asam - oklahoma asam overview.pdf · inter-rater reliability asam . the consumer should be seen as...
TRANSCRIPT
![Page 1: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/1.jpg)
ASAM
An Overview 2013
![Page 2: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/2.jpg)
Ray Caesar LPC, LADC-MH
Director of Addiction Specialty Programs
ODMHSAS (405)522-3870 [email protected]
ASAM
![Page 4: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/4.jpg)
Eiffel Tower
108 stories
1665 stairs
![Page 5: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/5.jpg)
Eiffel Tower
2,500,000 rivets
15,000 pieces of iron
40 tons of paint
![Page 6: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/6.jpg)
Eiffel Tower
Weight approximately 10,000 tons
![Page 7: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/7.jpg)
Eiffel Tower
The stress on no joint exceeds eleven pounds
![Page 8: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/8.jpg)
Eiffel Tower
Height 984 to 990 feet
(Depending on the temperature)
![Page 9: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/9.jpg)
AMERICAN SOCIETY OF ADDICTON MEDICINE
ASAM
ASAM
![Page 10: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/10.jpg)
ASAM is a professional organization comprised of physicians specializing in the treatment of addiction
ASAM
![Page 11: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/11.jpg)
The American Society of Addiction Medicine is an organization of over 5000 physicians board certified in the recognition and treatment of those individuals with substance use or co-occurring issues.
ASAM
![Page 12: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/12.jpg)
The goals of the Society include
~ Defining addiction medicine
~ Improving access to services
~ Improving treatment services
~ Gaining recognition for this medical specialty
ASAM
![Page 13: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/13.jpg)
ASAM has become the most widely used and comprehensive set of guidelines for placement, continued stay and discharge of patients with addictive, substance-related and co-occurring disorders.
ASAM
![Page 14: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/14.jpg)
CURRENT VERSION
ASAM
![Page 15: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/15.jpg)
The ASAM Criteria
Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions
2013
ASAM
![Page 16: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/16.jpg)
ASAM Criteria
ASAM
![Page 17: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/17.jpg)
Cleveland & NAATP Criteria 1987
ASAM Patient Placement Criteria 1991
ASAM Patient Placement Criteria-2 1996
ASAM Patient Placement Criteria-2R 2001
Supplement to the ASAM PPC-2R 2010
ASAM Criteria 2013
ASAM
![Page 18: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/18.jpg)
PAST ASSESSMENT
&
SERVICE MODELS
ASAM
![Page 19: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/19.jpg)
PAST
ASSESSMENT/SERVICE MODELS
Diagnosis defined service placement
ASAM
![Page 20: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/20.jpg)
PAST
ASSESSMENT/SERVICE MODELS
Assessment tools identified only inpatient or residential placement needs
ASAM
![Page 21: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/21.jpg)
PAST
ASSESSMENT/SERVICE MODELS
Poor outcomes meant more intensive treatment was needed and the consumer was at fault
(treatment resistant)
ASAM
![Page 22: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/22.jpg)
PAST
ASSESSMENT/SERVICE MODELS
Placement “program based”
“One size fits all”
Typically a single option is available
ASAM
![Page 23: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/23.jpg)
PAST
ASSESSMENT/SERVICE MODELS
“Negative consequences” “Graduation”
“Complete the program” “Our program is _____ in length”.
“Phases”
ASAM
![Page 24: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/24.jpg)
PAST
ASSESSMENT/SERVICE MODELS
CHARTING
“More willing to follow the rules”.
“Compliant in group”.
“Serious and persistent”.
ASAM
![Page 25: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/25.jpg)
What is ASAM?
ASAM
![Page 26: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/26.jpg)
The ASAM PPC-2r is NOT an assessment instrument.
ASAM
![Page 27: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/27.jpg)
Instruments for ASAM placement
LOCI-2R
DAPPER
ASAM
![Page 28: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/28.jpg)
Instruments for ASAM placement
Level of Care Index second edition, revised
LOCI-2R
ASAM
![Page 29: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/29.jpg)
Instruments for ASAM placement
Dimensional Assessment for Patient Placement Engagement and Recovery
DAPPER
ASAM
![Page 30: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/30.jpg)
All information necessary to properly determine placement decisions is based on screening and assessment that PRECEDES using ASAM criteria.
