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Presentation on the ASAM Dimensions and Treatment Planning

Published in: Health & Medicine
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  1. 1. ASAM Overview and Treatment Planning By Elizabeth Kotkin, LMFT Clinical Standards Coordinator July 2008
  2. 2. Objectives o To provide an introductory overview of the six dimensions of ASAM Patient Placement Criteria o To describe the ASAM Levels of Care o To explain how the ASAM Assessment supports treatment planning
  3. 3. Overview of Key Elements • The assessment is multi-dimensional • Each dimension is given a severity rating • The severity ratings determine what areas will be the focus of treatment (treatment priorities) • Treatment Assessments and Plans must be individualized and tailored to that specific client.
  4. 4. What is ASAM? • American Society of Addiction Medicine • ASAM has developed Patient Placement Criteria (PPC) for specific levels of care for substance disorder treatment
  5. 5. Six Dimensions Help to Classify and Assess Treatment Need and Placement • 1: Intoxication and withdrawal potential • 2: Biomedical conditions and complications • 3: Emotional behavioral conditions and complications • 4: Readiness for change • 5: Relapse potential • 6: Recovery environment
  6. 6. Let’s look at each dimension
  7. 7. 1: Acute intoxication and/or withdrawal potential • What risk is associated with the patient’s current level of acute intoxication? • Is there significant risk of severe withdrawal symptoms or seizures, based on the patient’s previous withdrawal history and current use? • Are there current signs of withdrawal? • Does the patient have supports to assist in ambulatory detoxification, if medically safe?
  8. 8. 2: Biomedical conditions/complications • Are there current physical illnesses, other than withdrawal, that need to be addressed because they create risk or complicate treatment? • Are there chronic conditions that affect treatment?
  9. 9. 3: Emotional, behavioral or cognitive conditions and complications • Are there current psychiatric illnesses or psychological, behavioral, emotional, or cognitive problems that need to be addressed because they create risk or complicate treatment? • Do any emotional, behavioral or cognitive problems appear to be an expected part of the addictive disorder or do they appear to be autonomous? • Even if connected to the addiction, are they severe enough to warrant specific mental health treatment? • Is the patient able to manage the activities of daily living? • Can s/he cope with any emotional, behavioral or
  10. 10. 4: Readiness for Change • Expect resistance to treatment • Treatment resistance should not exclude a person from receiving treatment • It is the degree of readiness to change that helps to determine the setting and intensity of motivational strategies needed • What things, if any, can be leveraged to help enhance the patient’s readiness to change?
  11. 11. 5: Relapse, Continued Use or Continued Problem Potential • Is the patient in immediate danger of continued severe mental health distress and or AOD use? • Does the patient have any recognition or understanding of, or skills in coping with, his or her addictive or mental disorder in order to prevent relapse, continued use or continued problems such as suicidal behavior? • How severe are the problems or further distress that may continue or reappear if the patient is not successfully engaged in treatment at this time? • How aware is the patient of relapse triggers, ways to cope with cravings to use, and skills to control
  12. 12. 6: Recovery / Living Environment • Do any family members, significant others, living situations, or school or work situations pose a threat to the patient’s safety or engagement in treatment? • Does the patient have supportive friendships, financial resources, and educational or vocational resources that can increase the likelihood of successful treatment? • Are there legal, vocational, social service agency or criminal justice mandates that may enhance the person’s motivation for engagement in treatment? • Are there transportation, housing, childcare, or employment issues that need to be clarified or
  13. 13. Severity Levels • High Severity=Immediate need for treatment on the dimension being assessed (as in today, it is an emergency) • Medium Severity=Treatment needs to address this within the next two weeks • Low Severity= Treatment needs to address this within the next three months.
  14. 14. Levels of Service
  15. 15. Continuum of Care ASAM describes treatment as a continuum marked by five basic levels of care n ideal ASAM continuum includes these levels of care: • Level 0.5 - Early Intervention • Level I- Outpatient Services (OP) • Level II - Intensive Outpatient Services • Level III - Residential/Medically Monitored Inpatient Services • Level IV - Medically Managed Intensive Inpatient Services (MM/IP)
  16. 16. Level 0.5: Early Intervention • Provides services for those who are deemed to be at risk or those for whom enough information is not available to document a substance use disorder. • This is different from “prevention” services.
  17. 17. Level I: Outpatient Treatment • Professionally-directed evaluation, treatment and recovery services • Delivered in a variety of settings • Provided in regularly scheduled sessions • Following a defined set of policies, procedures or medical protocols • Services address major lifestyle, attitudinal, and behavioral issues that have the potential to undermine the goals of treatment or inhibit the individual’s ability to cope with major life tasks without the non-medical use of alcohol or other drugs.
