The ASAM Criteria 3 . Edition · ASAM criteria, but rather is an introduction to it,ASAM criteria,...

TAADAS TAADAS TTennessee ennessee AAssociation of ssociation of AAlcohol, lcohol, DDrug and rug and other other

AAddiction ddiction SServiceservices

Treatment Criteria for Addictive, Substance-R l d d C O i C di i

The ASAM Criteria 3The ASAM Criteria 3rdrd. Edition. Edition

Developed & Provided By: Thomas Developed & Provided By: Thomas H. Coyne, H. Coyne, Ed.DEd.D., LCSW., LCSW

Related, and Co-Occurring Conditions

Developed & Provided By: Thomas Developed & Provided By: Thomas H. Coyne, H. Coyne, Ed.DEd.D., LCSW., LCSWEmailEmail: : [email protected] [email protected] Phone: 516 Phone: 516 –– 429 429 –– 4739 4739

Making Level of Care Recommendations and Writing Clinical Justifications Using the ASAM Criteria 3rd. Edition

The Great State of Tennessee, November 20161

TAADAS TAADAS TTennessee ennessee AAssociation of ssociation of AAlcohol, lcohol, DDrug and rug and other other

AAddiction ddiction SServiceservices

Treatment Criteria for Addictive SubstanceThe ASAM Criteria 3The ASAM Criteria 3rdrd. Edition. Edition

Developed & Provided By: Thomas Developed & Provided By: Thomas H. Coyne, H. Coyne, Ed.DEd.D., LCSW., LCSWEmailEmail: : [email protected] [email protected] Phone: 516 Phone: 516 –– 429 429 –– 4739 4739

Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions

Module 1:Module 1:Goals & Objectives

1 Name Job Title & Tasks1. Name, Job Title & Tasks.

2. What are your learning expectations?

GOALGOALTo develop and/or enhance the knowledgeTo develop and/or enhance the knowledge and skills required to make more informed and accurate clinical decisions (e.g., level of care recommendations, and the services and interventions), and write clear, concise li i l j tifi ti f th d i iclinical justifications for those decisions

utilizing the ASAM Criteria 3rd. Edition.

OBJECTIVES OBJECTIVES Identify and explain the rationale and benefits of using the

American Society of Addiction Medicines (ASAM) Criteria to make patient placement decisions.

Identify and explain the key components of the ASAM Criteria.

Identify the general characteristics used to differentiate between the various levels of care along the continuum of care.

Identify and differentiate the levels of care, along the continuum of care used for the treatment of substance use disorders.

Thomas H. Coyne, Ed.D., LCSW www.ASITrainingOnline.org

www.ASAMTrainingOnline.com [email protected] 1

The Great State of Tennessee



OBJECTIVES OBJECTIVES Identify and differentiate between ASAM’s six dimensions of

assessment. Identify the specific sections of standard assessment

instruments e.g., ASI, that inform ASAM’s Six Dimensions. Identify clinical information /symptoms that correspond to

the “Assessment Considerations” of at least two of ASAM’s six dimensions.

OBJECTIVES OBJECTIVES Identify, analyze and interpret the necessary clinical

information to formulate a dimension risk rating for at least two of ASAM’s six dimensions.

Synthesize risk ratings for ASAM’s Six dimensions to formulate a level of care recommendation.

Learn how dimension risk ratings & clinical justifications directly drive treatment planning.

Know how to write clinical justifications for dimension risk jratings and level of care recommendations.

Critical Thinking PractitionersCritical Thinking PractitionersPractitioners who are willing to call into question g qthe assumptions underlying their customary, habitual ways of thinking and acting, and are ready to think and act differently on the basis of critical questioning……….

(Stephen D. Brookfield, 1987)

Training is Training is NOTNOTDesigned to answer all of your questionsDesigned to answer all of your questions regarding the assessment, placement, and treatment of persons with addictive disorders.

Sufficient to make you competent in the use of the ASAM criteria, but rather is an introduction to it,ASAM criteria, but rather is an introduction to it, and it’s components. Further training and individual study is required to learn how to use the criteria successfully.






DisclaimerDisclaimer

Completion of this workshop will not inferCompletion of this workshop will not infer competence in any one of the areas of emphasis.

Continued learning and performance feedback is critical for application and mastery of the core concepts highlighted in the workshopconcepts highlighted in the workshop.