ASAM
![Page 31: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/31.jpg)
One of the primary determinants of level of care placement is the potential lethality of the consumers’ current condition.
ASAM
![Page 32: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/32.jpg)
The ASAM Criteria were developed to better coordinate treatment across multiple levels of care and to identify the intensity of the services needed.
ASAM
![Page 33: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/33.jpg)
ASAM TERMINOLOGY
Clinically Managed
Length of service
Levels of service
Continued service
ASAM
![Page 34: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/34.jpg)
The ASAM Criteria were developed to:
ASAM
![Page 35: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/35.jpg)
Treat the consumer in the most available, least restrictive level of care possible.
ASAM
![Page 36: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/36.jpg)
Takes a less conservative approach to withdrawal management based on recent clinical research
ASAM
![Page 37: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/37.jpg)
Develop a method of expanding the levels of care available
ASAM
![Page 38: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/38.jpg)
Define commonly used terms in ways that enhance communication among users of ASAM criteria
To promote a common clinical service (provider language)
ASAM
![Page 39: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/39.jpg)
Shift from uni-dimensional to multi-dimensional assessment.
ASAM
![Page 40: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/40.jpg)
Change program driven treatment to clinically driven services
ASAM
![Page 41: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/41.jpg)
Move from fixed length of service to variable length of service
ASAM
![Page 42: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/42.jpg)
Move from a limited number of discrete levels of care to a continuum of care
ASAM
![Page 43: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/43.jpg)
THEORETICAL FOUNDATIONS
OF ASAM
CRITERIA
ASAM
![Page 44: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/44.jpg)
Clinical services should be individualized and tailored to the needs of the consumer within each of the six dimensions.
ASAM
![Page 45: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/45.jpg)
The service plan should be based on a comprehensive biopsychsocial assessment.
This includes, whenever possible, a comprehensive assessment of the family.
ASAM
![Page 46: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/46.jpg)
Length of service should be linked directly to the consumers response to services.
ASAM
![Page 47: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/47.jpg)
The goals of intervention & service delivery determine the
Methods,
Intensity,
Frequency and
Types,
of services provided.
ASAM
![Page 48: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/48.jpg)
Progress through the levels of service
Progress in all 6 dimensions must be assessed continuously to ensure comprehensive service delivery.
ASAM
![Page 49: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/49.jpg)
As service delivery progresses, new problems and priorities may be discovered requiring a review of service status.
ASAM
![Page 50: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/50.jpg)
Always find the level of care that can best address the service plan in the least restrictive environment.
ASAM
![Page 51: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/51.jpg)
ISSUES
Objectivity
Choice of service levels
Continuum of care
Service level failure
Length of stay
Mutual Support Groups
Clinical outcomes
ASAM
![Page 52: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/52.jpg)
The ASAM Criteria address three areas
ASAM
![Page 53: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/53.jpg)
INITIAL PLACEMENT ~
CONTINUED STAY and/or
REFERRAL ~
DISCHARGE
ASAM
![Page 54: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/54.jpg)
SIX ASSESSMENT DIMENSIONS
ASAM
![Page 55: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/55.jpg)
Dimension 1 Acute Intoxication and/or Withdrawal Potential
Dimension 2 Biomedical Conditions and Complications
Dimension 3 Emotional, Behavioral or Cognitive Conditions and
Complications Dimension 4
Readiness to Change Dimension 5
Relapse, Continued Use, or Continued Problem Potential
Dimension 6 Recovery/Living Environment
SIX DIMENSIONS
![Page 56: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/56.jpg)
Dimension 1
Acute Intoxication and/or Withdrawal Potential
ASAM
