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ASAM Patient Placement Criteria: Understanding the
Latest Updates
© BHM Healthcare Solutions 2014
Learning Objectives
To gain a comprehensive understanding of the
latest ASAM Criteria updates and changes
To understand how ASAM plays a critical role
in determining Level of Care
To apply knowledge obtained via case vignettes
which will put attendee knowledge into play in
making appropriate ASAM determinations
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ASAM UPDATES
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Updated ASAM Patient
Placement Criteria
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The Goal of the ASAM Criteria
To unify the
addiction
field around
a single set
of criteria
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ASAM Criteria Background
• Previous Editions
Patient Placement Criteria (1991)
Patient Placement Criteria-2 (1996)
Patient Placement Criteria-2R (2001)
The ASAM Criteria: Treatment Criteria for Addictive,
Substance-Related, and Co-Occurring Conditions
(2013)
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Underlying Concepts of The ASAM
Criteria: Individualized, Clinicallydriven Treatment
Patient/Participant
Assessment
BIOPSYCHOSOCIAL
Dimensions
Progress
Severity of Illness/LOF
Problems/Priorities
Severity of Illness/LOF
Plan
INTENSITY OF SERVICEModalities and Levels of
service
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Assessment of Biopsychosocial
Severity and Level of Function
1. Acute Intoxication and/or Withdrawal
Potential
2. Biomedical conditions and complications
3. Emotional/Behavioral/Cognitive conditions
and complications
4. Readiness to Change
5. Relapse/Continued Use/Continued
Problem potential
6. Recovery Environment
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Introduction to the Levels of
Service
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What’s Not New in The ASAM
Criteria
• The six assessment dimensions
• The overall levels of care (though not Roman numerals)
for addiction management
• The “decision rules,” which link Intensity of Service back to
the Severity of Illness maintained except for some updates
in Withdrawal Management (“Detox”)
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What is New in The ASAM
Criteria
• New Title: The ASAM Criteria – Treatment Criteria for
Addictive, Substance Related, and Co-Occurring
Conditions
• Diagnostic Admission Criteria terminology changed to be
compatible with DSM-5
• Section on working with managed care
• Shaft away from “placement” criteria to “treatment” criteria
It’s more than just “placement”
© BHM Healthcare Solutions 2014
What is New in The ASAM
Criteria
• Table of Contents
• Re-ordered to be more user friendly
• Follows the flow from Historical Foundations to Guiding
Principles to Assessment, Service Planning, and
Placement Decisions
Historical
Foundations
Guiding
Principles to
Assessment
Service
Planning
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Placement
Decisions
What is New in The ASAM
Criteria
• Adolescent Criteria
No longer separate/stand-alone
Consolidated Adult and Adolescent
content to minimize redundancy while
preserving adolescent specific content
© BHM Healthcare Solutions 2014
What is New in The ASAM
Criteria
• Appendices
• Withdrawal Management Instruments
• Dimension 5 constructs
• Glossary
• Withdrawal Management
• The wording in the Levels of Care
• Former section “Detoxification” becomes “Withdrawal
Management”
• Levels are now called WM-1, WM-2, WM-3, WM-4
• New approaches described to support increased use of less
intensive levels of care for safe/effective management of
withdrawal
© BHM Healthcare Solutions 2014
What is New in The ASAM
Criteria
• Updated/revised terminology
• Contemporary, strength-based, recovery-oriented:
“Dual
Diagnosis”
• Now becomes “cooccurring disorders”
“Inappropriate • Now becomes “high
risk of substance
use of
abuse”
substances”
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What is New in The ASAM
Criteria
• Opioid use disorder specialized services
“Opioid
Maintenance
Therapy”
(OMT)
• Now becomes “Opioid Treatment
Services” (OTS)
• Opioid antagonist medications
• Opioid agonist medications
• Their use in OTPs (regulated
“Opioid Treatment Programs”)
or in “Office-Based Opioid
Treatment” (OBOT)
© BHM Healthcare Solutions 2014
What is New in The ASAM
Criteria
• New Content and Sections
• Additional text to improve application to address
addiction treatment for Special Populations:
•
•
•
•
Older Adults
Persons in Safety Sensitive Occupations
Parents with Children and Pregnant Women
