ALOC the ASAM Integrated Tool 2018/lp-asam-aloc-ppt-03...0.5 Early Intervention 3.5 Res 3.3 Res...
Transcript of ALOC the ASAM Integrated Tool 2018/lp-asam-aloc-ppt-03...0.5 Early Intervention 3.5 Res 3.3 Res...
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Medical Necessity for Residential Treatment The client must have a primary SUD DSM-5 diagnosis which is the cause of
significant functional and psychosocial impairment.
The client’s condition requires residential supervision to ensure the development
of effective coping skills to live safely in the community, to participate in self-care
and treatment and to manage the effects of his/her disorder.
The client’s own resources & social support system are not adequate to provide
the level of support and supervision needed to become abstinent and stabilize in
his/her recovery.
As a result of the client’s clinical condition (impaired judgment, behavior control,
or role functioning), there is a significant current risk of Hospitalization and/or
Harm to self or others based on recent events.
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ASSESSMENT AND
LEVEL OF CARE AUTHORIZATION
(ALOC)
The ALOC is a brief assessment and authorization form used to document the appropriate Level of Care using ASAM placement criteria.
It is done:
✓ At Intake ✓At Discharge ✓ For Transfers
and
✓ Authorization for Residential
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ASAM 6 DIMENSIONS
1. Dim 1 – Acute Intoxication and/or Withdrawal Potential
2. Dim 2 – Biomedical Conditions and Complications
3. Dim 3 – Emotional, Behavioral, or Cognitive Conditions & Complications
4. Dim 4 – Readiness to Change
5. Dim 5 – Relapse, Continued Use, or Continued Problem Potential
6. Dim 6 – Recovery/Living Environment
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ASSESSING RISK AT EACH DIMENSION
Freese & Hasson, UCLA, PSATTC www.uclaisap.org
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RISK RATING SCALES
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1. Initial Authorization for Residential LOC:
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2. Reauthorization for Residential LOC.
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3. Progress Report, Transfer or
Other Re-Assessment Documentation:
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ASAM DIMENSION 1
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ASAM DIMENSION 5
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ASAM DIMENSION 6
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(ASAM Criteria, p.222-224 ):
• Living situation toxic to recovery: substance exposure, substance-
infested environment, culture of substance-involved and antisocial
behaviors, peer use and pressure to use
• Chaotic home situation
• Drug using family or significant others
• Lack of daily structured activity, such as school or work, or not able to
function at school or work due to use
• Patient’s functional deficits include greater than average susceptibility
to peer or other influence
Dim 6 Environment-related issues
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1 OP
2.1 IOT
2.5 Partial
Hospitalization
3.1 Residential
3.2 WM
0.5 Early
Intervention
3.5 Res
3.3 Res
SBIRT (Screening, Brief Intervention & Referral to Treatment occur with
Primary Care) (Offered in Medical Homes-PCBH)
Less than 9 hrs adult
Less than 6 hrs adolescents
9 to 19 hrs/week - adult
6 to 19hrs/week - adolescent
Approx. 20 hrs per week (Only
in PSAP currently)
Withdrawal Mgmt., Intoxication Mgmt.
Non-medical clinical services where TX is
provided based on person’s ability
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Min 5 hrs clinical service/week
20 hrs per week
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3.1: Minimum 5 hrs. TX per week – not responding to increased services in OS,
IOS. Repeated returns to use, environment unsupportive of recovery efforts.
• Risk in environment; examples: using partner, family, dealers nearby,
released from custody and risk of overdose if not is safe environment
(particularly with Opiate use)
• Inability to deal with peer pressure
• Parental inability to support adolescent.
3.3: High intensity Res for Special Populations - cognitively impaired, Seniors,
developmentally delayed. Treatment is offered at slower pace, repetitive
• Cognitive deficits and related dangerous consequences of use
• Risk in environment
3.5: High Intensity Residential - Multiple limitations: SMI, chaotic interpersonal, have never
developed adequate coping skills
• Functional deficits in mental health, such as inability to control impulses
• Difficulty with or marked opposition to treatment with dangerous consequences
• No recognition of skills needed to prevent continued use, with imminent dangerous
consequences
• Risk in environment.
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LEAST RESTRICTIVE LEVEL OF CARE
Research findings: Outpatient Services are at least as effective as Residential.
Longer length of time in any type of treatment shows better outcomes.
(3+ months)
Outpatient Considerations: Increase number of group and individual sessions
Move to Intensive Outpatient Services
Use a Recovery Residence as adjunctive support to OP TX
No need to fail in treatment first if Residential is indicated per Medical
Necessity
Residential Treatment is primarily for STABILIZATION
RESIDENTIAL AUTHORIZATION
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Type of Authorization:
Determination:
Reason for Determination:
AUTHORIZATION DETERMINATION
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www.changecompanies.nethttps://www.changecompanies.net/account/register.php?reg_code=hhs052617
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QUESTIONS?
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