9

QUESTIONS ? QUESTIONS ?

Introductions Goals / Objectives Goal Setting

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________






Module 2:Module 2:Challenges Facing the Behavioral Challenges Facing the Behavioral

Health Care Field Health Care Field EXERCISEEXERCISE

Major Challenges in Substance Abuse TreatmentMajor Challenges in Substance Abuse Treatment

1. Standardization in the collection of client information (a.k.a., clinical data)

2. Consistency of the interpretation of data collected for patient placement and treatment planning purposes.

3. Matching of appropriate evidence based, proven and effective treatment interventions to the client’s identified problems.

4. Correct implementation of evidenced based interventions

5. Development and implementation of policies and procedures to monitor the above.

©TCoyne2007 15www.ASITraining.com

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________






Module 3Module 3Rationale & Benefits of Standardized Rationale & Benefits of Standardized

Instruments & Evidence Based Instruments & Evidence Based CriteriasCriterias’’

What's happening in What's happening in “SOME”“SOME” programs in programs in America? America?

Client’s are being referred to the wrong levels of care.

Client’s assessed are referred to, and treated in the agency conducting the assessment.

Clinical Assessment’s do not justify the recommendations being made.

Clinical Justifications are not required.

If provided clinical justifications do not include clinical rationale / If provided clinical justifications do not include clinical rationale / evidence supporting the recommendation.

There are little to no policies or procedures that address the format and or quality of assessments, patient placement decisions, and clinical justifications.

What Does Research Say?What Does Research Say?

Clients that are mismatched to treatment haveClients that are mismatched to treatment have lower retention rates and poorer outcomes.

Less treatment is NOT Good.

More treatment is NOT Good.

One Research Study One Research Study Real data from a study conducted in part on patientReal data from a study conducted in part on patient placement decision making and clinical justifications.

201 Counselors and Social Workers were asked to make a patient placement decision and provide a clinical justification for that decision.

They were all given the same case.






What Do You Think Happened?What Do You Think Happened?Recommendations Recommendations

The use of standardized, valid and reliable evidence based criteria e.g., DSM-5, ASAM, & LOCUS, help increase the consistency of the interpretation of the information collected.

Benefits of Evidence Based CriteriaBenefits of Evidence Based Criteria

Improved Performance and Treatment Outcomes Increase Initiation, Engagement & Retention Rates More Efficient & Effective Utilization of Resources Establishment of a common language Shift to Performance Based Contracting Positions Organizations for Medicaid and Private

insurance Reimbursement

IMPORTANT !!!IMPORTANT !!!

Tools, and Criteria’s are NOT substitutes for GOOD Clinical Judgment.

Tools, and Criteria’s support, guide and enhance GOOD Clinical Judgment!






Things to Think AboutThings to Think AboutSubstance using offenders are often required to undergo a comprehensive assessment, after which many are referred or mandated to treatmentmany are referred or mandated to treatment. Offenders who relapse or fail to complete treatment often experience significant repercussions, including jail time. Discussion Questions

1. What if the LOC Recommendation is wrong? g2. Who should be held accountable when offenders,

probationers or parolees relapse or fail to complete treatment?

3. How do you know the TX recommendations are correct?

Patient Placement: Patient Placement: Life and Death DecisionsLife and Death Decisions

State Supreme Court Justice Robert Doyle had promised to sentence Fisher to 3 & 1/3 to 10 years if she admitted to the hit-and-run and stayed sober.

East Hampton woman pleads guilty to fatal DWI.

y

But yesterday, after learning of her lapses in rehab, Doyle added two-thirds of a year to her minimum sentence and two years to the maximum.

SummarySummaryEvidence Based Criteria are similar to

i hi h d h lsorting machines, they are used to help you sort through and interpret the information collected.

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________






Module 4Module 4The ASAM Criteria & Clinical Decisions: The ASAM Criteria & Clinical Decisions: Components, Process and Cognitive TasksComponents, Process and Cognitive Tasksp , gp , g

ASAM Criteria ASAM Criteria

The ASAM Criteria describes in detail an “IDEAL” continuum of care, the various services and interventions provided at these levels, and the nature and severity of symptoms warranting a recommendation to each level along the continuum.

