ASAM 101: How to complete the ASAM Placement Form
What is the ASAM? The ASAM Placement Form is a document required by contract The ASAM Form is an ASSESSMENT tool as well as a PLACEMENT tool It seeks to match intensity of treatment to severity of illness Method for justifying clinical decisions
What is the ASAM not? The equivalent of the DSM-IV A substitute for clinical judgment A checklist or cookbook A replacement for the ASI
Common Errors No client identification numbers Incorrect level of ASAM forms used Characteristics are not selected (circled) for all six dimensions Dimensions are not validated in the yes or no box Summaries are generalized and insufficient ASAM forms are not signed or dated Client does not meet criteria but are forced into specific level of care
On Top of the Form Make sure handwritings are LEGIBLE The Client ID can be the client s s SSN, MIS # or client s s agency s s ID Tells you which form you are using: Admission, Continued Stay or Discharge/Transfer
Using the Correct ASAM Form Adult or Adolescent client? Level of care to which the client is being assessed for? The correct ASAM level that corresponds to the program s s level of care
ASAM &Treatment Levels Crosswalk Adult Clients Level 0.5 Level I Level II.1 Level II.5 Level III.1 Level III.3 Level III.5 Level I-DI Intervention Outpatient Intensive Outpatient Day/Night Level IV Residential Level III Residential Level I & II Residential Detoxification
Outpatient Levels of Care & Services Level 0.5 Level I Level II.1 Level II.5 ~ Early Intervention Outpatient less than 9 contact hours/week ~ 1-2/week1 Intensive Outpatient 9 or more contact hours/week in a Structured Program (6hrs for adolescent) 3/week 9-19hrs total Partial Hospitalization (Day/Night) 12 or more contact hours/week in a Structured Program
Residential Levels of Care & Services Level III.1 Level III.3 ~ Residential Level IV 5 hours/week (halfway house) Residential Level III For clients requiring extended care due to cognitive disabilities, brain injuries/disorders. Level III.5 Residential Levels I & II Provides residential treatment, includes all services except medical services. Level I-D Detoxification Services provided by a licensed hospital only, medical or psychiatric needs, e.g. patients acutely suicidal
ASAM & Treatment Levels Crosswalk Adolescent Clients Level 0.5 Level I Level II.1 Level II.5 Level III.5 Level III.2-D Level III.7-D Intervention Outpatient Intensive Outpatient Day/Night Level I & II Residential Addiction Receiving Facilities Detoxification
ASAM criteria for all levels of care
Examples of ASAM Requirements Adult Intervention Level.05 (Admission) Must meet one of the Dimensions of 4,5, or 6 and any identifiable problems in Dimensions 1,2, or 3 that are stable or being addressed through appropriate outpatient medical or mental health services. Adolescent Intensive Outpatient Level II.1 (Continued Stay) The client is sufficiently stable in Dimensions 2 and 3 to allow participation in this level of care, and the client meets the criteria in one of Dimensions 4,5, or 6. Adult Residential Level III.5 (Discharge) The client meets criteria in at least one of the six Dimensions
Correlation between ASI/ASAM ASI Assessment Areas Medical Status Employment/Support Status Alcohol/Drugs Legal Status Family/Social Status Psychiatric Status ASAM Dimensions Acute Intoxication/Withdrawal Potential Biomedical Conditions & Complications Emotional/Behavioral/Cognitive Conditions & Complications Readiness to Change Relapse/Continued Used/Problem Potential Recovery Environment
Factors affecting Dimension I Acute Intoxication/Withdrawal Potential What are the risks associated with the client s current level of acute intoxication? Current signs of withdrawal? What are the client s frequency and amount of substance(s) use and the history of withdrawal symptoms? Client s drug(s) of choice in relation to the drug s withdrawal symptoms. Substances that may require medically managed detox due to the possibility of death if stopped immediately: barbiturates, alcohol and benzodiazepines.
Factors affecting Dimension II Biomedical Conditions & Complications Does the client have any current untreated severe medical problems that may interfere with treatment? Does the client have any illness or requires medical attention that may interfere with treatment? E.g., hypertension, diabetes, the need for dialysis or chemotherapy? Is the client being treated with narcotic analgesics for chronic pain?
Factors affecting Dimension III Emotional/Behavioral/Cognitive Conditions & Complications Are there current psychiatric illness, psychological, behavioral or emotional problems? Is it being addressed? Impulse with regards to suicide, homicide or other behaviors that pose a risk/threat to self or others? What is the client s current mental status? Client s orientation to all three spheres (person, place, time). Is the client currently on psychiatric medications and are they complying with treatment?
Factors affecting Dimension IV Readiness to Change How ready is the client to change (stage of readiness to change)? Pre-contemplation Contemplation Preparation Action Maintenance Relapse and Recycling Termination Is the client compliant with treatment to avoid negative consequences? E.g., enter drug treatment or go to jail for 6 months How accepting is the client towards treatment?
Factors affecting Dimension V Relapse/Continued Used/Problem Potential Compliance vs. Adherence client maybe willing but unable How aware is the client of relapse triggers, ways to cope with craving and skills to control impulses to use? What is the client s history of treatment compliance in areas of medical, mental health and/or substance abuse? Is the client in immanent danger of continued severe distress and substance use or other high-risk behavior due to a co-occurring mental problem?
Factors affecting Dimension VI Recovery Environment Is client surrounded by individuals or situations that threatens treatment engagement and success? Does the client have supportive friendship, financial or education/vocational resources to improve the likelihood of successful treatment? Are there barriers to access to treatment? E.g., transportation, child care responsibilities? What is the client s motivation for treatment and does the client see value in recovery?
ASAM Recommendations/Notes Insufficient and generalized client summaries: Client will benefit from this level of care. Client meets the criteria for admission. Client appears ready to continue with residential treatment. Client is a 40 y/o male. Client will benefit from outpatient treatment due to history of substance abuse.
ASAM Recommendations/Notes Example of Summary: Paragraph Format CL is a 33 y/o male, referred to res. tx from JMH detox. CL reported a 6yr hx of cocaine use at approx. 5g of cocaine 3x/day. CL also reported that he drinks a 6pk of beers and 3 magnum bottles of vodka per day. CL stated that his last use was 5 days ago prior to detox at JMH. CL denied any medical problems. CL denied hx of psychiatric treatment. CL is married with 2 kids but was kicked out of the house 3 months ago due to his use. CL was oriented to all spheres at the time of assessment. Based on the information provided, CL meets ASAM criteria for Residential Substance Abuse Treatment.
ASAM Recommendations/Notes Example of client summary: Dimension Format D1 Client reported smoking 1 joint of marijuana and drinking 4-64 beer 2/wk and reported last used 7 days ago. D2 Client stated that he suffers from hypertension and is compliant with medication. D3 Client stated that he feels depressed due to his drug use but has never see a psychiatrist or treated with medication. D4 Client appears to be in the contemplation stage of change due to his DUI charge and court order status. D5 Client is not aware of his triggers and is predisposed to continued use due to his cycle of substance use. D6 Client stated that he has been staying with a friend b/c mother does not want him at her house. Client meets the criteria for outpatient treatment and his appointment is next Wednesday.
Questions and Comments
Reference Department of Children and families Substance Abuse program, (2006). Florida Supplement to the American Society of Addiction Medicine patient Placement Criteria for the Treatment of Substance-Related Disorders Second Edition (ASAMPPC-2R). Shulman, G. D., (2007). Using the ASAM PPC-2R Throughout the Treatment Process. 2008 SFPC Strategic Planning & Development Department