Download Understanding the New ASAM Criteria

Understanding the New
ASAM Criteria
Misti Storie, MS, NCC
Director of Training & Professional Development
NAADAC, the Association for Addiction Professionals
Presented by David Mee-Lee, M.D.
www.naadac.org
[email protected]
April 23, 2015
www.naadac.org/webinars
Produced By
NAADAC, the Association for Addiction Professionals
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1 Webinar Learning Objectives
Using GoToWebinar – (Live Participants Only)
1
§  Control Panel
2
3
§  Asking Questions
Identify what is new in
the new edition of The
ASAM Criteria and how
it was developed
§  Audio (phone
preferred)
Review what new
sections were added
and why
Discuss how to apply
The ASAM Criteria in a
variety of settings and
with different
populations
§  Polling Questions
Webinar Presenter
David Mee-Lee, M.D.
Chief Editor, The ASAM Criteria
www.ASAMcriteria.org
Senior Vice President, The Change Companies
www.changecompanies.net
David Mee-Lee, M.D.
Chief Editor, The ASAM Criteria
www.ASAMcriteria.org
Senior Vice President,
The Change Companies
www.changecompanies.net
2 ®  Around
1989, NAATP and ASAM assemble
taskforce to integrate two existing
admission/continued stay criteria sets:
­  The Cleveland Criteria
­  The NAATP Criteria
®  NAATP
decided to relinquish any
ownership/branding of the Criteria
To unify the addiction field around a
single set of criteria
®  New
Edition:
®  Historical
and current development of
The ASAM Criteria
­  Collaborative consensus process
­  Experienced clinical experts and researchers as
Editors
­  Coalition of stakeholders (Coalition for National Clinical
Criteria, est. 1992) — ASAM and addiction physicians
not the sole stakeholders
®  Previous
Editions
­ Patient Placement Criteria (1991)
­ Patient Placement Criteria-2 (1996)
­ Patient Placement Criteria-2R (2001)
Audience Polling Question #1 ­ The ASAM Criteria – Treatment Criteria
for Addictive, Substance-Related, and
Co-Occurring Conditions
­ Released in Fall 2013
­ Editor-in-Chief: David Mee-Lee, MD
3 ®  What
are the ASAM Criteria?
­  Guidelines for assessment, service
planning, placement, continued stay, and
discharge
­  Framework for multidimensional patient
assessment
®  What
are the ASAM Criteria?
­  Description of levels of care (service
continuum)
­  Algorithm for determining appropriate
Intensity of Service based on assessment
of patient’s Severity of Illness (IS/SI)
Relapse
3. Individualized, Clinically-driven Treatment
4. Client-directed, Outcome-informed
4 1. Acute Intoxication and/or Withdrawal
Potential
2. Biomedical conditions and complications
3. Emotional/Behavioral/Cognitive conditions
and complications
•  Motivate
- Dimension 4
•  Manage – All Six Dimensions
4. Readiness to Change
5. Relapse/Continued Use/Continued
Problem potential
6. Recovery Environment
Levels of Service
1. Outpatient Treatment
•  Medication – Dimensions 1, 2, 3, 5
2. Intensive Outpatient and Partial Hospitalization
•  Meetings – Dimensions 2, 3, 4, 5, 6
3. Residential/Inpatient Treatment
•  Monitor- All Six Dimensions
® 
More levels of care within each of the broad
levels
® 
Changes from Roman numerals to Arabic
numerals, e.g.:
®  “Level I” becomes “Level 1”
®  “Level II.1” becomes “Level 2.1”
4. Medically-Managed Intensive Inpatient
Treatment
®  Workgroup
chairs and small committees
developed drafts
®  Extensive
field review online with input
from Steering Committee of the Coalition
for National Clinical Criteria and others
®  “Level II.5” becomes “Level 2.5”
®  “Level III.1” becomes “Level 3.1”
5 Audience Polling Question #2 ®  Released
October 2013 at ASAM’s “State
of the Art Conference” in Arlington, VA
®  Criteria
updated to reflect current science
– impact on The ASAM Criteria Software
now branded as Continuum™, The ASAM
Criteria Decision Engine™
The Process: (from http://www.asam.org/publications/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”)
® 
Oversight and revision of the criteria is a
collaborative process between ASAM
leadership and the Steering Committee of
the Coalition for National Clinical Criteria
(CNCC)
The Process: (from http://www.asam.org/publications/the-asam-criteria )
® 
The coalition represents major
stakeholders in addiction treatment and
has been meeting regularly since the
development of the first ASAM Patient
Placement Criteria in 1991
®  New
Title: The ASAM Criteria -- Treatment
Criteria for Addictive, Substance-Related,
and Co-Occurring Conditions