30

ASAM CRITERIA ASAM CRITERIA Key Components:

Levels / Continuum of Care Six Dimensions of Assessment Risk Ratings Criteria e.g., admission, continued stay &

discharge

31

discharge

Continuum of CareContinuum of CareOutpatient Inpatient Early Intervention

As the Nature and Severity of Problems Increase The Scope of Services Increases The Scope of Services Increases The Intensity of Services Increases The Structure Provided Increases The Medical & Licensed Personnel Increases

Abstinence Experimental Use Problem Use / Abuse Dependence / Addiction

As the Nature and Severity of Use IncreasesSo Does the Nature and Severity of Problems Associated With its Use






Continuum of Care Continuum of Care Less Intensive ------------------------------ More Intensive ------------- More Intensive

The Traditional Continuum of Care

Outpatient Levels of Care Inpatient Levels of Care

Traditional Continuum

Less Intensive ------------------------------ More Intensive ------------- More Intensive

ASAM’s Continuum

Level 4.0Medically Managed Intensive Inpatient$$$$$$$$$$$$$$$$$$$$$$$$$$Level 3.7 M di ll M i d

S

E

ASAM Levels of Care ASAM Levels of Care

Medically Monitored$$$$$$$$$$$$$$$$$$$$$$Level 3.1, 3.3, 3.5, Clinically Managed $$$$$$$$$$$$$$$$$$Level 2:1 & 2.5Intensive Outpatient Treatment / Partial Hospitalization$$$$$$$$$$

E

V

E

RLevel 1:Outpatient Treatment$$$$$$Level 0.5Early Intervention$$$

I

T

Y

Withdrawal Management Services:

ASAM’s Levels of Care ASAM’s Levels of Care

Withdrawal Management Services: Levels: 1WM, 2WM, 3WM, & 4WM.

Opioid Treatment Services Can be provided at all LOCCan be provided at all LOC






Levels of CareLevels of CareLevels of care reflect treatment settings and intensity.

Treatment setting describes the characteristic environmental features needed in the various levels of care.

Treatment intensity refers to the scope and frequency of service provision and the number of resources utilized in providing such services.

Availability of Medical Services Variety of Professional Disciplines Program Elements Patient to Staff Ratio

ASAM’s Patient Placement ASAM’s Patient Placement Criteria Criteria IIIIMore Structured More Hours Interdisciplinary

MD’s, RN’s, MSW, Licensed & Credentialed

Medical & Clinical

Level 4.

Setting Services Available Intensity Personnel

Clinical

Medical & Clinical

Medical & Clinical

InterdisciplinaryPA, LPN’s, MSW,

Credentialed Counselors

Level 3.7

Level 3.5

Level 3.3

Level 3.1

Level 2.5

Level 2 1

Less Structured Education Less Hours Credentialed

Level 2.1

Level I.0

Level 0.5

ASAM’s Patient Placement ASAM’s Patient Placement Criteria Criteria IIIIMore Structured More Hours Interdisciplinary

MD’s, RN’s, MSW, Licensed & Credentialed

Medical & Clinical

Level 4 0

Setting Services Available Intensity Personnel

$$$$$$$$$$$$$$$$

Clinical

Medical & Clinical

Medical & Clinical

InterdisciplinaryPA, LPN’s, MSW,

Credentialed Counselors

Level 4.0

Level 3.7

Level 3.5

Level 3.3

Level 3.1

Level 2.5

$$$$$$$$$$$$$$$$$$$

$$$$$

Less Structured Education Less Hours Credentialed

Level 2.1

Level I.0

Level 0.5

$$$$$

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________








discharge

41

discharge

ASAM’s Six Dimensions of AssessmentASAM’s Six Dimensions of Assessment

1. Acute Intoxication and / Withdrawal Potential. cute to cat o a d / W t d awa ote t a

2. Biomedical Conditions and Complications

3. Emotional, Behavioral or Cognitive Conditions and Complications

4. Readiness to Change (formerly treatment acceptance / resistance)

5. Relapse, Continued Use or Continued Problem Potential

6. Recovery / Living Environment

©TCoyne2006 www.ThomasCoyne.com

ASAM DimensionsI: Acute Intoxication and Withdrawal PotentialII: Bio-Medical Complications and/or ConditionsIII: Emotional, Behavioral, & Cognitive

Conditions and /or Complications.

Generally Indicate Inpatient or Outpatient

I.