Persons in the Criminal Justice system (CJS)
• Additional text to address treatment of conditions not
traditionally included in specialty addiction treatment
services:
• Tobacco Use Disorder
• Gambling Disorder
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ADULT LEVELS OF CARE
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Adult Levels of Care: Level 0.5
Early Intervention
Dimensions
Adult LOC 0.5 Early Intervention
Dimension 1: Acute Intoxication and/or
withdrawal potential
No withdrawal risk
Dimension 2: Biomedical Conditions
and Complications
None or very stable
Dimension 3: Emotional, Behavioral, or None or very stable
Cognitive Conditions and Complications
Dimension 4: Readiness to Change
Willing to explore how current use or
high risk behaviors may affect personal
goals
Dimension 5: Relapse, Continued Use,
or Continued Problem Potential
Needs understanding of or skills to
change current use patterns and/or high
risk behavior
Dimension 6: Recovery/Living
Environment
Social support system or significant
others increase the risk of personal
conflict about alcohol, tobacco, and/or
other drug use
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Adult Levels of Care: OTP-Level
Opioid Treatment Program
Dimensions
Adult LOC: OTP-Level Opioid
Treatment Program
Dimension 1: Acute Intoxication and/or
withdrawal potential
Physiologically dependent on opioids
and requires OTP to prevent withdrawal
Dimension 2: Biomedical Conditions
and Complications
None or manageable with OP medical
monitoring
Dimension 3: Emotional, Behavioral, or
Cognitive Conditions and Complications
None or very stable, or is receiving
concurrent mental health monitoring
Dimension 4: Readiness to Change
Ready to change negative effects of
use, not ready for total abstinence
Dimension 5: Relapse, Continued Use,
or Continued Problem Potential
At risk of relapse or cont. use without
ITP and structured therapy
Dimension 6: Recovery/Living
Environment
Recovery environment is supportive
and/or the patient has skills to cope
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 1
Outpatient Services
Dimensions
Adult LOC: Level 1- Outpatient
Services
Dimension 1: Acute Intoxication and/or
withdrawal potential
Not exp. Significant withdrawal or at minimal risk of
severe withdrawal. Manageable at Level 1(see
withdrawal management criteria)
Dimension 2: Biomedical Conditions
and Complications
None or very stable, or is receiving concurrent
medical monitoring
Dimension 3: Emotional, Behavioral, or
Cognitive Conditions and Complications
None or very stable, or is receiving concurrent
medical health monitoring
Dimension 4: Readiness to Change
Ready for recovery but needs motivation; or needs
ongoing monitoring and disease management; or
high severity in this dim. But not others: needs L 1
motivational enhancement strategies
Dimension 5: Relapse, Continued Use,
or Continued Problem Potential
Able to maintain abstinence or control use and
pursue recovery or motivational goals with minimal
support
Dimension 6: Recovery/Living
Environment
Recovery environment is supportive and/or the
patient has skills to cope
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 2.1
Intensive Outpatient Services(IOP)
Dimensions
Adult LOC: Level 2.1- IOP
Dimension 1: Acute Intoxication and/or
withdrawal potential
Minimal risk of severe withdrawal, manageable at
level 2-WM (see withdrawal management criteria)
Dimension 2: Biomedical Conditions
and Complications
None or not a distraction from treatment.
Manageable at Level 2.1
Dimension 3: Emotional, Behavioral, or
Cognitive Conditions and Complications
Mild severity, with potential to distract from
recovery; needs monitoring
Dimension 4: Readiness to Change
Variable engagement in treatment or lack of
awareness of problem and requires structured
program several x’s/week to promote progress
Dimension 5: Relapse, Continued Use,
or Continued Problem Potential
Intensification of symptoms indicate high likelihood
of relapse or cont. use or cont. problems without
close monitoring several x’s/week
Dimension 6: Recovery/Living
Environment
Recovery environment is not supportive, but with
structure and support the patient can cope
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 2.5
Partial Hospitalization Services
Dimensions
Adult LOC: Level 2.5-Partial
Hospitalization Services
Dimension 1: Acute Intoxication
and/or withdrawal potential
Moderate risk of severe withdrawal manageable at
Level 2-WM (See withdrawal management criteria)
Dimension 2: Biomedical Conditions
and Complications
None or not sufficient to distract from treatment.
