Adopting ASAM What’s in the new criteria? State Specialty Court Conference DuAne L. Young The...

Adopting ASAMWhat’s in the new

criteria?

State Specialty Court Conference

DuAne L. Young • The Change Companies®

What works?

What

Work

sThe E

mp

iric

al Evid

ence

Wampold, B. E. (2001). The great psychotherapy debate: Models, methods, and findings. New York: Lawrence Erlbaum.

Miller, S.D., Mee-Lee, D., & Plum, B. (2005). Making treatment count. In J. Lebow (Ed.), Handbook of clinical family therapy. New York: Wiley.

Treatment:•Alliance/Relationship•Hope •Model/Modality

Extra-therapeutic

Changing Compliance Into

Behavior Change

This person…in this setting

on this dayat this stage of

interest or readinessto change

Participant-centered

Emphasize self-efficacy

Self-efficacy is“The optimism & confidence to know that if you decide to make a change,

it’s worth trying because you feel like you have a chance for success.”

Dr. David Mee-Lee

Elicit personal motivation and change talk

Promote personal responsibility for change

All change is self-change

How many people here believe they can change another person?

Participant Messages

Self-changers believe change is possible. They recognize they’re

deserving and capable of change, and are personally responsible for

making it happen.

The choice to change is yours and yours alone.

Promotingself-change

is a multifaceted

process

Implementation of ASAM supports a paradigm shift and is necessary to effectively use the criteria.

What are the ASAM criteria?

Guidelines for assessment, service planning, placement, continued stay and discharge

Framework for multidimensional patient assessment

Description of levels of care (service continuum)

What are the ASAM criteria?

Algorithm for determining appropriate Intensity of Service based on assessment of patient’s Severity of Illness

A way of unifying the addiction field around a single set of criteria

His

tory

• Around 1989, NAATP and ASAM assembled a task force to

integrate two existing admission/ continued stay criteria sets

* The Cleveland Criteria * The NAATP Criteria

• NAATP decided to relinquish any ownership/branding of the criteria

His

tory

Historical and current development

of the ASAM criteria

• Collaborative process

• Use of experienced clinical

experts and researchers as

editors

• Coalition of stakeholders

(Coalition for National Criteria, est.

1992)

Brief Timeline of the ASAM Patient Placement Criteria(ASAM PPC-2R pp. 12-14)

Previous Editions • PPC 1991• PPC-2 1996 • PPC-2R 2001

• Upcoming Edition October 2013:

“The ASAM Criteria”Chief Editor: David Mee-Lee, MD

Paradigm Shift

• From unidimensional to more multidimensional assessments;

• From program-driven to more clinically driven treatment;

• From a fixed length of stay to variable length of service; and

• From a limited number of discrete levels of care to a continuum of care.

Clie

nt-

cen

tere

d

Mod

el

Guid

ing

Pri

nci

ple

s• Objectivity

• Choice of treatment levels

• Continuum of care

• Treatment failure

• Length of stay

• Twelve-step/Mutual-/Self-help recovery groups

• Informed consent

Program-driven

Treatment

Generations of Clinical Care

Diagnosis-driven Treatment

Diagnosis Program Aftercare

Relapse

PROGRAM-DRIVEN

All patients receive the same services as “part of the program”

PROGRAM-DRIVEN

Same treatment plan

PROGRAM-DRIVEN

Sometimes goals are developed before the patient is ever met

PROGRAM-DRIVEN

Progress is measured by how the patient functions in the program

PROGRAM-DRIVEN

Discharged based on a set length of time

PROGRAM-DRIVEN

CLINICALLY DRIVEN TREATMENT

Dimensional assessment of

individual needs


Level of service based on severity of clinical

problems


Individualized treatment plan


Variable lengths of stay, dictated by resolution of clinical problems


Services are specific to the clinical

problems that supported admission

Participant AssessmentData from all

biopsychosocial dimensions

Problems or PrioritiesBuild engagement and alliance working with

multidimensional obstacles

PLANBiopsychosocial treatment

intensity of service modalities and levels of

service

ProgressTreatment response: Clinical functioning,

psychological, social, interpersonal

The criteria have evolved over time to reflect current

scientific research

Criteria Revision Process & Principles

Workgroup chairs and small committees developed drafts

Extensive online field review with input from the Steering Committee of the Coalition for National Clinical Criteria and others

Criteria Revision Process & Principles

Publication date October 2013; to be launched at ASAM’s “State of the Art Conference” in Arlington, VA

Actual criteria changed with updated science – impact on The ASAM Criteria Software

What’s Not New in The ASAM Criteria?