  18. 18. Level II: Intensive Outpatient Treatment / Partial Hospitalization • Outpatient services that delivers treatment during the day, before or after school or work, in the evenings or on weekends for 6 hours (for adolescents) of structured programming • Provides essential education and treatment components about substance-related mental health problems • Leaves room for “real-world” application of new skills • Can arrange fore medical and psychiatric consultation, medication management, and 24-hour crisis services
  19. 19. Level III: Residential/Medically Monitored Inpatient Services • A planned regimen of care in a 24- hour facility staffed by addiction and mental health professionals. • Highly structured with clearly-defined policies and procedures • Serve individuals who need safer, more stable living environments in order to develop their recovery skills
  20. 20. Level III: Residential/Medically Monitored Inpatient Services (con’t) • Encompasses four types of programs • Decimal numbers appearing after the ASAM level of care are used to indicate the graduated intensity of levels of care o Level III.1: Clinically-Managed Low-Intensity Residential Treatment o Level III.3: Clinically-Managed Medium-Intensity Residential Treatment o Level III.5: Clinically-Managed High-Intensity Residential Treatment o Level III.7: Medically-Monitored Inpatient Treatment
  21. 21. Level IV: Medically Managed Intensive Inpatient Services (MM/IP) • Provides a planned regimen of 24-hour medically directed evaluation, care and treatment of mental and substance-related disorders in an acute care inpatient setting. • Staffed by addiction-credentialed physicians, including psychiatrists, as well as other mental health- and addiction- credentialed clinicians. • Provides care to patients whose MH and substance-related problems are so severe that they require primary biomedical, psychiatric and nursing care. • Treatment is provided 24-hours/day and the full resources of a general acute-care hospital or psychiatric hospital are available to allow for the treatment of any co-occurring biomedical conditions that need to be addressed.
  22. 22. Exceptions to the PPC • Three factors that can override patient-treatment match, with regard to levels of service: o Lack of availability of appropriate, criteria- selected care o Failure of the patient to progress at a given level of care, so as to warrant a reassessment of the treatment plan o State laws regulating practice of medicine or licensure of a facility requiring criteria different from these.
  23. 23. Treatment Assessment • Purpose: To identify the client’s specific area of concern (presenting problems) and to determine the level of severity in each area of concern. • The treatment assessment helps the counselor identify the client’s immediate needs and provides a basis for treatment.
  24. 24. Goals of Treatment • Treatment should be individually tailored and guided by an individualized treatment plan that is developed in consultation with the client. • The clinician’s referrals and recommendations should be based on how that treatment and its duration will affect client outcome and problem resolution. • The treatment goals should determine the methods, intensity, frequency and types of services provided, i.e. “In the process of completing a comprehensive evaluation, making a placement decision is the last step.”
  25. 25. Progress Through Treatment • As the person moves through treatment in any level of service, his or her progress in all six dimensions should be continually assessed. • Degree of problem resolution or improvement in treatment determines movement between levels of care as the treatment plan is re-assessed. • “Treatment failure” does not need to be a prerequisite for approval of admission to a higher level of care.
  26. 26. Individualized Treatment Planning • Writing Problem Statements • Writing Goals • Writing Action Plans (strategies)
  27. 27. Individualized Problem Statement Includes: • One Issue for each problem statement • Briefly Stated • For the correct dimension • Stated as a problem that needs improvement • Stated as a correctable negative consequence that is specific to this client • What does the client think the problem is?
  28. 28. Problem Identification: ABC’s • Achievable: time, place, person • Brief and Behavioral • Caring: stated in accepting and non- judgmental terms • Different for each client
  29. 29. Individualized Goal Statements Will: • Be brief • Relate the goal to the problem • Relate the problem statement to the goal which leads to the action plan (strategies) • Be appropriate to the client’s stage of change • What does the client want?
  30. 30. Short-Term Goals • An expected result which takes a short time to achieve • Related to the identified clinical problem • Stated in measureable terms • Use action verb to illustrate direction of change • One goal per statement • Appropriate to the client’s stage of change • Provides guidelines for the direction of care
  31. 31. Individualized Action Plan includes: • Action steps must be directly related to the matching problem statement • Action steps must be stated in measurable terms (observable, recordable, reportable and verifiable) • Action steps must be stated as actions/tasks that the client is willing and able to do • Action steps must be specific to this client • Action steps are realistic and achievable by this particular client • What is the client motivated to actually do?
  32. 32. Plan of Treatment: • Describes the services or actions to meet the stated goal • Specifies the frequency of treatment interventions or services • Has a reasonable time for achievement • Identifies who is responsible for the action or strategy (client or staff or?) • Takes into account the client’s degree of motivation by applying appropriate strategies that specific to the client’s stage of change.
  33. 33. Steps for Writing Short- term Goals and Strategies • Write a problem for the client and ask what about this is unique to this individual? • Write a specific short-term goal • Ask yourself: what behavior/action would help this client achieve this goal, keeping in mind the stage of change • Make sure the strategy is observable so you can track progress • Is this something the client is willing and able to do in the time specified?
  34. 34. Sample Strategies for Treatment Plans: • List two reasons the court sent you to treatment • Write down the most recent thing that got you in trouble when you were using alcohol or drugs • What will happen if you don’t comply with probation and report this to the treatment group • List the pros and cons of your continuing to use • Attend a meeting and see if you can relate to anyone’s story. Report back to group. • Share in group what has helped to prevent relapsing and get other suggestions • Any others?