Such problems are manageable at Level 2.5
Dimension 3: Emotional, Behavioral,
or Cognitive Conditions and
Complications
Mild to moderate severity, with potential to distract
from recovery; needs stabilization
Dimension 4: Readiness to Change
Poor engagement in treatment, ambivalence, or lack
of progress; requires a near daily structured program
or intensive engagement to promote progress
Dimension 5: Relapse, Continued
Use, or Continued Problem Potential
Intensification of symptoms despite active
participation in a Level 1 or 2.1 program; high
likelihood of relapse or cont. use w/o near daily
monitoring
Dimension 6: Recovery/Living
Environment
Recovery environment is not supportive, but with
structure, support, and relief from home environment
the patient can cope
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 3.1
Clinically Managed Low-Intensity
Residential Services
Dimensions
Adult LOC: Level 3.1-Low Intensity
Residential Services
Dimension 1: Acute Intoxication
and/or withdrawal potential
No or minimal or stable withdrawal concurrently
receiving Level 1-WM or Level 2-WM services
Dimension 2: Biomedical Conditions
and Complications
None or stable, or receiving concurrent medical
monitoring
Dimension 3: Emotional, Behavioral,
or Cognitive Conditions and
Complications
None or minimal; not distracting recovery. If stable a
co-occurring capable program is appropriate; if not a
co-occurring enhanced program is required
Dimension 4: Readiness to Change
Cont. recovery but needs structured environment to
maintain therapeutic gains
Dimension 5: Relapse, Continued
Use, or Continued Problem Potential
Understands relapse but needs structure to maintain
therapeutic gains
Dimension 6: Recovery/Living
Environment
Environment is dangerous, but recovery is
achievable if Level 3.1 24hr structure is available
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 3.3
Clinically Managed Pop. Specific High
Intensity Residential Services
Dimensions
Adult LOC: Level 3.3-Pop. Specific High
Intensity Residential Services
Dimension 1: Acute Intoxication and/or
withdrawal potential
At minimal risk of severe withdrawal, if withdrawal is present,
manageable at Level 3.2-WM
Dimension 2: Biomedical Conditions
and Complications
None or stable, or receiving concurrent medical monitoring
Dimension 3: Emotional, Behavioral,
or Cognitive Conditions and
Complications
Mild to mod. Severity; needs structure to focus on recovery.
Treatments should be designed to address sig. cognitive
deficiencies; if stable a co-occurring program is appropriate; if
not a co-occurring enhanced program is required
Dimension 4: Readiness to Change
Req. awareness and needs interventions only available at level
3.3 to engage and stay in treatment. If high severity in D4, but
no other dimensions motivational enhancement strategies
should be provided in Level 1
Dimension 5: Relapse, Continued
Use, or Continued Problem Potential
Little awareness and needs interventions available only at
Level 3.3 to prevent current use with imminent dangerous
consequences because of cognitive deficits or comparable
dysfunction
Dimension 6: Recovery/Living
Environment
Environment is dangerous and patient needs 24hr structure to
learn to cope
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 3.5
Clinically Managed High-Intensity
Residential Services
Dimensions
Adult LOC: Level 3.5-High Intensity
Residential Services
Dimension 1: Acute Intoxication
and/or withdrawal potential
At minimal risk of severe withdrawal, if withdrawal is
present, manageable at Level 3.2-WM
Dimension 2: Biomedical Conditions
and Complications
None or stable, or receiving concurrent medical
monitoring
Dimension 3: Emotional, Behavioral,
or Cognitive Conditions and
Complications
Demonstrates inability to control impulses, or
unstable or dangerous signs/symptoms require
stabilization. Req 24hr setting to prepare for
common integration and cont. care. Co-occurring
enhanced setting req for those with severe and
chronic mental illness
Dimension 4: Readiness to Change
Difficulty with or opposition to treatment with dangerous
consequences. If high severity in D4 but no other Dimension,
motivational enhancement strategies provided in Level.1
Dimension 5: Relapse, Continued
Use, or Continued Problem Potential
No recognition of the skills needed to prevent cont.