Six assessment dimensions

Overall levels of care (though not Roman numerals) for addiction management

“Decision rules” which link intensity of service back to severity of illness maintained except for updates in withdrawal management (“detox”)

Assessment of Biopsychosocial Severity and Level of Function

1. Acute Intoxication and/or Withdrawal Potential

2. Biomedical Conditions and Complications

3. Emotional, Behavioral or Cognitive Conditions and Complications

4. Readiness to Change

5. Relapse, Continued Use or Continued Problem Potential

6. Recovery Environment

Broad Treatment Levels of Service Description of the Continuum of Care

1. Outpatient Treatment2. Intensive Outpatient and Partial Hospitalization3. Residential/Inpatient Treatment4. Medically Managed Intensive Inpatient Treatment

More levels of care within each of the broad levels New edition changes to Arabic numerals, e.g.,

Level I becomes Level 1; Level II.1 becomes Level 2.1; etc.

What’s New in The ASAM Criteria?

The title: “The ASAM Criteria - Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions”

Shift from “placement” to “treatment” criteria: It’s more than just placement

Diagnostic admission criteria terminology changed to be compatible with DSM-5

Section on working with managed care


Table of Contents reordered to be more user-friendly and follow the flow from historical foundations to guiding principles to assessment, service planning and placement decisions

Adolescent criteria no longer separate/standalone: consolidated adult and adolescent content to minimize redundancy while preserving adolescent-specific content

Appendices include withdrawal management instruments, Dimension 5 constructs and a glossary


The wording in the levels of care for withdrawal management

The former “detoxification” section is now called “withdrawal management” and the levels are now WM-1, WM-2, WM-3 and WM-4

New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal

Dim

en

sion

1

Wit

hd

raw

al M

anag

em

ent Broader range of severity of withdrawal

syndromes discussed as being able to be safely and appropriately managed on an outpatient basis

Risk Rating Assessment Format used to help understand how to link severity, function and service needs when determining treatment plans & level of care

Updated PPC-2R criteria, linked to

algebraic “decision rules” of The ASAM Criteria Software


Updated/revised terminology, to be contemporary strength-based & recovery-oriented:

“Dual diagnosis” becomes “co-occurring disorders” “Inappropriate use of substances” becomes “high-risk use of

substances”Specialized services for opioid use disorder renamed:• “Opioid Maintenance Therapy”(OMT) becomes “Opioid

Treatment Services”(OTS)• Mention made of opioid antagonist & opioid agonist

medications that can be used in OTPs (regulated “Opioid Treatment Programs”) or in office-based opioid treatment (OBOT)

New Content & Sections

Additional text to improve application to address addiction treatment for Special Populations: Older Adults Persons in Safety Sensitive Occupations Parents with Children and Pregnant Women Persons in the Criminal Justice System (CJS)


Additional text to address treatment of conditions not traditionally included in specialty addiction for treatment services: Tobacco Use DisorderGambling Disorder


Revision of the text to address emerging issues: Health reform and the integration of

addiction treatment into general medical care

The role of physicians in the care team, in particular, addiction specialist physicians (addiction medicine physicians, addiction psychiatrists)


Revision of the text to address emerging issues: The ASAM Definition of Addiction and implications for

Substance Use Disorders and other Addictive Disorders• “The pathological pursuit of reward or relief”• Involves alcohol, tobacco and/or other substance use• Also involves addictive behaviors• “Addiction involving alcohol, tobacco, other substances and

gambling”

The ASAM Criteria Software

The ASAM Criteria book and The ASAM Criteria Software are companion text and application The text delineates dimensions, levels of care &

decision rules that comprise The ASAM Criteria

The software provides an approved structured interview to guide adult assessment & calculate the complex decision tree to yield suggested levels of care


The text and software are used in tandem:

The text provides background and instruction for proper use of software

The software enables comprehensive, standardized evaluation


• Effective, reliable treatment planning requires that both be used together

• The ASAM Criteria Software is undergoing nationwide open-source release by the Substance Abuse and Mental Health Services Administration (SAMHSA)


The ASAM Criteria text is synchronized with The ASAM Criteria Software, such that definitions and specifications are in the text: the dimensions, levels of care and admissions “decision rules” serve as reference manual for The ASAM Criteria Software released by SAMHSA

Publication Phase and Beyond

• The Change Companies® (TCC) was contracted by ASAM to publish and market The ASAM Criteria and to co-develop secondary products and services

• The publication phase will innovate color-coding, graphics & cross-linking to help readers locate material in the book quickly; a subscription web-based version is also available

• Collaboration between ASAM and TCC for marketing – conferences, targeted outreach

Publication Phase and Beyond

• Training model developed including Master Trainers, developing Change Agents

• eLearning Modules in conjunction with onsite learning and consultation

• Dedicated website: www.ASAMcriteria.org

Resources from The Change Companies®: Participant Journals

Resources from The Change Companies®:

Multidimensional Assessment eLearning Course

Resources from The Change Companies®: Introduction to The

ASAM Criteria

Thank You!

www.changecompanies.net 888.889.8866

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