Patient Placement Criteria

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Patient Placement Criteria

• George Mangual,
• ACSW, ADC II, CCS
• SACC, MCRD

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Choice of Treatment Levels

• Any referral for a specific level of care must be
  based on a careful assessment of the client with
  an alcohol or other drug dependence problem.
• The goal is to place client in the most
  appropriate level of care.
• For clinical and financial reasons the preferred
  level of care is the least intensive that will
  accomplish treatment objectives

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Continuum of Care

• Within and across the levels of care, there is a
  continuum of the severity of illnesses treated
  and intensities of services provided.
• Movement between levels might mean referring the
  client out of the providers program.
• ASAM believes that a description of patient needs
  and treatment levels will assist the treatment
  field in developing the continuum of care needed
  for effective and efficient treatment.

4
Length of Stay

• Consideration was given to incorporating
  normative lengths of stay or durations of
  treatment for the criteria presented at each
  level of care. While it is desirable to have
  expected or reasonable lengths of stay specified,
  none are established at this time.

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12 Step/Mutual and Self-helpRecovery Groups

• Mutual/self-help groups are a crucial element of
  all of the levels of care.
• Not a formal treatment level
• In situations where a client may be evaluated for
  a substance-related disorder and, based on a
  conclusion that no condition exists that warrants
  formal treatment, the client may be referred to
  these types of groups.
• (AA, NA, Smart Recovery)

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Assessment Process

• The client is evaluated on the six ASAM
  assessment dimensions (and additional operational
  commitment dimension).
• Type and level of service may depend on other
  diagnosis, both physical and emotional/behavioral,
  as well as psychosocial variables, stressors and
  conditions.
• Addiction treatment recognizes the totality of
  the individual in their life situation. (PIE)

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Concept of the PPC
Levels of Service

• Levels of service in the Patient Placement
  Criteria range from early intervention through
  outpatient services to medically-managed
  intensive inpatient care.
• Each level of care or service describes a range
  of resources available to be applied within a
  given period of time to addiction and related
  problems.
• The levels of service described in the Criteria
  are
• 1. Level 0.5 Early Intervention
• 2. Level I Outpatient Services
• 3. Level II Intensive
  Outpatient/Partial Hospitalization Services
• 4. Level III Residential/Inpatient
  Services
• 5. Level IV Medically-Managed intensive
  Inpatient Services

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Assessment Dimensions

• The following problem areas (dimensions) have
  been identified as most commonly addressed in
  making patient placement decisions and the
  subsequent formulation of an individual clients
  treatment plan

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Assessment Dimensions Primary Problems Areas

• Acute intoxication and/or withdrawal potential
• Biomedical conditions and complications
• Emotional/behavioral conditions and complications
• Treatment acceptance/resistance
• Relapse/continued use potential
• Recovery/living environment
• Operational Commitments

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Intervention/TreatmentGoals

• Safe and comfortable detoxification
• Attainment of skills to maintain abstinence
• Treatment should be tailored to the needs of the
  individual and guided by an individualized
  treatment plan based on a comprehensive
  biopsychosocial assessment of the client and when
  possible a comprehensive evaluation of the family

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Changing Levels of Service

• Progress in all dimensions should be continually
  assessed when there is movement through treatment
  in any level of service
• The discharge criteria listed for each level of
  service presume that the client progressed toward
  a state of greater health

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Exceptions to the PPC

• In making treatment placement decisions, three
  important factors override the patient-placement
  match with regard to levels of service
• While these criteria are intended to be as
  specific as possible, unique clinical
  presentation or extenuating circumstances may
  dictate some flexibility in application of the
  criteria to ensure the safety and welfare of the
  patient.
• The three factors are listed on the following
  slide.

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Exceptions to the PPC

• Lack of availability of appropriate,
  criteria-selected care
• Failure of a patient to progress at any given
  level of care, so as to warrant a reassessment of
  the treatment plan with a view to modification of
  the treatment approach.
• State laws regulating the practice of medicine or
  licensure of a facility requiring criteria
  different from these. (The Commanding Officers
  input may affect treatment regimen, increasing or
  decreasing the recommended level of care.)

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Patient Placement Criteria
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Assessing Severity Intensity of Service
Required

• Dimension 1. Acute Intoxication and/or withdrawal
  potential
• What risk is associated with the patients
  current level of acute intoxication?
• Is there significant risk of severe
  withdrawal symptoms or seizures?
• Are there current signs of withdrawal?
• Does the patent have supports to assist in
  ambulatory detoxification, if medically safe?

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Dimension 2. Biomedical Conditions and
Complications

• Are there current physical illnesses, other than
  withdrawal, that need to be addressed or that may
  complicate treatment?
• Are there chronic conditions that affect
  treatment?

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Dimension 3, Emotional/Behavioral Conditions
Complications

• Are there current psychiatric illnesses or
  psychological, behavioral or emotional problems
  that need to be addressed or which complicate
  treatment?
• Are there chronic conditions that affect
  treatment?
• Do any emotional/behavioral problems appear to be
  an expected part of addiction illness or do they
  appear to be autonomous?
• Even if connected to the addiction, are they
  severe enough to warrant specific mental health
  treatment?

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Dimension 4, Treatment Acceptance/Resistance

• Is the patient actively objecting to treatment?
• Does the patient feel coerced into treatment?
• How ready is the patient to change?
• If willing to accept treatment, how strongly does
  the patient disagree with others perception that
  s/he has an addiction problem?
• Does the patient appear to be compliant only to
  avoid a negative consequence, or does he or she
  appear to be internally distressed in a
  self-motivated way about his or her alcohol/other
  drug use problems?

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Dimensions 5Relapse/Continued Use Potential

• Is the patient in immediate danger of continued
  severe distress and drinking/drug-taking
  behavior?
• Does the patient have any recognition of,
  understanding of, or skills with which to cope
  with his or her addiction problems in order to
  prevent relapse or continues use?
• What severity of problems and further distress
  will potentially 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 impulses to use?

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Dimensions 6Recovery Environment

• Are there any dangerous family members,
  significant others, living situations, or
  school/working situations that pose a threat to
  treatment engagement and success?
• Does the patient have supportive friendships,
  financial resources, or educational/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 patients motivation for engagement
  in treatment?

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Dimension SevenOperational Commitments

• Command willing to commit to treatment
  requirements
• Schedule does not allow for participation in
  another treatment program at this time.

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