use; with imminently dangerous consequences
Dimension 6: Recovery/Living
Environment
Environment is dangerous, patient lacks skills to
cope outside of a highly structured 24hr setting
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 3.7
Medically Monitored Intensive Inpatient
Services
Dimensions
Adult LOC: Level 3.7-Medically
Monitored IIP Services
Dimension 1: Acute Intoxication
and/or withdrawal potential
High risk of withdrawal, but manageable at Level
3.7-WM and does not req. the full resources of a
licensed hospital
Dimension 2: Biomedical Conditions
and Complications
Req’s 24hr medical monitoring but not intensive
treatment
Dimension 3: Emotional, Behavioral,
or Cognitive Conditions and
Complications
Moderate severity; needs 24hr structured setting; if
the patient has a co-occurring mental disorder, req’s
concurrent mental health services in a medically
monitored setting
Dimension 4: Readiness to Change
Treatment adherence and impulse control is poor; needs
motivating strategies in 24hr structured setting; if there is high
intensity in D4 but no other Dimension, motivational
strategies should be provided in Level 1
Dimension 5: Relapse, Continued
Use, or Continued Problem Potential
Unable to control use, with imminently dangerous
consequences, despite active participation at less
intensive LOC
Dimension 6: Recovery/Living
Environment
Environment is dangerous and the patient lacks
skills to cope outside of a highly structured 24hr
setting
© BHM Healthcare Solutions 2014
Adult Levels of Care: Level 4
Medically Managed Intensive Inpatient
Services
Dimensions
Adult LOC: Level 3.7-Medically
Monitored IIP Services
Dimension 1: Acute Intoxication
and/or withdrawal potential
High risk of withdrawal req’s Level 4-WM and the full
resources of a licensed hospital
Dimension 2: Biomedical Conditions
and Complications
Req’s 24hr medical and nursing care and the full
resources of a licensed hospital
Dimension 3: Emotional, Behavioral,
or Cognitive Conditions and
Complications
Severe and unstable problems, req’s 24hr care with
concomitant addition treatment (co-occurring
enhanced)
Dimension 4: Readiness to Change
Problems in this Dimension do not qualify the patient
for Level 4 services. If the patients only severity is in
4,5, and 6 w/o high severity in Dimensions 1,2, and 3
the patient does not qualify for Level 4.
Dimension 5: Relapse, Continued
Use, or Continued Problem Potential
Problems in this dimension do not qualify the patient
for Level 4 services. See further explanation in
Dimension 4
Dimension 6: Recovery/Living
Environment
Problems in this dimension do not qualify the patient
for Level 4 services. See further explanation in
Dimension 4
© BHM Healthcare Solutions 2014
ADOLESCENT LEVELS OF
CARE
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Adolescent Levels of Care:
Level 0.5 Early Intervention
Dimensions
Adolescent LOC 0.5 Early Intervention
Dimension 1: Acute Intoxication and/or withdrawal
potential
No withdrawal risk
Dimension 2: Biomedical Conditions and
Complications
None or very stable
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
None or very stable. Any D3 issues are being
addressed through concurrent mental health
services and do not interfere with early intervention
addition treatment services *see details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Willing to explore how current alcohol, tobacco,
medication other drug use, and/or high-risk
behaviors may affect achievement of personal
goals
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
Needs an understanding of, or skills to change,
current alcohol, tobacco, other drug, or medication
use patterns, and/or high-risk behaviors
Dimension 6: Recovery/Living Environment
Risk is initiation of or progression in substance use
and/or high risk behaviors is increased by
substance use or values about use. High risk
behaviors of family, peers, or others in the
adolescent’s social support system
© BHM Healthcare Solutions 2014
Adolescent Levels of Care:
Level 1 Outpatient Services
Dimensions
Adolescent LOC 1 Early Outpatient Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
No withdrawal risk
Dimension 2: Biomedical Conditions and
Complications
None or very stable; or is receiving concurrent
medical monitoring
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by all of the following A) not at
risk; B) minimal interference; C) mild to moderate
impairment; D) mild to moderate difficulties w/daily
living; E) minimal imminent risk *see details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Willing to engage in treatment; at least
contemplating change but needs motivation and
monitoring
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
Able to maintain abstinence or control use and
pursue recovery or motivational goals with minimal
support
Dimension 6: Recovery/Living Environment
Family environment can support recovery with
limited assistance
© BHM Healthcare Solutions 2014
Adolescent Levels of Care: Level
2.1 Intensive Outpatient Services
Dimensions
Adolescent LOC 2.1 Intensive Outpatient
Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
Minimal withdrawal or at risk of withdrawal
Dimension 2: Biomedical Conditions and
Complications
None or stable, or distracting from treatment at a
less intensive LOC; Manageable at L2.1
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by 1 or more of the following A)
low risk; B) moderate interference; C) moderate
impairment; D) moderate difficulties ; E) history
predicts need for monitoring/interventions *see
details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Req’s close monitoring and support several
x’s/week to promote progress through stages of
change because of variable treatment engagement
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
Significant risk of relapse or cont. use or cont.