ASAM DimensionsIV: Readiness to ChangeV: Relapse, Continued Use, Continued Problem

Potential.VI: Recovery Environment

Generally Indicate Outpatient or Intensive Outpatient. Inpatient

II. III.

IV.

vs.Outpatient

Outpatient vs

V.

VI.

vs.Intensive Outpatient

Decision Hierarchy Decision Hierarchy

Dimensions I, II, and III, generally help indicate Inpatient or Outpatient.

If symptoms are not severe enough to warrant treatment in an inpatient facility then then treatment in either standard out patient or intensive outpatient is recommended.

Dimensions IV, V, VI, generally help indicate the intensity of outpatientof outpatient.

NOTE: Generally Indicate, there are often times that dimensions V, and VI will indicate treatment inpatient, i.e, residential.








discharge

45

discharge

Risk Risk Rating Scale Rating Scale ASAM Uses a Five (5) Point Risk Rating Scale

Low End - - - - - - Medium - - - - - - High End0 - 1 – 2 – 3 - 4

The higher the risk rating is, the greater the chances are, that the problem, condition or situation will , p ,interfere with, and/or prevent the client’s successful initiation and engagement of treatment, unless adequately addressed.

Risk Ratings Risk Ratings Risk ratings are indications of the degree to which the status, or the nature and severity of a problem, condition, and/or situation in a particular dimension;

1. Poses risk, or danger to the clients overall health and well-being.....and/or

2. Affects clients functioning…..

Both of which can distract, interfere with and/or prevent the client's successful initiation and/or engagement of treatment.

3 5

4

Severity Risk Ratings None 0 – 4 Severe

1.5

2

2.5

3

3.5

LOC?

Risk or Severity Status

0

0.5

1

I II III IV V VIDimensions






EXERCISEEXERCISENotes:

___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________








discharge.

53

discharge.

How Are Clinical Decisions MadeHow Are Clinical Decisions Made? ?

Often Based on interviewers experience.

Without Utilization of Standardized Criteria

Whether they walk through your door or not

The Door They Walked Through is Usually The Door They Walked Through is Usually the One they Get Treatment Inthe One they Get Treatment In

66% Chance of Getting IOP, whether needed or not.

IOPOP

IOP

66% Chance of Getting IOP, whether needed or not.

Length of Stay & DischargeLength of Stay & Discharge

Program DrivenNOT

Clinically DrivenClinically Driven






70’s, 80’s & 90’s 70’s, 80’s & 90’s Criteria Guiding DecisionsCriteria Guiding Decisions

Intuition & Experience: I’ve been in the field 20 years, I know when someone needs detoxification.

Disruptive Behavior: Disruptive, angry, belligerent, and/or resistant client’s, warranted inpatient.

Insurance Coverage: Good coverage warranted 28 g gDay Inpatient Treatment.

Lack of the use of criteria and/or adherence to criteria.

ASAM CRITERIAASAM CRITERIA

Admission

Continued Stay

Discharge

ASI CASI

Information Collected w/the Assessment Tool Informs ASAM’s Six Dimensions

Emotional, Behavioral , or

Cognitive Conditions and Complications

Readiness to Change

Relapse, Continued Use,

Continued Problem Potential

Recovery / Living

Environment

Acute Intoxication and / or Withdrawal

Potential

Bio-Medical Conditions and Complications

Dimension I. Dimension II. Dimension III. Dimension IV. Dimension V. Dimension VI.

The Client’s Risk Status in ASAM’s Six Dimensions Informs the Patient Placement Decision

Less Intensive ------------------------------ More Intensive


------------- More Intensive

0.5 1.0 2.1 2.5 3.1 3.3 3.73.5 4.0






LOC Recommendation Process LOC Recommendation Process Interpret the Assessment Information

Select Risk Ratings and Write Clinical Justifications for Each of the Six Dimension’s

Assess If the Risk Status of Some Dimensions Influence / Increase the Risk Status of Other Dimensions

Assess Recovery & Other Support Services A il bl i th Cli t’ C itAvailable in the Client’s Community

Level of Care / Service Recommendations

Treatment Planning

EXERCISEEXERCISE

3 5

4


1.5

2

2.5

3

3.5

LOC?


0

0.5

1


3 5

4


1.5

2

2.5

3

3.5

LOC?


0

0.5

1

1 II III IV V VI

Dimensions







3.5

4

1

1.5

2

2.5

3

3.5

LOC?