![Page 57: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/57.jpg)
Dimension 2
Biomedical Conditions and Complications
ASAM
![Page 58: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/58.jpg)
Dimension 3
Emotional, Behavioral or Cognitive Conditions and Complications
ASAM
![Page 59: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/59.jpg)
Dimension 4
Readiness to Change
ASAM
![Page 60: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/60.jpg)
Dimension 5
Relapse, Continued Use, or Continued Problem Potential
ASAM
![Page 61: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/61.jpg)
Dimension 6
Recovery/Living Environment
ASAM
![Page 62: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/62.jpg)
INTERVENTION LEVELS
ASAM
![Page 63: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/63.jpg)
Level 0.5 Early Intervention
Level 1 Outpatient Services
Level 2 Intensive Outpatient/Partial Hospitalization Services
Level 3 Residential/Inpatient Services
Level 4 Medically Managed Intensive Inpatient Services
Opioid Treatment Services (OTS) Withdrawal Management Services
FIVE LEVELS
![Page 64: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/64.jpg)
Level 0.5
Early Intervention
ASAM
![Page 65: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/65.jpg)
0.5 Early Intervention Institute of Medicine Intervention Spectrum
EARLY INTERVENTION
PR
EV
EN
TIO
N
TREATMENT
MA
INTE
NA
NC
E
Mental Health Promotion
Universal
Selective
Indicated
Identific
atio
n o
f
Pro
ble
ms o
r
Dis
ord
ers
Ea
rly T
rea
tme
nt
Tre
atm
ent fo
r
Know
n D
isord
ers
Longer-term
Treatment
(Goal: R
eduction in
Relapse and R
eoccurence)
Aftercare
![Page 66: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/66.jpg)
Level 1
Outpatient Services
ASAM
![Page 67: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/67.jpg)
Level 2
Intensive Outpatient/Partial Hospitalization Services
ASAM
![Page 68: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/68.jpg)
Level 3
Residential/Inpatient Services
ASAM
![Page 69: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/69.jpg)
Level 3 Residential/Inpatient Services
Level 3.1 Clinically Managed Low-Intensity Residential Services
Level 3.3 Clinically Managed Population Specific High-Intensity Residential Services
Level 3.5 Clinically Managed High-Intensity Residential Services
Level 3.7 Medically Monitored Intensive Inpatient Services
ASAM
![Page 70: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/70.jpg)
Level 4
Medically Managed Intensive Inpatient Services
ASAM
![Page 71: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/71.jpg)
Opioid Treatment Services (OTS)
Opioid Treatment Services and/or
Office Based Opioid Treatment
ASAM
![Page 72: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/72.jpg)
The levels are also identified through decimals (.1 through .9) to better express the gradations of intensity within each level of care
Allows for improved precision and better inter-rater reliability by focusing on five broad levels of service.
ASAM
![Page 73: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/73.jpg)
ISSUES
ASAM
![Page 74: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/74.jpg)
DSM 5
ASAM
![Page 75: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/75.jpg)
WITHDRAWAL
MANAGEMENT
ASAM
![Page 76: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/76.jpg)
GAMBLING
DISORDER
ASAM
![Page 77: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/77.jpg)
TOBACCO
DISORDER
ASAM
![Page 78: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/78.jpg)
Inter-rater Reliability
ASAM
![Page 79: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/79.jpg)
The consumer should be seen as entering a
continuum of care – not entering a treatment
program
ASAM
![Page 80: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/80.jpg)
ALCOHOL
25% to 40% of the population 20% of the population
never drink consume 90% of the alcohol ===========================================================================
| | | | =========================================================================== Of this group only 30%, or 10% of the total population are
physically dependent
![Page 81: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/81.jpg)
LEVEL 4 Inpatient
LEVEL 3 Residential
LEVEL 2 IOT
LEVEL 1 OP
LEVEL 0.5 ED
ASAM
![Page 82: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/82.jpg)
ADOLESCENT
PATIENT
PLACEMENT CRITERIA
ASAM
![Page 83: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/83.jpg)
ADOLESCENT PPC
Dimensions will most often focus more on Mental Health issues than on Substance Use disorders.