problems and deterioration in level of functioning;
poor prevention skills and needs close monitoring
and support.
Dimension 6: Recovery/Living Environment
Environment is impeding his/her recovery and
adolescent req’s close monitoring and support to
overcome that barrier
© BHM Healthcare Solutions 2014
Adolescent Levels of Care: Level
2.5 Partial Hospitalization Services
Dimensions
Adolescent LOC 2.5 Partial Hospitalization
Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
Mild withdrawal or is at risk of withdrawal
Dimension 2: Biomedical Conditions and
Complications
none or stable or distracting from treatment at a
less intensive LOC; manageable at Level 2.5
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by one or more of the following 3
A) low risk of harm; B) moderate interference; C)
moderate impairment; D) moderate difficulties ; E)
history predicts need for near daily
monitoring/interventions *see details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Req’s near daily structured program to progress
because of little engagement or escalating use and
impairment or no awareness of role of use in
problems
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
High risk of relapse or cont. use or cont. problems
and deterioration in level of functioning; minimal
prevention skills and needs daily monitoring and
support
Dimension 6: Recovery/Living Environment
Environment renders recovery unlikely without near
daily monitoring and support or frequent relief from
his/her home environment
© BHM Healthcare Solutions 2014
Adolescent Levels of Care: Level
3.1 Clinically Managed Low Intensity
Residential Services
Dimensions
Adolescent LOC 3.1 Clinically Managed Low
Intensity Residential Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
State of withdrawal is being managed concurrently
at another LOC
Dimension 2: Biomedical Conditions and
Complications
None or stable or receiving concurrent medical
monitoring as needed
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by one or more of the following 3
A) needs stable living environ.; B) moderate
interference req 24hr support; C) moderate
impairment 24hr supervision; D) moderate
difficulties ; E) history predicts need for near daily
monitoring/interventions *see details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Open to recovery but needs limited 24hr
supervision to promote or sustain progress
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
Understands potential for cont. use and has
emerging recovery skills, needs supervision to
reinforce skills or maintain gains
Dimension 6: Recovery/Living Environment
Environment poses a risk to his/her recovery so
that he/she requires alternative residential secure
placement or support
© BHM Healthcare Solutions 2014
Adolescent Levels of Care: Level
3.5 Clinically Managed Medium
Intensity Residential Services
Dimensions
Adolescent LOC 3.5 Clinically Managed Medium
Intensity Residential Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
Mild to moderate withdrawal, does not need
pharmacological management or frequent
monitoring
Dimension 2: Biomedical Conditions and
Complications
None or stable or receiving concurrent medical
monitoring as needed
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by one or more of the following 3
A) moderate but stable.; B) moderate to severe; C)
moderate to severe impairment; D) moderate to
severe difficulties ; E) history predicts
destabilization w/o medium intensity treatment *see
details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Needs intensive motivational strategies in a 24hr
structured program to address engagement and/or
lack of recognition of current severe impairment
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
Unable to control use w/o 24hr structured program;
unable to overcome triggers at a less intensive
LOC or has high chronicity and/or poor response
Dimension 6: Recovery/Living Environment
Environment is dangerous to his/her recovery so
that he/she requires residential treatment to
promote recovery goals or for protection
© BHM Healthcare Solutions 2014
Adolescent Levels of Care: Level
3.7 Medically Monitored High
Intensity Inpatient Services
Dimensions
Adolescent LOC 3.7 Medically Monitored High
Intensity Inpatient Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