0

0.5

1

I II III IV V VI

Dimensions

3 5

4


1.5

2

2.5

3

3.5

LOC?


0

0.5

1


3 5

4


1.5

2

2.5

3

3.5

LOC?


0

0.5

1


Cognitive Task Analysis Cognitive Task Analysis

1. Understands the definition of the dimensions.

2. Knows which section(s) of the / assessment PRIMARILY inform each dimension.

3. Knows the specific items within the assessment sections that PRIMARILY informs each dimension.

4. Can rate the client’s RISK status in each dimension.

5. Understands how the dimensions collectively inform the patient placement decision.

6. Select the most appropriate Level of Care.






Module Module 5.5.The Relationship & Functionality of The Relationship & Functionality of Standardized Instruments & ASAMStandardized Instruments & ASAM

R i t id ti f thi di i Review assessment considerations for this dimension. Identify the section(s) of the instrument(s) used to collect client

information that primarily inform this ASAM dimension of assessment.

Identify item(s) within sections of the instrument(s) used to collect client information that primarily and most directly inform this ASAM dimension of assessment.ASAM dimension of assessment.

Identify additional items required in order to make more informed dimension risk ratings, and Level of Care Recommendations.

Knowledge Required Prior to the Interview Knowledge Required Prior to the Interview The interviewer must have a good working knowledge of;knowledge of;

The DSM criteria for substance use disorders.

The criteria guiding level of care recommendation ASAM LOCUSe.g., ASAM or LOCUS.

Familiarity with the types of problems most often experienced by the population being assessed.

Interviewer Must Know Interviewer Must Know Clinical significance of the information and symptoms obtained.

Or Put Another WayHow the information and symptoms obtained collectively inform the purpose of the interview e.g., diagnosis, level of care recommendations and/or criminogenic risk assessment.

Number of times in treatment? How long was the last period of voluntary abstinence? Nature and severity of the types of problems experienced? Number of days of problems experienced How many days ago were the problems experienced?

LOC Recommendation Decision LOC Recommendation Decision Cognitive Task Analysis Cognitive Task Analysis

1. Understands the “Assessment Considerations” of the dimensions.d e s o s.

2. Knows which section(s) of the / assessment tool PRIMARILY inform each dimension.

3. Knows the specific items within the assessment sections that PRIMARILY informs each dimension.

4 Can rate the client’s RISK stat s in each dimension4. Can rate the client’s RISK status in each dimension.

5. Understands how the dimensions collectively inform the patient placement decision.

6. Select the most appropriate Level of Care.






ASI

Information Collected w/the Assessment Tool Informs ASAM’s Six Dimensions

Emotional, Behavioral , or

Cognitive Conditions and Complications

Readiness to Change

Relapse, Continued Use,

Continued Problem Potential

Recovery / Living

Environment

Acute Intoxication and / or Withdrawal

Potential

Bio-Medical Conditions and Complications

Dimension I. Dimension II. Dimension III. Dimension IV. Dimension V. Dimension VI.

The Client’s Risk Status in ASAM’s Six Dimensions Collectively Informs Clinical Decisions e g LOC Services and Interventions Needed

Less Intensive ------------------------------ More Intensive


------------- More Intensive0.5 1.0 2.1 2.5 3.1 3.3 3.73.5 4.0

Decisions e.g., LOC, Services and Interventions Needed.

EXERCISEEXERCISE

General Info

Medical Employment AOD Legal Family / Social

Psychiatric

Acute Intoxication and /

Which section of your assessment instrument contain information that inform and/or influence the “Assessment Considerations for the identified ASAM dimension?

ASAMDIMENSIONS

Acute Intoxication and / or Withdrawal Potential

Emotional, Behavioral & Cognitive Conditions &

Complications

Readiness to Change

Bio-Medical Conditions Complications Explain how or why?

____________________________________________________________________________________________________________________The client’s status / risk status in which of the remaining ASAM Dimensions has the potential to influence and/or increase the clients risk status in this dimension?

? ? ?

Relapse/ Continued Use, Continued Problem

Potential

Recovery / Living Environment

Explain how or why? ____________________________________________________________________________________________________________________

General Info

Medical Employment AOD Legal Family / Social

Psychiatric

Acute Intoxication and /

Which “ITEMS” in the identified section(s) of your assessment instrument inform and/or influence the “Assessment Considerations for the identified ASAM dimension, ultimately informing the client’s risk status in this dimension?

