CDC 3.3

Before meeting patient to develop a treatment plan…

• Review EHR for

  • Past treatment history

  • Dual diagnoses

  • Symptom severity

  • Referral source(s)

During pt interview, collect the following:

• Strengths

• Weaknesses

• Preferences

• Abilities

• Needs

• Problem statements

ADAPT Treatment Plan

1. Patient strengths

2. Patient weaknesses

3. Problem statement #1

4. Need

5. Goal statement

   1. Make at least 1 short-term and 1 long-term SMART goal

   2. Goals must directly related back to pt’s problem(s)

6. 3 Methods

   1. Include

      1. Begin date

      2. Target date

      3. Description

7. Signatures (Pt and counselor)

Implementing Treatment Plan

1. Monitor progress

2. Focus sessions on established goals

3. Emotional evaluation and support

4. Acknowledge successes and failures

5. Modify plan when needed

When should you modify a treatment plan?

• No progress

• Change in symptoms/diagnosis

• New life stressors

• Medication issues

• Crisis

• Pt goals change

• Plateau

• New research/treatment available

• Patient gives feedback

Transition in Care

• Happens when

  • HLoC

  • Aftercare required

  • Treatment termination (graduation)

  • Treatment failure

  • Utilization of supporting resources (additional or reduced services)

Relapse isn’t a spur-of-the-moment event. It’s a three-part process, including:

• Emotional Relapse +

• Mental Relapse +

• Physical Relapse =

  • The stage when someone returns to drug or alcohol use

What is a Relapse Prevention Plan?

• Helps pt recognize behaviors that may point to a relapse in the future

What to consider when meeting with pt to create a Relapse Prevention Plan:

• Assess pt history

• Determine relapse signs

• Have a step-by-step action plan for each sign

Developing a Written Relapse Prevention Plan

What to include…

1. Triggers (people, places, things, thoughts)

2. Craving management (people to call, distractions, coping skills)

3. Preventative/healthy tools (support meetings, journaling, exercise)

4. Support groups/programs (sponsors, recovery groups)

5. Lifestyle changes/damage repair (rebuilding areas harmed by addiction)

Relapse Prevention Plan Maintenance

• The plan should be continually updated as recovery progresses and circumstances change

American Society of Addiction Medicine (ASAM) Criteria

• Provides standardized, evidence-based guidelines for

  • Placement

  • Continued service

  • Transfer/discharge

Core Components of The ASAM Criteria

ASAM Criteria standards include 3 core components that work in tandem when making LoC recommendations

Patient enters addiction treatment

1. Level of Care Assessment (assess dimensions 1-5)

2. Decision Rules (apply dimensional admission criteria, give level of care recommendation, assess dimension 6)

3. Continuum of Care

   1. Reassessment leads back to Decision Rules

ASAM Dimensions

1. Intoxication, Withdrawal, and Addiction Medications

2. Biomedical Conditions

3. Psychiatric and Cognitive Conditions

4. Substance Use-Related Risks

5. Recover Environment Interactions

6. Person-Centered Considerations

*LoC recommendations are made based on assessment of 1-5

*6 involves a shared decision-making process to determine where the pt is able and willing to engage in treatment (HLoC must be voluntary, pt can only be involuntarily treated for acute psychosis/psychiatric intervention)

Levels of Care (Loc)

1. Outpatient

   1. 1.0 Long-term remission monitoring

   2. 1.5 Outpatient therapy (less than 9 hours/week)

   3. 1.7 Medically managed outpatient

2. IOP/HIOP

   1. 2.1 IOP (9-19 hours/week)

   2. 2.5 HIOP (at least 20 hours/week)

   3. 2.7 Medically managed IOP

3. Residential

   1. 3.1 Clinically managed low-intensity (9-19 hours/week)

   2. 3.5 Clinically managed high-intensity (at least 20 hours/week)

   3. 3.7 Medically managed residential

4. Inpatient

   1. 4 Medically managed inpatient (for severe withdrawal, high medical/psychiatric risk)

*Recovery Residence

What is important about level x.1 and x.5 programs?

• Clinically managed (treatment planning is led by clinical staff)

X.1 Programs

• Least intensive, providing 9-19 hours of clinical services per week that consist of…

  • Counseling

  • Psychoeducation

X.5 Programs

• Greater focus on psychotherapy

X.7 Programs

• Medically managed (treatment planning led by medical staff)

• Greater focus on withdrawal management and biomedical services

Level 4

• Most severe criteria rating, requires inpatient medically managed care

Recovery Residence

• Not considered a level of care, but depicted in graphs

Early Intervention (Level 0.5)

• Alcohol Brief Counseling

MH Treatment Assessment Planning Process

1. Initial assessment

2. Diagnosis

3. Setting goals and developing treatment plan

4. Implementation, evaluation, and adjustment

5. Continued service transition and/or discharge planning

6. Reassessment