Moderate to severe withdrawal but this is manageable
at L3.7
Dimension 2: Biomedical Conditions and
Complications
Requires 24hr medical monitoring, but not intensive
treatment
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by one or more of the following 3 A)
moderate risk of harm needing high intensity 24hr
monitoring.; B) severe interference req 24hr support;
C) severe impairment 24hr supervision; D) severe
difficulties ; E) history predicts destabilization w/o high
intensity IP Services *see details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Needs motivating strategies In a 24hr medically
monitored program due to no treatment engagement or
because he/she needs high intensity case
management
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
unable to interrupt high severity or frequency pattern of
use and avoid dangerous consequences w/o high
intensity 24hr interventions
Dimension 6: Recovery/Living Environment
environment is dangerous to his/her recovery and
he/she requires residential treatment to promote
recovery goals or for protection and assistance in
transitioning to a less intensive LOC
© BHM Healthcare Solutions 2014
Adolescent Levels of Care: Level
4 Medically Managed Intensive
Inpatient Services
Dimensions
Adolescent LOC 4 Medically Managed Intensive
Inpatient Services
Dimension 1: Acute Intoxication and/or withdrawal
potential
Severe withdrawal and requires intensive active medical
management
Dimension 2: Biomedical Conditions and
Complications
Req’s 24hr medical and nursing care and the full resources
of a licensed hospital
Dimension 3: Emotional, Behavioral, or Cognitive
Conditions and Complications A) Dangerous lethality; B)
D3 Characterized by one or more of the following 3 A)
severe risk of harm; B) very severe interference; C) very
severe, dangerous impairment; D) very severe difficulties ;
E) history predicts destabilization w/o inpatient medical
management *see details
Interference with Addiction and MH Recovery Efforts; C) Social
Functioning; D) Ability for Self-Care; E) Course of Illness
Dimension 4: Readiness to Change
Problems in this dimension do not qualify the patient for L4
services; If the patient’s only severity is in D4, 5, and 6 w/o
high severity in D1,2, or 3 patient does not qualify for L4
Dimension 5: Relapse, Continued Use, or
Continued Problem Potential
Problems in this dimension do ot qualify the patient for L4
services; If the patient’s only severity is in D4, 5, and 6 w/o
high severity in D1,2, or 3 patient does not qualify for L4
Dimension 6: Recovery/Living Environment
Problems in this dimension do ot qualify the patient for L4
services; If the patient’s only severity is in D4, 5, and 6 w/o
high severity in D1,2, or 3 patient does not qualify for L4
© BHM Healthcare Solutions 2014
Service Planning and Placement:
Level of Withdrawal Management for
Adults
Level of Withdrawal
Management For Adults
Level
Description
Ambulatory Withdrawal
Management without Extended
On-site Monitoring
1-WM
Mild withdrawal with daily or less than daily out-patient
supervision; likely to complete withdrawal management and
to continue treatment or recovery
Ambulatory Withdrawal
Management with Extended Onsite Monitoring
2-WM
Moderate withdrawal with all day withdrawal management
support and supervision; at night, has supportive family or
living situation; likely to complete withdrawal management
and increase likelihood of continuing treatment or recovery
Clinically Managed Residential
Withdrawal Management
3.2-WM
Moderate withdrawal, but needs 24hr support to complete
withdrawal management and increase likelihood of
continuing treatment or recovery
Medically Monitored Inpatient
Withdrawal Management
3.7-WM
Severe withdrawal needs 24hr nursing care and MD visits as
necessary; unlikely to complete withdrawal management
without medical, nursing monitoring
Medically Managed Intensive
Inpatient Withdrawal Management
4-WM
Severe, unstable withdrawal and needs 24hr nursing care
and daily physician visits to modify withdrawal management
regimen and manage medical instability
© BHM Healthcare Solutions 2014
Contact Information
Website: www.bhmpc.com
Email: [email protected]
Twitter: @BHMHealthcare
Phone Number: 1-888-831-1171
Fax Number: 1-888-818-2425
© BHM Healthcare Solutions 2013
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