ASAMDIMENSIONS

Acute Intoxication and / or Withdrawal Potential

Emotional, Behavioral & Cognitive Conditions &

Complications

Readiness to Change

Bio-Medical Conditions Complications

?status in this dimension?

When identifying items categorize them as follows; Here and Now Items = Observations made during the interview; Statements made by the client during the interview; vital signs, blood work, BAC levels etc…

Recent History = Past 30 Day Items.

Relapse/ Continued Use, Continued Problem

Potential

Recovery / Living Environment

Historical = Lifetime Items

Additional Probes / Questions: Please identify any additional probes and/or questions that should be asked in order to make the most informed risk assessment in each dimension.






Module Module 6.6.Clinical Clinical Justifications: An Introduction Justifications: An Introduction

Risk Rating Clinical Justifications Level of Care Clinical Justifications

Level of Care RecommendationLevel of Care RecommendationClinical JustificationClinical Justification

1. A clinical justification is a summary of the id th t t d j tifi li i levidence that supports and justifies a clinical

decision i.e. Risk Ratings & Level of Care Recommendations.

2. Clinical justifications generally include the evidence i.e., symptoms that meet the established criteria e g ASAM or LOCUScriteria e.g., ASAM or LOCUS.

3. Treatment professionals are responsible for documenting clinical decisions, and the evidence justifying them.

Clinical Justifications Clinical Justifications Consistent Clinical Justifications for Dimension Risk Ratings and LOC Recommendations require a standard;

Format A Process Language Language Monitoring Policy

Dimension Risk Rating Format Dimension Risk Rating Format

ASAM Dimension Summaries:ASAM Dimension Summaries: Each dimension summary includes a

statement indicating severity / risk rating.

Clear, concise, clinical justification. A , , jsummary of the evidence justifying the rating.






Level of Care RecommendationLevel of Care Recommendation1. Is a recommendation to place an individual in the

appropriate level of care (LOC) without placing the individual at riskindividual at risk.

2. It is generally based on a comprehensive assessment of the client’s needs, clients demographics, and other client centered contextual factors.

3. The LOC recommendation is guided by established criteria, in conjunction with knowledge of available

t i ( k d i )recovery support services (a.k.a., wrap around services) that are currently available.

4. The LOC recommendation, (a.k.a., Patient Placement Decision), is accompanied by a clear, and concise, clinical justification.

Clinical JustificationClinical JustificationWhat is your rationale for recommending

I have been doing this for over 20 years, don’t

thi k I k hthe client for a medical detoxification?

you think I know when someone needs medical

detoxification.

LOC Recommendation LOC Recommendation Clinical Justification FormatClinical Justification Format

ExampleExampleLOC Recommendation Summary: y

Includes a statement indicating the LOC being recommended.

Clear, concise, clinical justification. The justification may include the six preceding dimension summary statements; an explanation as to y ; pwhy the LOC was chosen; and why the next lowest or higher levels were not chosen.

EXERCISEEXERCISE






Module Module 7.7.Treatment Planning & the ASAM CriteriaTreatment Planning & the ASAM Criteria

Level of Care & Treatment Planning Dimension Risk Rating Clinical Justifications &

Treatment Planning

ASAM & Treatment Planning ASAM & Treatment Planning

Treatment Planning is Dimensional

Goals of the LOC chosen in part establishes treatment planning priorities.

Client’s inability to be successful in treatment may be in part related to being placed in the wrong level of carepart related to being placed in the wrong level of care, and receiving an inadequate treatment plan while in treatment.

ASI Linear TX Planning

Treatment Planning using the ASI domains can be Linear, and Limited.

ASI & Treatment PlanningASI & Treatment Planning

PROBLEM

1. Medical

2. Employment

3. AOD

TX PLAN FOR

Medical,

Employment,

AOD,

87

4. Legal

5. Family/Social

6. Psychiatric

Legal,

Family/Social

Psychiatric.