®  Shift
away from “placement” criteria to
“treatment” criteria: it’s more than just
“placement”
6 ®  Diagnostic
Admission Criteria terminology
changed to be compatible with DSM-5
®  Section
Criteria
of contents
­  Re-ordered to be more user-friendly
on working with managed care
®  Adolescent
® 
®  Table
­  Follows the flow from Historical Foundations to
Guiding Principles to Assessment, Service
Planning, and Placement decisions
®  Appendices
­ Still separate criteria for adolescents
­ Withdrawal Management instruments
­ Consolidated Adult & Adolescent content
on principles to minimize redundancy,
while preserving adolescent-specific
content
­ Dimension 5 constructs
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, and WM-4
® New approaches described to support increased use
of less intensive levels of care for safe/effective
management of withdrawal
­ Glossary
® 
Withdrawal Management
® New approaches described to support increased use
of less intensive levels of care for safe/effective
management of withdrawal
® A broader range of severity of withdrawal syndromes is
discussed in The Criteria as being able to be safely
and appropriately managed on an outpatient basis
7 ®  Updated/revised
terminology
® 
® Opioid Maintenance Therapy” (OMT) becomes
“Opioid Treatment Services” (OTS)
® Contemporary, strength-based, recoveryoriented:
®  Opioid antagonist medication (naltrexone)
•  “dual diagnosis” becomes “co-occurring disorders”
®  Opioid agonist medications (methadone, buprenorphine)
•  “inappropriate use of substances” becomes “high
risk use of substances”
Audience Polling Question #3 Opioid use disorder specialized services
®  Their use in OTPs (regulated “Opioid Treatment
Programs” for methadone) or in office-based opioid
treatment (OBOT for buprenorphine)
® 
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
® 
Revision of the text to address emerging issues:
•  Healthcare Reform and the integration of addiction
treatment into general medical care
•  The role of physicians on the care team, addiction
specialist physicians in particular (addiction medicine
physicians, addiction psychiatrists)
8 ® 
ASAM’s New Definition of Addiction
•  http://www.asam.org/docs/publicy-policy-statements/
1definition_of_addiction_long_4-11.pdf?sfvrsn=2
•  Implications for Substance Use Disorders and other
Addictive Disorders
• 
• 
• 
• 
“The pathological pursuit of reward or relief”
Involves alcohol, tobacco, and/or other substance use
Also involves addictive behaviors
“Addiction involving alcohol, tobacco, other substances and
gambling”
® 
The ASAM Criteria book and The ASAM Criteria
Software now branded as Continuum™ are
companion text and application
® 
The text delineates the dimensions, levels of
care, and decision rules that comprise The
ASAM Criteria
® 
®  The
software provides an approved
structured interview to guide adult
assessment and calculate the complex
decision tree to yield suggested levels of
care, which are verified through the text
® 
® 
The Change Companies® (TCC) was contracted by
ASAM to publish and market The ASAM Criteria
The new edition features these tools to help readers
locate material quickly:
­  content-specific chapter tabs
­  color, graphic illustrations, and icons
­  cross-linking
® 
® 
A subscription web-based version is available alongside
the book
More info: www.ASAMcriteria.org
For Patients
•  Improves Patient Outcomes
® 
For Payers
•  Improved Patient Outcomes >
Lower Long-Term Costs
•  Standardizes prior approval
process (utilization
management)
•  I.T. can facilitate/automate
approval process (U.M.)
•  Decreases expensive &
unnecessary overtreatment
•  Improves inter-rater reliability
® 
For Providers
•  Facilitates reimbursement
process through fewer
disputes,
less administrative burden,
& faster turnaround on
payment
•  Provides training to new
counselors
•  Generates sophisticated
reports & analyses
®  New
training model developed in
collaboration with TCC
­  eTraining modules
­  onsite learning
­  consulting and coaching
®  Resources
co-developed with TCC
®  www.ASAMcriteria.org
9 The ASAM Criteria
David Mee-Lee, MD
[email protected]
The ASAM Criteria Software now branded as
Continuum™
David R. Gastfriend, MD
[email protected]
www.changecompanies.net
www.ASAMcriteria.org
www.naadac.org/understandingthenewasamcriteria
The Change Companies
Carson City, NV
www.changecompanies.net
www.ASAMcriteria.org
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