understanding the new asam criteria misti storie, ms, ncc · understanding the new asam criteria...
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Presented by David Mee-Lee, M.D.
April 23, 2015
Understanding the New ASAM Criteria Misti Storie, MS, NCC
Director of Training & Professional Development
NAADAC, the Association for Addiction Professionals
www.naadac.org
Produced By NAADAC, the Association for Addiction Professionals
www.naadac.org/webinars
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www.naadac.org/understandingthenewasamcriteria Cost to Watch: Free CE Hours Available: 1.5 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $20
To obtain a CE Certificate for the time you spent watching this webinar:
1. Watch this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/understandingthenewasamcriteria
3. If applicable, submit payment for CE certificate or join NAADAC.
4. A CE certificate will be emailed to you within 21 days of submitting the quiz.
CE Certificate
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Using GoToWebinar – (Live Participants Only)
§ Control Panel
§ Asking Questions
§ Audio (phone preferred)
§ Polling Questions
Webinar Learning Objectives
Identify what is new in the new edition of The ASAM Criteria and how it was developed
Review what new sections were added and why
Discuss how to apply The ASAM Criteria in a variety of settings and with different populations
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Webinar Presenter
David Mee-Lee, M.D. Chief Editor, The ASAM Criteria www.ASAMcriteria.org
Senior Vice President, The Change Companies www.changecompanies.net
David Mee-Lee, M.D. Chief Editor, The ASAM Criteria www.ASAMcriteria.org Senior Vice President, The Change Companies www.changecompanies.net
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® Around 1989, NAATP and ASAM assemble taskforce to integrate two existing admission/continued stay criteria sets: The Cleveland Criteria The NAATP Criteria
® NAATP decided to relinquish any ownership/branding of the Criteria
® Historical and current development of The ASAM Criteria Collaborative consensus process Experienced clinical experts and researchers as
Editors Coalition of stakeholders (Coalition for National Clinical
Criteria, est. 1992) — ASAM and addiction physicians not the sole stakeholders
To unify the addiction field around a single set of criteria
® Previous Editions Patient Placement Criteria (1991) Patient Placement Criteria-2 (1996) Patient Placement Criteria-2R (2001)
® New Edition: The ASAM Criteria – Treatment Criteria
for Addictive, Substance-Related, and Co-Occurring Conditions
Released in Fall 2013 Editor-in-Chief: David Mee-Lee, MD
Audience Polling Question #1
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® What are the ASAM Criteria? Guidelines for assessment, service
planning, placement, continued stay, and discharge
Framework for multidimensional patient assessment
® What are the ASAM Criteria? Description of levels of care (service
continuum)
Algorithm for determining appropriate Intensity of Service based on assessment of patient’s Severity of Illness (IS/SI)
Relapse
3. Individualized, Clinically-driven Treatment 4. Client-directed, Outcome-informed
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1. Acute Intoxication and/or Withdrawal Potential
2. Biomedical conditions and complications 3. Emotional/Behavioral/Cognitive conditions and complications
4. Readiness to Change
5. Relapse/Continued Use/Continued Problem potential
6. Recovery Environment
• Motivate - Dimension 4
• Manage – All Six Dimensions
• Medication – Dimensions 1, 2, 3, 5
• Meetings – Dimensions 2, 3, 4, 5, 6
• Monitor- All Six Dimensions
Levels of Service 1. Outpatient Treatment
2. Intensive Outpatient and Partial Hospitalization
3. Residential/Inpatient Treatment
4. Medically-Managed Intensive Inpatient Treatment
® More levels of care within each of the broad levels
® Changes from Roman numerals to Arabic numerals, e.g.: ® “Level I” becomes “Level 1” ® “Level II.1” becomes “Level 2.1” ® “Level II.5” becomes “Level 2.5” ® “Level III.1” becomes “Level 3.1”
® Workgroup chairs and small committees developed drafts
® Extensive field review online with input from Steering Committee of the Coalition for National Clinical Criteria and others
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® Released October 2013 at ASAM’s “State of the Art Conference” in Arlington, VA
® Criteria updated to reflect current science – impact on The ASAM Criteria Software now branded as Continuum™, The ASAM Criteria Decision Engine™
Audience Polling Question #2
® The six assessment dimensions ® The overall levels of care (though not Roman
numerals) for addiction management ® The “decision rules,” which link Intensity of
Service back to the Severity of Illness maintained except for some updates in Withdrawal Management (“Detox”)
The Process: (from http://www.asam.org/publications/the-asam-criteria )
® Oversight and revision of the criteria is a collaborative process between ASAM leadership and the Steering Committee of the Coalition for National Clinical Criteria (CNCC)
The Process: (from http://www.asam.org/publications/the-asam-criteria )
® The coalition represents major stakeholders in addiction treatment and has been meeting regularly since the development of the first ASAM Patient Placement Criteria in 1991
® New Title: The ASAM Criteria -- Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions
® Shift away from “placement” criteria to “treatment” criteria: it’s more than just “placement”
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® Diagnostic Admission Criteria terminology changed to be compatible with DSM-5
® Section on working with managed care
® Table of contents Re-ordered to be more user-friendly
Follows the flow from Historical Foundations to Guiding Principles to Assessment, Service Planning, and Placement decisions
® Adolescent Criteria Still separate criteria for adolescents
Consolidated Adult & Adolescent content on principles to minimize redundancy, while preserving adolescent-specific content
® Appendices Withdrawal Management instruments
Dimension 5 constructs
Glossary
® Withdrawal Management ® The wording in the Levels of Care
® Former section “Detoxification” becomes “Withdrawal Management”
® Levels are now called WM-1, WM-2, WM-3, and WM-4
® New approaches described to support increased use of less intensive levels of care for safe/effective management of withdrawal
® Withdrawal Management ® New approaches described to support increased use
of less intensive levels of care for safe/effective management of withdrawal
® A broader range of severity of withdrawal syndromes is discussed in The Criteria as being able to be safely and appropriately managed on an outpatient basis
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® Updated/revised terminology ® Contemporary, strength-based, recovery-
oriented: • “dual diagnosis” becomes “co-occurring disorders”
• “inappropriate use of substances” becomes “high risk use of substances”
® Opioid use disorder specialized services ® Opioid Maintenance Therapy” (OMT) becomes
“Opioid Treatment Services” (OTS) ® Opioid antagonist medication (naltrexone)
® Opioid agonist medications (methadone, buprenorphine)
® Their use in OTPs (regulated “Opioid Treatment Programs” for methadone) or in office-based opioid treatment (OBOT for buprenorphine)
Audience Polling Question #3 ® Additional text to improve application to address
addiction treatment for Special Populations: • Older Adults
• Persons in Safety Sensitive Occupations
• Parents with Children and Pregnant Women
• Persons in the Criminal Justice System (CJS)
® Additional text to address treatment of conditions not traditionally included in specialty addiction treatment services: • Tobacco Use Disorder
• Gambling Disorder
® Revision of the text to address emerging issues: • Healthcare Reform and the integration of addiction
treatment into general medical care
• The role of physicians on the care team, addiction specialist physicians in particular (addiction medicine physicians, addiction psychiatrists)
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® ASAM’s New Definition of Addiction • http://www.asam.org/docs/publicy-policy-statements/
1definition_of_addiction_long_4-11.pdf?sfvrsn=2 • Implications for Substance Use Disorders and other
Addictive Disorders • “The pathological pursuit of reward or relief” • Involves alcohol, tobacco, and/or other substance use • Also involves addictive behaviors • “Addiction involving alcohol, tobacco, other substances and
gambling”
® The ASAM Criteria book and The ASAM Criteria Software now branded as Continuum™ are companion text and application
® The text delineates the dimensions, levels of care, and decision rules that comprise The ASAM Criteria
® The software provides an approved structured interview to guide adult assessment and calculate the complex decision tree to yield suggested levels of care, which are verified through the text
® For Patients • Improves Patient Outcomes
® For Payers • Improved Patient Outcomes >
Lower Long-Term Costs • Standardizes prior approval
process (utilization management)
• I.T. can facilitate/automate approval process (U.M.)
• Decreases expensive & unnecessary overtreatment
• Improves inter-rater reliability
® For Providers • Facilitates reimbursement
process through fewer disputes, less administrative burden, & faster turnaround on payment
• Provides training to new counselors
• Generates sophisticated reports & analyses
® The Change Companies® (TCC) was contracted by ASAM to publish and market The ASAM Criteria
® The new edition features these tools to help readers locate material quickly: content-specific chapter tabs color, graphic illustrations, and icons cross-linking
® A subscription web-based version is available alongside the book
® More info: www.ASAMcriteria.org
® New training model developed in collaboration with TCC eTraining modules onsite learning consulting and coaching
® Resources co-developed with TCC ® www.ASAMcriteria.org
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www.changecompanies.net
The ASAM Criteria David Mee-Lee, MD [email protected] The ASAM Criteria Software now branded as
Continuum™ David R. Gastfriend, MD [email protected] www.ASAMcriteria.org
The Change Companies Carson City, NV
www.changecompanies.net
www.ASAMcriteria.org
www.naadac.org/understandingthenewasamcriteria
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Cost to Watch: Free CE Hours Available: 1.5 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $20
To obtain a CE Certificate for the time you spent watching this webinar:
1. Watch this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/understandingthenewasamcriteria
3. If applicable, submit payment for CE certificate or join NAADAC.
4. A CE certificate will be emailed to you within 21 days of submitting the quiz.
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