ASAM Flashcards
ASAM Definition of Addiction
Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an indivdiual’s life experiences.
What kind of care does the criteria provide?
Outcome-oriented, results-based care
What is ASAM criteria used for?
- Evaluating individual needs on an ongoing basis
- Determining appropriate level of care.
- Individualize tx
- Create a tx plan that is client and outcomes driven
- Meet insurance requirements for reimbursement.
Guiding Principle of ASAM Criteria: 1
Admission is based on patient needs, not arbitrary prerequisites
Guiding Principle of ASAM Criteria: 2
Multidimensional assessment addresses bio, psychological, social, and cultural factors that contribute to addiction/recovery.
Guiding Principle of ASAM Criteria: 3
Tx plans are based on patient needs and preferences.
Guiding Principle of ASAM Criteria: 4
Care is interdisciplinary, evidence-based, patient-centered, and delivered from a place of empathy.
Guiding Principle of ASAM Criteria: 5
Co-occurring conditions are an expectation, not an exception.
Guiding Principle of ASAM Criteria: 6
Patients move along the continuum of care based on progress, not predetermined lengths of stay.
Guiding Principle of ASAM Criteria: 7
Informed consent and shared decision-making accompany tx decisions.
3 Core Components of the ASAM Critera
- Assessment standards
- Dimensional Admission Criteria Standards
- Continuum of care standards
Level of Care Assessment
Used to determine the recommended level of care at the beginning of tx and when re-assessing for continued service or care transitions.
The Tx Planning Assessment
Used to develop the individual’s treatment plan.
Level of Care Assessment 1-5
Assessed first as they are used in the initial level of care recommendations.
Level of Care Assessment 6
Used as part of a shared decision-making process to determine which level of care the patient is willing and able to engage in.
Medical Necessity
Healthcare services or products that a prudent clinician would provide to an individual to prevent, diagnose, or treat an illness, injury, disease, or its symptoms in accordance with standards of medical practice, clinical appropriateness, and not primarily for the economic benefit of the health plans and purchasers.
Basic Elements of Medical Necessity
-Reasonable
-Necessary
-Specific
-Effective
-Delivered by a skilled professional
Utilization Management
Process by which payers determine whether the requested care is medically necessary based on the ASAM Criteria decision rules.
Two Dimensions of Utilization Management Process
- Dimensional Admission Criteria (used for initial clinical case review)
- Transition and Continued Service Criteria (used for making determinations regarding when a patient should be transitioned to a more or less intensive level of care.)
Dimensional Drivers
The highest severity concerns that determine the recommended level of care in the tx continuum.
What type of care does the continuum of care promote?
Integrated system of care and a chronic care model.
What are the 4 broad treatment levels in the COC?
Outpatient, Intensive Outpatient (IOP), residential, inpatient.
x.1 or x.5
Clinically managed
x.7 and Level 4
medically managed
1.5 COE, 1.7 COE, 2.5 COE, 2.7 COE, 3.5 COE, 3.7 COE, and 4 Psych
Enhanced services for treating co-occurring mental health conditions.
3.7 BIO
Enhanced biomedical capabilities
Medically managed care
Includes medical evaluations, medications, medical monitoring, and psychosocial services to address both the medical and psychosocial aspects of SUD - providing a comprehensive, evidence-based approach to addiction tx.
Level 4
Provides hospital care, including 24-hour medical management and nursing care with access to intensive care services.
Chronic Care Model
Emphasizes the need for ongoing, patient-centered care. It includes tailored tx plans, community resource linkages, and evidence-based decision support.
What percentage of individuals experience relapse in the first year of tx?
60%
Recovery support services
Peer support, mutual support groups, recovery community organizations, and other community resources.
What is one standard universal standard every level of care should be able to provide?
Overdose reversal medication, trauma-responsive practices, expectations for care coordination, and the availability of recovery support services.
How many individuals in addiction tx settings have a diagnosed MH disorder?
Nearly half.
Co-Occurring Capable
Assessment, triage, and symptom management support
Co-Occurring Enhanced
Psychiatric oversight, integrated skilled MH interventions, higher staff to patient ratio
Level of Care Assessment
Collecting just enough info to recommend an appropriate level of care and support initiation of tx for immediate needs.
Treatment Planning Assessment
A comprehensive biopsychosocial assessment to inform longer-term tx planning.
Reassessment for Tx Plan Review
Repeated assessments to support tx plan updates, outcome-based care, and inform level of care transitions.
When does the tx planning assessment occur?
Post-admission and is updated throughout the course of tx as needed based on reassessments and Tx Plan reviews.
Recommendations for an Effective Assessment
- Maintain a nonjudgmental mindset.
- Use open-ended questions.
- Build a therapeutic alliance.
- Recognize different levels of readiness.
- Consider unique experiences and world views.
- Respect autonomy.
What do you do if the level of care is not available?
Recommend an alternative that can safely and effectively meet the needs, typically involving a more intensive level of care.
Dimension 1
Intoxication, Withdrawal, and Addiction Medicine
Care coordination for Dimension 1
Med-adherence support, patient navigation services, addressing psychosocial issues that impact engagement in care, educational services, and care coordination.
Dimension 2
Biomedical Conditions
COWS
Clinical Opioid Withdrawal Scale
CIWA-Ar
Clinical Intoxication Withdrawal Assessment for Alcohol Revised
