ASAM 101:
ASAM 101:
How to complete the
How to complete the
ASAM Placement Form
What is the ASAM?
What is the ASAM?
The ASAM Placement Form is a
The ASAM Placement Form is a
document required by contract
document required by contract
The ASAM Form is an ASSESSMENT
The ASAM Form is an ASSESSMENT
tool as well as a PLACEMENT tool
tool as well as a PLACEMENT tool
It seeks to match intensity of
It seeks to match intensity of
treatment to severity of illness
treatment to severity of illness
What is the ASAM not?
What is the ASAM not?
The equivalent of the DSM
The equivalent of the DSM
-
-
IV
IV
A substitute for clinical judgment
A substitute for clinical judgment
A checklist or cookbook
A checklist or cookbook
Common Errors
Common Errors
No client identification numbers
No client identification numbers
Incorrect level of ASAM forms used
Incorrect level of ASAM forms used
Characteristics are not selected (circled)
Characteristics are not selected (circled)
for all six dimensions
for all six dimensions
Dimensions are not validated in the
Dimensions are not validated in the
“
“
yes
yes
”
”
or
or
“
“
no
no
”
”
box
box
Summaries are generalized and
Summaries are generalized and
insufficient
insufficient
ASAM forms are not signed or dated
ASAM forms are not signed or dated
Client does not meet criteria but are
Client does not meet criteria but are
“
On Top of the Form
On Top of the Form
…
…
Make sure handwritings are
Make sure handwritings are
LEGIBLE
LEGIBLE
The Client ID can be the client
The Client ID can be the client
’
’
s SSN, MIS #
s SSN, MIS #
or client
or client
’
’
s agency
s agency
’
’
s ID
s ID
Tells you which form you are using: Admission,
Tells you which form you are using: Admission,
Continued Stay or Discharge/Transfer
Using the Correct ASAM Form
Using the Correct ASAM Form
Adult or Adolescent client?
Adult or Adolescent client?
Level of care to which the client is being
Level of care to which the client is being
assessed for?
assessed for?
The correct ASAM level that corresponds to
The correct ASAM level that corresponds to
the program
ASAM &Treatment Levels Crosswalk
ASAM &Treatment Levels Crosswalk
Level 0.5
Level 0.5
Level I
Level I
Level II.1
Level II.1
Level II.5
Level II.5
Level III.1
Level III.1
Level III.3
Level III.3
Level III.5
Level III.5
Level I
Level I
-
-
D
D
Intervention
Intervention
Outpatient
Outpatient
Intensive Outpatient
Intensive Outpatient
Day/Night
Day/Night
Level IV Residential
Level IV Residential
Level III Residential
Level III Residential
Level I & II Residential
Level I & II Residential
Detoxification
Detoxification
Early Intervention
Early Intervention
Outpatient Levels of Care & Services
Outpatient Levels of Care & Services
Level 0.5
Level 0.5
Outpatient
Outpatient
less than 9 contact hours/week 1
less than 9 contact hours/week 1~~ --2/week2/week
Level I
Level I
Level II.1
Intensive Outpatient
9 or more contact hours/week in a Structured Program (6hrs for adolescent) 3/week 9-19hrs total
~ ~
Level II.5
12 or more contact hours/week in a Structured Program
Residential Level IV
Residential Level IV
5 hours/week (halfway house)
5 hours/week (halfway house)
Residential Levels of Care & Services
Residential Levels of Care & Services
Level III.1
Level III.1
Residential Level III
Residential Level III
For clients requiring extended care due to
For clients requiring extended care due to
cognitive disabilities, brain injuries/disorders.
cognitive disabilities, brain injuries/disorders.
Level III.3
Level III.3
Level III.5
Residential Levels I & II
Provides residential treatment, includes all services except medical services.
Services provided by a licensed hospital only,
medical or psychiatric needs, e.g. patients acutely suicidal
Level I-D
Detoxification
ASAM & Treatment Levels Crosswalk
ASAM & Treatment Levels Crosswalk
Level 0.5
Level 0.5
Level I
Level I
Level II.1
Level II.1
Level II.5
Level II.5
Level III.5
Level III.5
Level III.2
Level III.2
-
-
D
D
Level III.7
Level III.7
-
-
D
D
Intervention
Intervention
Outpatient
Outpatient
Intensive Outpatient
Intensive Outpatient
Day/Night
Day/Night
Level I & II Residential
Level I & II Residential
Addiction Receiving Facilities
Addiction Receiving Facilities
Detoxification
Detoxification
ASAM criteria for all levels of care
ASAM criteria for all levels of care
Examples of ASAM Requirements
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
Correlation between ASI/ASAM
ASAM Dimensions
Acute Intoxication/Withdrawal Potential
Biomedical Conditions & Complications
Emotional/Behavioral/Cognitive Conditions & Complications
Readiness to Change
Relapse/Continued Used/Problem Potential
Recovery Environment
ASI Assessment Areas
Medical Status Employment/Support Status Alcohol/Drugs Legal Status Family/Social Status Psychiatric Status
Factors affecting Dimension I
Factors affecting Dimension I
What are the risks
associated with the client’s current level of acute
intoxication? Current signs of withdrawal?
