1 Authorized Environments

Tier 1 delivery is appropriate for low-to-moderate acuity settings where participants are stable, community-dwelling, and have access to external clinical resources if needed.

Vet Centers and community outreach programs
Peer support groups and recovery organizations
Outpatient behavioral health clinics
Community colleges and adult education programs
Workplace wellness initiatives

1.2 Facilitator Requirements

Certification Level: Tier 1 Foundational Facilitator
Training Hours: 40 hours of WRH System Logic Training
Prerequisites: Background in peer support, behavioral health, or related field
Annual Audit: One live session audit per year

1.3 Safety Infrastructure

RGP Application: Standard RGP at session start and end
Clinical Support: On-call clinical staff (not necessarily on-site)
Crisis Protocol: Basic SPI awareness; warm handoff to external clinical resources
Documentation: Standard session notes and adverse event reporting (Level 1 only)

1.4 Participant Screening

Participants must be screened to ensure they are appropriate for Tier 1 delivery:

Stable psychiatric condition (no acute crisis in past 30 days)
No active suicidal ideation
Ability to self-regulate or access external support if dysregulated
Informed consent acknowledging the non-clinical nature of the program

1.5 Session 12 Restrictions

Session 12 is NOT authorized for Tier 1 delivery. Organizations wishing to deliver Session 12 must upgrade to minimum Tier 2 (Structured) delivery standards.

2.0 Tier 2: Structured Program Delivery (Moderate-High Acuity)

2.1 Authorized Environments

Tier 2 delivery is appropriate for moderate-to-high acuity settings with structured clinical oversight and on-site or readily available clinical support.

Intensive Outpatient Programs (IOP)
Partial Hospitalization Programs (PHP)
Residential treatment programs
Day treatment centers
Correctional behavioral health programs
Military installation behavioral health clinics

2.2 Facilitator Requirements

Certification Level: Tier 2 Core Facilitator
Training Hours: 40 hours (Tier 1) + 60 additional hours = 100 hours total
Prerequisites: Successful delivery of one complete Foundation Cohort (Sessions 1-26); Advanced Somatic Redline Recognition Training
Annual Audit: One live session audit per year; quarterly competency review

2.3 Safety Infrastructure

RGP Application: Mandatory RGP at session start and end; RGP available during session as needed
Clinical Support: Licensed clinical staff on-site during all sessions
Crisis Protocol: Full SPI Handoff Protocol; clinical staff co-located and immediately available
Documentation: Comprehensive adverse event reporting (Levels 1-3); S-Prefix Metrics for all incidents
Monitoring: Weekly adverse event review by Program Coordinator and Clinical Director

2.4 Participant Screening

Participants must be screened and deemed appropriate for Tier 2 delivery:

Moderate psychiatric condition (stable on medication, in active treatment)
No active suicidal ideation in past 14 days
Ability to participate in group setting with clinical support available
Informed consent acknowledging the non-clinical nature of the program and availability of clinical support

2.5 Session 12 Requirements

Session 12 is authorized for Tier 2 delivery with the following mandatory requirements:

Clinical staff must be on-site during the session
Participant activation levels (S-ACT) must be monitored continuously
RGP must be available and deployed proactively if S-ACT exceeds 3
Hardened Overlay HO-12.1 (Somatic Redline Protocol) must be implemented
Facilitator must have completed Advanced Somatic Redline Recognition Training
Post-session debrief with clinical staff is mandatory

3.0 Tier 3: Clinical-Intensive Delivery (High-Acute Acuity)

3.1 Authorized Environments

Tier 3 delivery is appropriate for high-acuity, acute settings where participants may be in crisis, recently hospitalized, or requiring intensive clinical oversight.

Inpatient psychiatric units
Psychiatric Residential Rehabilitation Treatment Programs (PRRC)
Crisis stabilization units
Acute care hospitals with behavioral health units
Intensive residential treatment programs for complex trauma

3.2 Facilitator Requirements

Certification Level: Tier 3 Master Facilitator
Training Hours: 100 hours (Tier 2) + 100 additional hours = 200 hours total
Prerequisites: Tier 2 certification; Institutional Risk Management Certification; demonstrated ability to train other facilitators
Annual Audit: Two live session audits per year; quarterly competency review; annual ethics review

3.3 Safety Infrastructure

RGP Application: Mandatory RGP at session start and end; RGP deployed proactively throughout session
Clinical Support: Licensed clinical staff on-site and actively engaged throughout session; psychiatrist or psychiatric nurse practitioner available on-call
Crisis Protocol: Full SPI Handoff Protocol with immediate clinical escalation; emergency services access on-site
Documentation: Comprehensive adverse event reporting (Levels 1-4); S-Prefix Metrics for all incidents; real-time clinical notes
Monitoring: Daily adverse event review by Clinical Director; weekly review by Program Coordinator and Compliance Officer

3.4 Participant Screening

Participants must be screened and deemed appropriate for Tier 3 delivery:

Acute or severe psychiatric condition; may be in active crisis
Recent suicidal ideation or self-harm (past 7 days) with active clinical management
Significant difficulty with self-regulation; requires frequent clinical intervention
Informed consent acknowledging the non-clinical nature of the program and intensive clinical support available

3.5 Session 12 Requirements (Highly Recommended)

Session 12 is authorized for Tier 3 delivery and is HIGHLY RECOMMENDED for optimal participant safety:

Clinical staff must be on-site during the session with real-time monitoring
Participant activation levels (S-ACT) must be monitored continuously with clinical documentation
RGP must be deployed proactively and frequently; clinical staff may co-facilitate RGP
All Hardened Overlays (HO-12.1, HO-12.2, HO-12.3) must be implemented
Facilitator must be a Tier 3 Master Facilitator with extensive experience in high-acuity settings
Post-session clinical debrief is mandatory; psychiatric consultation may be required
Participant disposition and 7-day follow-up plan must be documented prior to session conclusion

4.0 Tier Selection Decision Matrix

Factor	Tier 1	Tier 2	Tier 3
Participant Acuity	Low-Moderate	Moderate-High	High-Acute
Clinical Support	Off-site	On-site	On-site + Intensive
Facilitator Certification	Tier 1	Tier 2	Tier 3
RGP Frequency	Start/End	Start/End/As-needed	Proactive/Frequent
Session 12 Authorized	No	Yes (with requirements)	Yes (recommended)
Adverse Event Reporting	Level 1	Levels 1-3	Levels 1-4
Monitoring Frequency	Monthly	Weekly	Daily

5.0 Tier Transition & Escalation

5.1 Mid-Program Escalation

If a participant’s acuity level increases during program delivery, the following procedure must be followed:

Identification: Facilitator or clinical staff identifies that participant is no longer appropriate for current tier.
Assessment: Clinical Director conducts rapid assessment to determine appropriate tier level.
Transition: Participant is transitioned to appropriate tier with minimal disruption to program continuity.
Documentation: Transition is documented with rationale and date.

5.2 De-Escalation

If a participant’s acuity level decreases, transition to a lower tier may be considered with clinical approval and participant consent.