ASAM & Treatment PlanningASAM & Treatment PlanningASAM Components Treatment Plan Components

Dimension Summary Statement

Dimension Clinical Justifications

Problem Statement

Goal

Objectives

Level of Care Recommended

Prioritizes Planning






Treatment PlanningTreatment PlanningDimension Summary Statement Client has considerable biomedical conditions and complications that will greatly interfere with, and / or prevent client’s successful initiation and engagement of treatment at this timeand engagement of treatment at this time. Problem StatementClient has considerable biomedical conditions and complications that will greatly interfere with, and / or prevent client’s successful initiation and engagement of treatment at this time.GoalsStabilize and manage biomedical condition so they will not interfere with, and/or prevent client’s successful engagement treatment. p g g

Dimension Summary = Objectives Address1. Asthma Difficulty Breathing2. Medication Compliance3. Chronic Pain

Continued Use / Relapse PotentialContinued Use / Relapse Potential

G l G lGeneral Goals:

The integration of relapse prevention skills into theirbehavior.

Generally, these treatment goals include awareness, early

www.ASITRAINING.com

90

Generally, these treatment goals include awareness, earlyidentification, urge and craving management, andmanagement of progressive relapse signs, as well asearly intervention planning for relapse.

Continued Use / Relapse PotentialContinued Use / Relapse PotentialObjectivesObjectives

Help client understand the relationship between triggers,craving, and relapse.

Help client identify personal triggers for AOD cravingand use.

Help client develop, integrate, and internalize skills andstrategies for coping with triggers and high-risksituations.

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91

Help client to stop participating in high-risk behaviors,and activities and help discontinued high-riskrelationships.

Help client develop AOD-refusal skills.

General Treatment GoalsGeneral Treatment Goals

Withdrawal Potential Absence or reduction in of the severity of the acute withdrawal syndrome

Biomedical Conditions and Complications Stabilization of medical problems so that medical monitoring is not required

Resolve biomedical problems enough to allow transition to a lower level of care

Emotional or Behavioral Conditions or Complications Stabilization of problems so that intensive management is not required

TIP # 8, SAMHSA Treatment Improvement Protocols






General Treatment GoalsGeneral Treatment GoalsReadiness for Change Awareness and self recognition of the AOD use disorder and it’s consequences Recognition of severity of AOD use disorder Recognition of severity of AOD use disorder Personal acceptance of AOD use problem and the general goals of treatment

Relapse Potential Integration of relapse prevention skills into behavior Awareness, early identification of and management of progressive relapse signs Early intervention planning for relapse

Recovery Environment Improve patient environment to support ongoing recovery Develop skills to cope with problem environment

TIP # 8, SAMHSA Treatment Improvement Protocols

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________






Module Module 8.8.Review & Relapse PreventionReview & Relapse Prevention

Review Goals & Objectives Review & Update Knowledge & Skills Self

Assessment Review & Update Goal Setting & Learning

Agreements Relapse Prevention

Relapse Prevention & the Workplace Relapse Prevention & the Workplace One of the central components of relapse prevention theory is that persons

recovering from drug addiction who are prepared to manage high risk situations, th h t ld h hi h lf ffi di th i bilitversus those who are not would have higher self efficacy regarding their ability

to successfully deal with threats to their recovery.

The same principles can be applied by trainees faced with inevitable threats to maintaining and applying knowledge and skills learned in a training context in their work environments.

1. What are the work environment factors that may inhibit or prevent your use of y p ywhat you learned back in the workplace?

2. How can you prepare to deal with these challenges?3. What are the work environment factors that may enhance and support your

learning back in the workplace?

What are the work environment factors that may inhibit or prevent your use of what you learned back in the workplace?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How can you prepare to deal with these challenges?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What are the work environment factors that may enhance and support your learning y pp y gback in the workplace?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________






Module 9Module 9..EvaluationEvaluation

Workshop Evaluation: Content & Delivery

Notes: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

ReferencesReferences American Psychiatric Association, Diagnostic and Statistical manual of Mental

Disorders, Fourth Edition, Text Revision. Washington DC, American Psychiatric Association, 2000.

C ll h d l i l i d bl i h f b Carroll, K.M. Methodological issues and problems in the assessment of substance use. Psychological Assessment 7:349–358, 1995.

Donovan, D.M., and Marlatt, G.A., eds. Assessment of Addictive Behaviors. New York: Guilford Press, 1988.

McLellan, A.T.; Kushner, H.; Metzger, D.; Peters, R.; Smith, I.; Grissom, G.; Pettinati, H.; and Argeriou, M. The fifth edition of the Addiction Severity Index. J Subst Abuse Treat 9:199–213, 1992b.

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