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.
Acute Intoxication/Withdrawal Potential
What are the client’s
frequency and amount of substance(s) use and the history of withdrawal symptoms?
Factors affecting Dimension II
Factors affecting Dimension II
Does the client have any current untreated severe medical
problems that may interfere with
treatment?
Is the client being treated with narcotic analgesics for chronic pain?
Biomedical Conditions & Complications
Does the client have any illness or requires medical attention that may interfere with treatment? E.g.,
hypertension, diabetes, the need for dialysis or
Factors affecting Dimension III
Factors affecting Dimension III
Are there current psychiatric illness, psychological,
behavioral or emotional problems? Is it being addressed?
Is the client currently on
psychiatric medications and are they complying with treatment?
Emotional/Behavioral/Cognitive
Conditions & Complications
What is the client’s current mental status? Client’s
orientation to all three spheres (person, place, time).
Impulse with regards to suicide, homicide or other behaviors that pose a
risk/threat to self or others?
Factors affecting Dimension IV
Factors affecting Dimension IV
How ready is the client to change (stage of
readiness to change)?
Is the client compliant with treatment to avoid negative consequences? E.g., enter drug treatment or go to jail for 6 months
Readiness to Change
How accepting is the client towards treatment? • Pre-contemplation • Contemplation • Preparation • Action • Maintenance • Relapse and Recycling • Termination
Factors affecting Dimension V
Factors affecting Dimension V
How aware is the client of relapse triggers,
ways to cope with craving and skills to
control impulses to use? Compliance vs. Adherence
client maybe willing but unable
Relapse/Continued Used/Problem Potential
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
Factors affecting Dimension VI
Factors affecting Dimension VI
What is the client’s
motivation for treatment and does the client see value in recovery?
Is client surrounded by individuals or situations that threatens treatment engagement and success?
Recovery Environment
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?
ASAM Recommendations/Notes
ASAM Recommendations/Notes
Insufficient
Insufficient
and
and
generalized
generalized
client
client
summaries:
summaries:
“
“
Client will benefit from this level of care.
Client will benefit from this level of care.
”
”
“
“
Client appears ready to continue with
Client appears ready to continue with
residential treatment.
residential treatment.
”
”
“
“
Client is a 40
Client is a 40
y/o
y/o
male. Client will benefit
male. Client will benefit
from outpatient treatment due to history of
from outpatient treatment due to history of
substance abuse.
substance abuse.
”
”
“
ASAM Recommendations/Notes
ASAM Recommendations/Notes
Example of Summary: Paragraph Format
Example of Summary: Paragraph Format
CL is a 33
CL is a 33
y/o
y/o
male, referred to res.
male, referred to res.
tx
tx
from JMH
from JMH
detox. CL reported a 6yr
detox. CL reported a 6yr
hx
hx
of cocaine use at approx.
of cocaine use at approx.
5g of cocaine 3x/day. CL also reported that he drinks a
5g of cocaine 3x/day. CL also reported that he drinks a
6pk of beers and 3 magnum bottles of vodka per day.
6pk of beers and 3 magnum bottles of vodka per day.
CL stated that his last use was 5 days ago prior to
CL stated that his last use was 5 days ago prior to
detox at JMH. CL denied any medical problems. CL
detox at JMH. CL denied any medical problems. CL
denied
denied
hx
hx
of psychiatric treatment. CL is married with 2
of psychiatric treatment. CL is married with 2
kids but was kicked out of the house 3 months ago due
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
to his use. CL was oriented to all spheres at the time of
assessment. Based on the information provided, CL
assessment. Based on the information provided, CL
meets ASAM criteria for Residential Substance Abuse
meets ASAM criteria for Residential Substance Abuse
Treatment.
ASAM Recommendations/Notes
ASAM Recommendations/Notes
Example of client summary: Dimension Format
Example of client summary: Dimension Format
D1
D1 –– Client reported smoking 1 joint of marijuana and drinking 4Client reported smoking 1 joint of marijuana and drinking 4--6 6 beer 2/wk and reported last used 7 days ago.
beer 2/wk and reported last used 7 days ago.
D2
D2 –– Client stated that he suffers from hypertension and is Client stated that he suffers from hypertension and is compliant with medication.
compliant with medication.
D3
D3 –– Client stated that he feels depressed due to his drug use but Client stated that he feels depressed due to his drug use but has never see a psychiatrist or treated with medication.
has never see a psychiatrist or treated with medication.
D4
D4 –– Client appears to be in the contemplation stage of change due Client appears to be in the contemplation stage of change due to his DUI charge and court order status.
to his DUI charge and court order status.
D5
D5 –– Client is not aware of his triggers and is predisposed to Client is not aware of his triggers and is predisposed to continued use due to his cycle of substance use.
continued use due to his cycle of substance use.
D6
D6 –– Client stated that he has been staying with a friend Client stated that he has been staying with a friend b/cb/c mother does not want him at her house.
mother does not want him at her house.
Client meets the criteria for outpatient treatment and his
Client meets the criteria for outpatient treatment and his
appointment is next Wednesday.
Questions and Comments
Questions and Comments
Reference
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.
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