Levels do not include withdrawal maintenance or opioid maintenance therapies as these are less common with adolescents
ASAM
![Page 84: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/84.jpg)
ADOLESCENT PPC
Level 0.5 More common for adolescents
Level 1
Level 2 IOT 6 to 19 hours
Level 3 3.5 & 3.7
Level 4
ASAM
![Page 85: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/85.jpg)
Level 3 Residential/Inpatient Services
Adolescent Criteria
Level 3.5 Clinically Managed Medium-Intensity Residential Services
Level 3.7 Medically Monitored High Intensity Intensive Inpatient Services
ASAM
![Page 86: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/86.jpg)
REAL WORLD
CONSIDERATIONS
ASAM
![Page 87: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/87.jpg)
Unbundling of services
ASAM
![Page 88: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/88.jpg)
ASAM criteria and State certification requirements.
ASAM
![Page 89: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/89.jpg)
Need for a safe environment
Consider sober living
ASAM
![Page 90: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/90.jpg)
Assessment of imminent danger
ASAM
![Page 91: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/91.jpg)
Mandated level of care or length of stay
ASAM
![Page 92: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/92.jpg)
Interactions across dimensions
ASAM
![Page 93: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/93.jpg)
ALWAYS treat the consumer in the most
available, least restrictive
level of care
ASAM
![Page 94: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/94.jpg)
ASAM OVER RIDES
Service not available
Provider judgement
Patient preference
On waiting list for appropriate level
No payment resource
Geographic accessibility
Family responsibility/preference
Language
ASAM
![Page 95: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/95.jpg)
Appendix A
Withdrawal Management Instruments
ASAM
![Page 96: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/96.jpg)
Appendix B
Special Considerations for Dimension 5 Criteria: Relapse, Continued Use or Continued Problem Potential
ASAM
![Page 97: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/97.jpg)
Appendix C
Glossary of Terms Used in the ASAM Criteria
ASAM
![Page 98: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/98.jpg)
The Three “H’s”
HISTORY
HERE AND NOW
HOW CONCERNED AM I
ASAM
![Page 99: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/99.jpg)
~ Sometimes we have to let go of what's killing us, even if its killing us to let go!
ASAM
![Page 100: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/100.jpg)
Lethality 1 Acute Intoxication or Withdrawal Potential
This information comes directly from the consumere substance use history and current use patterns. The clinician must have knowledge of dependency and withdrawal complications from alcohol or various classes of drug.
ASAM
![Page 101: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/101.jpg)
Lethality 2) Biomedical Conditions and Complications
This information comes from the medical section of assessment. The question to answer is “Do medical conditions interfere with the clients’ ability to engage in treatment?”
and/or “Does this condition have the possibility of
death if medical treatment is not provided?”
ASAM
![Page 102: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/102.jpg)
Lethality 3) Emotional, Behavioral or Cognitive Conditions or
Complications.
“Does this consumer represent a threat to himself or someone else?”
and/or
“Does this consumer have sufficient cognitive capability to participate in and benefit from services (at a sub-acute level of care)?”
ASAM
![Page 103: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/103.jpg)
Addiction
Severity
Index Fifth edition
ASAM
![Page 104: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/104.jpg)
Medical Section
Corresponds to ASAM Dimensions 1, 2 & 4
ASAM
![Page 105: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/105.jpg)
Employment & Support
Corresponds to ASAM Dimension 6
ASAM
![Page 106: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/106.jpg)
Drug and Alcohol Sections
Corresponds to ASAM Dimensions 1, 4, & 5
ASAM
![Page 107: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/107.jpg)
Legal Status
Corresponds to ASAM Dimensions 4 & 6.
ASAM
![Page 108: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/108.jpg)
Family and Social Status
Corresponds to ASAM Dimensions 5 & 6
ASAM
![Page 109: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/109.jpg)
Psychiatric Status
Corresponds to ASAM Dimensions 4, 5 & 6
ASAM
![Page 110: ASAM - Oklahoma ASAM Overview.pdf · Inter-rater Reliability ASAM . The consumer should be seen as entering a continuum of care](https://reader030.vdocument.in/reader030/viewer/2022013006/5b397c317f8b9a1a678c86bb/html5/thumbnails/110.jpg)
Ray Caesar LPC, LADC-MH
Director of Addiction Specialty Programs
ODMHSAS (405)522-3870 [email protected]
ASAM